Using psychedelics for terminal illness and end of life

Death is the one thing all humans have in common, and everyone deserves to end their lives with dignity. There are several physical, mental, and emotional symptoms those at the end of life can face depending on their condition: pain, dyspnea (shortness of breath), mental confusion or delirium, agitation (also known as terminal restlessness), and retained respiratory secretion.

In 2018, of the 270,000 or so Canadians who passed annually, 90 percent died of chronic illnesses such as cancer, heart disease, organ failure, dementia or frailty. Forty-four percent of adults age 20 or over have at least one common chronic disease, and the likelihood of being diagnosed with cancer increases with each decade of life, from 29 cases per 100,000 in Canadians less than 30 years old to over 2,200 cases per 100,000 in Canadians in their 80s.

Effects of terminal illness diagnoses

The announcement of a terminal illness can also have several effects. People with serious, chronic, or terminal illnesses are at increased risk of experiencing anxiety and depression. After diagnosis, 40 percent of cancer patients report developing worry, panic attacks, depression, and post-traumatic stress disorder (PTSD). People with diabetes or rheumatoid arthritis are six times more likely to develop depression than people without these illnesses. Transplant patients, those with chronic pain, respiratory disease patients, and others with disorders that require a lifetime of coping report increased levels of depression and anxiety. Caretakers may also experience these symptoms. 

Hospice care—typically provided by government medical programs—includes care from a team of health care professionals to maximize comfort for a person who is terminally ill. Programs vary and are based on need. 

The potential for psychedelics and end-of-life

With the resurgence of psychedelic studies in recent years, researchers have explored the potential for the use of psychedelics in end-of-life care.

A review of clinical trials dating back to the 1960s published in Progress in Neuropsychopharmacology & Biological Psychiatry suggested that psychedelic-assisted therapy appeared to be a safe and potentially effective intervention for psychological and existential distress associated with life-threatening illnesses (LTIs).

Johns Hopkins University and New York University (NYU) completed two noteworthy psychedelic studies of depression and anxiety associated with cancer in 2016. The Johns Hopkins University study included 51 patients and used a crossover design, whereby each patient received both an experimental high dose of psilocybin and a low dose of an active placebo control. The NYU trial included 29 patients randomized to receive psilocybin or the active placebo niacin in a crossover design involving one drug session each. 

Both trials involved preparatory and post-treatment psychotherapy sessions and included patients with life-threatening cancers and a range of psychiatric disorders involving mood and anxiety. The studies showed immediate and critically lasting benefits up to 6 months or more after active treatment sessions in each case, based on standardized measures of anxiety and depression. They also showed a robust safety profile of the experimental intervention in a medically ill population. Medical symptoms included short-term elevations in blood pressure, with no serious adverse medical or psychological outcomes reported in either study.  

Photo: Johannes Plenio

The studies also suggested a central role of the psilocybin-caused mystical-type experience: features of unity, a noetic quality (a sense of encountering “ultimate reality”), sacredness, deeply felt positive mood, a transcendence of space and time, and ineffability. The experiences correlated significantly with therapeutic outcomes. In the NYU study, participants reported that the psilocybin therapy helped them to reconnect to life, reclaim their presence, and increase their confidence in the face of cancer recurrence.

Dr. Anthony P. Bossis, coprincipal investigator on the 2016 clinical trial at NYU, said the following in an interview published in Alternative and Complementary Therapies in 2021: “While there have been significant advances and a greater acceptance of the fields of palliative and hospice care in America, we still have a paucity of therapies to address the existential and psychological suffering that may be experienced by a person with a terminal illness. For years, death and dying were a taboo conversation in our culture and within health care training. Finally, we are now seeing some improvements in the national conversation about death and dying.”

Besides psilocybin, researchers have also explored MDMA for treatment of anxiety and other psychological distress related to LTIs. A study published in 2020 in Nature investigated MDMA-assisted psychotherapy to treat anxiety in people with an LTI. Participants received MDMA or placebo in combination with two eight-hour psychotherapy sessions. Follow-up assessments occurred six and twelve months after the participant’s last experimental session. 

The MDMA group had a greater mean reduction in State-Trait Anxiety Inventory (STAI) Trait scores, showing less anxiety compared to the placebo group. Results supported the feasibility of MDMA-assisted psychotherapy as a novel approach for potential long-term treatment of LTI-related anxiety. 

“Research shows that receiving spiritual and psychological services at the end of life are unmet needs for many patients. The health care establishment can improve by increasing courses on death and dying in professional training and with increased utilization of palliative care teams,” said Dr. Bossis in Alternative and Complementary Therapies.

“The attention to meaning and spirituality are vital aspects of caring for the whole person. While there have been improvements in pain and symptom management and we have improved chemotherapies, we are continually reminded to improve our care for the challenging and often difficult emotional journey of the dying patient.”

With the prevalence of chronic and terminal illnesses, psychedelics and psychedelic therapy may someday have the potential to normalize and hopefully ease end-of-life distress.

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