The therapeutic potential of psychedelic substances in Hospice and Palliative Care

After a period of halted research in the 1970s, studies since the 2000s have resumed investigating psychedelic therapies for patients with serious diseases. Psychedelics, classified as classic psychedelics, empathogens, dissociative anaesthetics, and atypical psychedelics, are substances that alter perception, cognition, and emotion and can evoke mystical experiences. In hospice and palliative care, preliminary evidence suggests that assisted psychedelic therapies can profoundly impact psychological, existential, and spiritual outcomes. Controlled psychedelic experiences may help patients turn toward fear of death, reducing anxiety and increasing compassion, acceptance, and present-moment living. A randomized placebo-controlled trial is also underway to evaluate psilocybin-assisted psychotherapy for healthcare providers experiencing COVID-19-related depression, anxiety, burnout, and post-traumatic stress.

Study at a glance

Abstract

The healthcare field and society at large are witnessing a resurgence of interest in the effects and applications of psychedelic therapies in a wide range of settings. In the 1950s and 1960s, research was conducted to explore different applications for psychedelics, such as lysergic acid diethylamide (LSD) and mescaline, in the healthcare setting. However, psychedelic research was dramatically reduced in the 1970s due to regulatory, political, and social issues. With the resumption of studies involving psychedelics mostly since the 2000s, several studies have been conducted in order to investigate the therapeutic potential of these substances, including in patients with serious diseases. Psychedelics, formerly known as ‘hallucinogens,’ are substances that elicit changes in perception, cognition, emotion and may also evoke peak or mystical experiences. Based on their pharmacological profiles, psychedelics can be classified into four classes: 1) classic psychedelics (serotonin 2A receptor agonists, e.g., LSD, psilocybin, dimethyltryptamine [DMT], mescaline); 2) empathogens or entactogens (mixed serotonin and dopamine reuptake inhibitors and releasers such as methylenedioxymethamphetamine [MDMA]); 3) dissociative anaesthetic agents (glutamate receptors antagonists such as ketamine); and 4) atypical psychedelics (diverse mechanisms of action, e.g., ibogaine, tetrahydrocannabinol [THC], salvinorin A). Most of these compounds are found – or are similar to chemical compounds found – in plants or fungi that have been used for millennia in traditional spiritual or folk healing rituals. Primarily in the fields of hospice and palliative care, assisted psychedelic therapies have been investigated as a potential novel therapeutic modality due to preliminary evidence suggesting their profound impact on psychological, existential, and spiritual outcomes in patients with serious diseases. Results indicate that psychedelic experiences, in a controlled setting, can catalyze psychological processes associated with illness and fear of death, promoting therapeutic effects that impact the physical, mental, and spiritual spheres – thus representing a possible therapeutic tool for providing care to critically ill patients. In a recent interview, Dr. Anthony Bossis, clinical psychologist and clinical assistant professor of psychiatry at New York University School of Medicine, a scientist working in the field of palliative care and psychedelic therapies, states that one of the insights that many psychedelic research volunteers shared is that by turning emotionally toward fear and feelings regarding their death, they often felt less anxiety, more compassion, love for themselves and others, and nurtured new insights. While it can be a challenging experience, by turning to grief, they spoke of experiencing greater acceptance and openness to the mystery of death. In doing so, they reported being able to live more wholeheartedly in the present moment. Taken together, these potential benefits are consistent with the mindfulness, self-kindness and self-compassion that have been identified as important for severely ill patients and palliative care professionals. In addition to patients, studies investigating the therapeutic potential of psychedelics among healthcare providers in crisis settings have also been conducted. Seeking to further assist in improving the condition of healthcare providers active on the forefront during the COVID-19 pandemic, the biotechnology company Cybin and the University of Washington are sponsoring the randomized placebocontrolled trial on psilocybin-assisted psychotherapy for these healthcare providers experiencing COVID19-related issues. The primary goal of the study led by Dr. Anthony Back is to evaluate the effectiveness of psilocybin-assisted psychotherapy in treating symptoms of depression, anxiety, burnout, and post-traumatic stress among these providers. Hospice and palliative care providers are also frequently exposed to existential issues, psychological challenges, and emotional distress associated with end-of-life care. In this regard, future studies could perhaps investigate the therapeutic potential of psychedelics among the hospice and palliative care workforce, since in order