By Scott Hoener.
Mysterious government experiments, be it the paranormal realm of the “Upside Down” in small town U.S.A., the thrilling sagas of Jason Bourne, or the bizarre cinematic depiction of U.S. government officials attempting to harness psychic abilities, have long been the subject of popular American media and culture. While viewers might find fascination in the “conspiracy” elements of such film and TV endeavors, an even more bizarre and disturbing fact is that the CIA really did conduct such experiments in the latter part of the 20th century.
In the aftermath of World War II, U.S. intelligence officers recruited Nazi scientists to America in what is now known as “Operation Paperclip.” Some of these scientists conducted experiments with mescaline to study their effects on prisoners in concentration camps. CIA officials believed this information could aid in the development of a tool to enhance interrogations or even develop a potential “truth serum,” largely to keep up with perceived Soviet advances in counter intelligence. The CIA conducted experiments beginning in the 1950’s through the 1970’s, in what is now infamously known as MKULTRA. Throughout the project’s existence, substances such as LSD were administered to human subjects, often without their knowledge or expressed informed consent, in order to observe acute and longterm effects. A number of U.S. service members even “participated” in these experiments, often under coercive influences and in situations where they were not afforded the ability to freely withdraw.
In the present day, psychedelic substances are not being unethically researched as agents of war. Rather, psychedelics such as 3,4-methylenedioxymethamphetamine (MDMA) and Psilocybin are being studied for their potential to provide a balm for the psychological scars of war. Results from phase 3 studies for MDMA-assisted therapy have been highly promising, and it is anticipated that MDMA may achieve FDA approval as soon as 2024.
Many currently Active Duty U.S. service members have failed existing treatments aimed at healing post traumatic stress disorder, depression, or substance use issues acquired during their military service. Psychedelic-assisted therapies represent a promising avenue through which these unmet needs could be met. The upcoming National Defense Authorization Act may include substantial funding for psychedelic research in Active Duty military populations, in addition to funding psychedelic therapy training for military mental health clinicians. The potentials for such federally funded research endeavors are significant, as the military could serve as a federally funded leader in clinical research exploring the safety, mechanism, and efficacy of psychedelic therapies in service member populations. Moreover, such investigations may not only aid the development of these treatments for military populations but also advance the field for the civilian population as well.
Despite the promise of these emerging treatments, there are a number of concerns about the potential for history to repeat itself if acute mind altering agents are administered to service members. Numerous patient protections now exist which did not at the time of MKULTRA experiments, including the Common Rule, which helps to ensure research participants are protected from coercive influences in military research. Still, other concerns regarding other unintended psychological sequelae, such as expanded suggestibility or personality shifts, warrant further discussion and investigation. Our paper aims to highlight these issues.
Mark Twain is often quoted as saying “History may not repeat itself. But it rhymes.” The existence of policies and legal protections does not always ensure moral integrity is upheld. Those seeking to investigate psychedelic medicines in military populations must not only be acutely aware of past unethical experiments, but also vigilant with regards to how a lack of rigor or attention to safety might set the field of psychedelics back in the future. Psychedelics might really be better conceptualized as tools, similar to the surgeon’s scalpel. Whether their outcomes are harmful, or beneficial, will truly depend on the manner in which they are used. For those of us in military medicine, recalling past mistakes can ensure our medical community aims to develop safeguards for the use of these tools in the future so that we might first, do no harm.
Paper Title: Ethical considerations for psychedelic assisted therapy in military clinical settings
Authors: Scott Hoener1, Aaron Wolfgang2,3,4, David Nissan1,4, Edmund Howe4
Affiliations:
- Department of Psychiatry, Naval Medical Center San Diego, San Diego, CA, USA
- Department of Psychiatry, Brooke Army Medical Center, Fort Sam Houston, TX, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychiatry, Uniformed Services University, Bethesda, MD, USA
Disclaimer: The views expressed herein are those of the authors and do not reflect the official policy or position of San Diego Naval Medical Center, Brooke Army Medical Center, the Uniformed Services University, the Defense Health Agency, U.S. Army Medical Department, the Department of the Army, the Department of the Navy, the Department of Defense, or the U.S. Government.
Competing Interests: None declared