As the war on drugs approaches its end, a new doctrine could soon take hold: psychedelic drugs for active-duty soldiers suffering from PTSD.

In two studies funded by the Department of Defense (DoD), 186 service personnel with PTSD will likely next year undergo multiple sessions of MDMA-assisted therapy.

The deputy under secretary of war for personnel and readiness, Sean O’Keefe, is following the research closely, a January letter shows, and a new group of DoD and Veterans Affairs (VA) department therapists are to begin training in psychedelic-assisted therapy next week ahead of soldier enrollment.

It is hoped guided sessions with the euphoria-inducing drug could, perhaps counterintuitively, help soldiers fight for their country for longer – and that once they leave the military they will not be crippled by traumatic stress.

“Helping people process trauma, whoever they are, is probably better than not,” said Rick Doblin, the founding president of advocacy group the Multidisciplinary Association for Psychedelic Studies (Maps), which has helped bring MDMA-assisted therapy to the brink of federal approval.

“There’s something noble about being willing to sacrifice yourself for other people. I don’t feel morally conflicted by working with active-duty soldiers.”

The funding for the new studies was signed off by former president Joe Biden as part of the National Defence Authorization Act in December 2023, which included provisions to mandate the research from Republican congressman Morgan Luttrell. “Our men and women in uniform deserve every tool available to heal and stay in the fight,” the veteran Navy Seal who has personally undergone psychedelic therapy said at the time. “This is just the beginning.”

On 18 April, Luttrell stood beside Donald Trump as he signed an executive order to accelerate research into psychedelics and to widen access, principally to veterans. “The suicide epidemic among veterans is a national tragedy,” Trump said in the Oval Office. “Since 9/11, we’ve lost over 21 times more veteran lives to suicide than on the battlefield.”

In the second world war, the US army treated soldiers with PTSD with barbiturate drugs which induced a deep sleep of up to 48 hours and allowed many to return to the battlefield days later – but it soon became clear it did not relieve trauma in any lasting way.

MDMA, and other psychedelics like psilocybin, appear far more effective in addressing mental health issues, but there is growing concern over their potential use to improve combat readiness.

Dennis McKenna, an ethnobotanist and author, warned of the potential human consequences of someone becoming traumatized during war, being restored to health through psychedelic therapy, and then returning to the frontline.

“It would be completely cynical and cruel of the government to throw them back into combat,” McKenna said. “It’s an abuse of psychedelics to use them to reconstruct people so that they can become more efficient killing machines.”

Doblin also acknowledged the potential dangers. “What we find is that people are somewhat more likely to relapse [into a PTSD response] after treatment if they go back into a stressful situation,” he said.

In Ukraine, Maps has trained 55 therapists to facilitate MDMA-assisted therapy sessions for soldiers amid concern over troop shortages and the scale of untreated PTSD within the country’s military. Doblin said that he supports “helping Ukrainians who choose to potentially sacrifice their life to fight the Russians”.

MDMA-assisted therapy is not yet permitted in Ukraine but hundreds of troops have already undergone legal therapy with the dissociative anaesthetic drug ketamine to address symptoms of PTSD and enable a return to the front in what is considered an existential war for Ukraine’s future.

In the US, the two randomized placebo-controlled MDMA studies for soldiers could begin recruiting volunteers later this year before dosing likely next year. Department of Defense grants of $4.9m each to the Walter Reed national military medical center and to Emory University, which is working with the University of Texas Health Science Center, were confirmed in February last year.

At Walter Reed, 91 military, guard and reserve personnel suffering from PTSD will receive three separate MDMA doses across 10 months, and will not be deployed over the course of the study. It was unclear how long they will be afforded once the research has been concluded before potentially returning to a posting. If the treatment shows promise, it could be adopted within the military as a standard therapy.

Access to psychedelic therapy for soldiers should begin long before they might become traumatized, said Doblin. “As part of boot camp, which is physical training, we should do emotional training,” he said, “and give them MDMA sessions to work through whatever issues they might have had to make them less likely, if they’re traumatized in the future, to develop PTSD.”

Soldiers might have transformative experiences that lead them to question their military service, said psychologist Rachel Yehuda, director of the Parsons Research Center for Psychedelic Healing at Icahn School of Medicine at Mount Sinai, which has trained 250 therapists in MDMA-assisted therapy in recent years, a large proportion of them from the VA and DoD.

“But it could go the other way and reaffirms one’s sense of mission,” she added. “In an active-duty setting, treating somebody when trauma is ongoing is different from treating somebody in its aftermath.”

The studies will be the first to officially investigate the effects of psychedelics on soldiers. From the late 1950s, the US army dosed soldiers at a classified military facility in Maryland with LSD to assess whether the psychedelic drug could incapacitate enemy troops. “In the military, if you don’t do something you will be ostracized,” a soldier given LSD in 1958 told the New Yorker. “I believe they did give us the option to leave, at first, but you didn’t really have a choice once you were in.”

In Israel, an MDMA-assisted group therapy study for victims of the 7 October Hamas attack could also begin dosing patients later this year. With 168 participants, it will be the largest clinical trial involving psychedelics to date in the country, and will include Israeli military veterans and potentially serving soldiers.

“We would like it to be a model to work with collective trauma that we can duplicate, not only in Israel, for Israelis, but around the world,” psychologist Keren Tzarfaty, the co-founder of Maps Israel, who is leading the research, said in January.

There will, however, be consternation that psychedelics could help soldiers effectively erase moral injuries derived from committing war crimes. But Doblin said such concerns are based on a misunderstanding of the effects of MDMA therapy.

“A lot of times, people become more sensitive to the emotional consequences of what they did,” he said. “If they’re not treated at all … I think they’re more dangerous of a soldier that way.”