(a) None was conducted and none was deemed necessary.
(b) None was conducted and none was deemed necessary.
(c) The specific policy regarding the consumption of alcohol is left to the field commander who determines the amount of alcohol permitted per day during deployment. In Somalia, members were not permitted any alcohol during the first six weeks of their deployment, following which each member was allowed two beers per day, except on special occasions where no restrictions were imposed, e.g. regimental birthday. In Rwanda, members are permitted two beers per day for six days of the week with no alcohol one day a week. The field commander may remove these restrictions for special occasions.
Until quite recently, there was no scientific evidence that personnel taking mefloquine were at an enhanced risk of a serious adverse interation when drinking alcohol. Further, the prescribing information for mefloquine does not mention concern about such an interaction. Thus, when Canadian forces members were deployed to Somalia and Rwanda, there was no evident need to warn those taking mefloquine about an interaction with alcohol. However, a Canadian medical journal has recently, on February 15, 1995, reported a single case of a likely serious interaction between mefloquine and copious alcohol ingestion which resulted in a temporary psychotic state in the patient. This is the first reasonably documented reported case among the millions of persons who have taken mefloquine worldwide in the last decade, many of whom likely drank alcohol, even substantial quantities, hence the risk of such an interaction would seem quite small. In light of this report, it is felt by the Surgeon General that it is prudent specifically to caution members taking mefloquine against the concurrent excessive use of alcohol; the necessary direction is being drawn up. Reducing the mefloquine dosage to minimize potential
mefloquine/alcohol interaction was not and is not recommended since this would enhance the risk of getting malaria.
It is important to state that responsible use of alcohol is already the expected norm in the Canadian forces for other substantial reasons, e.g., injury control, whether inside or outside Canada.
(d) The usual precautions for the prescribing of mefloquine were employed. The Canadian forces have an education based drug and alcohol prevention program, DAPP, to which personnel are to be exposed annually. The Canadian airborne regiment had a DAPP session for the junior non-commissioned members in the fall of 1992 and for senior non-commissioned members and officers before departure to Somalia. At the time of deployment, there was no published literature that indicated an adverse interaction between recreational drugs and mefloquine; therefore, specific advice was not given to those who might use recreational drugs when taking mefloquine, although it is standard policy that recreational drugs are not to be taken by Canadian forces members.
(e) There has been a longstanding caution against using mefloquine among persons for whom dizziness might be particularly detrimental. While there is no evidence that this caution is necessary, out of prudence, the Canadian forces follows it and mefloquine was not and is not used in certain occupational groups, primarily pilots and divers. Hence, in Somalia and Rwanda, pilots and divers were not to be prescribed mefloquine.
(f) Mefloquine marketed in Canada is the European formulation which has 250 mg of base drug. The U.S. formulation has 228 mg of base drug, or 9 per cent less active drug. Medical studies have been done on both formulations with similar conclusions. It is unlikely that the minimally lower dose in the U.S. preparation is of practical significance.