Facing Death Without Fear: Psychedelics for End-of-Life Care
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For Christine “Cat” Parlee, who has stage IV metastatic melanoma, the Roots to Thrive program was a godsend. Not that she expects it to save her life: The probability of surviving advanced melanoma for 5 years is about 15%-20%, according to the American Cancer Society, and Parlee was diagnosed in 2017. But an innovative approach to group therapy at Roots to Thrive, based in Nanaimo, British Columbia, has helped her deal with this life-threatening disease.
“But you don’t grow, or grieve, or eventually accept the end if you don’t process your fears,” she continues. Roots to Life has “allowed me to experience my own anger, fear – the feeling that this is SO unfair – without pain or panic attacks. … It’s one of the hardest yet most beautiful experiences I have ever had to put in words.”
“Once that safe community is built, a psilocybin mushroom session with that same group of people creates a healing container, where patients can deeply explore their challenges while under the influence of the medicine,” says Kryskow, who is also a clinical instructor at the University of British Columbia and adjunct professor at Vancouver Island University.
Clinical Trials at Full Tilt
Research confirms the promise of psychedelics – from plant-based psilocybin and DMT to synthetic MDMA (ecstasy) and LSD – for palliative and end-of-life patients. In 2016, a landmark study at NYU Grossman School of Medicine found that a single dose of psilocybin relieved depression, anxiety, and hopelessness in cancer patients. More recently, in a follow-up study, 80% of the same patients reported that the positive effects were sustained 4½ years later. And more testing is in progress.
That exploration dates back to the 1950s, when psychiatrists like Humphry Osmond, who coined the word “psychedelic,” first experimented with LSD-assisted psychotherapy. Studies during that period were less than rigorous by today’s standards, however, and in the United States they virtually came to a halt with the 1970 signing of the Controlled Substances Act. But decades later, in 2014, Scientific American called for an end to the ban on clinical trials involving psychedelics. By then, the country was in the middle of what psychiatrist Ben Sessa dubbed a “psychedelic renaissance.”
Right-to-try laws, which give gravely ill patients access to experimental drugs without having to wait for FDA approval, have helped jump-start the surge in psychedelic research. Currently, 41 states have their own versions of these statutes, which stand alongside the federal Right to Try Act, signed into law 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 is expected to pave the way for similar changes in Colorado laws that prohibit other plant-based psychedelics, such as DMT, ibogaine, and certain forms of mescaline, in June 2026.
How Psychedelics Work
As defined by the National Institutes of Health, psychedelics are potent psychoactive substances that alter cognition, changing the user’s mood and perceptions by acting on neutral circuits in 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 see the world. “Psychedelic drugs, including psilocybin, are believed to all act on what are called serotonin 2A receptors,” explains Charles Nemeroff, MD, PhD, chair of the Department of Psychiatry and Behavioral Sciences and co-director of the Center for Psychedelic Research and Therapy at the University of Texas’s Dell Medical School in Austin.
This isn’t to suggest that psychedelics are a panacea. Johnson notes, for example, that the therapy is especially risky for patients with schizophrenia or severe heart disease. Gauging the risks calls for further research, says Gregory A. Fonzo, PhD, an 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 focused primarily on establishing efficacy,” he points out. “But future studies with larger numbers of participants are necessary in order to identify individuals who are likely – and not likely – to respond well to this treatment.”
Separating the Patient From the Diagnosis
For those who respond well to psychedelic therapy, it isn’t just an individual experience. “Many patients report breakthroughs in family dynamics,” says Johnson. In some cases, this happens as “they start having more open conversations about potential or pending death.”
There have been other kinds of breakthroughs as well. “We’ve heard many reports of profound insights, transpersonal experiences, and rapid shifts in patients’ moods and their sense of self occurring during psychedelic experiences,” Fonzo says. “It’s possible that these patients’ subsequent changes in their belief systems, their perceptions of self and others, and their overall mood state are key factors that promote benefits for conditions such as depression. But additional research is needed to validate that.”
In helping terminal patients overcome the fear of death, psychedelic therapy often frees them, paradoxically, to live more fully. “[Patients] say that they have healed old traumas they’ve carried, so they are able to be more present with their family and friends,” Kryskow says. “They are able to focus on having more fun and more connection.”
Still, results vary, and Cat Parlee maintains that each psychedelic experience is unique. “Mine changed me to the very core of my DNA,” she says. Before she signed up for Roots to Thrive, she says, “the very thought of death caused me to have massive panic attacks.” But those days are gone. Her advice to prospective patients considering a similar program: “Be open. Be vulnerable. And no matter what you’ve heard, leave your expectations at the door.”