Much of the research focus on psychedelics revolves around their potential application to treatment-resistant mental health conditions such as depression and PTSD. However, could these mind opening drugs have applications in the palliative care context, helping patients with terminal diagnoses to overcome existential dread? Let’s take a look.
What is palliative care?
There is no universally accepted definition of palliative care, meaning that definitions and types of care offered differ from institution to institution. The World Health Organisation (WHO) views palliative care as:
“an approach that improves the quality of life of patients (adults and children) and their families who are facing problems associated with life-threatening illness. It prevents and relieves suffering through the early identification, correct assessment and treatment of pain and other problems, whether physical, psychosocial or spiritual.”
Palliative care doesn’t involve one single service. Instead it involves a range of services provided by a range of people, and can include the input of clinicians, pharmacists, support workers, volunteers, etc. Although addressing physical symptoms of terminal conditions is the most overt element of palliative care, it’s also important to acknowledge the dedication of service providers to improving the emotional wellbeing and quality of life of those in the last few years of their lives.
According to data from WHO, around 56.8 million people, including 25.7 million in the last year of their life, are in need of palliative care each year. The majority of adults requiring palliative care have chronic diseases, e.g. cardiovascular diseases (38.5%), cancer (34%) and chronic respiratory diseases (10.3%).
The potential of psychedelics in palliative care
Research literature exploring palliative care has previously criticised conceptualisations of the service for not extending past symptom control into psychiatric, psychosocial, spiritual and existential domains. Breitbart et al. (2004) note the importance of refocusing these conceptualisations, considering how highly patients and medical professionals prioritise the psychosocial and existential domains of palliative care.
Therefore, with the adoption of spiritual aspects into the WHO definition of palliative care and its importance among people who are affected by the service, it appears there is a space for psychedelics as a tool within this realm.
According to experts in the area, psychedelics can be helpful for different things dependent on the patient’s progress through the end-of-life process. For those in the earlier stages, psychedelic-assisted therapy may help with accepting the changing circumstances and emotional coping. For those in the later stages, therapy may help someone to understand their feelings of existential distress and anxiety.
In many cases, psychedelics have been found to help ease terminal patient’s feelings of depression and anxiety and end-of-life psychological distress. Two key studies in the 2010s highlighted the power of psychedelic-assisted therapy within the palliative care setting.
In 2016, researchers at Johns Hopkins University carried out a double-blind, randomised , crossover study exploring the impact of psilocybin on the mental health outcomes of patients with life-threatening cancer. The study involved 51 participants with life-threatening cancer diagnoses and a DSM IV diagnosis involving anxiety and/or mood disturbance. Researchers explored the effects of a small placebo-like dose vs. a high dose of psilocybin, with 5 weeks between sessions and a 6 month follow-up.
The results confirmed that high-dose psilocybin produced large decreases in both clinician and participant self-rated measures of depressed mood and anxiety. As well as this, increases in quality-of-life, life meaning and optimism as well as decreases in death anxiety were also noted. These changes were sustained at the 6-month follow up, with around 80% of participants still showing clinically significant decreases in depressed mood and anxiety.
In the same year, researchers from New York University published a double-blind, randomised, active-placebo controlled, crossover study documenting symptom reduction in patients following psilocybin treatment. The study involved 29 participants with potentially life-threatening cancer and a DSM-IV diagnosis involving anxiety. The participants were randomly assigned to receive treatment with a single dose of niacin or psilocybin in conjunction with psychotherapy.
Prior to the crossover, psilocybin was found to produce “immediate , substantial, and sustained” improvements in anxiety and depression, as well as decreases in cancer-related demoralisation and hopelessness and improved spirituality and quality of life. At the 6.5 month follow-up psilocybin was associated with sustained anxiolytic and antidepressant effects. Researchers also observed enduring benefits in existential distress and improved attitudes towards death.
Whilst much of the research to date focuses on the use of ‘traditional’ psychedelics (e.g. psilocybin) in palliative, studies are beginning to expand into the use of other drugs such as MDMA and ketamine.
Can patients legally access psychedelics for palliative care?
Although research into the effectiveness of psychedelics within palliative care has been permitted, legal access to this service is rare and only exists within a few jurisdictions.
A limited number of countries have legalised psychedelics – in these areas individuals can access substances both recreationally and within the therapeutic context.
In other areas of the world, access to psychedelic therapy depends on individual circumstances. For example, in Canada psilocybin remains a schedule III substance. However, provisions under the Special Access Program introduced by the Canadian government, mean that individuals may be able to access substances that are yet to be approved, but may be helpful in specific circumstances.
Therefore, Canadians may be able to legally access psychedelic-assisted treatments in cases where conditions are treatment-resistant or where conventional treatments are unavailable or unsuitable. However, there must be sufficient evidence and the drug must have good availability.
Other countries, such as Jamaica and the Netherlands have become popular destinations for psychedelic retreats due to the ‘grey area’ that surrounds their laws on these substances.
Again in the US, psychedelics such as psilocybin remain illegal at the federal level. However, in 2020, Oregon became the first state to legalise the therapeutic use of psilocybin under Measure 109. This allowed individuals over the age of 21 to access psilocybin-assisted therapy within state-regulated centres. Interestingly, patients don’t need a prescription or referral from their healthcare provider.
Some individuals in the US have also attempted to access psychedelic-assisted palliative care under the Right to Try laws passed in 2018. These laws allow patients to access treatments that haven’t been fully approved by the Food and Drug Administration (FDA). These laws only apply to patients with a terminal illness and/or have exhausted FDA-approved treatments, who cannot access a clinical trial.
Despite no mention as to whether these laws extend to controlled substances, to date there has been no known access to psychedelics via Right to Try, despite numerous appeals to the Drug Enforcement Administration (DEA).
This piece was written by Volteface Content and Media Officer Megan Townsend. She is particularly interested in the reform of drug legislation, subcultural drug use and harm reduction initiatives. She also has an MA in Criminology from Birmingham City University. Tweets @megant2799.