The last known experiment at a Department of Veterans Affairs clinic with psychedelic therapy began in 1963, the year President John F. Kennedy was assassinated. “Surfing USA” top of the chartsand US troops had not yet been deployed to Vietnam.
At the time, the federal government was a hotbed of psychedelic research. The CIA investigated with LSD as a mind-control tool against opponents. The US military tested the drug’s potential to incapacitate enemies on the battlefield. And the VA used it in an experimental study to treat alcoholism.
But the thriving recreational use of drugs, including hallucinogens, sparked fierce political backlash and helped spark the war on drugs that, among other things, ended an era of research into psychedelics’ therapeutic potential.
Nearly six decades later, a handful of clinicians have brought psychedelic therapy back into the Veterans Affairs health care system. If their studies show promising results, they could take an important step in the quest to both legalize and legitimize psychedelics and make them widely available for clinical use.
I spoke to four of the government researchers who conducted studies on the use of MDMA, often referred to as ecstasy, and psilocybin, to treat mental illnesses that for many veterans have been resistant to current therapies. The researchers discussed their motivations, doubts and hopes for the future of medicinal psychedelics.
Digging through memories like an archaeologist
dr. Shannon Remick, 34, has the military in her blood – raised by an army mother, a navy father and a naval stepfather. That familiarity with the armed forces was part of what led her to become a psychiatrist at the VA, where she found that a significant number of war veterans with post-traumatic stress disorder were unresponsive to conventional treatments.
Last October, she probably became the first clinician since the 1960s to administer psychedelics as medicine to a patient in a VA clinic. The 10 patients in her study at the Veterans Affairs clinic in Loma Linda, California, are combat veterans with PTSD who have voluntarily undergone three sessions of MDMA in the hopes of exploring the underlying roots of their distress.
dr. Remick said it is crucial to build rapport and trust with patients during conventional therapy sessions prior to MDMA trips. Before taking the Pill, a patient creates a calming mood by doing a breathing exercise, reading a poem, or having a veteran hold a personally meaningful object. The MDMA sessions themselves, she said, are often self-directed, with the therapist listening more than talking.
The goal is to put patients in a state where they can examine and think about traumatic memories with less fear and disgust than they normally experience. She compared the process of understanding painful moments from the past to searching an archaeological dig, a delicate process of discovery and understanding.
“We are next to and with the patient as they explore some sort of dig site,” she said. “Ultimately, it’s not up to us to point and say, ‘Hey, look at that,’ because what I see may not be the same from their point of view.”
MDMA Therapy Made Her Postpone Her Retirement
When Dr. As Rachel Yehuda approached 60 a few years ago, he began to think about retirement. She was a prolific researcher and clinician for over three decades studying, among other things, how intergenerational trauma affects the children of Holocaust survivors.
“I was proud of our work, but it didn’t lead to practical solutions for treating trauma survivors,” said Dr. Yehuda, a professor of psychiatry and neuroscience at the Icahn School of Medicine at Mount Sinai and director of mental health at the VA. clinic in the Bronx.
But in recent years, Dr. Yehuda, now 62, became fascinated with the renaissance of psychedelic therapy and postponed his retirement. In early 2020, she began seeking permission to treat veterans with PTSD with MDMA.
Her study, which began in January and will include about 60 participants, will look at whether three sessions of MDMA are more effective than two in reducing PTSD symptoms.
dr. Yehuda said MDMA trips can be powerful catalysts for healing. She underwent one in 2019 as part of a therapist training program — an experience she called revealing.
“It really made me understand what you should do in psychotherapy,” she said. “I never quite understood what it means to have a breakthrough.”
But she cautioned that researchers still have a lot to learn about the types of patients who will benefit from this treatment, the role therapists should play, and the potential dangers.
“The process of opening up has to be done with the right therapists,” she said.
Exploring whether MDMA can restore strained marriages
During her 23 years treating veterans and studying the strengths and weaknesses of conventional PTSD therapy, Dr. Leslie Morland that standard treatments often failed to address the challenges veterans face at work and at home.
Her search for more holistic interventions led her to develop a study to investigate whether MDMA can make couples therapy more effective.
“Many of our military are learning to emotionally disconnect in order to be effective in combat,” said Dr. Morland, 52. “And then we bring them back and say, now we need you to open up with our talk therapy.”
People with PTSD often have trouble connecting with intimate partners. Veterans who see improvements in symptoms often experience setbacks when they return to a dysfunctional home environment, said Dr. morland. According to the VAveterans with PTSD have struggled with intimacy in the past and have more marital and parenting problems than veterans without the disorder.
While no one has formally studied the use of MDMA with veterans and their partners, clinical studies with civilians have shown that the drug can… changing the dynamics of a relationshipsaid Dr. morland.
“It creates more bonding and more empathy,” she said.
In a clinical trial she expects to launch by the end of the year, Dr. Morland plans to recruit eight veterans in San Diego who have had strained marriages and guide them through two sessions of MDMA that will be punctuated by talk therapy. The goal is to give couples the tools they need to understand the causes of disagreements and address them in a meaningful way.
“How do they work together to really support the improvements achieved in therapy?” she said.
Psilocybin as therapy for meth addiction
Between 2010 and 2019, Veterinary Overdose Death Rates increased by 53 percent, killing more than 42,000. The number of deaths from psychostimulants, including methamphetamine, was particularly high, rising by 669 percent.
Reliable treatment options are scarceas a result, the relapse rate has remained high.
These high mortality and relapse rates motivated Dr. Christopher Stauffer, 41, to treat veterans addicted to methamphetamine with psilocybin at a VA residential program in Portland, Oregon. The study will begin recruiting participants in the near future.
Psilocybin – the psychoactive ingredient in magic mushrooms – has shown promise as a experimental treatment for substance abuse.
dr. Stauffer said his research and clinical practice with citizens showed him that during a psilocybin session, patients often gain a new understanding of the impulses that drive their addiction. A patient from a previous study compared addiction to feeling trapped in a dense jungle.
“The psilocybin was like a machete,” said Dr. stauffer. “They were able to pave a way to connect with the people around them who were important relationships.”
dr. Stauffer is coming psilocybin study will compare the results of 30 veterans addicted to methamphetamine who were admitted to a residential rehabilitation program. Half will receive a combination of conventional therapy and two psilocybin sessions, while the other half will receive conventional therapy alone.
In a second studywill dr. Stauffer is testing whether MDMA can improve group therapy for veterans with PTSD by making participants more emotionally open and supportive of each other.
“Group dynamics can potentially be very healing in a way that one-on-one therapy cannot,” he said.
dr. Stauffer said this new era of psychedelic research feels both retro and groundbreaking.
“It’s brand new to a lot of people and yet it’s been around longer than most of our psychiatric drugs have been around,” he said. “But it feels like we’re approaching it this time with a lot more knowledge and much more rigorous research practices that didn’t really exist in the ’50s and ’60s.”