The U.S. Department of Veterans Affairs (VA) launched a new podcast last week about the future of veteran health care, and the first episode of the series focuses on the healing potential of psychedelics.
Hosted by VA Under Secretary for Health Shereef Elnahal, episode one of the New Horizons in Health podcast featured discussion from two other VA doctors—Ilse Weichers, executive director of the Office of Mental Health and Suicide Prevention, and Joshua Woolley, whom the department describes as one of its “leading researchers on psilocybin-assisted therapies in San Francisco.” The three were joined by Jonathan Lubecky, a Marine and Army veteran who participated in an MDMA research trial nine years ago that treated his PTSD and suicidal ideation after returning home from a 2005 deployment to Iraq.
Overall, the conversation took an optimistic but cautious tone. “If and when this becomes available,” Elnahal at one point said of psychedelic-assisted therapy, “VA will be able to scale it, I think, better than any other health care system because of our focus particularly on veterans.”
The Biden-appointed under secretary began by acknowledging that September was Suicide Prevention Month, reminding viewers that veterans in crisis as well as their loved ones can call 988 and press 1 to be directed to the Veterans Crisis Line.
He then introduced Lubecky, who returned home in November 2006 and, within two months, made the first of multiple attempts to end his life.
“After my final suicide attempt, in November of 2013, one of the things before I was released from the hospital, VA said, ‘Hey, what can we do for you? What can we do different?’” Lubecky recalled. “I said I desperately needed weekly counseling every week without fail.”
For a while, he got it—and things were working well, he said. Then one week he couldn’t meet with a psychiatrist because they were dealing with another issue in the hospital. At the time Lubecky was “on about 42 pills a day for various things,” and when the psychiatrist couldn’t meet with him, he went to refill his prescriptions. While waiting, he sat down with an intern.
“It’s one of the best decisions I’ve ever made,” the veteran said, “because that intern for the Medical University of South Carolina was aware of the [psychedelics] research being conducted in Charleston and slid this piece of paper across the desk and said, ‘Don’t open this until after you leave the VA. I don’t know if I’m supposed to tell you about this.’”
“I open it up and it said: ‘Google MDMA PTSD.’”
“I took my first dose of MDMA on November 22, 2014, exactly eight years after I came back from Iraq,” Lubecky said. “It’s been nine years now, and I’ve honestly been PTSD-free longer than I had it.”
Woolley, the VA researcher in San Francisco, said there have been “pivotal” trials into MDMA- and psilocybin-assisted psychotherapy, “and those have had shown very promising results for PTSD and depression.” As in Lubecky’s case, he said, “PTSD symptoms can go away for months or even years after one or a few treatments. And so there’s a lot of excitement about this.”
Weichers, executive director of the VA Office of Mental Health and Suicide Prevention, emphasized the importance of the therapy part of psychedelic-assisted therapy.
“The psychotherapy piece is the essential piece of this,” she said. “I mean, the psychotherapy piece is kind of the cornerstone, so it really needs to be a combination of the medication and the psychotherapy together to ensure great success.”
Much of the conversation between the four participants focused on striking a balance between the therapeutic promise of psychedelics and the potential dangers of hasty self-medication.
“You really need to be under the care of a licensed professional to get the full scope of therapy benefits that we’re seeing in the research that Dr. Woolley mentioned,” Elnahal noted.
At the under secretary’s request, Lubecky detailed the treatment procedure: 12 sessions, ranging from 90-minute talk therapy sessions without MDMA to 8-hour sessions under the influence of the substance. All told, the regimen involved three separate sessions with MDMA.
“I’ll be clear, I’ve taken MDMA three times in my life—nine years ago as part of the trial,” he said. “I haven’t taken it since and I haven’t felt the need to.”
He likened the experience to his recent back surgery. In that case, anesthesia knocked him out “so the surgeon could actually go in and do the work.”
With psychedelic-assisted therapy, he continued, “MDMA is a tool that opens up the mind, body and spirit to the place it can be so that you can heal and process all of those memories and all the things, trauma, that are causing you issues. Without it, people with PTSD, they have issues with trust, they have issues—they don’t want to talk about it. They also either shut down emotionally and can’t process or they become hyperemotional and can’t process. So the MDMA puts you in this this middle ground, where you stay in a place where you can talk about trauma without having panic attacks, without your body betraying you, and look at it from a different perspective.”
Lubecky had previously tried cognitive behavioral therapy, exposure therapy and “a lot of talk therapy,” he said, but the 50-minute sessions seemed more about managing symptoms—”What happened this week? What can we do to make sure he’s here next week?”—and less about rooting out trauma.
“Before I felt comfortable enough to open up and talk about anything traumatic,” he remembered, “I’d hear these magic words: ‘Well, that’s all the time we have for this week. We’ll take it up there next week.’ And then it never gets taken up that next week.”
He said he knows the therapy doesn’t work for everybody. In the study he participated in, “88 percent of people had reduction in symptoms. Sixty-seven percent no longer had PTSD,” he noted. “But that number does mean 12 percent had no effect and—rough math—33 percent still had some form of PTSD.” Still, he says there’s a need for VA to undertake more research.
“Me going through that therapy and trial nine years ago is the sole reason that my son has a father instead of a folded flag,” he concluded. “If you’re not willing to at least allow people to research this and come up with an answer, than you’re sentencing more sons and more daughters and more spouses to being handed a folded flag.”
Both Weichers and Woolley noted that participants in clinical trials are typically screened fairly strictly for comorbidities, including, for example, cardiac functioning and blood pressure. Substances are of known purity and strength, and monitoring is considerable.
“Both psilocybin and MDMA can increase blood pressure and have other effects,” Woolley said, “and so a lot of effort goes into making sure it’s safe for this particular person to take the drug at the doses that the intervention requires.”
Treatments still need further study involving a wider range of participants and different trial designs that, for example, compare psychotherapy alone to psychedelic-assisted treatment, he said. “There’s just lots of different questions that we have that still need to be answered. We’re still at the early days.”
Weichers added that in clinical studies, “we can guarantee a high-quality, pharmaceutical-grade medication is being delivered. And you can’t when you’re using recreationally or finding something on the street. You just don’t know what you’re taking and what’s in that pill. And so that’s a risk that I hope will cause people some pause.”
She also referenced recent Phase 3 clinical trial results of a study into MDMA-assisted therapy for PTSD, which could set the drug up for consideration by the Food and Drug Administration next year, which could also lead to rescheduling of the substance. “It’s usually weeks to months for that workgroup process to take shape and play out,” she said, “but, you know, we’re anticipating things like that could be happening very soon, based on some of the study information that’s coming out.”
In an interview with Marijuana Moment after participating in the podcast, Lubecky said he understands the methodical approach being taken by VA officials and he’s grateful the exposure that the episode is giving to his cause.
“It’s huge that they did the podcast, specifically having the under secretary,” he said. “This wasn’t, like, low-level people just discussing, ‘Hey, this is some cool science that’s out there. This was talking about doing trials in the VA and things like that.”
As for changes he’d like to see, Lubecky said that one of the biggest obstacles to psychedelic-assisted therapy is an insufficient number of appropriately trained therapists, noting the problem could be addressed either through hiring, training or expanding the pool of who could seek qualification to people like chaplains. “I personally understand the position that it’s very difficult for them to do things when they don’t have approval to do things,” he added.
For its part, the department says it wants to be a leader in psychedelic therapies if the evidence supports it. “VA is excited about the potential of these treatments and getting the scientific questions answered,” the department said in announcing the podcast episode. “If the science supports it, we want to bring the best and most innovative therapies to Veterans across America.”
Under Secretary Elnahal, who hosted the program, was confirmed by the Senate in 2022. Previously, as the New Jersey health commissioner from 2018 to 2019, he worked to improve that state’s medical marijuana program and made clear that he personally believed that federal prohibition should come to an end.
During a confirmation hearing before the Senate Veterans’ Affairs Committee in April, Sen. Dan Sullivan (R-AK) brought up Elnahal’s cannabis regulatory background and expressed frustration over VA’s consistent opposition to legislation, including his own, that would promote clinical research into the therapeutic potential of marijuana for conditions that commonly afflict the veteran population.
The since-confirmed official spoke about how, when he was serving as New Jersey’s health commissioner, he ran the medical marijuana program and “expanded access to the program across the state, and made it easier for veterans to enroll, as well.”
But some feel that 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. Michigan’s legislature, for example, recently urged federal lawmakers to prioritize psychedelics and other “non-technology treatment options” to treat psychological trauma from military service.
As individual states continue to push ahead with psychedelics reform the federal government has made comparatively slow progress in evaluating and approving the substances for therapeutic use.
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, however, 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. (Full Story)