Opening Doors of Perception: Psychedelic Drugs and End-of-Life Care

Interest in psychedelic drugs for therapeutic use has revived, with recent studies examining psilocybin for anxiety in advanced-stage cancer patients. A 2010 study by Charles Grob and colleagues, the first in 35 years, gave 12 patients a modest dose (0.2 mg/kg) or placebo, finding no adverse effects and psychological benefits like restored meaning and autobiographical life review. A NYU team using a higher dose (0.3 mg/kg) plus psychotherapy reports rapid clinical improvement, reduced death anxiety, and increased spirituality, though data are not yet analyzed. Researchers suggest benefits stem from spiritual epiphany, which meditation might also induce.

Study at a glance

Abstract

Psychedelic drugs are still tarred with their 1960s-era image of “turn on, tune in, and drop out,” but serious investigators had been studying these compounds at least since the 1940s to manage conditions such as alcoholism, chronic pain, and terminal illness. By the mid-1970s, most of that research had been shut down. But interest in the therapeutic properties of psychedelic agents never completely subsided, and over the past decade a new generation of researchers has quie tly been studying the effect of psilocybin on people in the late stages of cancer. When Charles Grob, M.D., and his colleagues published their findings in the Archives of General Psychiatry in 2010, they noted that their study was “the first in 35 years to explore the potential utility of a psilocybin treatment model for patients with reactive anxiety associated with advanced-stage cancer.” Their subjects were 11 women and 1 man, aged 36–58 years. Four patients had no experience with hallucinogens. In initial meetings with the study staff, they learned about the study design and had a chance to develop a rapport with the investigators. Patients received a capsule containing 0.2mg per kg of body weight of psilocybin (considered a modest dose) or a placebo capsule with 250mg of niacin. Patients and investigators did not know the contents of each capsule, and each patient acted as his or her own control. Control and placebo sessions occurred several weeks apart. The sessions began at 10 a.m. and lasted 6 hours. Subjects were encouraged to lie in bed, wear eyeshades, and listen to classical music during their experience. They were left undisturbed, except for brief hourly checks. “All 12 of our subjects tolerated the treatment very well,” said Grob, professor of psychiatry and biobehavioral sciences at the David Geffen School of Medicine at UCLA. “There were no adverse effects. We were most concerned that there might be high levels of anxiety or transient psychotic events, but our people did not experience that,” Grob said. Because these patients had taken a relatively low dose of psilocybin, the psychedelic effect “was not a ‘knock-your-socks-off’ type of experience” like those reported by people taking higher doses, he explained. But the psychological effects of the drug were real, and it “helped restore a sense of meaning, a sense of who [the patients] are,” Grob said. “Many of our subjects went through a kind of autobiographical life review, examining the different facets of their lives from before their illness and through their illness, and they often reported a sense of continuity that had become somewhat disrupted.” A team at New York University is using a paradigm with similar outcome measures, but a higher dose of psilocybin at 0.3mg/kg. Patients there also underwent 9 months of psychotherapy in addition to receiving the drug. Currently, the team has data on 12 patients, with six more who have recently signed up. The goal is to have 32 patients by the time enrollment ends. “We haven’t analyzed our data yet, but we do have some very strong anecdotal clinical impressions,” said Stephen Ross, M.D., assistant professor of psychiatry and child and adolescent psychiatry at the NYU School of Medicine. “All subjects experienced a rapid clinical improvement. Those who had death anxiety had a significant reduction or resolution of that anxiety. We’ve also seen decreased anxiety and depression in general; patients are becoming more spiritual and philosophical, and people are becoming better integrated with their families and dealing with unresolved conflicts, preparing more for their future, and preparing, in some ways, for their death,” said Ross. Anthony Bossis, Ph.D. “People say they feel interconnected to other forms of energy. They feel as if their consciousness is part of a greater consciousness. They feel connected to transcendental forces and a sense of sacredness, and they have intuitive insights that are part of these experiences, all of which are core aspects of a mystical experience.” Anthony Bossis, Ph.D., assistant professor of clinical psychiatry at NYU, reported similar patient experiences. “All patients I’ve worked with say the drug has allowed them to live more fully in the present, to be less concerned with yesterday and tomorrow and whether tomorrow will bring more suffering,” he said. “Patients say it reframes how they see life and death. One patient, now deceased, said he realized that consciousness doesn’t end, it doesn’t die, it continues, and that his body is one aspect of life, that physical death is part of the life experience, but there’s a broader continuum.” Psilocybin is not the only key to the doors of perception: studies of MDMA (ecstasy), mescaline, and dimethyltryptamine—found in the Amazonian medicine ayahuasca—can produce similar results. Nor is taking a drug even necessary. Investigators seem to agree that the salutary effects come not from the compounds themselves but from the spiritual epiphany they produce, so nonpharmacologic ways of achieving the same outcome should be just as beneficial. For example, many people use meditation to attain a transcendental state similar to that produced by psilocybin, and evidence indicates that the changes in brain activity evoked by the drug mimic those seen in Buddhist monks while meditating. Ross pointed out that throughout history, people have used prayer, fasting, dancing, and even sex to expand consciousness. “Palliative-care doctors will tell you people can have these shifts toward the end of life that really transform the relationship of the patient to the dying process, so we know that humans are capable of [profound changes],” said Roland Griffiths, Ph.D., professor of behavioral biology at Johns Hopkins University, who has studied psilocybin in healthy volunteers and is now recruiting subjects with cancer. Despite these encouraging findings, it will probably be a while before magic mushrooms become part of the standard oncology regimen. Grob warned that the studies to date have all been small, the subjects carefully selected. “Before psilocybin leaves the research setting, probably several hundred subjects will have to be studied,” he said. He speculated that someday, doctors may become certified to use this treatment. Bossis said he hopes this research will draw clinicians’ attention to the spiritual and existential distress that afflicts so many patients with terminal illnesses. After all, he explained, “it is a key part of suffering.”