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Facing Death Without Fear: Psychedelics for End-of-Life Care

For Christine “Cat” Parlee, who has stage IV metastatic melanoma, the Roots to Thrive program has been a godsend. Not that she expects it to save her life: the chance of surviving advanced melanoma for 5 years is about 15% to 20%, according to the American Cancer Society, and Parlee was diagnosed in 2017. But an innovative approach to group therapy at Nanaimo, B.C.-based Roots to Thrive helped her cope with this life-threatening illness.

Parlee’s health issues are complex. As if the malignant skin cancer wasn’t enough, the 50-year-old Vancouver Island resident also suffers from a condition called trigeminal neuralgia with painful anesthesia. With this rare disorder, she says, “the emotional outbursts can literally cause me intense pain. So I got really good at suppressing my emotions.

“But you don’t grow or cry or come to terms with the end if you don’t process your fears,” she continues. Roots to Life has “enabled me to feel my own anger, my fear – the feeling that it’s SO unfair – without pain or panic attacks. … It’s one of the most difficult but beautiful experiences I’ve ever had to put into words.

A key ingredient in this experience is psilocybin, aka magic mushrooms. Founded in 2019, the nonprofit organization Roots to Thrive is the first Canadian medical practice to legally use psychedelic drugs, specifically psilocybin and ketamine, in group therapy for end-of-life patients. Combined with two other ingredients — a psychotherapist and a supportive patient community — the drugs have proven to be highly effective in alleviating the distress that accompanies a terminal diagnosis, according to Pamela Kryskow, MD, medical lead at Roots to Thrive.

“Once this safe community is built, a psilocybin mushroom session with this same group of people creates a container of healing, where patients can deeply explore their challenges under the influence of medicine,” says Kryskow, who is also a clinical instructor at the hospital. University of British Columbia and Adjunct Professor at Vancouver Island University.

Clinical Trials at Full Tilt

Research confirms the promise of psychedelics – from psilocybin and plant-based DMT to synthetic MDMA (ecstasy) and LSD – for palliative care and end-of-life patients. In 2016, a milestone to study at NYU Grossman School of Medicine discovered that a single dose of psilocybin relieve depression, anxiety and hopelessness in cancer patients. More recently, in a Follow-up study, 80% of the same patients said that the positive effects were maintained 4.5 years later. And other tests are in progress.

“There are 113 clinical trials currently registered at clinicaltrials.gov,” says Paul Stametsa mycologist whose 2020 book fantastic mushrooms is a companion of a popular Netflix Documentary. “This is unprecedented and reflects the scientific rationale for exploring the benefits of psilocybin on a wide range of mental health issues.”

This exploration dates back to the 1950s, when psychiatrists like Humphry Osmond, who coined the word “psychedelic,” first experimented with LSD-assisted psychotherapy. However, studies from this period were far from rigorous by today’s standards, and in the United States they all but came to a halt with the signing in 1970 of the Controlled Substances Act. But decades later, in 2014, American scientist called for an end to the ban on clinical trials involving psychedelics. At that time, the country was in the midst of what psychiatrist Ben Sessa called a “psychedelic renaissance”.

Right to try laws, which give seriously ill patients access to experimental drugs without having to wait for FDA approval, have helped reinvigorate the boom in psychedelic research. Currently, 41 states have their own versions of these laws, which accompany the federal Right to Try Act, enacted in 2018. Two states have focused on psilocybin in particular. In 2020, Oregon became the first to legalize the therapeutic use of psychedelic mushrooms. Colorado voters recently followed suit, decriminalizing magic mushrooms on Election Day 2022. This should pave the way for similar changes to Colorado laws that ban other herbal psychedelics, such as DMT, ibogaine and certain forms of mescaline, in June 2026. .

How Psychedelics Work

As defined by the National Institutes of Healthpsychedelics are potent psychoactive substances that alter cognition, altering the user’s mood and perceptions by acting on the neutral circuits of the brain that involve the chemical serotonin. Much of this happens in the prefrontal cortex, the part of the brain that regulates how you feel and how you view the world. “Psychedelic drugs, including psilocybin, are all thought to act on what are called serotonin 2A receptors,” explains Charles Nemeroff, MD, PhDchairman of the Department of Psychiatry and Behavioral Sciences and co-director of the Center for Psychedelic Research and Therapy at the Dell Medical School at the University of Texas at Austin.

Matthew W. Johnson, Ph.D., professor of psychiatry and behavioral sciences at Johns Hopkins University School of Medicine in Baltimore, describes activation of the serotonin receptor subtype as “the first step in the chain”, the one that leads to “changes in cerebral communication” during the psychedelic experience. “It’s likely that the brain looks different over the long term in ways that correlate with psychological and behavioral improvements,” he says, noting that psilocybin “works more like psychotherapy than other psychiatric drugs.”

Regardless of their effectiveness, psychedelics have been shown, under certain circumstances, to be an effective adjunct to the psychological support of patients at the end of life. In a recent to study of more than 3,000 adults, the Johns Hopkins Center for Psychedelics and Consciousness Research found that taking these drugs under the right conditions made people less afraid of death, in the same way that a near-death experience unrelated to drugs can reduce fear of death. The result, of course, can be a dramatic improvement in the quality of life of terminally ill patients.

That’s not to say that psychedelics are a panacea. Johnson notes, for example, that the therapy is particularly risky for patients with schizophrenia or severe heart disease. Risk assessment requires further research, according to Gregory A. Fonzo, PhD, assistant professor and co-director of the Center for Psychedelic Research and Therapy in the Department of Psychiatry and Behavioral Sciences at Dell Medical School. “Current studies have mainly focused on establishing efficacy,” he points out. “But future studies with larger numbers of participants are needed to identify individuals who are likely – and not likely – to respond well to this treatment.”

Separate the patient from the diagnosis

For those who respond well to psychedelic therapy, it is not just an individual experience. “Many patients report breakthroughs in family dynamics,” says Johnson. In some cases, this happens when “they start to have more open conversations about potential or impending death.”

There have also been other types of breakthroughs. “We’ve heard many reports of deep insights, transpersonal experiences, and rapid shifts in patients’ moods and sense of self occurring during psychedelic experiences,” says Fonzo. “It is possible that these patients’ subsequent changes in their belief systems, their perception of self and others, and their general state of mind are key factors that promote benefits for conditions such as depression. But further research is needed to validate this.

Clinical trials have even dipped into the realm of spirituality. In 2021, a Johns Hopkins review of psychedelic research focused on end-of-life and palliative care noted that some psilocybin studies used a mystical experience questionnaire designed to measure things like “a sense of oneness, reverence and authoritative truth…the transcendence of time/space and ineffability.

But for many end-of-life patients, one of the most important benefits of therapy is more concrete: they come to see themselves as separate from their diagnosis. “These sessions typically lead to altered narratives a person carries about cancer and themselves,” Johnson says. “I think these patients actually learn about themselves and about life, and that’s what separates psilocybin from other psychiatric drugs.”

By helping terminally ill patients overcome the fear of death, psychedelic therapy often, paradoxically, frees them to live more fully. “[Patients] say they have healed old traumas they carried, so they can be more present with family and friends,” Kryskow says. “They’re able to focus on having more fun and more connection.”

Still, results vary, and Cat Parlee argues that every psychedelic experience is unique. “Mine changed me to the very core of my DNA,” she says. Before enrolling in Roots to Thrive, she says, “the mere thought of death gave me huge panic attacks.” But that era is over. His advice to potential patients considering a similar program: “Be open. Be vulnerable. And no matter what you’ve heard, leave your expectations at the door.

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