Politics
Veteran Access To Psychedelics Requires Balance Of Speed And Caution, Says Panel With VA And Former CDC Officials
Experts and advocates—including a Department of Veterans Affairs (VA) official and a former director of the Centers for Disease Control and Prevention (CDC)—recently convened for a Harvard University panel to discuss efforts to expand veteran access to psychedelic-assisted therapy. Speakers broadly agreed that psychedelic substances like MDMA and psilocybin hold powerful potential to help treat PTSD and curb suicide rates in service members, but they cautioned against hasty, unsupervised use of psychedelics given the possibility for further harms.
“I am really excited about this,” said Rachel Yehuda, the director of mental health for the VA medical center in the Bronx who is also a psychiatry and neuroscience professor at the Mount Sinai School of Medicine. “And yet I also know that what’s important is to proceed slowly, methodically, soberly and just get the data, especially about people who are having not as great outcomes.”
Yehuda, who also started a center for psychedelic therapy research, said there’s still a need to better understand psychedelic therapies before recommending them for everyone.
“It’s very important to understand that about a third of the people that are treated with psychedelics in clinical trials really don’t have this promise of breakthrough therapy or breakthrough healing,” she said. “So that’s kind of why we want to do the research. About a third of the people speak so glowingly about it, but another third have a marked improvement that still requires some treatment but clearly made a dent through the use of psychedelics.”
Panelists at last week’s event, hosted by Harvard Law School’s Petrie-Flom Center for Health Law, Biotechnology, and Bioethics, emphasized that they were speaking for themselves and did not represent the views of their respective institutions.
Rochelle Walensky, who directed the CDC under President Biden from 2021 to 2023 and now lectures at Harvard Law School, noted that both rates of PTSD and suicide are “particularly high in veterans compared to the U.S. population”—a problem that’s worsened in recent years.
“One of the most disturbing statistics, I think, is the differential rate in increased suicide that we’re seeing in our U.S. veterans,” she said. In 2001, the suicide rate among civilians was 15 per 100,000 people, while the rate for veterans was 17 per 100,000.
“Those rates are now 18 and 27 per 100,000,” Walensky said, “so you’re seeing a much larger increase in rates of suicide among our U.S. veterans.”
Meanwhile veterans are hearing anecdotes from fellow service members of life-changing experiences aided by psychedelics, which seem to allow therapists to target underlying trauma rather than simply treat conditions’ symptoms.
Today: Psychedelic Law and U.S. Military Veterans
📆 Oct 25, 12:30pm
🏢 Online
👥 @CohenProf, @RWalensky, @netteaverill, @MarcusC236, @RachelYehuda, Juliana Mercer, @MasonMarksMDRegister here ⬇️https://t.co/fz0oRTX04H
— Petrie-Flom Center (@PetrieFlom) October 25, 2023
“The word is out that these things work, especially in the veteran community,” said Juliana Mercer, a Marine Corps veteran who now directs veteran advocacy and public policy for the nonprofit Healing Breakthrough, which advocates for system-wide adoption of MDMA-assisted therapy in the VA. “We do a really good job of networking and talking to each other about the good things, the solutions that we’ve been finding, and this is the one that veterans are coming back home and telling their brothers and sisters, ‘This is it. This has healed me.'”
While some veterans seek out psychedelics through illicit markets in the U.S., others have been traveling to countries where the therapies are legal or tolerated, then returning home to share their experiences.
Marcus Capone, a Navy SEAL veteran who with his wife co-founded VETS, a nonprofit that sponsors veterans to go abroad to receive psychedelic therapies, said that he was prescribed as many as 10 different medicines at a time over the course of seven years of mental health treatment before trying psychedelic-assisted therapy himself.
“What I was trying to achieve in seven years, I was able to achieve in almost a week,” he said.
Capone and others on the panel called for more federal investment into psychedelics research related to veterans. “There’s only so many people that me and Rachel know who have a lot of money that could continue donating to these efforts,” he said. “We need federal dollars released.”
Asked by moderator Mason Marks, a senior fellow at Harvard’s Petrie-Flom Center who leads its Project on Psychedelics Law and Regulation (POPLAR), why more wasn’t being done in Congress to promote research or broader access, Capone pointed to conservatives “using religion and conservatism and some other things, saying that, you know, these drugs are bad.”
At the same time, he noted that support for reform is bipartisan, especially among veterans and their families. “My wife is a strong conservative Christian from the Midwest, and she runs a psychedelic nonprofit,” he said, adding, “And by the way, she’s never had the need to do psychedelic therapy. Her mental health is fine, but she sees the healing power in this.”
After five years, the nonprofit has funded close to 1,000 veterans, Capone said, and currently receives up to 10 applications per day. The more that people learn about psychedelics’ healing potential, the more they go seek them out, he said, “and so I think, as a country, it’s our responsibility to do this correctly.”
Walensky, the former CDC director, said she was encouraged by the conversation. “While the mental health burden is increasing” among veterans, she said, “the treatment options and treatment access haven’t been keeping up the pace.”
“We know in the medical community that once a new, novel methodology or method is reported in the literature, it can take 17 years to reach the community,” she continued, “and we don’t have that kind of time.”
Lynnette Averill, a psychiatry and behavior sciences professor at Baylor College of Medicine and co-founder and chief science officer at Reason for Hope, which advocates for psychedelics reform, said broader study into psychedelics is difficult in the current legal environment.
“Doing any sort of clinical trial is always burdensome from a regulatory perspective, a paperwork perspective,” Averill said. “Doing research on psychedelic medicines right now is especially so, because they are Schedule I drugs, meaning there are various restrictions and additional bits of paperwork, approvals, bureaucracy that the scientist or investigators have to get through.”
But speakers said VA support for research and implementation could be a game-changer.
“They’re the largest healthcare system in our nation, they’re the foremost experts on PTSD and we think that they’re in the best position to be able to roll this out,” Mercer said. “We believe that the federal government needs to be involved and financially support these efforts to heal our veterans here at home.”
Marks, the event’s moderator, noted that states like Oregon and Colorado have already passed laws to remove barriers to psychedelics, for example by allowing therapeutic psilocybin. He asked whether veterans should travel abroad, visit a state with fewer restrictions or proceed some other way.
Mercer said she always recommends veterans work with a therapist in addition to a coach who can help navigate the process. “Without those conversations, we’re putting people in danger,” she said.
Not only do powerful psychedelics carry the risk of uncomfortable side effects, but research indicates that the therapy part of psychedelic-assisted therapy is an essential component.
“The idea that this is a full-course meal—if you just do a psychedelic journey—it’s probably a misleading message,” Yehuda said. “We just want to make sure that all avenues are open and that everybody’s really understanding of how to work with someone who might have gone to Peru [for treatment with psychedelics] last year but is still bringing up a lot of memories and wants to process them. And that’s something that will require, you know, a reeducation of clinicians across the country and the world.”
Capone summed up the dilemma facing VA officials, lawmakers and even advocates who support broader access to psychedelic-assisted therapy: “If we’re too cautious, we’re never going to get there, and people are going to die,” he said. “And if we’re too aggressive, people may get hurt.”
Speakers said they felt like lawmakers and federal agencies were finally paying attention to the potential of psychedelics to treat PTSD, traumatic brain injuries and suicidal ideation, especially in veterans. Mercer, for example, said her organization had met with over 300 legislative offices “and garnered overwhelming support from both sides.”
“When we walk into a legislator’s office and we tell them the efficacy rate of MDMA-assisted therapy based on the Phase 3 clinical trials,” she said, “and they hear that something has the potential to be 70 percent effective in eliminating a PTSD diagnosis, they start paying attention.”
Mercer was referring to recent results of trials that put MDMA on track for approval by the Food and Drug Administration (FDA) as soon as next year.
Yehuda described the current moment as one “of great optimism.” As for lawmakers, she said, “I think they’re listening. I think we have everybody’s attention.”
Congress was scheduled to hold its first-ever commitee hearing dedicated to veterans and mental health care earlier this month, but the event was postponed as Republicans in the House scrambled to select a speaker. Yehuda was among the VA officials scheduled to appear.
In written testimony filed before the House Veterans’ Affairs Subcommittee on Health hearing was postponed, Carolyn Clancy, VA’s assistant undersecretary for health for discovery, education and affiliate networks, said the agency’s top goal is veteran safety.
“Based on our assessment of the literature to date, there is still much to learn, and much yet to be understood, about the potential benefits of psychedelic compounds,” she wrote. “Our Department is not only focused on finding the best innovative treatments and cures, but doing so safely.”
A number of the subcommittee’s members—Republicans especially—have expressed interest in psychedelics reform before. Rep. Jack Bergman (R-MI), for example, is the co-founding member of the Congressional Psychedelics Advancing Therapies (PATH) Caucus, a bipartisan group relaunched this past March.
Another member, Rep. Morgan Luttrell (R-TX), has publicly shared how treatment with ibogaine and 5-MeO-DMT “changed my life” and was “one of the greatest things that ever happened to me.” Earlier this year, he and several other GOP lawmakers spoke in favor of a bill to create a $75 million federal grant program to support research into the therapeutic potential of psychedelics for certain health conditions among active duty military service members.
And the House subcommittee’s chair, Rep. Mariannette Miller-Meeks (R-IA), led a roundtable this summer to discuss emerging therapies for PTSD and substance abuse.
As Capone noted during the Harvard panel, Republicans in Congress have been some of psychedelics’ most stubborn critics as well as some of the most vocal champions of expanding access for veterans.
A similar point was made by former Texas Gov. Rick Perry (R) in a recent documentary from the publication Reason. Though he said the issue shouldn’t be about politics, Perry went on to assert that GOP lawmakers are more open to psychedelics reform than Democrats are—at least among those in Congress.
“At the federal level, this is more supported by the Republicans,” he said.
At the state level, however, blue states have taken the lead on psychedelics reform. Oregon in 2020 legalized psilocybin therapy in addition to decriminalizing possession of all drugs. The state approved the first legal psilocybin service center this past May.
And in Colorado, Gov. Jared Polis (D) signed a psychedelics regulation bill into law in May, setting rules for a psychedelics legalization law that voters passed last year.
In California, meanwhile, Gov. Gavin Newsom (D) recently vetoed a psychedelics legalization bill. In a veto message, however, he said he wants the legislature to send him a new bill next year establishing guidelines for regulated therapeutic access to psychedelics and also consider a “potential” framework for broader decriminalization in the future.
California officials cleared a campaign this summer to begin signature gathering for a 2024 ballot initiative to legalize the possession, sale and regulated therapeutic use of psilocybin. It’s one of three campaigns in the state that are seeking to enact psychedelics reform through the ballot process next year.
Another California campaign filed a proposed initiative for the state’s 2024 ballot this summer that would create a $5 billion state agency tasked with funding and promoting psychedelics research that it hopes will accelerate federal legalization of substances like psilocybin and ibogaine.
A third campaign filed a prospective initiative to legalize psychedelics broadly for therapeutic and spiritual use with a doctor’s recommendation.
Last month VA launched a new podcast about the future of veteran health care, with its first episode focused on the healing potential of psychedelics.
Some feel VA still isn’t doing enough to prioritize therapies that involve controlled substances, even as states have legalized medical marijuana and some move to legalize possession of some psychedelics.
Earlier this year, House lawmakers passed a spending bill with a number of veteran-focused marijuana and psychedelics amendments. One would allow VA doctors to issue medical cannabis recommendations to former servicemembers, and the other would encourage research into the therapeutic potential of psychedelics.
In August, three bipartisan co-chairs of the Congressional Cannabis Caucus wrote to VA Secretary Denis McDonough expressing “deep concern” over a recent VA marijuana directive that continues to prohibit its doctors from making medical cannabis recommendations to veterans living in states where it’s legal.
Rep. Earl Blumenauer (D-OR), one of the authors of that letter, recently sent a separate letter to McDonough and Department of Defense Secretary Lloyd Austin slamming their departments for perpetuating a “misguided denial of services” by recommending against the use of medical marijuana by veterans with post-traumatic stress disorder (PTSD).
VA and DOD “have a long history of claiming the best interest of our veterans and service-members only to deny the reality of medical marijuana as a key treatment option for those impacted by PTSD,” he wrote, referencing recently updated joint clinical practice guidelines that the departments released in July.
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Photo courtesy of Pretty Drugthings on Unsplash.
