Marie Phelan describes the moment her heart cracked open. She had been carrying years of unprocessed trauma from her deployment to Iraq in 2003, a weight she likened to a heavy rucksack she couldn’t put down. Then, through a clinical trial involving MDMA-assisted therapy, she found herself unpacking each painful memory one by one, placing them on the waves.
That experience changed her life. But whether it will change the lives of millions of other Americans struggling with PTSD and depression is a question that just got a lot more complicated.
In April, President Donald Trump signed an executive order aimed at accelerating research into psychedelic drugs for mental illness. The move followed priority review vouchers given to companies like Compass Pathways, Usona Institute, and Transisd Therapeutics. Wall Street noticed immediately. Shares rallied. Analysts started using words like “legitimacy” and “mainstream” to describe an industry that had long been dismissed as fringe.
Let’s pause there, because there’s a lot to unpack.
The Veterans Who Are Already There
Phelan isn’t an outlier. She’s part of a growing community of veterans who have sought out psychedelic-assisted therapy when traditional treatments failed. Juliana Mercer, a U.S. Marine Corps veteran and executive director of the nonprofit Healing Breakthrough, says these therapies “completely changed” her life after years of struggling with trauma.
“One of the things that this experience was able to give me was that permission to heal,” Mercer said.
These aren’t casual endorsements. These are people who tried everything the VA offered and found something that actually worked. That matters, and it’s worth acknowledging.
But here’s where it gets tricky. Some critics have pointed out the executive order’s timing, noting it comes as the Trump administration pursues VA staffing cuts and signals deeper military involvement in the Middle East. The perception, fair or not, is that this is about winning back veteran support ahead of midterms.
Phelan herself pushed back on that idea. “They’d made so many cuts to veteran benefits and medical services,” she said. “Great, you did a good thing. You did a right thing… I can’t speak for how other people will react, but if that’s the intention, I doubt it’s effective.”
That’s a pretty honest take from someone who actually benefits from these therapies. And it captures the tension perfectly.
The Science Is Still Figuring Itself Out
Here’s what the executive order doesn’t change: the FDA still rejected an application for MDMA-assisted therapy in 2024. The agency’s concerns centered on study design and the need for more data. That’s not politics. That’s the regulatory process doing what it’s supposed to do.
The research landscape is genuinely mixed. Late-stage trials sponsored by the Multidisciplinary Association for Psychedelic Studies showed roughly 71% of participants with severe PTSD no longer met diagnostic criteria after MDMA-assisted therapy. That’s impressive. But it’s also a single study from a biased source, and the FDA wasn’t convinced it was enough.
“Psilocybin, LSD, and ibogaine are very different drugs with very different safety profiles,” said Brandon Weiss, a researcher at the Center for Psychedelic and Consciousness Research at Johns Hopkins. He’s right, and it’s remarkable how often that gets lost in the conversation.
Take ibogaine, which the executive order specifically mentioned. It’s being explored for addiction and traumatic brain injuries, but it carries serious cardiovascular risks. It hasn’t undergone large-scale clinical trials in the United States. Weiss’s concern isn’t that psychedelic therapies are ineffective. It’s that political momentum could pressure regulators to lower standards. “My biggest worry would be that FDA standards are relaxed for politically motivated reasons,” he said.
That’s a legitimate concern, and it’s one worth taking seriously even if you’re enthusiastic about these treatments.
What This Actually Means for Patients
The therapies being studied aren’t simple. They’re not a pill you swallow and feel better. Most trials involve hours of preparation with clinicians, supervised treatment sessions, and follow-up integration therapy afterward. Patients can experience panic attacks, paranoia, elevated heart rates, or psychological distress during sessions. In some clinical settings, doctors use benzodiazepines or antipsychotics as “rescue drugs” to manage severe reactions.
Phelan’s experience sounds transformative, but it’s also carefully controlled. That’s not the same as what happens when (or if) these therapies become more widely available outside of research settings.
Kabir Nath, CEO of Compass Pathways, says his company is adhering to the same FDA standards as any other drug developer. He’s confident in the data. But even he acknowledges the executive order is more about political validation than immediate practical changes. Companies like Compass were already nearing final Phase 3 trials before the announcement. FDA submissions were likely coming regardless.
The order, in other words, signals acceptance more than acceleration.
The Broader Picture
Other countries have already moved ahead. Australia became the first to allow psychiatrists to prescribe MDMA and psilocybin for certain conditions in 2023. Canada, Switzerland, and the UK have expanded clinical studies. The U.S. is catching up, but it’s not leading.
For veterans like Phelan and Mercer, that’s frustrating. They’ve found something that works, and they want it accessible to others who are suffering. That impulse is understandable. But rushing toward legitimacy without solid safety data could hurt the very people these therapies are meant to help.
Phelan put it simply: she doesn’t think this will translate into political support for Trump. She might be right. Or she might be underestimating how desperate people are for answers.
Either way, the conversation around psychedelics is no longer fringe. It’s here, it’s messy, and it’s only going to get more complicated from here.
