This article discusses topics relating to depression, anxiety, and end-of-life care. It may be triggering to some readers. If you require support, resources will be listed at the bottom of this article.
In August 2020, four terminally-ill patients were granted permission to use psychedelic therapy in Canada. They were given psilocybin, the hallucinogenic component of what are popularly called “magic mushrooms,” to ease their anxieties and depression towards the end of their lives.
So how does psychedelic therapy work, and why is it being used for end-of-life care?
Psilocybin is just one type of psychedelic therapy that has piqued the interest of medical researchers since the 1950s. However, there has been a historical reluctance to adopt these therapies for mental health in end-of-life care, also known as palliative care.
End-of-life care involves helping someone remain comfortable, and physicians will use palliative practices to alleviate things like pain and shortness of breath, as well as provide support through death for patients with life-threatening conditions.
James Downar, MD, is a researcher and head of the palliative care division at the University of Ottawa. “To palliate is to cloak,” he explained in an interview with The Pigeon. “When we palliate a symptom, we are soothing or easing [it].”
Doctors choose this course of treatment when a condition is deemed unfixable. “There are times when you can’t actually fix the problem—but you may be able to reduce the effect it has on a person,” he said.
Downar explains that there are many kinds of suffering that may occur because of an incurable condition, including physical, mental, and existential.
According to Downar, existential distress occurs when a person is robbed of the ability to do the things that give their life purpose. When a person is given a terminal diagnosis, this feeling of loss takes on an air of permanence.
“You think to yourself, ‘Well I’m going to die, I know I’m going to die,’” he explained. “’The cause of my loss of purpose is permanent […] I’m basically just waiting out the rest of my time until a complication takes me away.’”
Existential suffering is where psychedelics hold the most potential for good, he said.
The challenge with existential suffering is that there is no reliable therapy to treat it. “People have tried a number of approaches,” he explains. “None of them have been all that effective.”
Outside of popular culture, however, psychedelics have undergone a long journey to be considered for use in palliative care. Researchers began investigating the therapeutic potential of the drugs as early as the 1950s, but that work was largely halted until recently.
In the recent cases of four terminally ill patients, they were prescribed psilocybin. However, psilocybin is just one of many substances that fall under the psychedelic umbrella. Others in this category include lysergic acid diethylamide, better known as LSD, and mescaline.
While each substance has a unique origin, they all have similar effects on the mind. When taken in high doses, they can have strong effects on a person’s perception of the world. Users might experience hallucinations and confused senses, such as hearing colours or seeing sounds. People can also experience what is commonly known as a “bad trip,” which can manifest as intense fear or paranoia.
These substances have also been known to induce rich, spiritual-like experiences. In the 1950s and early 1960s, users of psychedelics would often report feelings of connection, love, and compassion for others.
This was a big deal for early mental health researchers. Early advocates of the drugs, such as Canada-based Dr. Humphry Osmond and British science-fiction writer Aldous Huxley, were among the first to consider psychedelics as a treatment for mental health. Throughout the 1950s, the two men exchanged many letters on the topic, trying to understand how psychedelics affect the mind and how to leverage these drugs to treat conditions such as alcoholism.
At the time, Osmond was conducting LSD trials with his patients at the Weyburn Mental Hospital in Weyburn, Sask. Patients in these trials reported feeling stronger, more optimistic, and receptive to therapy. These feelings, the patients said, continued long after the hallucinogenic effects of the LSD wore off.
Huxley himself experimented with psychedelics as medical treatment. He would later write to Osmond about how the drugs helped him and his wife find peace as she succumbed to cancer. The experience was so profound that Huxley requested the same for his own death; he died with LSD in his veins in 1963.
Downar said the psychedelic experience is profound because it forces the user to undergo a process called ego dissolution.
“[This is] when the barrier between the self and the universe goes away,” he explained. “You essentially become one with the universe.”
He feels this experience of ego dissolution seems to be key to the effectiveness of psychedelic therapy for existential distress. When a person goes through this process, they can learn to adopt a new perspective on their life and their problems.
“The idea is that [your suffering] bothers you, but it’s not debilitating, crippling or making you want to end your life,” Downar explained.
In the context of end-of-life care, psychedelics can be used to reduce the sense of loss that causes existential distress, and are usually done with the help of a trained psychedelic therapist.
The user will sit comfortably in a room and they will be administered a large dose of a psychedelic like psilocybin. The therapist will then talk to them and help them explore their feelings.
The process lasts anywhere from six to eight hours, after which the ego dissolution wears off, but the lessons learned from the experience remain.
The problems with this method come down to expense and practicality, which is why it has taken so long for psychedelics to be taken seriously as a mental health therapy.
“You have to have a lot of therapists available at the drop of a hat,” said Downar. “We don’t really have that in Canada.”
In the absence of available therapists, micro-dosing was considered another potential treatment method for end-of-life patients.
In the 1950s, governments were looking for innovative ways to provide health care while reducing costs. Around the same time, over-the-counter prescriptions for anti-depressants or anti-anxiety pills were becoming a popular way to treat mental illnesses. People could receive treatment by taking their medications with no medical supervision required.
In a similar process, Downar said that micro-dosing psychedelics can help patients. Psychedelic micro-dosing involves having patients take sub-hallucinogenic amounts of the drug more frequently than they would higher dosages.
These micro-doses can be consumed at home and without the need for a trained therapist.
“The idea is that you can give people a prescription and they’ll get the same benefit as if they had six hours of therapy,” Downar explained.
However, micro-dosing still needs to be researched more thoroughly before it can be widely adopted.
Dr. Erika Dyck is a medical historian at the University of Saskatchewan and says that over-the-counter prescriptions are a useful fiscal solution to replace expensive in-person medical care.
Until recently, there hasn’t been an over-the-counter equivalent for psychedelics that could take the place of intense sessions with a trained therapist.
There also remain some cultural barriers to the acceptance of psychedelics as a viable therapy.
The history of psychedelics is a complicated one, Dyck explains.
“By 1962, there [was] the identification of a huge black market for LSD, and we started to see more and more teens freaking out, having bad effects.”
She says that newspapers at the time focused on these bad effects without acknowledging that the teens in question may have also been taking other substances.
“All of that doesn’t really matter when it becomes front-page headlines for years,” she explained.
By that point in time in Canada, LSD was categorized as a Schedule III narcotic, belonging to a category of drugs that were thought to pose the least amount of risk for abuse but were still illegal for non-research purposes.
Downar says that a stigma remains towards psychedelics in some parts of the palliative care community. He also explained that ketamine had a similar reputational problem before it became a common anaesthetic for surgeries.
With more research, Downar suggests that LSD might follow a similar path towards acceptance.
He has recently received funding to explore micro-dosing as a therapy for people in existential distress.
“For those of us who work in the business, this is a no-brainer,” he said. “We know how common these problems are and we know that we need the tools to be able to respond.”
If you require resources or assistance surrounding mental illnesses, please visit the Mental Health Commission of Canada’s website to learn more. You can also find palliative care resources on the Canadian Hospice and Palliative Care Association website.
Eric Dicaire is an aspiring health reporter in Montreal, Q.C. While facing his own health issues, he earned his master’s degree in Communication from the University of Ottawa. He has since worked in the Ontario health sector and is now taking a break to study journalism at Concordia University. He can usually be found with headphones on, taking in the podcasts of the week or listening to one of his favourite bands.