Clue: It Was the Drugs in the Solitary Confinement

Charlie Savage confirms what Jason Leopold had suggested earlier: Adnan Latif died from too much psychiatric drugs.

A Yemeni detainee who was found dead in September at the military prison at Guantánamo Bay, Cuba, died from an overdose of psychiatric medication, according to several people briefed on a Naval Criminal Investigative Service inquiry.

But while a military medical examiner labeled the man’s death a suicide, how the prisoner obtained excess drugs remains under investigation, according to American and Yemeni officials.

Savage’s sources suggest that Latif was stockpiling the drugs himself, perhaps in a bodily orifice.

One official, however, discounted [David Remes’] theories, saying investigators were working from the premise that Mr. Latif pretended to swallow his drugs for a period and hid the growing stash on his body. Prison monitoring policies — including how closely guards inspect detainees’ mouths after giving any medication and search their private areas — are now facing review.

Though of course, that would have required Latif to have brought them with him from the hospital ward to the solitary confinement ward, which would mean he managed to get the drugs by both the administration period but also the admission into solitary.

Savage also doesn’t mention a few details from Leopold’s earlier article. Shaker Aamer told David Remes that Latif had been told he’d be injected with a drug detainees say turns them into zombies for a month.

Aamer contends Latif was told on September 6, two days before his death, he would be given an “ESP injection,” that other prisoners claim “makes you a zombie” and “has a one-month afterlife,” according to unclassified notes of the meeting between Remes and Aamer.

More interesting still–given the points I raised above about how Latif would have managed to get drugs into solitary with him–is this detail.

Another prisoner said a female psychologist accompanied Latif from the hospital to Camp 5, where one prisoner told Remes the minimum stay is three months, “regardless of the magnitude of the offense.”

The female psychologist said she would communicate Latif’s concerns about being housed in Camp 5 to “higher-ups.”

Mind you, this psychologist at least sounds sympathetic. Moreover, this detail would seem to be unknowable to other detainees–how would they know what she had told Latif?–unless the psychologist had spoken to other detainees.

Finally, there’s this: Savage’s sources (as were some of Leopold’s) are citing the NCIS investigation, not the autopsy. But that’s not supposed to be done for nine months. Now perhaps NCIS doesn’t expect to have an explanation for how Latif got or stashed the drugs for another 7 months at least. Or perhaps the NCIS investigation will take that long only to make sure Latif’s remains will be good and decomposed by the time it’s done.

But as we discuss the minutia of how a detainee managed to overdose in closely guarded solitary, remember this: He was almost certainly innocent, and he surely should not have remained in Gitmo after habeas review.  Because of that legal injustice, we’re left playing clue about how a disturbed man died in America’s prison camp.

17 replies
  1. Jim White says:

    In a properly run prison, there would be extensive and meticulous records of drugs being dispensed to prisoners. We would know which drugs were given to Latif and on what days. Presumably, the blood analysis is able to distinguish which drug(s) Latif overdosed on and perhaps can even give a rough estimate of the dose he took. Something on the order 3 pills vs 10 pills vs 30 pills is the type of estimate I think could be made from blood analysis when it is coupled with a reasonable guess as to when he took the drugs.

    In a prison not populated with torture victims, the use of psychiatric drugs would be moderately rare, but at Gitmo we can assume many of the prisoners were on these drugs (as Jason and Jeff have reported extensively). At any rate, though, the NCIS investigation should have some chance of finding records on the drugs in question. Now whether those records are accurate or maintained properly is another question.

    I’ll go out on a limb here and predict that the crucial records on what drugs were given to Latif and when will somehow be “lost” before NCIS gets access.

  2. Jeff Kaye says:

    Great write-up, Marcy. Your emphasis on the injections is spot-on, and I look into that and other aspects of this psychiatric drug overdose issue in my write-up on this at FDL.

    A few other points: Savage quotes Remes as noting that there are other possible ways that a drug overdose could occur. One way would be via accident (which spans concepts from negligence to malpractice). But Remes also speculates about a scenario that is sometimes called facilitated suicide:

    “Mr. Remes, who has not seen the autopsy report, suggested that Mr. Latif instead may have negligently been given too many pills that day, which the lawyer doubted, or that the authorities might have deliberately given him access to too much medication hoping he would kill himself.”

    The latter scenario is also something I’ve speculated upon myself in the past — in the case of another purported Guantanamo suicide, Mohammed Salih Al Hanashi.

    But there are even other possiblities. Injections of drugs, particularly drugs used at Guantanamo, like haldol decanoate, are dangerous in and of themselves.

    I happen to think Latif was killed. But I could be wrong. NCIS, and possibly Savage, apparently think Latif killed himself. But they could be wrong, too. Here’s how another scenario could develop (taken from my story today):

    Another possible mode of death might have been via what has come to be called accidental death via “polypharmacy.” As critics of psychiatric practice have noted, drugs are often prescribed in too great a number, with some drugs prescribed to deal with side effects of other drugs, until the total number of drugs prescribed becomes dangerous, and the interaction between drugs prescribed unpredictable.

    The Department of Defense has been criticized for just this kind of practice, as described in this February 2011 Psychology Today article by Dr. Allen Frances, “psychiatry professor emeritus and former chairman of psychiatry, Duke University who chaired the DSM-IV Task Force revision.”

    “Individual psychotropic drugs can have serious side effects — in excessive combination they sometimes threaten respiratory and cardiac function in a potentially lethal way,” Frances wrote. “And the whole is even more dangerous than the sum of its parts since the medications can interact to increase each other’s blood levels. Prescription drugs are overtaking illegal drugs as the primary cause of accidental overdose and death.”

    In any case, there have been too many suspicious deaths at Guantanamo. Can the Democrats finally get some gumption and undertake the necessary investigation, or better yet, appoint an independent, comprehensive, public investigation? It would be good to think Latif did not die in vain.

  3. Jeffrey Kaye says:

    @emptywheel: Yeah, and in my practice I’ve seen it up close and it’s ugly. It’s the fancy description for good old overmedication.

    By the way, you saw in the Savage piece that supposedly Latuf’s body was frozen?

  4. sOLbus says:

    That’s pretty interesting regarding polymorhphism of drugs. Also, as I recall, about 20% of the population have metabolic breakdown issues due to genetic impairment of the cytochrome p-450 metabolic pathways. What it does is cause extreme toxic buildup – there are quite a few drugs that require p-450 to break down. Liver and Kidney specialists seem to be more familiar with it, as are HIV patients, but it’s hard to see that kind of awareness available in that environment, particularly as it requires genetic testing to determine. It’s hard to see how the “patient” complaining about the side effects there would be taken seriously.Perhaps the side-effects were themselves manifested as conducive to suicide ideation.

  5. hcgorman says:

    This gets back to the question I had in an earlier post about the supposed monitoring of the detainees. I don’t know how long it took Mr. Latif to die from his overdose but it seems to me he should have been unresponsive for quite some time. I haven’t seen anything from the military on when the last time anyone checked on him. the only thing I have seen are the boilerplate times that a guard is “supposed” to check on the detainees. if they are supposed to check every 3 minutes and did not check for many hours it suggests that something more was going on here.

  6. Jeff Kaye says:

    @hcgorman: Yes, the surveillance, which would include tapes, is the elephant in the room. The same issue surrounds the death of the other supposed suicides. In my article on the UN special rapporteur and the autopsies of Al Hanashi and Al Amri, I included two photos of exactly the kind of cell Latif would have been in. You can see the cameras and where they are placed.

    The other elephant in the room (crowded room!) is the allegation that guards threatened to kill Latif after an incident in early August, approx. one month before he died. See Jason Leopold’s story:

  7. Gitcheegumee says:

    @Jim White:

    Jim, in a properly run prison, are the guards themselves tested for drug usage?

    I have always wondered how the Gitmo guards are vetted and selected..are they private contractees a la Blackwater/Acedemi?

  8. hcgorman says:

    The guards are military.
    and Yes Jeff- the room is quite crowded- it adds more credibility to the theory that he was killed when the military violates its own rules and neglects to check in on him. It must have been at least several hours that he was unconscious and yet no one apparently raised an alarm or concern.

  9. emptywheel says:

    @hcgorman: Plus the comments in Jason’s piece about him not attending prayer.

    I think you’re right: it seems like they let him be for the day to allow him to die.

  10. Ken Hardy says:

    Gets curiouser and curiouser. First of all, the drug what done the deed is key. Years ago a handful of barbituates and you’re being fitted for wings. However, most modern psychotropics (E.g. benzodiazepines) require a boatload of pills to kill you. There are some that actually do not have a lethal dose–make you sick as hell but won’t kill you. Most that CAN cause death require more than Latif could have ever been smuggling from cell to cell–unless a blind eye were involved. Now, if he were also taking a TCA, the combined effect of a smaller overdose of the benzo and the TCA could have killed him. BUT, TCA’a are right up there with arsenic pills and orbital lobotomies in terms of no longer favored, rarely used therapies. Anyone writing for a TCA in this setting is a quack (and probably exactly the type of doctor they would have there.)

    Also dunno about you folks, but I have a little experience with purposeful/accidental overdosing some ending in death, and let me tell you, even if its sleeping pills, most do not go peacefully. The human body will go at it hammer and tongs before it gives up. I’m talking projectile vomiting, seizures, violent tremors, buckets of cold sweat, and turning a scary color of blue-ash not found in any crayola box. My point is that if Latif DID OD, anyone who says he went from perfectly normal appearing to unresponsive clinical death in a few minutes is a Goddamn liar.

  11. pdaly says:

    @Ken Hardy: “BUT, TCA’a are right up there with arsenic pills and orbital lobotomies in terms of no longer favored, rarely used therapies.”

    True, but if tricyclics are CHEAPER than modern pills, perhaps the military keeps them on the formulary?

  12. passepartout says:

    What about something like fluphenazine? There’s a protocol (from some years ago) for monthly IM injections to reduce self-harming behaviours in institutionalized patients. Hello, Gitmo! IIRC, this drug has a black box warning for increased risk of death and a good list of dangerous interactions.

  13. alex lerman says:

    I agree with other posters. It’s very hard to kill someone with psychiatric drugs – with the exception of a tranquilizer/alcohol mix, or indeed tricyclics. Most patients can survive massive overdoses on benzodiazepine tranquilizers alone.

    It would be quite bizarre to administer TCA’s in a prison setting, given their potential lethality, and prozac and many other safer drugs are dirt cheap – $4 /month at target.

    Fluphenazine and other antipsychotic drugs can kill, particularly if given by injection excessively – but this is usually through “neuroleptic malignant syndrome” – involving days of fever, rigidity, and mental status changes – and this should have been detected by even the dumbest prison orderly long before death.

    EW (not for the first time) touches on something that has really bothered me – how Bruce Ivins could have died from a “Tylenol overdose” while under intense FBI survelliance. Tylenol is indeed a highly dangerous drug, lethal in even modest overdoses – but it kills through inducing liver failure, usually after days/weeks of severe illness. How did it happen?

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