The Canadian Senate Subcommittee on Veterans Affairs recently released a striking report entitled The Time is Now: Granting Equitable Access to Psychedelic Therapies.
To address high rates of suicide and post-traumatic stress disorder (PTSD) among veterans, the report calls on Veterans Affairs Canada (VAC) to immediately implement “a robust research program funded by VAC and the Department of National Defence (DND) in partnership with Health Canada, the Canadian Institutes of Health Research, and all other relevant partners.”
With psychedelic research, Veterans Affairs Canada has a real chance to live up to its mandate “to provide exemplary, client-centred services and benefits that respond to the needs of veterans, our other clients and their families.”
As a psychedelics researcher with an interest in veteran health, I couldn’t be happier, especially with the Senate focus on timeliness, equity and access.
Not only is my PhD on the therapeutic application of psilocybin, but my father was a veteran of the Canadian Forces, as is my brother and two uncles and both of my grandfathers. I grew up on Canadian Forces bases.
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Lt. Col. (ret’d) Jack Shore, my father, graduate of the Soldier Apprentice Program and a United Nations Peacekeeper in the Congo mission of the early 1960s, passed away as I was working as a guest co-editor of a special edition of the Journal of Military and Veteran Health Research. The theme of the edition is “Therapeutic use of psychedelics, entheogens, entactogens, cannabinoids and dissociative anesthetics for military members and veterans.”
While my Dad rarely talked about his time in the Congo, he experienced what we would now recognize as moral injury, and most likely PTSD. These conditions directly shaped our family life and upbringing. That was before Sudan, Rwanda, the Yugoslav wars and Afghanistan.
My childhood on bases occurred in time of relative peace, but Canada has now had a few generations of soldiers experience active combat.
The 629,000 veterans living in Canada have rates of depression, anxiety and substance use disorder that are higher than the civilian population. One in seven is living with PTSD. Veterans are two to three times more likely to experience homelessness compared to the general population.
Duty of care
To veterans of the Canadian Forces and to their families, we owe a duty of care, and not just to provide services and access to novel treatments. We also have a duty to care enough to do the science well and to tackle the public policy challenges (including regulatory drug reform) necessary to provide Canadian veterans with effective care.
“It is the Government of Canada’s duty to assure veterans that it is doing everything in its power, immediately, to respect its solemn commitment to support, at any cost, those who chose to defend us with honour.” — The Subcommittee on Veterans Affairs, Senate of Canada
The role of the VAC includes paying for the cost of health-care benefits and other services for veterans through the Public Service Health Care Plan and supplemental treatment benefits. While this single-payer provider model has advantages, it relies heavily on VAC staff and managers to assess and approve plans of care.
Developing a psychedelics research program for veterans should be seen as a public health priority. It will most likely require an independent panel of experts and stakeholders, including veterans, to help shape the agenda in a timely manner for the VAC.
The Canadian Institute for Military and Veteran Health Research (CIMVHR), founded in 2010, is well positioned as the Canadian hub for military, veteran and family health research to provide the infrastructure to foster collaboration, ensure stakeholder engagement and work on the knowledge translation so necessary to rapidly developing the capacity and expertise of Canadian researchers.
We can build on the work of the U.S. Department of Veterans Affairs, which is currently conducting several psilocybin trials, and the long-standing work of MAPS (Multi-disciplinary Association of Psychedelic Studies) in advancing MDMA-assisted therapy for PTSD towards regulatory approval. We can also listen to the experts, such as Canada Health Research Chair in Mental Health Disparities Monnica Williams, who are calling for greater equity and improved inclusion of BIPOC veterans and researchers.
“When we have tried everything in our toolbox but still cannot help our patients, it is truly time for some new tools.” —Monnica Williams, Canada Health Research Chair in Mental Health Disparities
Psychedelic ketamine appears to have positive but short-lived outcomes in the treatment of mood disorders, and ketamine clinics require evaluation given recent FDA warnings about risks of commercialized mental health telemedicine and take-home doses.
Ultimately, the Canadian public may want to reconsider the policy framework that still severely limits access to these promising compounds for researchers, clinicians and those in need.
Veterans have taken it upon themselves to support each other and to advocate for change. The Heroic Hearts Project helps veterans access psychedelic therapies and has long championed the potential benefits of plant medicine ceremony.
Heroic Hearts Canada, which aims to provide Canadian veterans with equitable access to safe, effective and affordable psychedelic therapies, has recently partnered with University of Calgary for some important observational research.
Faster progress to medical use
The time lag from drug discovery to patient care is often decades, prompting the expression “valley of death” to refer to the gap between bench science and bedside care.
Given the real mental health needs of Canadian veterans, and the known limits on effectiveness for current standards of care, we must aim for quicker progress towards medical use, as both the United States and Australia have done. However, this progress must not be at the expense of safety and quality, and definitely not simply for commercialization.
Thought needs to be given to the development, evaluation and quality assurance of accessible programs for veteran-centred care, with Veterans’ voices at the table. It is time for more emphasis on psychedelics-related implementation science, the study of methods to promote the uptake (and identify barriers) of research findings into routine clinical use in order to improve effectiveness of health services.
There is robust and mounting evidence to support regulatory approval for MDMA and psilocybin-assisted therapies. Their availability and uptake by clinicians and the public is only a matter of time.
The need for more diverse research
Research funds now are best allocated towards large Phase 3 trials that treat wider cross-sections of the veteran community, to begin to assess the safety and efficacy of interventions such as the naturally ocurring and culturally significant psychedelic compounds ibogaine and 5-MeO-DMT and ayahuasca, and to invest in knowledge translation, program evaluation and training researchers and clinicians.
Apart from new biomedical research, it is time we recognized the widespread personal use of psychedelics, including among veterans, and develop safer use guidelines for psychedelics like those in place for alcohol and cannabis.
While the Senate report does not mention cannabis, it is worth noting that veterans in Canada have been approved for treatment with cannabis-assisted therapy.
This includes the use of cannabis as a psychedelic and mimics the preparation-session-integration protocols of psychedelic therapies. This intervention is also worth rapid evaluation and possible expansion.
Given the pressing needs of Canadian veterans and the limitations of our current tools, the need for research on psychedelic therapies, as well as for timely and equitable access, is urgent.
Ron Shore worked for, and consulted to Dimensions Health Centres in 2021 and 2022; he continues to own shares in the company.