Seven years clean, Oleksandr believed he had left addiction behind. Then, a year into fighting [Russia](https://www.theguardian.com/world/russia), the Ukrainian soldier was prescribed painkillers for a shoulder injury. Under the strain of war, he relapsed and quickly began using stronger illicit opioids. “From that moment, I was fighting two wars – one inside myself and one with Russia,” he said, speaking at a rehabilitation facility in Kyiv. Oleksandr continued to serve for another two years, rising to the rank of officer even as his addiction deepened. “I was hiding my use from the others. It’s the kind of thing you’re ashamed of,” he said. Last winter, he reached a breaking point. Unable to perform his duties, he came clean to his superiors. “Luckily, they were understanding and I was sent to rehabilitation.” [](https://www.theguardian.com/world/2026/apr/19/ukraine-soldiers-confront-addiction-struggles#img-2) * Oleksandr relapsed into addiction after treatment for a shoulder injury sustained during fighting. Drug and alcohol abuse have shadowed every modern conflict. In Ukraine’s war, now in its fifth year, the psychological toll on soldiers has been immense – and for some, addiction has followed. “Drug use among troops is a grey area,” said Oleh Olishevskiy, who runs a specialised rehabilitation clinic at Kyiv City Clinical hospital No 10, treating addiction alongside psychological trauma since the start of Russia’s full-scale invasion. “Everyone knows it exists, but few want to talk about it.” The scale of the problem is hard to measure. Ukraine’s military does not disclose how many soldiers are dealing with mental health problems, let alone addiction. “I don’t think we’ll ever know the real numbers. No one is keeping track,” Olishevskiy said. He cited a 2024 study by the Ukrainian charity 100% Life of 1,000 soldiers that found more than a third had used amphetamines at least once a month, while one in five reported using prescription drugs such as pregabalin. About 15% reported using cheap synthetic cathinones, known as “salt”, and opioids. At the Kyiv clinic, a drab three-storey building in a leafy part of Kyiv, Olishevskiy and his team treat about 25 patients at a time, with stays of up to four months. The aim, ultimately, is for the soldiers to return to the army. But those working in the mental health field say the need for addiction-related care among Ukraine’s troops far exceeds available treatment and will persist long after the fighting ends. As in many other countries, substance abuse also remains difficult to discuss openly – particularly for men, and even more so for soldiers. “The war’s scale is unmatched in modern history. And it is not even over; the worst still lies ahead when soldiers return,” Olishevskiy said. Widespread drug use in the Russian army has been well documented [in media reports](https://www.nbcsandiego.com/news/national-international/russian-troops-punished-for-drink-and-drugs-frontline-attacks-on-ukraine-rising-zelenskyy-says/3355602/), at the front and in the rear, where soldiers can be punished by deployment to high-risk assault units or forced to sit in pits and cellars for days**.** In Ukraine, there are efforts to take a different approach. While stigma around drugs remains, attitudes among commanders are shifting, medics say, with more soldiers being sent for treatment. “There is more understanding now, but much still depends on your superiors,” said Petro, one of the clinic’s counsellors, who asked for his last name to be withheld. “It’s getting better,” he added. Some of the rehab staff, including Petro, are former addicts and servicemen themselves. At the core of the clinic’s work is the belief that addiction and war trauma are inseparable. Counsellors say drug use can only be understood alongside the untreated PTSD and psychological wounds that often precede it. [](https://www.theguardian.com/world/2026/apr/19/ukraine-soldiers-confront-addiction-struggles#img-5) * Petro, a war veteran, who has been treated at the rehab centre and now works there. Stimulants are sometimes used to stay awake during long stretches of duty. But most patients say their addiction worsened away from the front, when they returned to base after weeks of fighting and struggled to unwind, turning to drugs or alcohol to blunt intrusive memories, manage anxiety or simply get through the night. “I never used it on a mission – you’d get killed quickly. You’re already running on adrenaline anyway,” said Dmytro, a Ukrainian soldier, speaking in the rehab’s cafeteria over a bowl of soup. “When you’re back, you just want to switch off. Forget everything you’ve seen – all the death and other shit.” Dmytro, who was undergoing rehabilitation for an addiction to synthetic stimulants, asked for his name to be changed, fearing Russia could use his addiction against him if he were taken prisoner. Like others, Dmytro said drugs were relatively easy to obtain – ordered through the Ukrainian post service or collected from hidden stashes shared through messaging apps. The drugs left him paranoid. He described strapping grenades to the door of his bedroom in Kramatorsk, an eastern Ukrainian city near the front where troops come to rest, convinced he was about to be ambushed by Russian forces. “I started to lose track of what was real,” Dmytro recalled. [](https://www.theguardian.com/world/2026/apr/19/ukraine-soldiers-confront-addiction-struggles#img-8) * The canteen is a place where the soldiers, veterans and civilians being treated can all share a meal. Inside the facility, the daily routine for Dmytro and others is structured, much like in any other rehab centre. Mornings begin with group therapy, followed by individual sessions and physical activity – yoga, light exercise, table tennis. But the war is never far away: drawings by patients on the walls show guns and other scenes of combat. Olishevskiy said he stays in close contact with specialists in western countries, drawing on their latest medical research. This summer, he has planned a retreat for his patients at a farm with horses in Kharkiv. His eyes lit up when talking about promising results for a trial using ketamine to treat PTSD. “If trauma isn’t processed and someone copes through drugs or alcohol, within months you can have severe PTSD that becomes much harder to treat,” said Olishevskiy. “Punishing a soldier at the front by docking his pay will not help treat the underlying issue behind drug use,” he added. But [Ukraine’s acute manpower shortages](https://www.theguardian.com/world/2025/jan/31/tired-mood-changed-ukrainian-army-desertion-crisis) create difficult trade-offs for Olishevskiy and his staff. Pressure to fill gaps has led to some patients being sent back to service before fully recovering. Complete recovery is the “ideal scenario”, said Olishevskiy. In practice, however, even reducing drug use to a level where they can function may be considered good enough, he added. Patients and medics also said mobilisation officers often allow prospective soldiers with existing drug use to serve in the army. “It was obvious to everyone, including the doctors, that I was addicted during my enlistment medical,” said Anton, who had been using synthetic drugs for six months before joining the army. He later developed a severe addiction and was sent to hospital after suffering a heart attack. Still, Anton said he wants to get better and return to the frontlines. “This clinic gave me another chance at life. I want to give something back.”

A new doctrine could soon take hold in part of the US war on drugs: 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](https://health.mil/Reference-Center/Reports/2026/01/15/DOD-Study-Certain-Conditions-Using-Certain-Psychedelic-Substances), 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](https://luttrell.house.gov/media/in-the-news/gop-congressman-cheers-defense-departments-10-million-investment-psychedelic). “This is just the beginning.” On 18 April, Luttrell stood beside Donald Trump as he [signed an executive order](https://www.theguardian.com/us-news/2026/apr/23/trump-psychedelic-drugs-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](https://www.theguardian.com/world/2026/apr/19/ukraine-soldiers-confront-addiction-struggles) 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](https://news.uthscsa.edu/4-9-million-grant-enables-test-of-psychedelic-mdma-as-enhancement-for-ptsd-therapy-2/) 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](https://www.newyorker.com/magazine/2012/12/17/operation-delirium). “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](https://themedialine.org/top-stories/could-a-psychedelic-breakthrough-expand-trauma-care-in-israel/?utm_source=beehiivemail&utm_medium=email&utm_campaign=our-new-book-ozempic-risks-legal-shrooms&_bhlid=17e4fee9af3c5c006ea3e6467b018fd5dcfb4795). 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.”

On the latest Last Week Tonight, [John Oliver](https://www.theguardian.com/tv-and-radio/john-oliver) focused on the rise of gas station drugs, the brightly colored bottles and pills that are sold at the registers of US convenience stores. Promising increased energy, pain relief or improved sexual performance, these unregulated products often contain tianeptine, a drug known as “gas station heroin”. “While you might assume they’re just snake oil, that’s not necessarily true,” said Oliver. “Some of these drugs can be actively dangerous, presenting risks of addiction just like controlled substances.” One such drug is the red-bottled Zaza, a synthetic product which mimics the effects of [opioids](https://www.theguardian.com/us-news/opioids) and is sold as a legal alternative to narcotics in gas stations. After playing an interview clip from a former addict who once consumed 250 Zaza bottles a month, Oliver said: “There is so much that is alarming here. From the notion of a gas station having an opiate aisle, to the fact that that is too many tiny bottles of _anything_ to go through in a month.” Stories like this are becoming increasingly commonplace, Oliver noted, as people seek these products out for recreational use, or to self-treat symptoms such as depression and fatigue. “These drugs exist in a regulatory wild west,” the host said. “Many of the companies try to evade regulation with creative labeling, marketing them with language like ‘For research purposes only’ or ‘Not for human consumption’. “But the most common tactic is simply labeling the product a ‘dietary supplement’” he went on. Thanks to a 1994 law, there is “no central process whereby products calling themselves supplements are tested or approved before they hit the shelves …All of which means that the FDA and other regulators are playing an impossible game of catchup.” Oliver then turned his focus to sexual enhancement drugs, which often have names to suggest wild, untamed animals such as Black Panther, Blue Panther, The Goat, Super Bull, Anaconda and Boner Bears. “Boner pills demonstrate pretty effectively the extent to which gas station drugs can be made by just about anyone,” Oliver said, explaining that packaging and pill casings can be freely built online and filled by vendors with whichever supplements or substances they choose. “You don’t want a pill’s ingredients to essentially be dealer’s choice,” laughed Oliver. “You would never tolerate that level of variance in other products. You would be justifiably annoyed if it turned out that some Cadbury Creme Eggs were filled with marinara sauce.” Some boner pills have been found to include the active ingredients in Viagra and Cialis, while others contained printer ink and ground-up drywall, and the FDA is basically ‘“powerless” to stop it. The host moved on to focus on products containing kratom, which is marketed as an energy booster or mood lifter, and has opioid-like properties. “Many states have no requirements for labeling when it comes to these products, \[so\] it can be hard to know exactly what you are buying,” said Oliver. And “because these products seem low risk, people can feel comfortable taking much more than the recommended dose.” After playing a clip of [Joe Rogan](https://www.theguardian.com/culture/joe-rogan) bragging about getting “fucked up” after taking eight kratom pills at once, far exceeding the recommended dose of two, Oliver responded: “Joe, what the fuck are you doing?” “It really is worth knowing what you’re ingesting and the potential dangers, because \[kratom\] can be addictive,” Oliver went on. “Certain components of the kratom plant interact with your brain in the same way as opioids.” Some manufacturers go even further, boosting the effects but synthesizing a compound called 7-Hydroxymitragynine (7-OH), which is about seven times stronger than morphine. A 2024 report found that kratom and 7-OH contributed to or caused at least 4,100 deaths over a three-year period. “And there is every chance that that is an undercount, given that these substances are new enough that death investigations don’t always detect kratom or 7-OH,” Oliver said. The final gas station drug that Oliver discussed was tianeptine, a “cognitive enhancer” often sold under the names Zaza, Tianna and Neptune’s Fix. While the drug is prescribed as an anti-depressant in Europe, the FDA has not approved it for US medical use. It’s “not a great sign,” Oliver commented, that tianeptine has become known as “gas station heroin”. “On its face, that sounds like the title of a pretty good [Lana Del Rey](https://www.theguardian.com/music/lana-del-rey) song,” he joked. But the drug has been linked to hundreds of overdoses and deaths, leading Alabama to ban the drug a few years ago. [ John Oliver on prediction markets: ‘Betting on war is really dark’ ](https://www.theguardian.com/tv-and-radio/2026/apr/20/john-oliver-last-week-tonight-recap-prediction-markets) “It is hard to believe that something so immediately dangerous could be sold at the gas station next to the lottery tickets. It would be like finding out that PetSmart sells hand grenades next to the hamsters.” [Robert F Kennedy Jr](https://www.theguardian.com/us-news/robert-f-kennedy-jr) and the FDA have been discussing the dangers of some of these products, “which I guess is good”, said Oliver. “I do worry that RFK is either going to say they cause autism or suggest that they somehow be replaced by ground up raccoon carcass. But still, it’s something. “If states are going to start banning some of these drugs, that should only happen alongside a plan to help people who cannot suddenly stop using them,” Oliver concluded. “Whether that’s because they have been using them to treat pain, or they’ve become addicted. “If we learned one thing from the opioid crisis, it’s that every family fortune is built on the blood of strangers,” he said, flashing up a Sackler family plaque. “But if we learned two things, it’s that when you take something very strong off the market, not everyone can just quit cold turkey.”