Psilocybin-Assisted Psychotherapy in Palliative Care

Abstract

Abstract Following a decades-long hiatus and building on an innovative research model first developed from the 1960s to 1970s utilizing psychedelic therapeutics to alleviate the marked psychic distress in end-of-life cancer patients, major academic centers are resuming contemporary clinical research into the safety and efficacy of psilocybin and other serotonergic psychedelics delivered in conjunction with psychotherapeutic platforms to treat psychiatric and existential distress associated with terminal medical illnesses. While there have been significant advances in the treatment of medical and pain symptomatology in palliative care, there remains a paucity of efficacious psychopharmacologic and psychotherapeutic interventions to alleviate the psychiatric and existential anguish—notably depression, anxiety, and demoralization—often present at the end of life. Relevant to end-of-life therapeutics, the World Health Organization and the Institute of Medicine have identified treating spiritual and existential distress as essential to improving the emotional well-being and quality of life in patients with advanced or terminal illnesses. This chapter covers topics related to psilocybin-assisted psychotherapy in palliative care: history, anthropology, ethnobotany, neuropharmacology, safety, efficacy data from first and second waves of psychedelic research, putative mechanisms of action, and future directions. Psilocybin-assisted psychotherapy offers a potential paradigm shift to improve the existential, psychosocial, and spiritual well-being of patients in palliative care settings.