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Ethical considerations for psychedelic-assisted therapy in military clinical settings
  1. Scott Hoener1,
  2. Aaron Wolfgang2,3,4,
  3. David Nissan1,4,
  4. Edmund Howe4
  1. 1Department of Psychiatry, Naval Medical Center San Diego, San Diego, CA, USA
  2. 2Department of Psychiatry, Brooke Army Medical Center, Fort Sam Houston, TX, USA
  3. 3Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
  4. 4Department of Psychiatry, Uniformed Services University, Bethesda, MD, USA
  1. Correspondence to Dr Scott Hoener, Department of Psychiatry, Naval Medical Center San Diego, San Diego, CA 92134, USA; shoener20{at}


Psychedelic treatments, particularly 3,4-methylenedioxymethamphetamine (MDMA)-assisted and psilocybin-assisted therapies, have recently seen renewed interest in their clinical potential to treat various mental health conditions. Clinical trials for both MDMA-assisted and psilocybin-assisted therapies have shown to be highly efficacious for post-traumatic stress disorder and major depression. Recent research trials for psychedelic-assisted therapies (PAT) have demonstrated that although they are resource-intensive, their effects are rapid-acting, durable and cost-effective. These results have generated enthusiasm among researchers seeking to investigate psychedelic therapies in active-duty service members of the US military, particularly those with treatment refractory mental health conditions. At the same time, psychedelics remain in early stages of clinical investigation, have not yet achieved regulatory approval for general clinical use and may confer unique psychological and neurobiological effects that could raise novel ethical considerations when treating active-duty service members. Should psychedelics achieve regulatory approval, military relevant considerations may include issues of access to these treatments, appropriate procedures for informed consent, confidentiality standards, and possible unanticipated mental health risks and other psychological sequelae. A service member’s deployability, as well as their ability to return to full military duty following PAT, may also be of unique concern. The authors argue that MDMA-assisted therapy currently represents a promising treatment that should be more rapidly investigated as a clinical therapy for service members while still taking a measured approach that accounts for the many military-specific uncertainties that remain.

  • Ethics
  • Psychiatry
  • Military Personnel
  • Psychopharmacology

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  • Contributors SH drafted the original manuscript and is the primary guarantor for the completed article. AW, DN and EH reviewed and edited the manuscript. All authors read and approved the final manuscript prior to publication.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • 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.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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