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• • • GUANTANAMO: Controversial Drug, Reglan, Used for Force-Feeding • • •


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Guantanamo manual supports controversial drug
Exclusive documents recommend use of Reglan, a drug known to cause neurological disorders, to hunger striking detainees.
By Jason Leopold
Date: 17th June 2013
Source: AJE


A new policy for force feeding hunger strikers at the US Naval Base at Guantanamo Bay includes the recommended use of a controversial drug that may cause serious neurological disorders, including one that mimics Parkinson's disease.

The UK-based human rights group, Reprieve, filed an incident report this week with the US Food and Drug Administration (FDA) demanding an immediate investigation into the use of the brain-altering drug, and asking the agency "to take all possible measures to prevent further use of metoclopramide in force-feeding at Guantanamo".

Al Jazeera first documented the use of metoclopramide last month in an exclusive report about the government's revised Standard Operating Procedures (SOPs) to deal with a massive hunger strike entering its fifth month.

More than 100 Gitmo detainees are refusing meals and military officials there have ordered dozens to be force-fed, a brutal procedure involving a mask, plastic tubing, powerful drugs and restraints, as detailed in last month's Al Jazeera report.

Metoclopramide, commonly known by its brand name Reglan, is supposed to speed up the digestive process and remove the urge to vomit during force feeding.

However, medical studies into the drug have determined that Reglan also is....

 

linked to a high rate of tardive dyskinesia (TD),

a potentially irreversible and disfiguring disorder characterized

by involuntary movements of the face, tongue, or extremities.

The studies prompted the FDA in February 2009 to slap Reglan

with a black box label - the agency's strongest warning -

to inform patients about the dangers associated with chronic use of the drug.

 

According to the FDA's own medication guide, additional side effects include depression, thoughts about depression and, in extreme cases, suicidal thoughts and suicide.

Reglan works by blocking the neurotransmitter dopamine and the black box warning cites one study that reported a TD prevalence of 20 percent among patients treated for at least 12 weeks.

"Treatment with metoclopramide for longer than 12 weeks should be avoided in all but rare cases where therapeutic benefit is thought to outweigh the risk of developing TD," according to the black box warning on the package.

Hundreds of lawsuits have been filed against the drug's manufacturers by law firms that have solicited patients who claim to have suffered irreversible side effects. The litigation is ongoing.

The revised Guantanamo hunger strike and force-feeding policy implemented in April recommends medical personnel administer Reglan to "enhance" the digestion of the liquid nutritional supplement Guantanamo prisoners are forced to take during tube feedings, according to the 30-page procedures manual obtained by Al Jazeera.

According to the manual, Reglan (along with other medications) may be given to prisoners during one phase of the force-feeding procedure to treat nausea and bloating after a tube is inserted into a prisoner's nose and snaked down to his stomach. Another phase of the force-feeding procedure says 10 milligrams of the medication "may be useful when using intermittent feeds…to enhance gastric motility".

Reglan can be administered orally, through disintegrating tablets, or by injection. The SOP does not advise the medical personnel administering force-feedings about the severe side effects associated with Reglan, nor does it state that its use should not exceed three months. Moreover, the SOP fails to state that Phenergan, another powerful drug recommended in the guidelines to treat nausea, is not to be given in combination with Reglan as it can heighten the risk of "Parkinson's-like symptoms".

With the hunger strike at Guantanamo now in its fourth month and more than a quarter of the protesting detainees being force-fed, the UK-based human rights organisation, Reprieve, fears Reglan has been administered to prisoners without their consent and beyond the recommended 12-week window when side effects become more apparent.

Human rights groups already have accused nurses and doctors of violating medical ethics by carrying out the prison's force-feeding policy, which the United Nations has said rises to the level of torture; the American Medical Association (AMA) said in April it violates the medical profession's "core ethical values".

An article published Wednesday in the New England Journal of Medicine called....

 

Guantanamo a "medical ethics-free zone".
"Force-feeding a competent person is not the practice of medicine;

it is aggravated assault,"

 

... the authors of the journal article wrote.

The hunger strike SOP notes that medical personnel are not authorised to act independently of security personnel and are simply on hand to carry out the prison's force-feeding policy.

Reprieve, which represents 17 Guantanamo prisoners, said the use of Reglan is another example of doctors failing to uphold their ethical duties to "do no harm". Cori Crider, the strategic director of Reprieve, signed the letter accompanying the adverse incident report to the FDA on behalf of three prisoners being force fed at Gitmo.

Crider also sent a letter to ANI Pharmaceuticals, the manufacturer of the 10 mg tablets of Reglan asking the company to "assist us in stopping the misuse of your drug".

According to materials she provided to Al Jazeera, Crider told API: "It is highly likely that prisoners are being medicated with Reglan without their informed consent. There is also a grave risk it is being administered for extended periods that may cause severe neurological side-effects…I am sure you will agree that the use of Reglan in the force-feeding of Guantanamo detainees is incompatible with your company's aims.

"It places one of your products, intended to promote health, at the centre of a notorious and ongoing human rights violation, and will cause irreparable damage to your corporate reputation. The forcible administration of Reglan places you in potential breach of your duty as a manufacturer to warn of these adverse side effects, since any warning pamphlet is obviously made otiose in these circumstances."

Neither the FDA nor a spokesman for ANI Pharmaceuticals returned calls for comment. Last month, Crider sent a letter to the chairman and chief executive of Abbott Laboratories, the manufacturers of the nutritional supplement Ensure, which has become symbolic with the force-feeding procedure at Guantanamo. The letter called on Abbott to "explicitly disassociate your product line from any use in force-feeding detainees at Guantanamo". The company never responded to Reprieve, Crider said.

No cause for concern

Guantanamo officials, meanwhile, say concern over the use of Reglan is unwarranted.

"Heartburn and gastric reflux medications are only given to detainees who want or who feel they need them at the time of feeding," said Lt Col Samuel House, a Guantanamo spokesman. "All medications provided to the detainees are the same FDA-approved medications available to treat US service members, with safeguards in place regarding dosage, drug interactions, dispensing and prescribing authority.

"No detainee has been provided 10 mg of Reglan on a regular basis for three months. I will need to check to see when the last time Reglan was used to treat a detainee."

House said health care providers inform prisoners about the "dangers of medications".

"In the end, it is up to the detainee," he added. "Like all medications, the healthcare provider chooses the medication, based on symptoms and medical diagnosis."

House did not provide a follow-up response as to when Reglan was last administered to a prisoner. Capt Robert Durand, the chief spokesman for the Guantanamo prison, told Al Jazeera on Wednesday there would be no further comment on Reglan or any other medications used at the prison.

"Prescriptions are provided with the consent of the detainee by licensed physicians who monitor for other drug interactions following warnings and label guidelines," he said.

But during a recent visit to Guantanamo, Al Jazeera spoke with the medical officer in charge of the detention camp, a woman whose name we were not permitted to print for security reasons. When queried about the adverse side effects associated with Reglan, she said, "I've never heard of any issues associated with the use of that medication".

"Reglan is just one option doctors use," she said. "If there are any concerns I'm not familiar with what they are."

The senior medical officer at the detention hospital, a physician whose name Al Jazeera was also not authorised to print, would not respond to direct questions about the use of Reglan. He said, "some [prisoners] complain of stomach distention and discomfort", and they are receiving "first-rate medical care".

Dr Joseph Jankovic, a neurologist at Baylor College of Medicine in Houston, told the Los Angeles Times in 2009 that Reglan "is prescribed by internists or gastroenterologists who are not necessarily familiar with the recognition of tardive dyskinesia".

Jankovic told the Times he analysed 443 tardive dyskinesia patients at the Baylor clinic over the course of 25 years. He said that prior to 2000, the antipsychotic medication Haldol was responsible for the bulk of TD cases. However, Reglan was blamed for all TD cases since then.

"It is a public health problem," Jankovic said. "Many of these patients who have metoclopramide-induced movement disorders aren't recognised until...they're at pretty advanced stages of the disease."

Jankovic was unavailable to speak to Al Jazeera about the use of Reglan on hunger striking Guantanamo prisoners. Several other doctors Al Jazeera contacted said they were unable to provide an immediate opinion about Reglan's use at the prison.

History of questionable use of drugs at Gitmo

This is not the first time the use of a controversial drug at Guantanamo has been called into question. In 2010, this reporter broke the story that all prisoners transferred to Guantanamo had been given treatment doses - 1,250 mg - of the powerful antimalarial, mefloquine, regardless of whether or not the prisoners had malaria. Mefloquine can cause severe neuropsychiatric side effects, including suicidal thoughts, hallucinations and anxiety.

An Army public health physician, Maj Remington Nevin, said in an interview at the time....

 

.... the use of mefloquine "in this manner...is, at best,

an egregious malpractice" and was tantamount to

"pharmacologic waterboarding".


The government exposed prisoners "to unacceptably

high risks of potentially severe neuropsychiatric side effects,

including seizures, intense vertigo, hallucinations, paranoid delusions,

aggression, panic, anxiety, severe insomnia, and thoughts of suicide",

[Nevin said.]

"These side effects could be as severe as those intended

through the application of 'enhanced interrogation techniques.'"

 

 

Pentagon officials defended the practice and noted the drug was given to US military personnel as well. However, following a series of news reports linking the drug to suicides, a formal policy memo was issued in February 2009 by Army Surgeon General Eric Schoomaker, removing mefloquine as a "first-line" agent, and changed the policy so that mefloquine would not be prescribed to Army personnel unless they had contraindications to the preferred drug, the antibiotic doxycycline. Nor could mefloquine be prescribed to any personnel with a history of traumatic brain injury or mental illness. By September 2009, the policy was extended throughout the Department of Defense.

Last year, this reporter also co-authored an investigative story, citing a Defense Department watchdog's report obtained through the Freedom of Information Act (FOIA), that showed Guantanamo prisoners were drugged against their will, "medically restrained" and interrogated while under the influence of powerful antipsychotic medications, such as Haldol, which also causes tardive dyskinesia....

 

 

 

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why are they spending money on all this shit?

 

if they want to starve ... let them....

or better yet.... release them back to their shit hole lives.... like America was supposed to do 6 years ago...

 

not like they're going to get trials at this point anyway....

and not like anyone stateside wants to pay for those trials tbh...

 

and if they join terrorist regime upon release....as feared.... so be it. Let them strap bombs to themselves and blow up their own people.... or let them get sniped by some military personnel.

All are better solutions then the cost of keeping Guantanamo up and running, drugging them, and shoving tubes down their throats....and all the bad press it garners.

 

but hey... Obama tried and failed... and the Right have fear mongered enough to ensure that the majority of US citizens never support the release of these men.

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oh no poor terrorist

Most of whom are thrown behind bars, continuously interrogated and put under extreme conditions to break down every aspect of human without any evidence of being a threat.

 

 

 

why are they spending money on all this shit?

 

if they want to starve ... let them....

or better yet.... release them back to their shit hole lives.... like America was supposed to do 6 years ago...

 

not like they're going to get trials at this point anyway....

and not like anyone stateside wants to pay for those trials tbh...

 

and if they join terrorist regime upon release....as feared.... so be it. Let them strap bombs to themselves and blow up their own people.... or let them get sniped by some military personnel.

All are better solutions then the cost of keeping Guantanamo up and running, drugging them, and shoving tubes down their throats....and all the bad press it garners.

Let them starve? Why not? The prisoners know, and are conditioned to know that, they would be better off dead than living in that hell. Their 'shit hole lives' were much better than what happens in Guantanamo. Keeping them alive does not mean that there is care for their lives, because there is definitely not: It just means that they need these humans to be 'alive' for experimental reasons.

 

Clearly human experimentation and enhancing interrogation techniques for 'security' is of greater importance to the American Government than just 'spending money' during this period of economic crisis.

 

I should also point out the force-feeding doesn't just happen during hunger-strikes, but also during the fasting period of Ramadan.

 

Trial? In the U.S. is most definitely never going to happen, but that is by no means reason as to why justice can not be elsewhere.

 

The common question asked is regarding when Guantanamo will be shut, but I rarely come across those who discuss how. The accountability is too immense to casually walk away from.

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Most of whom are thrown behind bars, continuously interrogated and put under extreme conditions to break down every aspect of human without any evidence of being a threat.

 

 

 

Let them starve? Why not? The prisoners know, and are conditioned to know that, they would be better off dead than living in that hell. Their 'shit hole lives' were much better than what happens in Guantanamo. Keeping them alive does not mean that there is care for their lives, because there is definitely not: It just means that they need these humans to be 'alive' for experimental reasons.

 

Clearly human experimentation and enhancing interrogation techniques for 'security' is of greater importance to the American Government than just 'spending money' during this period of economic crisis.

 

I should also point out the force-feeding doesn't just happen during hunger-strikes, but also during the fasting period of Ramadan.

 

Trial? In the U.S. is most definitely never going to happen, but that is by no means reason as to why justice can not be elsewhere.

 

The common question asked is regarding when Guantanamo will be shut, but I rarely come across those who discuss how. The accountability is too immense to casually walk away from.

i hope you know i was using sarcasm. i honestly could careless about them.

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