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Psychedelic-Assisted Therapy in Military and Veterans Healthcare Systems: Clinical, Legal, and Implementation Considerations

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Abstract

Purpose of Review

This review discusses the current and projected landscape of psychedelic-assisted therapy (PAT), with a focus on clinical, legal, and implementation considerations in Department of Defense (DoD) and Department of Veterans Affairs (VA) healthcare systems.

Recent Findings

3,4-Methylenedioxymethamphetamine (MDMA)- and psilocybin-assisted therapy have shown promising outcomes in efficacy, safety, tolerability, and durability for PTSD and depression, respectively. MDMA-assisted therapy is already approved by the Food and Drug Administration (FDA) on an Expanded Access (“compassionate use”) basis for PTSD, with full approval projected for 2024. Psilocybin-assisted therapy is projected to be FDA-approved for depression soon thereafter. Other psychedelics are in earlier stages of development. The VA is currently conducting PAT clinical trials.

Summary

Although there are clear legal pathways for the VA and DoD to conduct PAT trials, a number of implementation barriers exist, such as the very high number of clinical hours necessary to treat each patient, resource requirements to support treatment infrastructure, military-specific considerations, and the high level of evidence necessary for PAT to be recommended in clinical practice guidelines. Ongoing considerations are whether and how PAT will be made available to VA and DoD beneficiaries, feasibility and cost-effectiveness, and ethical safeguards that must be implemented to prioritize access to PAT given the likelihood of extremely limited initial availability. However, with imminent FDA approval of PATs and considerable national interest in these treatments, DoD and VA policymakers must be prepared with clearly delineated policies and plans for how these healthcare systems will approach PAT.

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Acknowledgements

The authors express their gratitude to Stephen Maleson for providing his legal expertise.

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Authors and Affiliations

  1. Walter Reed National Military Medical Center, 4494 Palmer Rd N, Bethesda, MD, 20814, USA

    Aaron S. Wolfgang

  2. Uniformed Services University, Bethesda, MD, USA

    Aaron S. Wolfgang

  3. Yale University School of Medicine, New Haven, CT, USA

    Aaron S. Wolfgang

  4. Walter Reed Army Institute of Research, Silver Spring, MD, USA

    Charles W. Hoge

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Correspondence to Aaron S. Wolfgang.

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Wolfgang, A.S., Hoge, C.W. Psychedelic-Assisted Therapy in Military and Veterans Healthcare Systems: Clinical, Legal, and Implementation Considerations. Curr Psychiatry Rep 25, 513–532 (2023). https://doi.org/10.1007/s11920-023-01446-4

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