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MoD: Troops to undergo risk assessment before being given anti-malarial drugs

Published 13/09/2016

The MoD has said it revising its malaria prevention policy
The MoD has said it revising its malaria prevention policy

The Ministry of Defence is revising the way it issues a controversial anti-malarial drug to troops on overseas operations amid fears it is ruining lives.

MPs earlier this year said there was ''strong anecdotal evidence'' that stringent conditions laid down by the manufacturers for issuing Lariam had been ignored by the armed forces.

It has been associated in a minority of users with depression, hallucinations and panic attacks.

In response to a critical report by the Defence select committee, the MoD has said it is revising malaria prevention policy to direct that all anti-malarial drugs are only supplied after a face-to-face travel health risk assessment is carried out.

Conservative Johnny Mercer, a member of the committee, said the MoD had failed to take the issue "seriously for quite some time".

He told BBC Radio Four's Today programme: "The evidence is very clear. Prescribing a drug outside the parameters clearly laid down by the manufactures is not acceptable."

The former army officer said the drug had been handed out without checking it was suitable.

"It was handed out without doing those risk assessments. Consequently there are a number of people in this country who feel that their lives have been ruined by taking this drug when they shouldn't have been."

While Lariam is not the main anti-malarial drug used by the armed forces, at least 17,368 personnel were prescribed it at least once between the start of April 2007 and the end of March 2015, according to official MoD figures.

The committee said it had received strong anecdotal evidence that a body of current and former service personnel had been adversely affected by its use and that the arrangements for supporting them were ''inadequate''.

While the manufacturer, Roche, had issued ''clear guidance'' that individual risk assessments should be conducted before prescribing the drug, the committee said the MoD appeared to have interpreted this to include ''desk-based'' assessments using medical records rather than face-to-face interviews.

The Defence select committee said the policy review was a "step in the right direction" but said it was "very disappointed" that its calls for Lariam to be designated a ''drug of last resort'' had not been acted on.

It said: "The committee welcomes the undertaking that, for military personnel, all anti-malarial drugs will be prescribed after face-to-face health risk assessments, and that checks will be introduced to ensure that when Lariam is to be prescribed, the patient must be offered an alternative.

"We also welcome the announcement that the MoD has established a single point of contact for present and former personnel who have concerns about their use of Lariam, as the committee requested.

"However, the committee is very disappointed that the MoD has yet to designate Lariam as a 'drug of last resort' as the report recommended.

"This would send out a clear message that the MoD has acknowledged and accepted the high risks associated with the use of Lariam and we urge the MoD to do this without further delay."

Hilary Meredith Solicitors has so far been contacted by over 1,000 former service personnel who were prescribed the drug and suffered side effects including hallucinations, severe depression, seizures, sleep disturbances and anxiety.

Partner Philippa Tuckman said she was "disappointed", saying "as well as apparently refusing to commit to using Lariam only as a drug of last resort, the MoD's response neither acknowledges the lamentable failings of the past nor reassures about the future."

She said: "I am not at all confident that the MoD is going to work with the servicemen and women who have been injured to ensure they receive the help and support they need."

In light of the committee's "very strong criticisms of the unsafe ways in which Lariam has been administered in the past," she said: "We give a qualified welcome to the MoD's commitment that no anti-malarial drugs will be given without an individual face-to-face risk assessment in the future.

"However, we have to be assured that these assessments really will protect individual service men and women from suffering in the future the damage that has already been caused to many of their colleagues."

The specialist armed forces and group actions team at Irwin Mitchell shares similar concerns and has received more than 230 inquires from service personnel affected by mental health issues such as depression, hallucinations and anxiety after taking Lariam.

Kevin Timms, a lawyer leading the cases, said: "We welcome that fact that the MoD is revising its anti-malaria policy and changing the checks it carries out before prescribing Lariam, but the fact is that this is too little, too late for the people who have already suffered adverse side-effects due to Lariam.

"This official response offers no apology or acknowledgement of the MoD's prior failings in prescribing Lariam and we are concerned about whether or not the MoD is taking into account the differences between civilian and military situations.

"In our view they continue to place too strong a reliance on guidance designed for civilians taking Lariam rather than military personnel. Being in the armed forces is unique and soldiers are put into situations that can cause extreme emotions and stress."

But Mr Timms said he is hopeful that the review will allow the MoD to make positive changes to its policy, adding: " For many, the mental health issues suffered have had a significant effect on their lives, so prompt action is required."

While also welcoming the special helpline set up for concerned military personnel to contact the MoD directly, lawyers say it is crucial that the MoD ensures the advice it provides is adequate.

Mr Timms said: "The helpline is a start but it will be important to monitor how the NHS and MoD advice works in practice as mental health issues related to service can be difficult to deal with."

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