By Dr. Dingle Spence
IAHPC Board Member and Senior Medical Officer, Hope Institute Hospital, Jamaica
As health care professionals working in the specialty of palliative care, we encounter many patients with serious health-related suffering who experience a wide range of physical symptoms.
However, as is well known, not all suffering is based solely in the physical realm. We also encounter patients whose misery is rooted in emotional, social, existential, and spiritual distress. Many life-limiting conditions—such as cancer, heart failure, liver failure and motor neuron disease—can result in a series of personal losses, including a loss of personal control, of enjoyment, and of the meaning and purpose of life.
Many patients with a life-threatening illness develop clinically significant symptoms of depression, anxiety, adjustment disorder, and other features of existential distress, often resulting in a significant decrease in their quality of life.
In recent times, both professional and public interest has been rekindled in the use of psychedelic medicines to provide relief for intractable symptoms of depression, anxiety, end-of-life distress, and post-traumatic stress disorder. In the 1950s and 1960s, psychiatric research using psychedelics such as psilocybin and LSD (lysergic acid diethylamide) showed significantly positive results in relieving many of the above-mentioned conditions.
Unfortunately, research into the application of psychedelic medicines was severely curtailed in the 1970s and 1980s when these medicines became listed as Schedule 1 drugs and thus became illegal for use in any setting. In the last 15 to 20 years, resurgent research with psychedelic medicines has centered principally around the use of three drugs: psilocybin, ketamine, and 3,4-methylenedioxy-methamphetamine (MDMA). This article focuses on research studies using psilocybin in the palliative care setting.
Psilocybin is a naturally occurring psychoactive compound found in many species of mushroom and belongs to a class of drugs known as classic hallucinogens. Psilocybin is an indole alkaloid chemically similar to serotonin and there is evidence that it has been used for centuries by Indigenous peoples to provide mystical experiences and spiritual healing, principally in Central and South America, a practice that continues to this day.
Resurgent interest for the use of psychedelics in a palliative care setting has been led by the publication in 2016 of two studies, both of which investigated the efficacy of psilocybin in treating anxiety and depression in patients with life-threatening malignancy. The studies were conducted in the USA at the Johns Hopkins Hospital and New York University (NYU), respectively. Both used a double-blind, placebo-controlled, crossover design with a single dose of psilocybin supported by psychotherapeutic interventions.
Both studies demonstrated that a single dose of psilocybin can produce both an acute and enduring reduction in the symptoms of depression, anxiety, and existential distress in terminally ill patients. In the NYU study, 70% of participants rated the psilocybin experience as among the top five most personally meaningful experiences of their lives. In both studies it seemed that a mystical experience was a significant mediator of the enduring effects of psilocybin therapy. Patients described this experience variously as being transcendent and sacred; many felt a powerful sense of unity or oneness with the universe and an enhanced awareness of positive emotions, including that of love. The fear of death was often vanquished. Such experiences can contribute to meaning-making at the end of life, and improve a patient’s spiritual well-being and their overall quality of life.
Psychedelic research also demonstrates that an individual may need only one or two experiences of a psilocybin “journey” to produce sustained and positive clinical benefits, as opposed to the need to take daily antidepressant or antianxiety medications to treat the same symptoms.
In Jamaica, where psilocybin is not a scheduled drug, research is beginning to test its application in the area of grief and bereavement, with a particular focus on bereaved parents who are finding that more standard approaches to grief therapy have not helped them process or cope with the loss of their child.
The rapidly growing interest in the success of psilocybin facilitated therapies for improving psycho-emotional and spiritual well-being, both in palliative care and in wider mental health settings, is likely to represent a paradigm shift in this area of work. It is time for us to sit up and take notice.