My position on this has developed somewhat over the years, and it's a complex and nuanced issue that also acknowledges the complex politics of this issue.
In the U.K., very recently, after our testimony and after a thorough parliamentary investigation, the Ministry of Defence essentially adopted a policy that mefloquine would be the drug of last resort. They didn't seemingly want to acknowledge it as such, but the policy is very clear. Mefloquine is to be used only when a soldier cannot tolerate any of the other safer and equally effective drugs.
If it takes allowing MOD to declare it a drug of last resort for the public health threat to be mostly mitigated, then that's fine. Perfect is the enemy of the good. I would prefer not to see any mefloquine used in military settings, because I believe it's virtually impossible for service members to abide by the product insert directions. How is it possible for a prescriber to counsel a patient who's going to a combat zone where they're going to be experiencing insomnia, where they're going to be experiencing anxiety, and where they may be experiencing nightmares as a result of what they're facing? How can a prescriber tell such a patient, “Here's a drug and to use it safely in accordance with the manufacturer's directions, you must discontinue it if you develop nightmares, insomnia, anxiety”? It would be malpractice for any civilian doctor to do that. I don't believe it's possible for us to use it safely in military settings.
That being said, I will concede there are some people who have good experiences with this drug and who have used it many times previously, For them, if they want to continue using it, I suppose that's okay, but for new soldiers who have no experience with the drug, I think it's a risk that's too great. I do believe that we will eventually be unanimous in our agreement that the drug has no place, but until then, I'm interested in reducing the use.