Drug Abuse: An Exploration of the Government's Use of Mefloquine at Guantánamo

Abstract

Mefloquine is an antimalarial drug that has long been known to cause severe neuropsychological adverse effects such as anxiety, paranoia, hallucinations, aggression, psychotic behavior, mood changes, depression, memory impairment, convulsions, loss of coordination (ataxia), suicidal ideation, and possibly suicide, particularly in patients with a history of mental illness. A prescribing physician must exercise caution and informed judgment when weighing the risks and potential benefits of prescribing the drug. To administer this drug with its severe potential side effects without a malaria diagnosis and without taking a patient’s mental health history is not medically justified. Yet as a matter of official policy, the standard operating procedure implemented by the United States military at Guantanamo Bay was to administer high doses of mefloquine to detainees whether or not any use of the drug was medically appropriate and without consideration of the detainees’ mental health. It is clear that the military employed a medically inappropriate treatment regime at Guantanamo Bay (GTMO). It is less clear why, although the available evidence supports several possible conclusions. In view of the continued and unexplained refusal of the government to release full medical records for all detainees, it is not possible to determine whether this conduct was gross malpractice or deliberate misuse of drug. In either case, it does not appear plausible from the available evidence that mefloquine was given to treat malaria. This suggests a darker possibility: that the military gave detainees the drug specifically to bring about the adverse side effects, either as part of enhanced interrogation techniques, experimentation in behavioral modification, or torture for some other purpose. While this Report does not reach a conclusion about the actual conduct, it does explore the legal rules that would apply were it determined that mefloquine was administered not to treat malaria but rather to exploit the neuropsychiatric effects of the drug.