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The Administration of Drugs with Psychotic Side Effects

Standard Operating Procedure Number 21 (Infection Control) of the Detainee Hospital, Guantanamo Bay, Cuba, required all detainees to undergo an "empiric therapy" of 1250 mg of the drug mefloquine.

Standard Operating Procedure Number 37 (In-processing Medical Evaluation) for the same hospital spells out this therapy in more detail: upon arrival to Camp Delta, all detainees must undergo "empiric treatment" for malaria, where this treatment involves the administration of 1250 mg of mefloquine split in two doses: 750 mg at in-processing time, and 500 mg twelve hours later (see also Standard Operating Procedure Number 29 (Nursing)).

Mefloquine is an anti-malarial drug that is prescribed either preventively (at a low dose of 250 mg) or therapeutically (at a high dose of 1250 mg). An empiric therapy is the initiation of treatment in the absence of--or prior to--diagnosis. 

Mefloquine (which is sold as Lariam) is known to have adverse neuropsychiatric side-effects such as severe anxiety, paranoia (feelings of mistrust towards others), hallucinations (seeing or hearing things that are not there), depression, feeling restless, unusual behavior, feeling confused, and suicidal ideation (see the Lariam Medication Guide approved by the FDA). These side effects were mentioned at the Spring 2003 Meeting of the Armed Forces Epidemiological Board by Captain Monica Parise (see at p. 71): "there are a host of […] neuropsychiatric issues that occur short-term [as reactions to mefloquine], such as insomnia, strange dreams, fatigue, lack of energy, inability to concentrate, and some people have reported that those effects have lasted a very long time […] I've heard cases that this has just ruined people's lives […] I had heard that there may be some data in DOD about how some of the studies might shed light on that […]."

Moreover, although these adverse side-effects obtain at any dose, studies suggest that the frequency and severity of these effects increases dramatically when the higher doses of therapeutic uses are administered.

Thus, as a matter of standard operating procedure, mefloquine was to be administered to all Guantánamo detainees upon arrival at the base--at high doses, without a diagnosis of malaria, and in spite of its psychotic side-effects.

Use of mefloquine is in addition contraindicated for patients with mental disorders in their medical histories. Yet, the administration of this drug per Guantánamo standard operating procedure was not made contingent on a detainee's history.

Moreover, the adverse effects of mefloquine could only be compounded by the documented practice of keeping a detainee in solitary confinement throughout his first six weeks in order to enhance and exploit the disorientation and disorganization felt by a newly arrived detainee in the interrogation process.

Although the lifespan of these directives is not known, SOP37 was last revised on July 2005. There is evidence, however, that it was already in effect in June 2002 (see the  dates on the medical in-processing forms for Mr. Ahmed we have linked to below). In any case, a DoD spokesman has acknowledged that mefloquine was administered to each arriving detainee at the high dose (see below).

The facts of this case are not disputed. In fact, according to the Leopold & Kaye article cited below, the DoD has acknowledged that "a decision was made to presumptively treat each arriving Guantanamo detainee for malaria," adding that this treatment was "completely appropriate". Not everyone agrees. Dr. G. Richard Olds, internationally recognized tropical disease specialist and Founding Dean of the University of California at Riverside School of Medicine, told Seton Hall researchers, "In my professional opinion, there is no medical justification for giving a massive dose of mefloquine to an asymptomatic individual. I also do not see the medical benefit of treating a person in Cuba with a prophylactic dose of Mefloquine." And Maj. Remington Nevin, an Army public health physician, who formerly worked at the Armed Forces Health Surveillance Center and has written extensively about mefloquine, said in an interview with Leopold & Kaye that the use of mefloquine "in this manner […] is, at best, an egregious malpractice," adding, in a 2012 article for a medical journal, that "this analysis raises the troubling possibility that the use of mefloquine at Guantánamo may have been motivated in part by knowledge of the drug's adverse effects".

It should be added that there is evidence that the instructions in these SOPs were actually carried out. Included in the cited SOPs are samples of the forms to be used for the medical in-processing of Guantánamo prisoners. Two of these forms have been released: that of Mr. Ali Abdullah Ahmed (ISN 693) and that of Mr. Mohamedou Ould Slahi (ISN 760). Both indicate that the required dose of mefloquine was administered during in-processing. And the neuropsychiatric sequelae one of them experienced shortly thereafter has been released as well (decreased duration and quality of sleep relating to anxiety, nightmares of "being in a box", and unprecedented suicidal ideations; a few days later, he reported some anxiety, suicidal ideation, audio-visual hallucinations of voices and of "the ceiling coming down", broken sleep due to nighmares, and loss of appetite).