Around 17% of recent military veterans in the UK report symptoms of post-traumatic stress disorder (PTSD) and currently available treatments don’t work for many of these. Here, Professor Jo Neill, Dr Verity Wainwright, and Frances Smith report the findings of a new study into the role that psilocybin (the active constituent of so-called ‘magic’ mushrooms) can have in the treatment of PTSD symptoms in veterans, and how the law can be updated to enable more research in this area.

• Psychedelic-assisted psychotherapy for PTSD shows potential as an effective, long-term treatment.
• Crucially, it offers an acceptable alternative to current treatment options for military veterans.
• But bureaucratic barriers are slowing research into this area in the UK.

When transitioning back into civilian life, some military veterans experience issues with their mental health, including symptoms of trauma. While many former service personnel with PTSD benefit from the treatment options currently available to them, a number report finding these options difficult to access, not effective, or not acceptable to them. Alternative forms of treatment 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 a range of mental health conditions, including PTSD.

“There’s just no such thing for me as PTSD anymore”

Researchers from The University of Manchester interviewed seven ex-armed forces personnel with either current or previous symptoms of trauma. Five of them had previously used psilocybin to self-medicate, while two had considered doing so. All of them said they had struggled to access treatment on the NHS, or had found previous attempts at treatment 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. Of those who had used psilocybin, all of them said they had experienced both immediate and long-lasting positive effects on their mental health and trauma symptoms.

“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’

The mechanism by which psilocybin acts on the brain is still being studied, but the effect is to increase neuroplasticity – the brain’s ability to reform and make new connections. This increased neuroplasticity is associated with patients’ ability to break out of harmful thought patterns following psychedelic-assisted psychotherapy (PAP), and may also explain why relapse rates following PAP are significantly lower than for other treatments.

This long-term efficacy is another reason for the attractiveness of psychedelic treatments for veterans. As ‘Chris’ put it;

“… 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, a growing number of veterans are now turning to psychedelics to self-medicate, either by purchasing them illegally in the UK, or travelling to countries where psychedelics have been decriminalised, such as the Netherlands. Some charities have begun providing support for veterans and emergency workers seeking to access psychedelic-assisted psychotherapy, 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 frontline care staff in the NHS reported symptoms consistent with PTSD as a result of their experiences during the COVID-19 pandemic.

Change begins in the Home (Office)

Despite growing evidence for the medicinal potential of psilocybin and other psychedelic substances, the UK has maintained their status as a Schedule 1 controlled substance. This category is reserved for drugs with “no medical value” – something psilocybin clearly has. While it is possible to conduct research with Schedule 1 drugs, the financial and bureaucratic hurdles to be overcome are a major barrier to smaller Universities and pharmaceutical companies. Meanwhile, heroin, cocaine, and ketamine are all under Schedule 2, and are therefore subject to less restrictions despite being consistently demonstrated as more harmful substances.

In response to a recent petition on rescheduling of psilocybin, the Home Office stated that it will review the Schedule 1 status of psilocybin as and 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 barriers this creates 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 the way mental health conditions are treated. The UK has the life sciences infrastructure and expertise to be a global leader in this new environment, but is held back by unnecessary red tape that is not supported by the scientific evidence.

To remove these barriers, the Home Office should grant an exemption to psilocybin’s Schedule 1 status for the purpose of medical and scientific research. Universities already have an exemption for research involving Schedule 2 drugs, and have proved that they can handle illegal compounds safely and sensibly.

In three years or thirty?

The UK has both 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 by trauma, anxiety, and depression. Not only could a scheduling exemption increase the UK’s global research prestige, but it could also ensure new treatments are available on the NHS so those who need them can access them.

With companies and institutions around the world investing in psychedelic medicines, it is inevitable that a treatment will eventually 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 the policymakers.