From Netflix documentaries to investment funds, psychedelics are having a moment. But these substances have been used by humans for millennia for both sacred and medicinal purposes. Now, researchers are investigating how psychedelics can help patients face the end of life.
How Psychedelics Can Help Patients Face the End of Life
What Are Psychedelics?
Psychedelic drugs or medications are a class of psychoactive substances that produce changes in perception, mood, and cognitive function. They range from naturally-occuring to lab-created, but have many similarities in their effects, which typically include feelings of euphoria, a sense of relaxation and well-being, and seeing things that aren’t there. Use of psychedelics may also have negative effects that include confusion and trouble concentrating, dizziness, blurred vision, and more.
There are many types of psychedelics, including psilocybin, MDMA, LSD, Dimethyltryptamine (DMT), peyote, and ketamine, among others. Many of these substances have been used since ancient times for mystical experiences and ingested by means of smoking, eating, or by being brewed into tea. These substances generally act on serotonin receptors that can induce alterations in thought, perception, and emotion, and sometimes provoke mystical-type experiences.
Early Psychedelics Research
In the 1950s, research into psychedelics and their applications for end of life patients began. By 1965, the peak of psychedelics research in the United States, there were over sixty active studies. However, tensions around the Vietnam War and the negative associations psychedelics had with the counterculture, led President Richard Nixon to sign the Controlled Substance Act into law in 1970, which deemed psychedelics a Class I substance. Psychedelic research was effectively banned in the United States until the 2000s.
Although psychedelics remain a Class I substance in the United States, research on psychedelics experienced a renaissance after a landmark study in 2006 (link opens pdf) showed that psilocybin held promise for end of life distress in cancer patients.
Psychedelics and End of Life Distress
The particular nature of a terminal diagnosis can cause existential or “end of life distress,” which can include loss of meaning and purpose. According to Daniel Rosenbaum at the University of Toronto, end of life distress typically includes feelings of “hopelessness, demoralization, powerlessness, perceived burdensomeness, and the desire for a hastened death.”
Ultimately, these symptoms can worsen the end of life and dying process. While palliative care has been shown to increase quality of life for patients facing terminal illness, there are limited tools to treat deep psychological burdens when someone is facing death. Additionally, Rosenbaum notes that there are no known pharmacological treatments that can address these symptoms in terminal patients.
How Could Psychedelics Be Used at End of Life?
Early studies into psychedelics suffered from poor methodologies and lack of control or comparison conditions. However, recent studies show that psychedelic-assisted therapy can have many long-lasting positive health outcomes for patients. A meta-analysis of research from 2011, 2014, and 2016, found “long-lasting anti-depressant and anxiolytic benefit from 1 to 2 administrations of either LSD or psilocybin,” and that no serious adverse effects were reported by participants in any of these studies. In fact, according to psychologist Jenna Varley, “it appeared that the most negative part of the study was not tripping enough.”
In 2016, Roland Griffiths et al., found that “high-dose psilocybin produced large decreases in clinician- and self-rated measures of depressed mood and anxiety, along with increases in quality of life, life meaning, and optimism, and decreases in death anxiety.” After 6 months, 80% of participants continued feeling these positive effects.
As for psychedelic’s role in diminishing end of life distress, terminal patients given high-dose psilocybin left a 2011 pilot study, “examining how their illness had impacted their lives, relationships with family and close friends, and [they had] a sense of ontological security. In addition, subjects reported powerful empathic cathexis to close friends and family members and examined how they wished to address their limited life expectancy.”
Challenges and Concerns
Psychedelics are classified as Schedule I– the drugs with the greatest potential to cause harm and no acceptable medical uses. Although their applications for end of life and psychiatric disorders are being researched by Harvard University and Johns Hopkins, not to mention around the world, they are still not available for use outside of carefully controlled research studies.
People have encountered challenges with psychedelics because they are federally illegal and have therefore received push-back from The Drug Enforcement Administration. Furthermore, psychedelic drugs still face wide stigma from an interpersonal perspective and even research at the academic level.
Another challenge moving forward has to do with the demographics of research participants. Varley’s meta-analysis found that most participants in psychedelics research were white. BIPOC are underrepresented in end of life research, which is reflected in medical research more generally. Of 18 studies from 1993 to 2017 reviewed in a meta-analysis of psychedelic-assisted psychotherapy, 82.3% of overall participants were white. While it is true that BIPOC in North America are less likely to complete advance directives and enrol in hospice, there are other systemic barriers to end of life care as well, and psychedelics research will need to contend with these challenges moving forward.
The Future of Psychedelics
Currently forty U.S. states have Right To Try laws, which means that patients facing terminal illness can access drugs that are not yet approved by the Food and Drug Administration.
In Canada, where psilocybin is also illegal, Health Canada has allowed dozens of terminal patients to access psychedelics in clinical settings. Despite the growing body of evidence of the efficacy and safety of psychedelics, as well as public support for its use, strict Health Canada rules mean that patients are often forced to illegally use psilocybin to treat end of life distress.
In Europe, where psychedelic compounds are classified as Schedule I drugs (ie: illegal), organizations are lobbying the EU to allow for more clinical research and clinical funding on the use of psychedelics for medicinal purposes.
Researchers in many parts of the world are hoping to expand the knowledge that we have about the outcomes of the use of psychedelics. Meanwhile, legal teams in many parts of the world are working to allow terminal patients access to these drugs while they are undergoing medical trials, and lawmakers are considering loosening restrictions on some forms of psychedelics. Psilocybin has been decriminalized in individual cities with more legislation on the docket.
Psychedelics have the potential to alleviate the unique and highly burdensome form of suffering that comes with a terminal diagnosis. How psychedelics can shape end of life care remains an open question, but the hopeful vision researchers have is that people who are at the end of life can be administered these drugs in therapeutic environments by trained clinicians. These treatments will hopefully improve quality of life for those in palliative care, but also those who have long-term debilitating illnesses, over their lifetimes.