Should ecstasy, mushrooms be legalized to treat PTSD?

Substances including LSD, psilocybin from so-called magic mushrooms and DMT, which is found in several plants, have been outlawed globally since being proscribed in a 1971 UN convention. But calls to permit their use in psychotherapy have been growing in Ukraine following Russia's full-scale invasion.

Cases of severe mental disorders have been soaring in Ukraine. And psychotherapists are increasingly turning to these banned substances, especially to help treat soldiers who have post-traumatic stress disorder (PTSD), as several people who spoke to DW have confirmed.

Legalization effort in Ukraine

Experts in Ukraine are appealing to parliament to facilitate the therapeutic use of these substances. Ksenia Voznitsyna, director of the Ukrainian Health Ministry's Center for Veterans' Mental Health and Rehabilitation, is a leading voice in the campaign. "We are driving these changes forward," she told DW.

Parliament should "set concrete steps for what we need to do to make psychedelic-assisted therapy available in Ukraine. Like cannabis, psychedelics are on the list of banned drugs. They are not included in treatment guidelines, for example, for PTSD. We want to change that," Voznitsyna said.

Voznitsyna is convinced her approach is the right one, especially in wartime Ukraine. "A traditional therapy session lasts one hour or two at most. A psychologically traumatized person needs many such sessions. The therapy often lasts one or two years," Voznitsyna said.

Psychedelic-assisted therapy can help speed the healing process, she said. "This is important because, due to the war, we have complex cases that do not respond to conventional treatment," Voznitsyna said.

Therapy under the influence

She cautions, however, that "the therapy heals, not the psychedelics." The conversational psychotherapy takes place while the patient is under the influence of a drug such as psilocybin from psychotropic mushrooms, MDMA or "Ecstasy," ketamine, among others. This kind of therapy must take place in clinical environments, Voznitsyna says, adding that it lasts up to eight hours and requires monitoring and supervision by professional psychotherapists.

Amid a war, Ukraine mirrors a trend that has occupied backers and critics of drug-assisted psychotherapy for years — and supporters have come up against the formidable resistance of the traditionalists.

But it's chiefly in the US that the lobby for drug-assisted psychotherapy has been growing. Advocates there have a powerful ally: the organizations for war veterans of the US military. The US government's Veterans Affairs Department likewise backs the use of MDMA in PTSD therapy. Experts anticipate that such treatment could be authorized as early as 2024.

US: MDMA authorization as early as 2024

It would be a decision with possibly far-reaching consequences for other currently illegal substances. Why should one drug be legalized while another remains banned? Medical researchers are, in fact, presently conducting a multitude of studies on the uses of these currently illicit substances.

Efforts to legalize MDMA in psychotherapy got a boost by the publication of a so-called phase-three study in the prestigious scientific journal Nature. Successful phase-three studies are often the last major hurdle in the authorization of medicines. The study on the "efficacy and safety" of MDMA concluded that the substance "reduced PTSD symptoms and functional impairment in a diverse population with moderate to severe PTSD and was generally well tolerated."

Research on the topic is also ongoing in Europe. Currently, the European Medicines Agency (EMA) is conducting four studies on the use of MDMA and one on LSD. Additionally, there are "11 ongoing clinical trials in the EU with psilocybin," wrote EMA Executive Director Emer Cooke in response to an inter-group request by deputies of the European Parliament. "I would like to let you know that EMA recognizes the need to support the developers of psychedelics and therefore engages with them to this end," Cooke writes.

Psilocybin trial in Germany nearing completion

In Germany, a trial of therapy using psilocybin from 'magic mushrooms' is nearing its completion next spring. "We are testing the efficacy and safety of psilocybin in therapy-resistant depression," research director Gerhard Gründer told DW. Gründer, a psychiatrist and psychotherapist, is a professor of medicine in Mannheim.

"What we can say briefly at this stage is that we've seen successful results in a limited number of patients," Gründer said. Many could still not be helped, but that had to do with the fact that many trial participants had long been suffering from acute depression, he added. "The trial's takeaway for us is that we should start treating earlier stages of the disorder," he said.

Although the use of MDMA in trauma therapy for war veterans shows demonstrable successes, Gründer regards other substances more skeptically. MDMA, he points out, is not classified as a psychedelic.

Substances including psilocybin "are not used in most clinical trials with post-traumatic stress disorders, the risk of retraumatization is too high," Gründer says. He also criticizes therapy amid war. "I think it is highly doubtful, ethically speaking, that doing this could be safe in a war zone," he told DW.

Ukrainian expert Ksenia Voznitsyna of the Health Ministry's Center for Veterans' Mental Health and Rehabilitation sees it differently. She wants to press forward with research in her country, even during wartime. However, she cautions traumatized soldiers against seeking out psychologists who offer illegal psychedelic-assisted therapies. What's important, she says, is that Ukraine's parliament promptly legalizes it so that access to controlled use of MDMA and psychedelics in Ukraine is made.

This article was originally written in German.

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