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Around 17% of recent military veterans in the UK report post-traumatic stress disorder (PTSD) symptoms. Professor Jo Neill, Dr Verity Wainwright, and Frances Smith from The University of Manchester discuss the findings of a new study into the medicinal potential of psilocybin (the active constituent of so-called ‘magic’ mushrooms) for veterans with PTSD symptoms, and how policymakers can enable more research in this area.
When returning to civilian life, some military veterans experience mental health issues, including trauma symptoms. While many veterans with PTSD benefit from currently available treatments, some report finding these options difficult to access, ineffective, or unacceptable. Alternative treatments are needed for those not benefitting from, or engaging with, current options.
There is emerging evidence for the efficacy of psychedelic medicines – in combination with clinical psychotherapy – for the treatment of many mental health conditions, including PTSD.
“There’s just no such thing for me as PTSD anymore”
Researchers from The University of Manchester interviewed seven veterans with current or previous trauma symptoms. Five had previously self-medicated with psilocybin, while two had considered doing so. All said they had struggled to access NHS treatments, or had found previous treatment attempts unsuccessful.
“I didn’t want to go onto antidepressants, because I’ve had a lot of friends who have been on antidepressants and all of the other pills they give you and all I’ve seen is them mess them up worse than when they started them.” – ‘Tom’
Several said they had turned to psilocybin in desperation. All who had used psilocybin said they experienced immediate and long-lasting positive effects.
“There’s just no such thing for me as PTSD anymore … if you use psychedelics, you can walk all over it, look at it at the floor around you and then just choose to scoop up all those piles of trauma and stuff, put it in a folder and it’s up to you, you can carry that around with you or not.” – ‘Nick’
Psilocybin’s mechanism of action is still being studied, but its effect is to increase neuroplasticity – the brain’s ability to reform and make new connections – which is associated with patients’ ability to break harmful thought patterns following psychedelic-assisted psychotherapy (PAP). This may explain why relapse rates following PAP are significantly lower than for other treatments.
This long-term efficacy is another reason why psychedelic treatments appeal to veterans. As ‘Chris’ explained;
“… not very many people who I am aware of in the military are very interested in taking antidepressants long-term, there’s a lot of shame associated with that… it’s appealing that psilocybin could be a treatment that would work with a with a singular, you know, it happens once and then you’re just, that’s it, you’re treated … that appeals to me and I think that that would appeal to service personnel and make them a lot more likely to seek help.”
Anecdotally, growing numbers of veterans are self-medicating with psychedelics, either by purchasing them illegally in the UK, or travelling to countries where psychedelics are decriminalised. Some charities now provide support for veterans seeking PAP, including psilocybin retreats in the Netherlands, as well as ayahuasca (an indigenous South American psychedelic substance).
Veterans are not the only group who may benefit from new treatments for trauma-related conditions – between 22% and 44% of NHS frontline care staff reported PTSD symptoms linked to their experiences during the COVID-19 pandemic.
Change begins in the Home (Office)
Despite growing evidence for the medicinal potential of psilocybin and other psychedelics, the UK maintains their Schedule 1 status – a category reserved for drugs with “no medical value”. While research can be conducted with Schedule 1 drugs, the associated financial and bureaucratic hurdles are a major barrier to smaller universities and pharmaceutical companies. Meanwhile, heroin, cocaine, and ketamine are Schedule 2 drugs, so are subject to fewer restrictions despite being more harmful.
Responding to a recent petition on rescheduling psilocybin, the Home Office stated that it will review psilocybin’s Schedule 1 status when a medicine is approved for market by the Medicines and Health Products Regulatory Agency (MHRA). However, it is the Schedule 1 status – and the associated barriers to scientific and medical research – that is slowing the development of psychedelic-derived medicines to be presented to the MHRA.
Internationally, there is growing evidence that psychedelics – taken in controlled settings alongside therapy – represent a paradigm shift in mental health treatment. The UK has the life sciences infrastructure and expertise to be a global leader, but is held back by unnecessary red tape.
To remove these barriers, the Home Office should grant an exemption to psilocybin’s Schedule 1 status for medical and scientific research. Universities already have an exemption for research involving Schedule 2 drugs, and have proved that they can responsibly handle illegal compounds.
In three years or thirty?
The UK has the potential and the need to be at the forefront of this. COVID-19 has escalated an already substantial mental health burden, with veterans only one of many groups affected. A scheduling exemption could increase the UK’s global research prestige and ensure new treatments are available on the NHS for those who need them.
With overseas institutions investing in psychedelic medicines, inevitably a treatment will make it to market and fulfil the requirements set by the Home Office on the MHRA. The question is whether this takes years or decades, and if the UK will fulfil its potential as a global pioneer of good mental health. The answer lies with policymakers.