PTSD isn’t a new conversation in the veteran community, but the treatment debate is shifting. A former chief of the defence staff, Sir Nick Carter, is urging ministers to back properly licensed clinical trials of MDMA-assisted therapy for post-traumatic stress disorder — and to cut the costs and bureaucracy that he says are pricing the UK out of serious research.
For Carter, this is not an argument for loosening drug laws for recreational use. It is a narrower, practical push; reduce specific barriers that make tightly regulated medical trials harder and more expensive in the UK than they need to be, and let researchers test whether MDMA-assisted therapy could help those whose symptoms have proved resistant to conventional treatment.
MDMA remains a Class A drug in the UK. Possession and supply are illegal outside a narrow, strictly licensed research or clinical framework. Carter’s point is that the same controls designed to prevent misuse can also, in practice, obstruct legitimate science through cost, delay and administrative friction.
What’s being discussed is also often misunderstood. MDMA-assisted therapy is not a case of handing out a pill and hoping for the best. In clinical settings, MDMA is administered in controlled doses, with patients screened beforehand and monitored throughout. It is typically paired with structured preparation sessions and follow-up psychotherapy, delivered by trained clinicians. Supporters argue it can help some patients stay emotionally present while revisiting traumatic memories, reducing the instinctive fear response that can shut therapy down before it has a chance to do its job.
None of that is a green light for private experimentation. Illicit MDMA carries real risks, including unpredictable strength and contamination, and the legal consequences are severe. The debate here is about whether properly supervised, ethically approved, tightly controlled clinical research should be easier to run in Britain.
Carter’s criticism is rooted in basic logistics. Because MDMA is tightly controlled, the licensing, storage, transport, sourcing and compliance requirements are substantial. He has highlighted how these layers can inflate the cost of obtaining medical-grade MDMA for research to a level that is wildly out of step with the substance itself, pushing UK trials into a bracket that only a handful of institutions and funders can realistically contemplate.
The evidence that drives the interest comes largely from the United States. A phase three study published in 2023 reported significant reductions in PTSD symptoms among participants receiving MDMA-assisted therapy, with a large proportion no longer meeting the diagnostic criteria for PTSD by the end of the study period. For veterans who have tried the accepted pathways — trauma-focused talking therapies, EMDR, multiple medication approaches — and still find themselves stuck, that sort of data inevitably gets attention.
But there is a serious caveat that needs to sit alongside any hopeful headline. International regulators and independent advisers have raised concerns about the strength and reliability of the evidence base as it currently stands, including questions around trial design, bias controls and how much benefit comes from the drug versus the intensity of the therapeutic support. In the US, an FDA advisory committee voted against approving an MDMA-based treatment for PTSD in 2024, citing concerns about both efficacy and the overall risk balance.
That does not kill the idea. It does, however, reinforce what a sensible UK approach should look like; rigorous trials, tight oversight, transparent reporting and long-term follow-up. The answer to uncertainty in medicine isn’t hype or fear; it’s better evidence.
Carter is patron of Supporting Wounded Veterans, a charity seeking to fund a UK-based clinical trial, with researchers linked to the University of Cambridge. The ambition is not limited to the armed forces community. The proposed work would also include other trauma-exposed groups such as first responders and war correspondents — people whose professional lives put them repeatedly in the path of human catastrophe.
Supporters argue the UK is well placed to run a high-quality trial that addresses the criticisms levelled elsewhere: robust methodology, clearer safeguards, and a focus on outcomes that matter over the long term, not just at the end of a short study window. If MDMA-assisted therapy proves beneficial, it could eventually become an additional option for the group of veterans for whom established treatments have not delivered meaningful relief. If it doesn’t, the UK would still have done the responsible thing: test it properly and publish the results.
The policy debate can sound abstract until you hear from those living inside it. Martin Wade, a former military lawyer who served in Helmand, has spoken publicly about developing complex PTSD and the slow damage that followed, including worsening mental health, heavy drinking, diagnosis and treatment in hospital. He has also described the moral weight that can attach itself to operational life, including moments where a decision is not just about tactics but about conscience and legal responsibility.
In recounting one incident, Wade has said that part of his role involved assessing whether the circumstances might require investigation under the laws of armed conflict. It is a reminder that trauma is not always about a single event; sometimes it is the accumulation of exposure, responsibility and moral injury over time.
His position on MDMA-assisted therapy is straightforward. After years of trying the conventional routes, he wants the option of something different in a safe, legitimate clinical setting, if the evidence supports it. That point will resonate with many veterans who don’t want slogans or pity, and who aren’t interested in culture-war noise. They want treatments that work, delivered properly, without being treated as a political football.
Carter’s challenge to ministers is essentially this: if the UK believes in evidence-led healthcare, it should remove unnecessary barriers to gathering evidence. Not by waving a Class A drug through for general use, but by creating a research environment where properly licensed trials can be run without being priced into extinction.
MDMA-assisted therapy may yet prove to be a genuine breakthrough for some patients, or it may fall short once the data is tighter and the follow-up is longer. Either way, veterans deserve a system that is brave enough to investigate promising options properly, and rigorous enough to say no when the evidence doesn’t stack up.
Right now, the UK’s biggest risk is neither moral panic nor blind optimism. It is inertia.
