MSG Jessica D. Lam, US Army
General James McConville, United States (U.S.) Army Chief of Staff, said, “People are the United States Army’s greatest strength and most important weapon system” (McConville, 2021, p. 18). Collaborating with the Secretary of the Army, General McConville published the Army People Strategy in October 2019, a strategy founded on the philosophy that investing in people equates to investing in Army readiness(McConville, 2021). Despite these efforts, the Army fell over 15,000 Soldiers short of its recruiting goal in 2022 (U.S. Army Public Affairs, n.d.). Current recruiting constraints amplify the importance of maintaining readiness among the existing force.
Soldier non-deployability falls within three categories: administrative, legal, and medical. Medical nondeployable conditions account for approximately 80% of Soldiers’ non-deployability (Devine et al., 2020). Behavioral health conditions are the second leading cause of medical non-deployability (Hepner et al., 2021). Psychedelic-assisted therapies, like those using psilocybin, have proven effective in both managing and inducing prolonged remission in individuals with specific behavioral health issues (Marseille et al., 2022). The Army’s failure to leverage the medical benefits of psilocybin perpetuates the Soldier readiness issues caused by behavioral health-related non-deployability.
More than two hundred mushroom species, commonly referred to as “magic mushrooms,” produce psilocybin (Barron, 2023). The historical use of psilocybin for medicinal and ritualistic purposes dates back thousands of years (Carod-Artal, 2015). Scientists recognized the potential benefits of psilocybin, for patients suffering from depression and other behavioral health conditions, in the first half of the twentieth century (Johnson et al., 2018). In 1960 a Swiss pharmaceutical company marketed psilocybin under the trade name Indocybin® to many countries, including the U.S. (Johnson et al., 2018).
Around the same time, the hippie subculture took hold, promoting psychedelic drug use as enlightening (Britannica, n.d.). The stigma of psychedelic drugs developed “causing the political leadership on both sides of the aisle to collectively take action, which resulted in the near banning of clinical research with these substances” (Belouin & Henningfield, 2018, para. 11). Congress passed the Controlled Substances Act in 1970, labeling psilocybin a Schedule I substance since the Food and Drug Administration (FDA) never approved it for therapeutic use (Belouin & Henningfield, 2018).
Chemical structure of psilocybin. Source.
The Controlled Substances Act separates drugs into five schedules; Schedule I, the most serious, contains drugs with “no currently accepted medical use and a high potential for abuse” (DeFeudis, 2022, para. 3). Laws do not prohibit research on Schedule I substances; however, the plethora of obstacles scientists must overcome to conduct such research discourages most (Belouin & Henningfield, 2018). In November 2022, senators Cory Booker, of New Jersey, and Rand Paul, of New York, introduced the Breakthrough Therapies Act. If passed, this act sets the stage for the FDA to reclassify psilocybin from a Schedule I to Schedule II drug removing “burdensome federal regulations that impede research and development” (DeFeudis, 2022, para. 4).
Despite significant red tape, research efforts began resurging in the 1990s (Barron, 2023). COMPASS Pathways, a mental health care company headquartered in the United Kingdom, has been conducting research trials on psilocybin with the aim of seeking FDA approval for the therapy by 2025 (Barron, 2023). Meanwhile, Oregon and Colorado have legalized therapeutic psilocybin use and are working through the specifics of the new laws (Kuta, 2023). Ever-growing evidence of psilocybin’s success in managing numerous behavioral health conditions drives scientists’ continued pursuit of psilocybin research (Barron, 2023).
How Psilocybin Works
Psilocybe mushrooms produce psilocybin (Department of Justice [DOJ], n.d.). Psilocybin is a compound within psilocybe mushrooms that metabolize within the body creating psilocin, an active form of psilocybin (DOJ, n.d.). Psilocin is “structurally similar to the neurotransmitter serotonin 5-HT” (European Monitoring Centre for Drugs and Drug Addiction, n.d., para. 2), allowing it to bind to 5-HT2a receptors. Doctor David Nichols, who has been studying psychedelics since the 1960s explains that “by activating these receptors, psilocin alters brain metabolic activity and neuronal connectivity in ways that influence cognitive function and perception” (Barron, 2023, para. 5). Mounting evidence supports the theory that psychedelics, like psilocybin, can increase brain neuroplasticity (Synthesis, 2019).
“Neuroplasticity is the ability of neurons (brain cells) to change their characteristics during your life” (Synthesis, 2019, para. 5). Neuroplasticity is the result of inputs from thoughts, emotions, experiences, and behaviors (Synthesis, 2019). Neurons connect to and communicate with other neurons; the strength and pathways of these connections vary from person to person. “For example, in people suffering from depression or stress-related conditions, often they will have fewer connections, or fewer overall neurons, in specific parts of the brain” (Synthesis, 2019, para. 6).
Evidence suggests psychedelics change neural connections, enhancing mental flexibility (Synthesis, 2019). Carhart-Harris et al. (2017) explain that psilocybin can “reset” (para. 17) the brain’s control structures into a healthier configuration. These control structures, often overactive in individuals with depression and anxiety, are associated with “awareness of ourselves and our place in the world, social thinking and cognitive empathy, and thinking about the past and planning the future” (Synthesis, 2019, para. 26). Psilocybin’s ability to affect physiology, reasoning, and mood are why scientists are leveraging it as a treatment for behavioral health conditions (de Vos et al., 2021).
Psilocybin as Treatment
Clinical evidence illustrates significant potential for psilocybin’s use, in conjunction with psychotherapy, for treatment of depression, post-traumatic stress disorder, and addictions (Marseille et al., 2022). Currently, most clinical studies on psilocybin have focused on its use as treatment for depression (Barron, 2023). Marseille et al. (2022) state, “psychotherapeutic approaches [alone] fail to help a substantial portion of depressed patients” (para. 3). However, a recent study showed significantly lower depressive symptoms in patients three weeks following one 25 mg dose of psilocybin, compared to patients in the control group (Barron, 2023). Psilocybin’s speed, effectiveness, and longevity are some of its most appealing qualities.
Psilocybin’s effects are evident within days of initial treatment, though full effects may take longer to present (Barron, 2023). A single dose of psilocybin, when paired with psychotherapy, results in demonstrated reduction or remission of symptoms for a year or longer (Belouin & Henningfield, 2018). Common side effects of psilocybin use include “headache, nausea, fatigue, and dizziness” (Barron, 2023, para. 15). Conversely, standard antidepressants typically take six weeks or more to become fully effective, and individuals must take them daily (Barron, 2023). The Mayo Clinic (n.d.) lists common side effects of antidepressants as: nausea, weight gain, fatigue, insomnia, dry mouth, constipation, dizziness, anxiety, agitation, and sexual side effects. Both psilocybin and standard antidepressants hold a small risk of patient self-harm ideology or behaviors (Barron, 2023).
An additional consideration when comparing psilocybin to standard antidepressants is the fact that psilocybin does not produce physical dependence or withdrawal symptoms the way antidepressants do (Johnson et al., 2018). A 2021 study comparing the effectiveness of patients treated with psilocybin versus escitalopram, a common antidepressant selective serotonin-reuptake inhibitor, found similar results (Marseille et al., 2022). As a fast-working, long-lasting, effective treatment, psilocybin is an untapped resource the Army can leverage to treat Soldier’s behavioral health conditions.
The Army’s Personnel Readiness Problem
“In 2020, 15% of Soldiers had a diagnosis of one or more behavioral health disorders” (Department of Defense [DOD], 2021, p. 40). Additionally in 2020, “9,780 Soldiers were put on temporary profiles longer than seven days for issues related to behavioral health” (DOD, 2021, p. 42). The average length of these profiles was fifty-one limited duty days (DOD, 2021). Common across all branches of the U.S. military, the Army holds the highest percentage of behavioral health diagnoses within their ranks (Hepner et al., 2021). Second only to musculoskeletal problems, behavioral health conditions are a leading cause of non-deployability in the Army (Hepner et al., 2021). Soldiers who are unable to deploy negatively impact readiness, and readiness is the Army’s number one priority (Devine et al., 2020).
Decreasing non-deployability requires understanding and mitigating the underlying cause(s) of conditions contributing the most to non-deployability (Devine et al., 2020). At the heart of the Army’s personnel readiness issue is behavioral health. Current treatment methods are not treating Soldiers’ behavioral health conditions in ways that enable them to remain consistently deployable.
Psilocybin as a Solution
The U.S. Army Medical Research and Development Command’s (USAMRDC’s) military operational medicine research program leads psychological health and resilience research, while their medical program management/product development and systems management oversees psychological health solutions (USAMRDC, n.d.). Prior to acceptance, USAMRDC must conduct research on psilocybin to build upon preestablished data regarding dosage impacts and effectiveness, short and long-term effects of usage on the individual, and short and long-term impacts on medical readiness. Congress provides medical research funds to the DOD through the congressionally directed medical research funds programs that could be directed toward psilocybin research (Mendez, 2022). Data derived from research and analysis drives policy changes including the education required for providers to administer psilocybin.
Training and Education Requirements
Providers must receive training and licensure to prescribe and administer psilocybin. As the first state to legalize psilocybin, Oregon is leading the U.S. in laws surrounding psilocybin and licensure requirements. Licensure course length varies by organization. InnerTrek, an organization licensed by Oregon’s Higher Education Coordinating Commission and the Oregon Health Authority, licenses individuals as psilocybin service facilitators in the state of Oregon following a six-month course and licensure exam (Foden-Vencil, 2023). The University of California, Berkeley’s psilocybin certification courses are nine months long, while other organizations’ courses last up to twelve months (UC Berkeley Center for the Science of Psychedelics, n.d.). Lee (2023) states:
In March 2022, Johns Hopkins, Yale, and NYU announced they were collaborating to create a psychedelics curriculum for psychiatrists. The goal is to have the curriculum certified by the Accreditation Council for Graduate Medical Education, which would create a pathway to make the program available to medical schools as an accredited specialty all across the country. (para. 32)
MEDCoE must determine the training and education Army providers require prior to licensure. Meanwhile, the DOD pharmacy and therapeutics committee must oversee psilocybin procurement efforts.
The DOD’s pharmacy and therapeutics committee’s “mission is to uniformly, consistently, and equitably provide appropriate drug therapy to meet the clinical needs of DOD beneficiaries in an effective, efficient, and fiscally responsible manner” (Military Health System, n.d., para. 1). As such, they must determine which pharmaceutical company’s psilocybin product is best suited to meet the needs of Soldiers with psilocybin-treatable behavioral health conditions. Currently, COMPASS Pathways’ trial of Comp360, their psilocybin patented drug, is leading the charge toward FDA approval; but many more companies are developing their own psilocybin prototypes to compete for market dominance (Halford, 2022).
Failure of Army leaders to approve psilocybin would result in Soldier behavioral health care treatments remaining the same. Statistics show that current behavioral health care treatment is not adequately improving Soldier medical readiness. Kim (n.d.) acknowledges the DOD’s encouragement for Soldiers to seek behavioral health care as needed. However, she also addresses the critical shortage of DOD behavioral health care providers available to treat Soldiers. This “shortage has led troops to rely on friends and family to get the help they need” and while friends and family may want to help they “are not trained counselors and aren’t always equipped to help service members to the level they need, which could lead to dangerous outcomes for military personnel who are struggling in the battle with mental health” (Kim, n.d., para. 8). Psilocybin’s long-term effectiveness can offer relief to providers by reducing required follow-up appointments specific to medication refills or adjustments. Without psilocybin, Soldiers will continue to experience significant wait times for care resulting in prolonged and potentially amplified behavioral health conditions.
The Army’s current failure to leverage the medical benefits of psilocybin perpetuates the Soldier readiness issues caused by behavioral health-related non-deployability. Despite its status as a Schedule I substance, psilocybin has shown tremendous potential as a long-term treatment solution for specific behavioral health conditions. As the second leading cause of medical non-deployability, the Army has not found a way to effectively manage Soldiers’ behavioral health. Psilocybin provides physicians another option to treat and manage Soldiers’ behavioral health conditions that will positively impact Army readiness.
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MSG Jessica Lam joined the U.S. Army in July 1999 as a Military Police Soldier. She has served across Europe, Asia, and the U.S. in duty positions that range from Army corrections, Drill Sergeant, antiterrorism officer, physical security officer, First Sergeant, and numerous staff positions. MSG Lam holds a Master’s degree in Emergency and Disaster Management and is currently a student at the U.S. Army Sergeants Major Academy.
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