John Cummins, M.P. Delta-South Richmond

News Release

FOR IMMEDIATE RELEASE
April 3, 1995

OTTAWA--The government responded today in the House of Commons to the question posed by John Cummins, M.P. (Delta) on November 14, 1994 in regard to the consideration given to adverse effects from mefloquine.

MCpl Clayton Matchee attempted suicide while being administered mefloquine in Somalia. Since the question was posed in the House of Commons on November 14th, there has been a suicide death of a Canadian soldier (Cpl Scott Smith) in Rwanda on December 25, 1994.

A military summary investigation found in January that mefloquine was a contributing factor in his Scott Smith's death. Smith had also suffered ill-effects from the drug while serving in Somalia in 1992-93.

Question No. 105: With regard to the mandatory use of mefloquine by Canadian forces personnel,

(a) What clinical or field studies did the Department of National Defence undertake or fund into the possible adverse effects including the impairment of judgment of the mandatory use of mefloquine by Canadian forces while in Somalia, both while the personnel were in Somalia and on their return to Canada?

Response: (a) None was conducted and none was deemed necessary.

(b) What clinical or field studies did the Department of National Defence undertake or fund into the possible adverse effects including the impairment of judgment of the mandatory use of mefloquine by Canadian forces while in Rwanda, both while the personnel were in Rwanda and on their return to Canada?

(b) None was conducted and none was deemed necessary.

(c) What amount of alcohol was available on a daily basis to Canadian forces personnel in Somalia and later in Rwanda who had received the mandatory dosage of mefloquine, what adjustments or precautions were made to the dosages by those administering the drug and what advice was given to persons required to take mefloquine who might be expected to use alcohol during their tour of duty?

(c) The specific policy regarding the consumption of alcohol is left to the field commander who determines the amount of alcohol permitted per day during deployment. In Somalia, members were not permitted any alcohol during the first six weeks of their deployment, following which each member was allowed two beers per day, except on special occasions where no restrictions were imposed, e.g. regimental birthday. In Rwanda, members are permitted two beers per day for six days of the week with no alcohol one day a week. The field commander may remove these restrictions for special occasions.

Until quite recently, there was no scientific evidence that personnel taking mefloquine were at an enhanced risk of a serious adverse interation when drinking alcohol. Further, the prescribing information for mefloquine does not mention concern about such an interaction. Thus, when Canadian forces members were deployed to Somalia and Rwanda, there was no evident need to warn those taking mefloquine about an interaction with alcohol. However, a Canadian medical journal has recently, on February 15, 1995, reported a single case of a likely serious interaction between mefloquine and copious alcohol ingestion which resulted in a temporary psychotic state in the patient. This is the first reasonably documented reported case among the millions of persons who have taken mefloquine worldwide in the last decade, many of whom likely drank alcohol, even substantial quantities, hence the risk of such an interaction would seem quite small. In light of this report, it is felt by the Surgeon General that it is prudent specifically to caution members taking mefloquine against the concurrent excessive use of alcohol; the necessary direction is being drawn up. Reducing the mefloquine dosage to minimize potential mefloquine/alcohol interaction was not and is not recommended since this would enhance the risk of getting malaria.

It is important to state that responsible use of alcohol is already the expected norm in the Canadian forces for other substantial reasons, e.g., injury control, whether inside or outside Canada.

(d) What screening and other precautions were taken by those administering mefloquine, and what advice was given to Canadian forces personnel in regard to self-administered recreational body building, locally grown stimulants and other such drugs that it could reasonably be expected that personnel might be taking concurrent to their usage of mefloquine?

(d) The usual precautions for the prescribing of mefloquine were employed. The Canadian forces have an education based drug and alcohol prevention program, DAPP, to which personnel are to be exposed annually. The Canadian airborne regiment had a DAPP session for the junior non-commissioned members in the fall of 1992 and for senior non-commissioned members and officers before departure to Somalia. At the time of deployment, there was no published literature that indicated an adverse interaction between recreational drugs and mefloquine; therefore, specific advice was not given to those who might use recreational drugs when taking mefloquine, although it is standard policy that recreational drugs are not to be taken by Canadian forces members.

(e) What ranks and occupations in the Canadian forces were not subject to the mandatory use of mefloquine in either Somalia or Rwanda and why were they not subject to the mandatory requirement to take mefloquine ?

(e) There has been a longstanding caution against using mefloquine among persons for whom dizziness might be particularly detrimental. While there is no evidence that this caution is necessary, out of prudence, the Canadian forces follows it and mefloquine was not and is not used in certain occupational groups, primarily pilots and divers. Hence, in Somalia and Rwanda, pilots and divers were not to be prescribed mefloquine.

(f) Why is the effective dosage of mefloquine taken by Canadian forces stronger than the equivalent dosage given U.S. military personnel and what are the possible adverse effects of such stronger dosages?

(f) Mefloquine marketed in Canada is the European formulation which has 250 mg of base drug. The U.S. formulation has 228 mg of base drug, or 9 per cent less active drug. Medical studies have been done on both formulations with similar conclusions. It is unlikely that the minimally lower dose in the U.S. preparation is of practical significance.

-30-

For more information, please contact:

John Cummins, M.P.
(604) 940-8040 or 970-0937 (cell)