John Henry Browne, the attorney for the U.S. soldier charged with killing 17 Afghan civilians on March 11, told the NewsHour in a telephone interview that he was interested in learning what medications his client, Staff Sgt. Robert Bales, was taking at the time of the shootings.
“We have to order his medical records, and they haven’t given them to us yet,” he said on Thursday. “He was taking medications, but we don’t know whether it was aspirin, heart medicines. We don’t know what it was.”
Browne said that in some previous legal cases, he has cited the side effects of a prescribed drug in a client’s defense.
“There are a lot of medicines that can backfire,” Browne said. He pointed, in particular, to recent reports about Lariam, an anti-malarial medication.
NewsHour viewers have their suspicions as well. “I can tell you that I personally ruined my life because of that substance in July 2011 and I have no memory of my actions,” one viewer said of the sleeping medication Ambien in an email to the NewsHour.
Online chat rooms also are buzzing with speculation about the popular drug. “Do you suspect Robert Bales will blame Ambien?” reads one March 21 message posted by the screen name “Reapist” to an online gaming discussion forum. Another commenter, “Floridadave,” writing at a Yahoo chat room, said: “If I were him, I would use the Ambien defense. Heck, it works for congressmen when they get stopped for DUI in DC.”
The chat room participant referenced how in 2006 Rep. Patrick Kennedy issued a statement saying he had been disoriented when he crashed his car on Capitol Hill because he had been on Ambien.
The NewsHour reported on March 26 that, according to an internal Pentagon document, investigators discovered suspected steroids were hidden in Bales’ living quarters. Anabolic steroids, when taken in high doses, are widely believed capable of triggering irritability and aggression, though any role in this particular case remains uncertain.
One former Army psychiatrist, retired Col. Elspeth Ritchie, recently said that Lariam — or the generic mefloquine — may have triggered a psychotic episode, which could have involved hearing voices or experiencing delusions. Ritchie told the NewsHour that a soldier would be given blood and urine tests after he or she is suspected of committing a crime. If Bales had taken mefloquine, it would be detected in those tests.
A Huffington Post report said the Defense Department had ordered an emergency review of the military’s use of this drug. However, a Pentagon spokesman on March 26 said this review was ordered in January and “has absolutely no connection to the ongoing case or investigation into the actions for which Staff Sgt. Robert Bales has been charged.”
Although there is little debate about the side effects of Lariam, there is a raging debate among psychiatrists about whether there could be a connection between Ambien and the alleged incident involving Bales.
Ambien — or the generic zolpidem — “is usually harmless,” but “bizarre behavior is well known as an uncommon side effect,” said Dr. Frank Ochberg, a clinical professor of psychiatry at Michigan State University.
The medication’s package insert warns the drug could lead to decreased inhibition such as “aggressiveness and extroversion that seem out of character” and is “similar to the effects produced by alcohol.” Hallucinations, confusion, agitation and depersonalization are also reported side effects. These so called “sleep-related, complex behaviors” are usually accompanied by anterograde amnesia, meaning one has no memory of doing these things.
Given reports that Bales might have been troubled by the wounding of a fellow soldier, might the sergeant have taken Ambien, fallen asleep, and then gotten out of bed and gone on a rampage?
“Not only possible, but the best angle for his defense to take,” Ochberg said in an email. “Soldiers have ‘gone berserk’ since ancient times. It is a state of mind that may be vengeful, but also may be a wild killing spree with no conscious control and little pleasure from the killing itself — as though a primitive drive is released and the beast-part of all of us is let loose.”
It could be that this brand of horrific violence cannot be fully explained, he said.
“After any unexpected violent act, we search for rational explanations. Sometimes the best explanation is that reason was turned off and primitive, predatory parts of the brain took over,” said Ochberg. “Lions do this when taking over a new pride. They kill the young of other males. They don’t hate ‘children.’ They are wired in a way that serves their DNA. We are ‘wired’ in a way that requires socialization, social control, law and consequences to keep our inner lions from ruling our behavior.”
Ochberg is not alone in suspecting the sleeping drug might have played a contributing role in the March violence.
“The whole thing is pretty mysterious to me if it’s not Ambien,” Dr. Jonathan Shay told the NewsHour. The author of two books about veterans and post-traumatic stress disorder, Shay said if the soldier “had a good dose of zolpidem in his blood stream,” it’s entirely possible he could slip off base and go on a rampage.
“Whichever way his imagination blew him is the direction he would go,” he said. “Unless somebody externally prevented him from doing so.”
“Ambien is commonly prescribed (to soldiers) on a short term basis for plane flights,” Ritchie said. “Only 5 or 10 tablets are given at a time, without refills.” The former Army psychiatrist also said Ambien can interact with alcohol and other medications to cause psychiatric reactions but they are not generally severe.
“Ambien is commonly used and is relatively safe,” Ritchie said.
Other psychiatrists are even more adamant in their opposing views. There is “no way” the soldier in Afghanistan was in an unconscious sleep state, according to retired Capt. William Nash, a former Navy psychiatrist.
“He could not possibly have done so much damage in such a short time. He had to have been completely and alertly focused on his tasks,” Nash said in an email. “I know of no cases or studies suggesting Ambien has contributed to violence of any kind in war zones.”
Other doctors believe there is just too much unknown about this case in order to speculate about any role for the sleeping aid.
“I think that is really a stretch,” said Dr. David Greenblatt, professor of molecular physiology and pharmacology at Tufts University. “There is not enough information to suggest that zolpidem or any other drug is causally related to it (the violence). Don’t forget we have millions of patients out there with insomnia, and sleep-related complex behaviors can occur without medications.”
“It’s speculation I wouldn’t want to make,” said Dr. Richard Shader, professor emeritus of pharmacology and experimental therapeutics at Tufts University. “I understand where somebody could say, yeah, it’s possible. But possible one in 10 times, one in 100 times, one in 1,000 times? Saying it’s possible doesn’t give you a denominator. And that’s what you need. Not only do you need a denominator, but you need to know if this individual would be the exception to the rule. Because the rule is it doesn’t happen.”
Shader has first-hand experience with amnesia of events while on a sleeping pill similar to Ambien.
In the late 1970s or 1980s, while flying to England to give a speech, he took the medication because he feared he would otherwise not be adequately rested for the next day. After arriving at the airport, Shader traveled to Surrey, southwest of London, and gave a lecture.
He then had dinner with friends, who asked him how he got to Surrey, whether he had any trouble finding his way and how the lecture went. Shader told the NewsHour he could not remember either getting to Surrey or giving the lecture.
“That’s the kind of thing that can happen” while on medications like Ambien, he said. “It’s a matter of the right dose at the right time.”
But Shader said it is unclear whether this has any relevance to Bales because it is not yet known whether he was taking sleep medications and, if he was, what the concentrations were. “I think it would be harmful speculation to try to implicate a pill,” Shader said.
There is precedent, though, for blaming criminal actions on medication.
“If an individual takes Ambien and then has an episode of some activity undertaken while he’s asleep, that would preclude any possibility of premeditation if he were to commit a crime,” said retired Lt. Col. Gary Solis, a former Marine Corps lawyer. “The individual would have the defense of essentially intoxication, a medical forum of intoxication. And premeditation would be precluded.”
Solis said that in most states the Ambien defense has been ineffective if the accused did not follow the medication’s directions. “For example, the directions say that one should immediately go to bed after taking Ambien. If one did not do so, then those states disregard the defense, and they treat it as if it were voluntary intoxication,” Solis said. “If an individual were to take Ambien in conjunction with alcohol, contrary to the directions, similar outcome.”
Solis said that given media reports allege Bales was drinking — citing information from unnamed Pentagon officials — any Ambien defense put forth probably would not succeed.