An online survey reveals that 79% of Canadians support the use of psilocybin to treat existential distress in patients suffering from an incurable disease. While the production, sale and possession of this active ingredient from hallucinogenic mushrooms is currently prohibited in Canada, a unique access program allows people to obtain an exemption for medical or scientific reasons.
“Studies have already shown that psilocybin, combined with psychotherapy, produces rapid, robust and lasting anxiolytic and antidepressant effects in patients who have advanced cancer,” states lead researcher Michel Dorval, professor at the Université Laval’s Faculty of Pharmacy and researcher at the CHU de Québec-Université Laval Research Center.
“Our results indicate that the social acceptability of this intervention is high in the Canadian population,” he comments. “If we consider only Québec respondents, the acceptability rate is similar to the national average.”
The survey included 1,000 respondents from Québec and 1,800 from Ontario, Alberta and British Columbia.
Psilocybin in healthcare
The study published in Palliative Medicine specifically focused on the social acceptability of the intervention when delivered by healthcare professionals.
While nearly four out of five respondents found psilocybin-assisted therapy a reasonable medical choice for a patient suffering from existential distress at the end-of-life, 84.8% agreed that the public health system should cover the costs of the intervention. Moreover, 63.3% would welcome the legalization of the substance for medical purposes.
In Canada, doctors can apply for the exemption of psilocybin on behalf of their patients if psychotherapy, antidepressants or anxiolytics have failed or if a patient’s condition requires urgent intervention.
“This substance can bring about a profound awareness that leads the patient to view existence from a different perspective. Treatment with psilocybin, combined with psychotherapy, can produce relief for up to six months,” underscores Dorval.
The researchers hope that the survey’s findings may contribute to improving access to therapy in palliative and end-of-life care settings and mobilizing resources.
Support drivers
Survey respondents exposed to palliative care had a higher support rating for psilocybin.
“Having been close to loved ones at the end of life, or having witnessed their distress, could explain this openness to new approaches designed to help people at this stage of their life,” he suggests.
In addition, support was higher among people who previously used psilocybin.
Dorval explains: “There are still many prejudices against psychedelic substances. Familiarity with these substances probably helps better understand their true effects and therapeutic potential.”
Market and research developments
Psilocybin and other psychedelics are gaining popularity in mental health support for their effects on the brain, treatment-resistant depression and addiction.
Last year, a clinical trial on psilocybin treatment found it could clinically and significantly reduce depressive symptoms and functional disability without serious adverse events. Participants received the psychedelic combined with psychological support before, during and after dosing.
Earlier research revealed that psychedelics outperformed antidepressants, as psilocybin activates a different set of serotonin depressors instead of suppressing emotions — common effects of antidepressants.
There have also been several movements to legalize psychedelics for public use to move the “magic mushroom” into the mainstream market.
Meanwhile, the US Food and Drug Administration has issued guidance to the industry as the use of psychedelic drugs for medical conditions gains interest and popularity. The guidance supports the development of treatments based on psychedelics and opens the discussion on the use of the products in clinical trials.
— End-of-life cancer patients in a therapy group in Canada used psilocybin to reduce their fears. It helped some find peace.
Valorie Masuda, left, Gail Peekeekoot, center, and Barb Fehlau participate in a grounding ceremony for staff members at Roots to Thrive, a wellness center in Nanaimo, British Columbia, in August.
By Meryl Davids Landau
When Brian Meyer received a Stage 4 prostate cancer diagnosis three years ago at age 62, he was determined to make the most of his remaining years. He immediately retired from a decades-long career in the grocery business and took every opportunity to hike, camp and — his all-time favorite — fish for salmon. Brian and his wife, Cheryl, regularly visited their two grown children and three grandsons and spent time with their many friends.
But it was sometimes hard to keep his mind off his pain and the reality that life was nearing an end. “It tugs at the heart all the time,” Meyer, from Vancouver Island, British Columbia, said in August. A calm person by nature, he found his anxiety skyrocketing.
By November, though, despite a new, highly aggressive liver cancer that shrank his prognosis to months or weeks, Meyer felt calm much of the time. The prime reason: a 25-milligram dose of the psychedelic drug psilocybin he had taken several months earlier, due to a Canadian program being watched elsewhere for the emotional benefits it may offer people nearing death.
In mid-August, Meyer and nine other people with terminal cancers had gathered in two rooms, and there, lying on plush floor mats with blankets covering their bodies, their eyes covered by sleeping masks and music piped in over headphones, they swallowed the psilocybin capsules. The consciousness-altering drug, administered by the nonprofit Vancouver Island wellness center Roots to Thrive, set Meyer and the others on a six-hour journey of fantastical images and thoughts. The hope was that this “trip” would lead to lasting improvements in mood and lessen their angst around death. It was accompanied by weeks of Zoom group therapy sessions before and after, along with an in-person gathering the evening before for a medical clearance and the opportunity for participants and their spouses to meet in person.
Canadian health-care providers have been able to offer this otherwise illegal drug since 2022 when the country’s national health-care system began a special access program for certain patients with serious or life-threatening diseases. To date, 168 Canadians have been authorized to receive the drug under the program. Similar access is not available in the United States, because a terminal patient’s right to try experimental therapies excludes psychedelics, which are banned by the Controlled Substances Act. Oregon and Colorado are in the early stages of allowing psilocybin-assisted psychotherapy due to ballot initiatives passed in the states, but people who receive the drug there could be charged with a crime under the federal law.
Clinical trials assessing psychedelics for various mental health concerns tend to administer them to patients individually. But Roots to Thrive prefers to do it in groups. “The group process in psychedelic-assisted therapy allows for a shared experience that helps people realize they are not alone in experiencing difficult emotions, symptoms or challenging life circumstances,” said Pam Kryskow, the center’s medical director.
By the time Meyer swallowed the psilocybin capsule, he felt comfortable with his cohort. Some, like Christine “Cat” Parlee, 53, who has Stage 4 melanoma that has spread to her lungs and throat, had become friends. At a restaurant where Parlee, her husband, Cory, and Cheryl gathered before the in-person meeting, Brian and Cat shared their hope that the drug experience would be joyful and that it would subsequently enhance their peace of mind.
The day after taking the psychedelic, however, sprawled on a couch in the resort room Brian and Cheryl had rented for the week, Meyer couldn’t conceal his disappointment. Although he didn’t have a negative trip, two of the other participants were overwhelmed by the drug’s intense effects and spent the hours yelling for it to stop. This repeatedly pulled Meyer away from the intriguing images filling his mind, including sword-fighting in a medieval castle yard and cooking elaborate meals of lobster and lamb in a massive industrial kitchen.
His mental journey was also interrupted by having to urinate regularly, a symptom of his prostate cancer, although he was struck by the intense spiritual connection he felt with one of the facilitators, registered nurse Gail Peekeekoot, as she touched his hands to guide him to the restroom. “It was like she was me, I was her. We were one together,” he marveled.
Psychedelic journeys don’t always proceed as people anticipate, leaving some feeling dissatisfied immediately after, said Barb Fehlau, a palliative care practitioner on Vancouver Island and the medical facilitator in the room, who herself has pancreatic cancer. Regardless of the experience while the drug is active, though, psychological healing often follows, she said.
That was the case for Meyer. In addition to his enhanced calmness, he remarked in November that taking the drug seemed to have deepened the connection he felt toward the friends and family who had streamed into his and Cheryl’s home following his worsened prognosis. “I have a way more sensitive outlook. I feel more love toward people,” Brian relayed at the time. Three weeks later, in a hospital surrounded by more than a dozen family members, Brian died. “He remained calm, peaceful and joyful” to the end, Cheryl said.
Should psychedelics ever be legalized as medicine — the first, methylenedioxy-methamphetamine, or MDMA, to treat post-traumatic stress disorder was submitted to the U.S. Food and Drug Administration in December by the MAPS Public Benefit Corporation (now called Lykos Therapeutics) — people who might benefit most are those who have a terminal diagnosis, said Anthony Bossis, a clinical assistant professor of psychiatry at New York University.
Psychedelics do not alter the course of the person’s disease, but they can help make the remaining time more meaningful, Bossis said. He is co-author of a 2016 study of 29 cancer patients that found that a single dose of psilocybin significantly reduced depression and anxiety and “led to decreases in cancer-related demoralization and hopelessness, improved spiritual wellbeing, and increased quality of life,” the study reported.
Feeling a sense of connection to something larger than themselves, akin to what Meyer experienced with Peekeekoot, may be especially important, the study found. “After this experience, people often say, ‘I realized I’m not just my cancer. I’m not just this body. I’m something more enduring.’ This is a real gift,” Bossis said.
How psychedelics might change a person’s outlook is under investigation. One study with mice this past summer by Johns Hopkins University researchers found that the drugs reopen “critical learning periods” in the brain for months after their use. Mice studies don’t translate exactly to humans, but this finding suggests that psychedelics may cause people to be especially receptive to new ideas and ways of being.
Still, the research on psilocybin for those at the end of their lives is in the early stage, and whether the drug might prove harmful for some isn’t yet known. Roots to Thrive’s unpublished research surveying 20 people from its prior three psilocybin group sessions found many felt more positive, peaceful, lighter and less stressed. But four felt little to no change.
Cat Parlee, who participated with Meyer in the August session, had taken psilocybin two prior times at Roots to Thrive in the previous 18 months. While some people experience lasting transformation after taking the drug once, Parlee found that after six months her fears and anxiety would return.
Reclining on a comfortable hammock chair on their home’s back patio the day after Parlee’s August session, her husband, Cory, says the two have come to view the psyche as if it were a cookie with pieces bitten off around the edges. “The psychedelics help Cat find the missing pieces that make her more whole,” Cory reflected. “Psychedelics help you answer questions you may not know or give yourself permission to ask.”
Cat Parlee agreed. “Every time I’ve walked out of psychedelic medicine session, I feel like I’ve left weight behind — weight I’ve consciously decided I’m not going to carry anymore,” she said. This included the negative emotions she had felt toward her deceased mother and the people who badgered her to try the cancer “cures” they read about online. “A lot of energy was wasted on a lot of anger, a lot of sadness and a lot of guilt. I realized I don’t have time to waste on that anymore,” she said.
While many people might benefit from addressing psychological issues that impede their lives, the urge to confront such demons often intensifies when a person is given a few months or years to live, according to Shannon Dames, the founder of Roots to Thrive. Most of us operate under the illusion that we have time to change these things, Dames said. “When you’re at a place when you don’t have that perception of time, there’s a calling that’s really potent.”
About a month before his death, Meyer credited the psychedelic with reducing the discomfort he felt about dying. “I don’t want to say I’m excited, but I am very curious now,” he said. He realized the mushrooms had taken him to an unknown, altered world; death would do the same.
In Parlee’s case, her fear “was that there is nothing — just emptiness — after you’re dead.” During her second psilocybin trip, she watched herself swim in brightly lit, vivid waters amid an intense feeling of love. She was soothed by the sense that experience may be similar to the afterlife.
Since her August session, Parlee has also increasingly found pleasure in standing up for her needs, rather than always worrying about other people as she had previously done. “There’s one thing I want to do before I leave this world: It’s to know that I spent my last few years happy. One thing I can say right now is I don’t have any real regrets,” she said.
Then she took a deep breath and smiled. “I don’t know if I would have ever gotten to that place without this psilocybin journey.”
From left to right: Dr. Alden Doerner Rinaldi, Dr. Caitlin Brennan, Dr. Zachary Sager, Dr. Roxanne Sholevar, and Dr. Yvan Beaussant pose for a portrait inside one of the rooms at the Care Dimensions “Hospice House” in Lincoln where dying patients can receive synthetic psilocybin as part of a small trial by researchers at Dana-Farber Cancer Institute.
Sixty years after Harvard fired Timothy Leary over his experiments with psychedelic drugs, a hospital affiliated with the university has reopened the door on such research by testing whether hallucinogenic mushrooms can help dying patients face death.
The small trial by researchers at Dana-Farber Cancer Institute’s Psychedelic-Assisted Therapy program is the first to test synthetic psilocybin — the active ingredient in so-called magic mushrooms — in patients in hospice care, according to experts. The patients have cancer, heart disease, and other terminal illnesses and six months or less to live.
The pilot study, which combinesa single dose of the psychedelic drug with talk therapy, began in 2022 with the approval of the Food and Drug Administration, and has so far provided psilocybin to eight patients, six of whom have since died. The trial, which is expected to be completed next year after two more patients receive doses, is gauging how well dying patients tolerate the drug and whether it eases their “psychological and existential distress.”
It is only the second study of psychedelics at a Harvard-affiliated institution since the school fired Leary as a psychology lecturer in 1963 for unethical scientific practices, according to researchers. McLean Hospital, a psychiatric teaching hospital of Harvard Medical School, began testing another psychedelic, MDMA, or ecstasy, on cancer patients with anxiety in 2006. But controversy derailed the study, which ended without publication of findings.
Dr. Yvan Beaussant, a palliative care physician at Dana-Farber who is leading the new trial, said he hopes it shows whether psilocybin — used for centuries by the indigenous peoples of Mexico and Central America — along with talk therapy can relieve “demoralization syndrome,” a clinical term for the hopelessness and meaninglessness often experienced by hospice patients.
“These people are facing the most challenging phase of life, dying,” said Beaussant. The eight psilocybin recipients reported varying reactions to the drug, he said, but many later felt a renewed sense of purpose and deeper connections to loved ones. To confirm those benefits, Beaussant said he hopes to launch a larger trial.
Dr. Yvan Beaussant, a palliative care physician at Dana-Farber who is leading a small trial testing synthetic psilocybin — the active ingredient in so-called magic mushrooms — in patients in hospice care.
Psilocybin, like LSD and other psychedelics, is illegal to buy, possess, or distribute outside of a clinical trial; in 1970 the Nixon administration placed it on the federal government’s list of Schedule One substances, on par with heroin.
But over the past 15 years or so, researchers have tested psilocybin’s potential therapeutic benefits, particularly for people with severe depression and anxiety. Some experts say a growing body of evidence shows that under the right circumstances, psilocybin can improve the mood of patients much faster than traditional psychiatric drugs or talk therapy.
Dr. Roxanne Sholevar, a Dana-Farber psychiatrist and fellow investigator in the psilocybin trial, said she was profoundly moved by the experiences of two terminally ill patients whom she counseled and stayed with during mind-altering trips.
One was a 47-year-old woman who had withdrawn emotionally from her two teenaged children while facing death from pulmonary fibrosis, a progressive lung disease. After taking the drug, the woman reported a mystical experience during which she came upon a primordial river where life began, Sholevar said.
She told Sholevar afterward that she realized that all living things had come from the river, and, like them, she would return to it when she died. That helped allay her depression and anxiety and led her to leave a videotaped message to her children saying she would always be with them.
The other patient, an 81-year-old man who was a devout Catholic, felt life was meaningless because of his impending death, and the death of his wife several years earlier. The man, who also had pulmonary fibrosis, took the capsule containing psilocybin and found himself transported to a dark cathedral where he encountered an “ominous presence” that scared him, Sholevar said.
The researchers summoned a hospice chaplain to comfort him, and the man’s agitation faded. He later told Sholevar that he realized that the purpose of his remaining days was to receive and share God’s love.
“These shifts that I’m describing are the type of things that take years of psychotherapy,” said Sholevar. “I am stunned and reverent and just deeply curious about what we are seeing here and how we can develop this to further enhance its safety and rigor.”
Sholevar and Beaussant said the study could also have a side benefit: repairing the reputation of Timothy Leary.
Timothy Leary caused a furor as a lecturer in clinical psychology at Harvard in the early 1960s when he was studying psilocybin, which was legal at the time.
Leary caused a furor as a lecturer in clinical psychology at Harvardin the early 1960s when he was studying psilocybin, which was legal at the time. Faculty members and administrators complained that he was giving hallucinogens to students and sometimes taking the substances with people he was studying. Leary contended that psychedelic drugs, including LSD, could transform personality and expand human consciousness.
After his firing, Leary went on to urge young people to “turn on, tune in, drop out,” becoming an oracle to hippies and a publicity-seeking crackpot in the eyes of critics. President Richard Nixon allegedly described him as “the most dangerous man in America.”
Still, the psychologist helped to pioneer the importance of “set” ― mindset — and “setting” in the safe use of psychedelic drugs, said Beaussant and Sholevar. That insight is crucial to the team of researchers who guide terminally ill patients through mind-altering trips.
All the participants are in home hospice care provided by Care Dimensions, a hospice provider in Massachusetts. The patients must undergo two counseling sessions at home with a team of two therapists who prepare them to take psilocybin and discuss what they hope to get out of it. Patients are advised to “trust, let go, and be open” to the experience “even if it’s intense or uncomfortable,” Beaussant said.
“People might have blissful experiences,” he said, but others have “very challenging” trips. “Sometimes what might come up is a sense of what you’ve lost, past trauma, painful memories,” he explained. “The idea is not to avoid that.”
Patients undergo two more therapy sessions at home after using the drug to discuss how the experience affected them and how that might change how they live the rest of their lives.
The setting for the trips isthe 18-bed Care Dimensions Hospice House, located on 12 wooded acres in Lincoln. Patients typically sit on a recliner or lie in a bed in a room with a patio and a view of landscaped gardens. They wear eye masks to focus their attention inward. Donning headphones, they listen to soothing music on a playlistsynched to the onset, peak, and fading effects of the psychedelic experience, which typically lasts about six hours.
At least one researcher stays by the patients’ side, checking their heart rate and blood pressure, both of which typically rise modestly under the influence of psilocybin. It’s critical that patients feel safe.
“The idea of set and setting — we know these factors are really important in shaping the nature of the experience and its potential therapeutic value,” Beaussant said. “That’s work Timothy Leary introduced.”
A curled-up Timothy Leary reads a book in 1961.
The notion of rehabilitating Leary’s reputation may seem improbable. But so is the surging interest in the potential benefits of hallucinogens to treat a variety of maladies, from depression to post-traumatic stress disorder to obsessive compulsive disorder — even to irritable bowel syndrome.
“We call it the psychedelic renaissance,”said Rick Doblin, a psychedelic drug activist and founder of the Multidisciplinary Association for Psychedelic Studies, who lives in Belmont. His organization hopes to win FDA approval in mid-2024 of MDMA as part of a treatment forpost-traumatic stress disorder.
In recent years, the country’s top medical schools have raced to set up psychedelic research centers, and investors have funneled millions of dollars into start-ups exploring the therapeutic potential of such compounds.
Prominent medical schools supporting psychedelic research include Johns Hopkins, NYU and UCLA.
Massachusetts General Hospital, another Harvard-affiliated teaching hospital, established the Center for the Neuroscience of Psychedelics in 2021 to study the substances. It is planning trials of psychedelics for maladies ranging from rumination to fibromyalgia but hasn’t started testing the compounds yet.
Michael Pollan, author of the best-selling 2018 book “How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence,” was startled to hear about the Dana-Farber study.
“That’s a big deal because of Harvard’s history with psychedelics and the institutional embarrassment over the Timothy Leary episode,” said Pollan, who teaches creative writing at Harvard but is on leave this semester. “I would have thought they’d be the last university in America to venture back into the water.”
Pollan was not surprised, however, by the scientific interest in psychedelics to treat mental disorders.
“The mental health care system is broken,” he said, and clinicians are “desperate for new tools.”
A bed in one of the rooms at the Care Dimensions “Hospice House” in Lincoln where dying patients can receive synthetic psilocybin as part of a small trial by researchers at Dana-Farber Cancer Institute.
— A 5-day Hamilton workshop taught participants how to use psilocybin therapeutically
Participants in TheraPsil’s psilocybin therapy training in Hamilton (clockwise from top left: psychiatrist Cheryl Willsie, psychotherapist Deven Wilkins and social worker Richard Utama) lay under a strobe light that produces altered states of consciousness, according to the organization.
Psychiatrist Cheryl Willsie spent nearly a week in Hamilton learning how to walk a patient through an experience on psychedelic drugs.
She and two other healthcare professionals learned how to prepare a patient for a therapy session where they take psilocybin – the psychedelic compound in so-called magic mushrooms.
Willsie also learned how to support the patient through the experience and how to help process what came up in a later session.
The five-day training session at Energy Tap, a psychotherapy office on York Boulevard, was offered by TheraPsil, a national organization that advocates for expanded access to psilocybin.
The group learned how to guide patients through an experience on psilocybin with the goal of helping them to better understand their inner world – and ideally, to feel better.
Many of the patients who can legally access this kind of treatment are facing death from a terminal illness, noted Willsie.
“Around end-of-life care, it’s been really remarkable to see the benefits people have had with only two or three dosing sessions,” she told CBC Hamilton on Monday.
“People have had a lot of relief around their mental and emotional suffering around having a terminal diagnosis.
Willsie, who is from Sarnia, Ont., was drawn to include psychedelics into her practice after seeing promising research into its mental health uses.
“I realized that with medication and with talk therapy alone, most people just weren’t getting better,” she said.
“That’s really driven my excitement about psychedelic-assisted therapy.”
‘Deepening and expanding the therapeutic process’
Willsie already offers therapy using ketamine, a dissociative drug that can also have psychedelic and anesthetic effects. It can be legally prescribed by a physician.
“I am seeing that [ketamine] allows people deeper access to their subconscious in reprocessing past trauma,” she said. “It’s sort of deepening and expanding the therapeutic process.”
Research is showing psilocybin can have positive outcomes for patients as well.
A Johns Hopkins University study published last year found two treatments of psilocybin, when paired with psychotherapy, can produce “substantial antidepressant effects” in patients with major depressive disorder for more than a year.
Psychiatrist Cheryl Willsie participates in a TheraPsil training session held in Hamilton over five days ending Tuesday, July 31, 2023. She is pictured doing a breathing exercise that produces an altered state in participants.
In late June, the federal government announced nearly $3 million in funding for the Canadian Institutes of Health Research to support three clinical trials examining psilocybin-assisted psychotherapy to treat alcohol use disorder, treatment-resistant depression and end-of-life psychological distress in advanced-stage cancer patients.
“While clinical trials with psilocybin have shown promising results, at this time, there are no approved therapeutic products containing psilocybin in Canada or elsewhere,” states Health Canada’s website, suggesting interested patients seek out clinical trials.
Patients with some conditions can apply for legal access
But while psilocybin remains illegal, patients with end-of-life distress, treatment-resistant depression and major depressive disorder can apply to Health Canada to access it.
In 2021, just over 60 Canadians were granted an exemption, according to Health Canada data obtained by CBC London. In 2022, 97 exemptions were granted. This year, only three patients had been approved to use psilocybin as of June.
Those are the patients TheraPsil is training healthcare professionals to support.
The organization is also pushing the government to simplify the program and expand access, says Yasmeen deRosenroll, the organization’s director of training and operations.
“Right now there are people who are dying because they aren’t getting a quick enough response and it is a bureaucratic process,” she said Tuesday. “People are either dying without access or going to the underground.”
A recent petition, created by University of Alberta ethicist Brendan Leier and supported by Conservative Member of Parliament from Alberta Garnett Genuis, is also asking the federal government to make it easier to prescribe psilocybin.
The petition, signed by 3,932 people as of Aug. 2, notes psilocybin’s “low potential for harm… It is paradoxical and unethical to allow physicians to provide [Medical Assistance in Dying] for their patients while preventing the same physicians from treating their end of life distress with psilocybin.”
Some dying patients ‘completely transformed’ by treatment :advocate
TheraPsil’s deRosenroll says that while there is risk in the treatment – it’s not a panacea, and can leave some patients disappointed and dejected if it doesn’t work for them – the risk is higher for people who don’t use trained professionals to guide their experience.
“We advocate for legal use and with trained healthcare professionals because professionals belong to a professional college with a code of ethics and a disciplinary body,” she said, noting TheraPsil has trained more than 500 people so far, and offers a directory where patients can search for a care provider who has been trained.
The organization has seen numerous success stories, which is what propels the organization’s work, says deRosenroll.
“We’ve had patients share stories about how their lives have been completely transformed and perhaps instead of choosing [Medical Assistance in Dying], they will then continue on with their life after the psilocybin session,” she said.
“We’ve also heard the opposite of people being like, ‘You know what? I had my psilocybin experience, I’m content, and I am now ready to die.'”
— In his new memoir, Prince Harry talks about taking psychedelics to deal with the ongoing pain over the death of his mother. Here’s what we know and don’t know about their effectiveness.
By Dana G. Smith
Prince Harry and Meghan Markle have been remarkably transparent about their psychological struggles. In a documentary about mental health that he filmed with Oprah Winfrey in 2021, Harry included a video of himself undergoing E.M.D.R., or eye movement desensitization and reprocessing therapy, which helps people with post-traumatic stress disorder cope with triggering memories. Ms. Markle has spoken candidly about experiencing depression and suicidal thoughts.
Harry’s new memoir, “Spare,” is no different, including raw and sometimes shocking details about his battles with mental illness. At the center of many of these experiences is his grief and trauma over the death in 1997 of his mother, Princess Diana, when he was 12 years old.
In the book, he described trying both traditional and unconventional ways to cope with his pain and that using psychedelics was particularly helpful. After one therapist suggested that he suffered from PTSD, Harry started to use mushrooms and ayahuasca “therapeutically, medicinally.” (He had previously experimented with psychedelics recreationally.) “They didn’t simply allow me to escape reality for a while, they let me redefine reality,” he wrote.
Psychedelic therapy has experienced a groundswell of enthusiasm over the past decade as research mounts showing the mind-altering drugs can be useful for treating depression and other mental health disorders. (The therapy is still illegal in most places and is primarily done in underground sessions, abroad or through clinical trials.) However, there is scant evidence about whether psilocybin — the psychoactive ingredient in hallucinogenic mushrooms — and ayahuasca might be helpful for processing grief and trauma specifically.
Dr. Joshua Woolley, director of the Translational Psychedelic Research Program at the University of California, San Francisco, is optimistic about the drugs’ potential. “Can psychedelics help with the experience of grief? I would say probably yes,” he said.
But other experts are less bullish on the idea of using them for trauma. “The actual evidence is really lacking,” said Dr. Shaili Jain, a PTSD specialist at Stanford University and author of “The Unspeakable Mind.” “It’s very early, and we still don’t know the long-term side effects. We are not there yet.”
Grief Versus Prolonged Grief
Grief is not a mental illness; it is a normal human experience that comes after the loss of a loved one. Sadness, anger and disbelief that the person is dead — something that Harry described in his book — are all typical responses to the profound pain of death and can last for months or years. However, if the grief has not improved at all after a year and is affecting a person’s ability to function, a diagnosis of prolonged grief, sometimes called complicated grief, might be warranted.
“What we see with prolonged grief is that the grief becomes very entrenched, that things look the same for this person today as they did the day after” the death, said Mary-Frances O’Connor, an associate professor of psychology at the University of Arizona and author of “The Grieving Brain.” “For a person who’s adapting more typically, a year after a loss, they’re still going to have sadness. They’re still going to miss the person who’s gone. But you can see this trajectory of change where they have started to restore a life that feels meaningful to them.”
People with prolonged grief may feel that life has lost its meaning or that a part of themselves has also died; they might have intense emotional pain or feel complete psychological numbness. Harry does not say in his book whether he was ever diagnosed with prolonged grief, but he does describe some of these emotions, and symptoms of PTSD and prolonged grief often overlap. About 10 percent of people mourning a loved one will develop prolonged grief, and the risk is higher if the death happened suddenly or traumatically.
Treatment for prolonged grief often involves cognitive behavioral therapy to help people start to move on and engage in meaningful activities again while they continue to cope with the grief. “It’s not about taking grief away,” Dr. O’Connor said. “It’s about learning how to live with the fact that you are a person who has waves of grief now.”
Using Psychedelics for Grief
Scientists think that psychedelics work in two ways: through their chemical effects on the brain and the subjective experiences a person has while on the drugs. For many people, psychedelics act like “a very intense, fast psychotherapy,” Dr. Woolley said.
Psychedelics “have this potential to induce these transpersonal states of consciousness where people might feel like they are connected” to the deceased relative or friend, added Greg Fonzo, co-director of the Center for Psychedelic Research and Therapy at Dell Medical School, University of Texas at Austin. “That might allow people to move past some of the stuckness that occurs when they’re in this phase of grief.”
In the brain, scientists think that psychedelics induce a “plastic state,” helping to rapidly form new connections between cells. Those new connections may be behind the insights and reprocessing that people can experience when they use the drugs in a therapeutic setting.
There are very few published studies focusing on psychedelics’ effect on people experiencing prolonged grief. In one of the few relevant trials, Dr. Woolley looked at whether psilocybin, combined with group therapy, could help older, long-term AIDS survivors process their depression and survivor’s guilt surrounding their diagnosis, as well as the loss of friends and family to AIDS. The 2020 study, which included just 18 men, assessed the participants’ levels of demoralization — a therapeutic term for an existential sense of hopelessness and loss of meaning in life. Most of the participants had experienced profound grief and trauma because of the AIDS epidemic; on average, the participants had lost 17 loved ones to the disease.
After one psychedelic therapy session, nearly 90 percent of the men experienced a reduction in demoralization, and many saw a decrease in symptoms of PTSD and complicated grief. In a follow-up paper describing the men’s subjective experiences, the researchers wrote that psilocybin was “a catalyst for reconstructing their identities from rigidly centered on their past traumas to more flexible and growth-oriented life narratives.”
“The people in our study often talked about feeling stuck and detached from people around them and not able to move forward,” Dr. Woolley said. The psilocybin “did seem to help them move forward, to become unstuck and start being more engaged in life.”
Another study published in 2020 by researchers in Spain found that 39 bereaved adults who took part in ayahuasca ceremonies at a retreat center in Peru reported a decrease in the severity of their grief, and those benefits lasted for at least a year. The researchers wrote that people using ayahuasca to process their grief “described emotional confrontations with the reality of the death, the reviewing of biographical memories, and a re-encounter with the deceased.”
While these results are promising, both studies were small and neither included a control arm to compare the effects of the psychedelics against a placebo or another medication. The majority of participants in the ayahuasca study also reported that they expected to benefit from the experience, which may have had an impact on the results.
There is stronger evidence that psilocybin can be useful in treating depression, including in trials comparing the drugs’ efficacy to standard antidepressant medications. Similarly, M.D.M.A, which is sometimes classified as a psychedelic, has been shown to be effective at treating PTSD. Some researchers think that because prolonged grief has many similarities with depression and PTSD, psychedelics could be useful for treating it too.
Dr. O’Connor said that given how scientists think psychedelics work in the brain to treat depression, it’s conceivable that the drugs could also be helpful for people with prolonged grief. However, she cautioned against using the drugs to cope with grief that had not been diagnosed as prolonged or complicated.
“I would not say that it is appropriate to intervene with something as mind-altering, as dramatic, as psychedelic therapy if a person is, in fact, healing in the way that we would expect them to,” Dr. O’Connor said. “Meaning, I would worry that you could do more harm than good and that it just may not be necessary.”
The experts also emphasized that experimenting with the drugs recreationally is not the same as using them in a controlled therapeutic environment. After trying psychedelics in both settings, Prince Harry echoed this sentiment. In an interview with 60 Minutes, he said that he “would never recommend people to do this recreationally,” but that in the right setting the drugs worked “as a medicine” to help him process his grief and trauma.
Psychedelics drugs may help dying patients face death. However, practitioners and researchers advise caution. End-of-life is a unique time with a distinct set of risks requiring specialized care. Using psychedelics for patients facing death has yet to be thoroughly tested.
Psychedelic drugs may help end-of-life patients by opening floodgates of new brain connections, reducing anxiety and feelings of isolation.
Research suggests side effects and risks of psychedelics for therapy are low in medically stable subjects.
End of life patients, however, face unique circumstance and are not medically stable.
Hope surrounds the promise of psychedelic-assisted therapy, but more research with terminally ill patients is needed.
In the meantime, there are other ways end-of-life patients can find connection, peace, and meaning.
Using psychedelic drugs (psilocybin, DMT/Ayahuasca, ketamine, MDMA, and LSD) for mental health treatment is a hot topic in current research.
America’s mental health crisis has not abetted, showing a need for innovative treatment. Evidence and confidence are growing around psychedelic use paired with talk therapy.
Mental anguish is common among people with terminal illnesses. As therapy with psychedelics continues to demonstrate emotional healing, more practitioners are eager to use the tool for end-of-life patients.
A powerful therapeutic tool
Psychedelic drugs, also known as magic mushrooms and hallucinogens, affect mood, energy levels, cognition, and perception. For many people, they stimulate profound spiritual experiences, dissolving the feeling of disconnection from self, the world, the universe, and a higher power.
People around the world have used psychedelics for centuries as a cultural and spiritual practice. Today psychedelics in both plant-based and synthetic forms are used recreationally and in scientific studies.
Many therapists, psychologists, and psychiatrists cite dramatic improvements in conditions like anxiety, depression, and post-traumatic stress disorder, lasting for weeks to months.
Science isn’t sure how psychedelics work, but they briefly quiet some parts of the brain and open others, causing a floodgate of new connections. This floodgate releases people from entrenched thought patterns and builds new neurological connections, something known as neuroplasticity.
As a result, many people change their minds and their lives.
These life-changing revelations can arise from disturbing psychedelic trips. Still, many who endure a gut-wrenching hallucinogenic journey say it was one of the top five most important events in their lives – worth the anguish for the rich healing.
Research suggests the best outcomes – long-lasting and life-changing – happen with intense therapy before and after taking a psychedelic drug.
Perhaps the most powerful outcome of using psychedelics for therapy is an increased sense of belonging. Connectedness is a deep, human need regardless of race, ethnicity, and culture. Feeling disconnected causes internal turmoil that can lead to chronic health problems.
Psychedelics for end-of-life care
In the last weeks and months of their lives, people face an intense rollercoaster of emotions, including fear, anxiety, and sadness.
Research has shown that psychedelic therapy can reduce death anxiety and increase a sense of connection and meaning for end-of-life (EOL) patients.
An academic book published in 2022 called Disruptive Psychopharmacology discusses the current science of psychedelic use for therapy and its safety and implementation. Psychiatrists and neuroscientists from John Hopkins and the University of California, San Francisco, collaborated on an end-of-life and palliative care chapter. They reviewed the research on psychedelics for patients facing the last stage of a terminal illness, often cancer.
As the authors noted, research with psychedelics for terminally ill patients started in the 1960s. Since then, research with dying patients continues to be promising – although narrow in scope – for improving depression, fear of death, discouragement, and connectedness.
Relief from fear and isolation are two serious emotional challenges for EOL patients. They seek peace and connection to their loved ones. Psychedelics coupled with therapy could achieve more comfort.
The risks of psychedelics for EOL
However, the psychology community advises caution in using psychedelics for end-of-life patients.
According to Dr. David B. Yaden and his team of researchers who wrote the EOL chapter in Disruptive Psychopharmacology, most researchers have studied psychedelic use with medically stable patients, even if they have a mental illness.
EOL patients are not medically stable and can be highly stressed. Psychedelics may worsen symptoms like insomnia, confusion, delirium, shortness of breath, and diarrhea.
They could also cause patients to question long-held spiritual beliefs, possibly adding more stress to the patient and loved ones.
The authors also said we know too little about whether psychedelics interact safely with medications commonly given to EOL patients.
Furthermore, there are no dosing and treatment protocols, certification processes, or professional organizations to oversee the safe use of psychedelic therapy.
Even worse, there are too many reports of sexual abuse by psychedelic-assisted therapists. Thorough training and vetting of therapists are needed because assisting psychedelic trips is very specialized and challenging for therapists.
In a 2022 Medium article, Dr. Rosalind Watts, a leading researcher on the therapeutic use of psychedelics, wrote that real healing is possible when psychedelics are “interwoven into very intentional therapy…The drug was a catalyst to the therapeutic process, not the therapeutic process itself.” She worries we focus on the drug and not the expertise of therapists.
Palliative care specialists say there are many natural wonders – spiritual and physical – in the dying process. They worry that psychedelics may negatively interrupt a naturally beautiful process that, by itself, can create positive transformation.
Obtaining psychedelics for EOL therapy
Psychedelics are only legally available for research studies, but in the coming years, that will change.
Oregon and Colorado legalized psychedelics for therapeutic use in the United States, while several other states have decriminalized them. Once a drug is legalized or authorized by the FDA, however, implementing their use can still take a few – sometimes several – years.
Other ways to open your mind
Music triggers the brain’s pleasure center and a broad, highly diverse network of brain neurons.
Studies suggest spirituality – like psychedelics – hushes the self-focused parts of the brain. This effect happens in the deepest states of prayer and worship, causing “me” to meld seamlessly into connectedness with others, the universe, and a higher power.
Various forms of meditation also open neurological pathways in transforming ways.
If you or a loved one face the end of life, it’s essential to talk with a spiritual advisor or a palliative care specialist who can help you find what works for you to feel connected and unafraid.
If you’re on TikTok or Instagram, you may have encountered one of nurse Julie McFadden’s viral videos about all things death and dying. Hospice Nurse Julie, as she’s known, shares just how beautiful and difficult dying can be, and has a thing or two to say about how we can make things better for the many people who suffer unnecessarily at the end of life.
“Sometimes no matter what we do, it’s not enough. Despite how hard we try to control symptoms for patients so they can have a good quality of life toward the end of their lives, they and their families still suffer,” McFadden said when we reached out to her recently. “We don’t always know why the medicine we give patients for pain, anxiety, or agitation isn’t working. If there could be a better way to treat people where they can still enjoy their loved ones at the end of life, then why not use it?” McFadden asks.
One of us is a nurse and one of us is a physician, so we know the terror and pain those at end of life can face. We’ve come to believe that the careful administration of psychedelic treatments can make a huge difference in a person’s end-of-life experience. Dying well may not be on the minds of voters in Colorado right now, but it should be on Tuesday, when the state will vote on a ballot initiative determining whether to legalize psychedelic mushrooms.
More than two dozen other states and the U.S. House of Representatives are also grappling with their own versions of psychedelic legislation. Colorado may end up following in the footsteps of Oregon. In 2020, Oregon voters approved Ballot Measure 109 and became the first state in the country to allow the use of psilocybin to treat chronic mental health issues like PTSD and depression. Measure 109 is the country’s first chance to create a model for psychedelic treatment for a variety of mental health conditions. Oregon will launch its state-licensed psilocybin services program in 2023, and the way it addresses access, equity, and safety will inform what happens next in other states and countries. (One of us, Barbara, is a member of the Oregon Psilocybin Services Advisory Board.) While Measure 109 doesn’t limit itself by specifying conditions that can be treated with psilocybin, therapists and health care providers plan to recommend its use to treat depression, PTSD, and anxiety, and to help people kick addictions.
They also plan to use it to reduce anxiety for patients at the end of life. From the start, researchers have been curious about how psychedelics might affect people who are dying. An early study on psychedelics in the 1970s at Johns Hopkins University, inspired by a terminal illness diagnosis received by one of the staff nurses, focused on the potential to use LSD to treat psychological and existential distress in cancer patients. Several other studies on psychedelics in end-of-life care followed, and the research has resumed in the last decade or so—all to good effect.
We have both worked with patients who struggle with deep existential, spiritual, and practical questions about their deaths: When will it happen? How much pain will there be? What happens after I die? How will my loved ones bear my being gone? Some find peace toward the end, but others experience mental and physical symptoms of profound anxiety, depression, agitation, and more. To treat these symptoms, we have only a handful of tools—opiates, antidepressants, and sometimes, unfortunately, palliative sedation.
“When we’ve tried everything and we can’t get the person comfortable, when we are not expecting them to be comfortable and awake, our last resort is palliative sedation. But they don’t have any quality of life with that. … The goal for hospice is not to put someone to sleep until they die,” said McFadden.
The human body and brain undergo a series of profound changes over the course of dying. Some of these, like elevated anxiety and agitation, can be difficult for the patient, family members, and caregivers. In the most extreme cases, our only recourse as health care providers is palliative sedation, which, as McFadden described, is essentially putting a person into an induced coma through to their death. This option can be a heartbreaking loss for the patient and family members who are deprived of any more meaningful interaction and can also cause tremendous moral distress for the clinicians involved. Having more therapeutic options available that can significantly reduce end-of-life distress without numbing or sedating the patient would be absolutely transformative for the field of medicine.
By contrast, based on several recent clinical trials, there is evidence that a single treatment with psilocybin produces lasting and significant reduction in anxiety and depression for people with a terminal diagnosis. The data to date show that using psilocybin in a controlled therapeutic environment decreases death anxiety and increases optimism and quality of life for people near the end of life.
The end of life is not only a universal experience, we also know it’s one where psychedelic medicines can spur a massive paradigm shift in how we provide care.
Oregon’s Measure 109 gave us a start. But some counties and cities in Oregon have put psychedelics back on the ballot this Election Day, pointing to a need for more public education about the benefits of psychedelic-assisted therapy, and more clarity on how these programs will work. Colorado’s ballot measure has the potential to move things much further. We hope that future legislation might more directly address the unique needs of those at the end of life. Some patients may not be able to travel to a service center or may have health care providers who are afraid to recommend the use of psilocybin. Others may not be able to afford to pay for psilocybin sessions out of pocket, since insurance coverage is still unknown. These details matter—pushing to get them included in legislation up front will speed up the ability of clinicians and therapists to provide psychedelic-assisted care for those at the end of life upon the adoption of new laws.
We’re on the verge of a transformation in end-of-life care that will touch us all, in some way, and voters in Colorado have a unique opportunity to help shape the future. From legislation to implementation and public conversation, it’s time to take a serious look at how psychedelic medicines can reframe our relationship with living and dying. Of course, it’s also time to vote.
