Wellbeing and living with the long term toxic effects of quinoline antimalarials

The adverse health effects of the quinolines are now well established in the medical-scientific literature. At the dosages used by the ADF, these drugs are able to concentrate at toxic levels in brain regions including the brainstem, vestibular system and limbic system, causing lasting or permanent neuronal injury. Since their exposure to the quinolines, many affected veterans have experienced chronic neuropsychiatric illnesses consistent with quinoline poisoning. Symptoms of chronic quinoline poisoning experienced by hundreds of the ADF mefloquine and tafenoquine veterans can be broadly categorised as follows:

 Psychiatric disorders including depression, anxiety, bipolar disorder and schizophrenia.

 Cognitive impairments including memory and concentration difficulties.

 Hearing problems including tinnitus, hearing loss and hyperacuity.

 Vestibular disorders including dizziness, vertigo and spatial disorientation.

 Neurological disorders including neuropathies, seizures, Parkinson’s disease and motor neurone disease (MND

 

 

Stuart McCarthy

Stuart McCarthy is a retired Australian Army officer whose 28-year career included six operational deployments. He is a veteran of the Afghanistan war, the Iraq war, peacekeeping in Eritrea and Bougainville, and disaster relief operations in Southeast Asia. He is one of the 3,000 former soldiers who were subjected to the Army Malaria Institute drug trials at the turn of the century. Since his medical retirement from the Army with a brain injury in 2017, his advocacy for injured veterans has included testifying to parliamentary inquiries, co-designing a brain injury rehabilitation program, engaging with politicians and appearances in the media.

 

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QVFA Presentation To VWS2020 26 March 2020

 

Q and A from the webinar

  • What about the RMA research? Regarding the research done by the Repatriation Medical Authority (RMA) on whether or not these drugs cause brain injury – This RMA previously found that there is no causal link between these drills and brain injury. However, the RMA is a medico-legal entity that answers to the Department of the Veterans Affairs. They do not give medical advice and their findings contradict safety warnings from drug regulators and the manufacturer.
  • What is the difference between men and women in the ways that they’ve been affected by the use of these drugs? Women are usually in the minority in the military, and they may have more difficulty in finding resources to deal with the outcomes of this drug use. According to a study done in Britain, it showed that women may be more likely to experience the neurological and psychiatric effects of this drug. There also may be some evidence that women also experience worse symptoms. 
  • Links to suicide? Veterans who experience these long term toxic effects and lack of appropriate medical care may be at risk of self-harm or suicide as a result. This is extremely important to take note of when dealing with this issue as a whole. 
  • What exactly is the Mending Military Minds Program  – the neurocognitive health program? This is a pilot program in Townsville that is actively recruiting people and is largely based on brain injury rehabilitation, including things like neurocognitive screening and referrals to allied health professionals. 
  • Is tafenoquine still in use? It was approved by drug regulators in 2018 during the Senate Inquiry. There is a concern that it may be used as a replacement for the other antimalarial drugs, and it may be used by the ADF. Tafenoquine also may be prescribed under other brand names and labels, though it is still the same drug. 
  • Where are we at with the research on these drugs? There is pretty good research done on mefloquine, such as individual case studies and some initial longitudinal studies. There has been a call to do longitudinal studies on the long term health effects of these drugs, including the differences between men and women to see how these symptoms play out. However, this has not been completed yet, and they are still looking for funding from the DVA or others in the veteran community.
  • Is there any help for carers or family members of these veterans? An organization called Brain Injury Australia provides state-based support groups and provides helpful resources for these people, such as social support. 
  • Is there a kit of information that veterans who believe they may have been affected by these drugs could bring to their GP? At the moment there is not, but there are some links to papers and articles that could be offered to create a kit. 
  • Who at DVA do you call for help? 1-800-mefloquine to assist with veterans’ liability claims. However, if you need a referral to a doctor, DVA is not a health provider. 
  • The link between PTSD and these drugs – can these drugs cause PTSD? No, they cannot.  The diagnostic criteria for PTSD exclude toxic exposure. The downside is that if a veteran is having these symptoms and they do not have access to the resources in this presentation, it is likely that a veteran will be diagnosed and treated for PTSD. That is a problem because if they have a brain injury and they are given drugs or other treatments for PTSD, there is a potential for further complications. That is why it is important for veterans to find out if they may have been exposed to these drugs, and inform their doctors if they have been. It is important to note, also, that PTSD and a brain injury can both be experienced by the same person, so it is important that doctors are provided with all the information available, and get a second opinion if necessary.

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