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Ann and Alexander Shulgin

Psychedelics in Palliative Care

by Mellody Hayes | Scientific American | 20 March 2020

Drugs that foster feelings of uplift and connection can be therapeutic for many conditions in many phases of life.

After my presentation at a psychedelic science conference, a young professional woman approached me to share her moving story of healing and recovery from depression after participating in ketamine-assisted psychotherapy.

She explained she had languished in depression for 12 years, feeling trapped by fears and insecurity. She smiled, her lips painted a flirty fuchsia, and she seemed to embody her newfound freedom. No longer languishing in bed, she described that the shackles were off and she was free.

Her inspiring story of healing is strikingly common in the world of psychedelic medicine research, and one that has broader implications across the lifespan.

As an anesthesiologist with a focus on palliative care and psychedelic medicine, I recently shared my own story of healing at the summit at Headlands Center for the Arts on psychedelic medicine and palliative care.

Following medical treatment with ketamine, I was able to recover from physician burnout and achieve deeper relational healing. As the founder of Ceremony Health, I shared details about the center’s group therapy, healing rituals, and ketamine therapy for those experiencing fear in the face of a new life-changing medical diagnosis or seeking recovery from anxiety, depression, post-traumatic stress disorder and social isolation.

During the summit, many conversations ground into a well-worn groove: “How do we explain to the public that palliative care is about living, not merely about death and dying?”

Branding is a frequent topic because many associate the speciality of palliative care only with the end of life. Perhaps that is because some remain unaware that, as experts in symptom management, palliative care physicians can provide quality of life improvement for those with long-term debilitating illnesses over their lifetimes.

If a person is gravely ill, they can seek a referral for a palliative care specialist who can offer so much to the process—trying to optimize joy, not merely treat an illness.

Palliative care–supportive treatment focused on increasing wellness and reducing symptoms can actually provide better survival rates than traditional cancer care. Researchers in one 2010 combined study out of Massachusetts General Hospital, Columbia and Yale found that despite not having aggressive lung cancer treatment, those who received palliative care lived nearly three months longer than those who did have cancer treatments.

Yes, the specter of death haunts the field. But once in palliative care, patients often report that it is the care they wished they had all along.

Patients report increased satisfaction with care and improved quality of life. A meta-analysis published in 2018 even found that palliative care decreases the cost of health care, with hospitals saving an average of $3,237 per patient per hospital stay.

With care that is holistic, supportive, a bit less rushed and often offered by clinicians with keen communication skills, patients may also find refuge. A patient may find a receptive and healing audience for their cultural, spiritual, and emotional needs during illness.

B.J. Miller, a practicing palliative care physician at the University of California, San Francisco Medical Center and co-author with Shoshana Berger of A Beginner's Guide To The End, told conference participants, “Over time it becomes less about talking about the symptom inventory and just a dance to get to the hug at the end of the visit.”

Getting to the hug may become easier as Federal Drug Administration trials for psychedelic medicines for end-of-life anxiety approach completion. Johns Hopkins Center for Psychedelic and Consciousness Research is in phase III clinical trials to approve psilocybin for market as a prescription medication.

The FDA has given MDMA, designation as a breakthrough therapy. It is also in phase III of its clinical trials, the last phase before going to market as a prescription.

Colloquially, providers refer to psilocybin as magic mushrooms. New research is confirming its potency by showing that cancer patients treated just once with psilocybin experienced treatment benefits present five years later.

For those with anxiety in the face of a new illness diagnosis, treatment with psychedelic medicine provided relief from anxiety, allowing patients the capacity to engage with their medical care with more presence and purpose.

Additional treatment frontiers for psychedelic medicine include Alzheimer's dementia, anorexia, and opioid use disorder as more researchers conduct studies to evaluate additional treatment indications.

Although these psychedelic medications are generally considered physiologically safe, health care providers and patients should not underestimate their potency. They may not be appropriate for persons with a diagnosis of psychosis, and counselors with training in psychedelic care need to be involved in treatment with patients prescribed these drugs.

It’s important to understand that although psychedelic medicines are swiftly effective, the psychological changes patients experience during treatment may be daunting to some. The experience of treatment, often called “a journey,” takes courage because one may discover the shadows of one's own psychology. Some report intensely increased sensitivity to sensation.

A police officer who said he experienced underground treatment with psychedelic medicine shuddered as he recalled the experience, saying he should have been warned that he would be able to feel even the air on his skin.

For some who struggle with mental illness, treatment with psychedelic medicine may not be about living well with illness; it may provide some with a treatment that allows them to live free from illness.

For example, research shows that MDMA-assisted psychotherapy has a 76 percent success rate for patients with post-traumatic stress disorder symptoms, measured by remission one year after treatment.

For people trying to quit smoking, treatment with psilocybin helped 80 percent of people stay smoke-free six months after treatment, while traditional treatments are only effective for 10–35 percent of people. And robust clinical research is rehabilitating the reputation of the previously maligned “hippie” drug LSD as study results demonstrate its efficacy in treating end-of-life anxiety and alcoholism.

These “hug drugs,” as empathogenic (empathy creating) medications are called, often provide rapid transformation from pain and grief into wellness and emotional health, from isolation and sadness into connection and appreciation. It can also be transformation that lasts.

The transformation, hope and engagement in purpose that patients who undergo psychedelic treatment experience as a part of their palliative care contributes to their wellness. This may also help end the branding problem of palliative care.

As more patients in palliative care report feeling uplifted, connected and hopeful, perhaps it is time to change the name of the field to magic medicine.

Psychedelics in Palliative Care

Drugs that foster feelings of uplift and connection can be therapeutic for many conditions in many phases of life

blogs.scientificamerican.com

 

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Australian hospital to dose dying patients with synthetic psilocybin

by Barbara E. Bauer, MS | Psychedelic Science Review | 17 Jan 2019

St. Vincent’s Hospital, located in Melbourne, Australia has announced a new medical trial “aiming to ease the paralysing anxiety felt by palliative care patients.” The trial will evaluate the effects of administering a single dose of synthetic psilocybin under the supervision of psychiatrists. The dose of psilocybin to be administered was not announced.

The St. Vincent’s study recalls the work of Dr. Roland Griffiths and colleagues at Johns Hopkins University, published in 2018.1 Researchers at Johns Hopkins reported that six months after the conclusion of the study, a majority of patients who had received a “high” dose (22 or 30 milligrams per 70 kilograms of body weight) of synthetic psilocybin experienced clinically significant decreases in depressed mood and anxiety, and increases in well-being or life satisfaction six months after the final session of the study. Dr. Margaret Ross, a clinical psychologist at St Vincent’s commented on the Johns Hopkins research in an interview with NewsCorp:​

“The US study was really profound: some people were able to transcend their ideas about dying. It really relaxes those old rigid ways we have built up in the way we look at the world. They had remission of symptoms [of psychiatric distress]. It was rapid, it was dramatic, and it was beyond impressive, because it lasted for up to six months.”​

The press release announcing the trial and subsequent media coverage thereof highlight the increased public interest in psychedelic research of late, particularly in regard to psilocybin. However, this coverage also underscores the need for improved scientific and journalistic integrity in reporting on psychedelics. The trial’s announcement is titled “Mushroom Trial for Dying” and goes onto report that “DYING patients will be treated with psychedelic synthetic magic mushrooms”. No mushrooms, mushroom extracts or mushroom products will be used in the trial, synthetic or otherwise. The term “synthetic mushroom” also begs questions as to how mushrooms could be synthesized. Several media outlets including RT and VICE went on to incorrectly report that “magic mushrooms” would be used in the trial — all using the catchphrase “mushrooms” in the title of their articles.

The process to obtain approval to conduct the trial from Australian federal and state authorities and ethics committees took more than a year to complete.

Australian Hospital to Dose Dying Patients with Synthetic Psilocybin

St Vincent's Hospital of Melbourne, Australia will begin treating patients in April…

psychedelicreview.com

 

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Therapist striving to give end-of-life cancer patients psilocybin in a clinical setting*

by Sherry Amatenstein LCSW | VICE

In recent years there’s been no shortage of research suggesting that psychedelic drugs have medicinal applications. Studies out of the United States and Canada have pointed to a whole range of (still experimental) uses for MDMA and psilocybin, from treating PTSD and depression, to breaking addictions, to helping us face death.

But when it comes to making emerging treatments available to the public, especially drugs with a not-insignificant amount of cultural baggage, research alone isn’t enough. Looking to the cannabis movement, which just celebrated legalization in Canada on October 17, it was court battles over medicinal access that really put gears in motion nearly 20 years earlier.

Which is why my ears perked up when Bruce Tobin, an adjunct professor at the University of Victoria and practicing psychotherapist, told a crowd of more than 100 academics last week that he’s preparing for precisely this kind of legal battle, only this time he’s seeking medicinal access to the active ingredient in mushrooms for end-of-life cancer patients.

In a Friday morning conference session titled Activist Therapists: Taking Initiatives to Change Laws, Tobin recounted how it was a patient suffering from a terminal illness who first asked him to supervise a psychedelic session—a request he knew he couldn’t fulfill under Canadian law.

Tobin said this patient had tried pills, talk therapy, and even $1,000-a-day residential treatment in effort to beat debilitating anxiety around the certainty of their own death. They had read the same studies many of us have, recounted in the New York Times and elsewhere, that found a one-time psilocybin trip in a clinical setting can help relieve overwhelming existential distress.

“I was uncomfortable about breaking the law, but I didn’t want to ignore the suffering of my patients or my ethical duty toward them,” Tobin told the crowd. “I thought if I don’t want to break the law, I better try to change the law.” (This call to action prompted one of the most enthusiastic rounds of applause I heard that morning.)

With studies from John Hopkins Medical Center and New York University in hand, Tobin applied for an exemption under the Controlled Drugs and Substances Act in January 2017. In early discussions with Health Canada, Tobin learned he was the first therapist to bring forward a proposal of this kind in Canada.

So far the feds have been reluctant to move forward with the application without enthusiastic endorsements from BC’s health ministry and medical regulators—players Tobin says have been “noncommittal” when approached by his team.

But Tobin says 'The project felt winds in its sails again this summer,' when he connected with two Toronto cannabis lawyers interested in taking on his case pro-bono. One of those lawyers, Paul Lewin, has 20 years’ experience on the cannabis file and even defended for one of Canada’s landmark cases in 2013.

“He told me the other day on the phone that this is my most exciting case,” Tobin told VICE shortly after his talk. “So that’s really infused a new sense of energy and momentum into our dream.” With his new legal team and six other therapists, Tobin officially launched the Therapeutic Psilocybin for Canadians project days before weed became legal.

Tobin hasn’t been formally rejected by Health Canada, and he still hopes for a solution outside a courtroom. But given that Canadian courts have already decided that limiting medicinal access to an illegal drug like cannabis violates our constitutional rights, Tobin is feeling optimistic about the future of psychedelic science and treatment in Canada.

“I expect the timeline is going to be much shorter,” Tobin told VICE. “My basic attitude toward this whole thing has been careful, modest steps. Slow and steady wins the race. So we have given our project a very narrow focus in terms of what we want to see initially. We’re targeting end-of-life patients for whom nothing else has worked.”

Of course, there’s still a lot we don’t know about psychedelics, particularly when it comes to long-term effects. For now Tobin is limiting his request to patients with terminal cancer diagnoses, people so paralyzed by psychological distress that it’s interfering with their other treatment, and who don’t have a “long-term” to look forward to. But Tobin suspects this definition could expand over time as more studies and clinical trials accumulate.

“At this point we are really focused on turning that door handle, and that door at first is going to open just a very thin crack,” he said. “My guess is that once we get that underway we’re going to start seeing news stories coming out about the success in treatment of those patients, and things will begin to broaden out from the focus on end-of-life cancer patients, to end-of-life patients suffering other kinds of serious diseases like HIV-AIDS, and things will continue to broaden out from there.”

But even by optimistic projections, Tobin recognizes that some patients aren’t going to live long enough to see his team get legal backing. “Unfortunately that’s true, that’s a sad part of this story,” he told VICE.

Tobin says he didn’t “consciously” choose the same week as weed legalization to go public, but the timing makes for an interesting comparison. While Tobin’s legal argument may align with arguments made by weed activists of the last 20 years, he’s reluctant to follow in the footsteps of the cannabis movement on a few points. For one, civil disobedience has been a major tool in the weed activism toolbox, but Tobin wants to stay far away from what he calls “underground” psychedelic treatment.

“I am prepared to stay legal, to completely respect the law,” he said. “We have chosen to emulate the research at Johns Hopkins Medical Center as closely as we possibly can because they are the leaders in the science, and I think the less we invent our own wheel, the more we go with the accepted paradigm, the easier it will be for us, either with Health Canada or later in a court situation.”

*From the article here :
https://www.vice.com/en_ca/article/pa94v7/here-comes-the-legal-case-for-medicinal-psychedelics​

 

[mr peabody]

Compassionate use – Psychedelic Therapy for those who can’t wait

by Abigail Calder, MSc | Psychedelic Science Review | 29 Dec 2020

“Obviously, bureaucracy is not a human being. People have compassion. Bureaucracies don’t always have compassion." - Spencer Hawkswell

For the moment, psychedelic-assisted therapy takes place primarily in clinical trials. Legal, widely accessible treatment is at least several years away, assuming these trials continue to find positive results. But for some of the most desperate patients, it is already here in the form of compassionate use.

What is Compassionate Use?

Compassionate use, also known as expanded access, allows severely ill patients to try an experimental treatment if conventional therapies fail them. Drug approval policies are slow, and there are good reasons for not rushing medicines to market prematurely. But while some patients can afford to wait, for others, it is now or never. Compassionate use acknowledges desperate patients’ suffering and allows them to legally access promising medicines that have not yet been fully approved. Certain countries currently allow compassionate use of LSD, MDMA, and psilocybin, with some doctors calling for these programs to expand as soon as possible.

“Mind-Dissolving” therapy with LSD

One country in the world allows legal LSD-assisted psychotherapy: LSD’s original birthplace. In Switzerland, LSD therapy has been quietly available to a small number of patients since 2015. Of course, there are limitations: patients must live in Switzerland, and they must attempt approved treatments first. Apart from that, psychiatrists use their professional judgment—and current science—to decide which patients will benefit most from LSD-assisted therapy.

The evidence in favor of LSD’s safety and efficacy is strongest for depression, alcohol abuse, and anxiety, especially anxiety associated with life-threatening diseases. The small sample sizes of many studies on LSD suggest restraint when interpreting the results. However, LSD’s effects closely resemble those of is closely related to psilocybin, which modern scientists have researched more heavily than LSD itself. This leads some psychiatrists to generalize promising results from psilocybin studies to LSD, although research should still investigate possible differences in efficacy between the two.

Switzerland is not only unique for offering LSD-assisted therapy; it also has its own treatment philosophy. In most clinical research today, patients receive one large dose of a psychedelic drug sandwiched between several drug-free therapy sessions. Switzerland, on the other hand, largely integrates them into psycholytic therapy.

“Psycholytic” means “mind-dissolving,” referring to the theory that psychedelics dissolve the mind’s defenses to the benefit of the therapeutic process. Rather than one large dose, psycholytic therapy uses multiple, often smaller doses embedded in conventional psychotherapy, starting at 30µg for LSD. According to Swiss psychiatrists, this allows patients to contact important issues in their lives quickly and have deeply spiritual experiences whose benefits extend beyond the therapy itself.

MDMA Therapy for PTSD

Of all the substances lifted by the rising tide of the current psychedelic renaissance, MDMA could gain approval first. Its ability to ease the processing of traumatic memories makes it particularly promising for treating post-traumatic stress disorder (PTSD). In one of several Phase 2 trials, 83% of patients no longer fulfilled clinical criteria for PTSD after receiving MDMA-assisted therapy, compared to 25% of patients who received non-pharmacological therapy. Another study found that 68% of patients were still cured one year after treatment – and many had previously had PTSD for over a decade.

Impressive data like this has convinced regulatory bodies in multiple countries to allow MDMA-assisted psychotherapy in special cases. Switzerland permits it according to the same regulations as for LSD, and Israel has also allowed 50 patients to receive MDMA treatment for PTSD outside of clinical trials. The United States, too, now has an expanded access program directed by MAPS. Researchers at MAPS hope this is just the beginning: they are aiming for widely available MDMA-assisted psychotherapy by 2023.

Psilocybin Therapy for end-of-life distress

Like MDMA, psilocybin-assisted therapy has strong data behind it which has begun to justify expanded access. Although psilocybin may be useful for a broad spectrum of mental health issues, one particularly well-established application is treating distress in patients with life-threatening diseases. In a landmark 2016 study of cancer patients with depression and anxiety, 80% of participants experienced clinically significant improvements that lasted for at least six months after psilocybin treatment. Over half of them no longer had depression or anxiety at all. Further studies have supported and expanded upon these findings.

Based on these impressive data and the urgency inherent in treating terminal patients, Canada has begun allowing compassionate use of psilocybin therapy. While initial permissions were limited to four terminal cancer patients, they will likely not be the last. And because someone must be competent to administer psilocybin therapy, Canada has granted 17 healthcare professionals access to psilocybin for use in their training. According to those therapists, patients should be led into psychedelic experiences by those familiar with the terrain.

Doctors appeal for greater access

While compassionate use of psychedelic therapy has been granted for a few patients in a few countries, some doctors are not satisfied with the pace of government approval. They argue that for patients with life-threatening diseases, the clock is running out, and indeed runs out for more people every day. To them, “life-threatening” does not only mean terminal illness: it also includes diseases with an elevated risk of suicide, like depression and PTSD. Their argument is simple: especially for treatment-resistant patients, the expected benefits far outweigh the risks, including the risks of doing nothing.

A recent policy paper, co-signed by several prominent doctors and scientists, focuses on the debilitating chronic pain condition of cluster headaches. Cluster headaches affect millions of people worldwide and rank among the worst pain known to humankind — right up there with childbirth and kidney stones. Nicknamed “suicide headaches” by patients, they can be excruciating enough to cause PTSD. They also share commonalities with other chronic conditions eligible for compassionate use: they increase the risk of suicide, current treatments aren’t always effective, and preliminary studies suggest that psychedelic drugs can help.

According to the signatories of the policy paper, this combination of patient need and promising safety and efficacy data should justify access to psilocybin therapy. To the chagrin of many patients and their doctors, it is not legally available outside of clinical trials, even for compassionate use.

Psychedelic therapy, once a strange and obscure research topic, may now have enough good data behind it to justify a small place in the medical system. Compassionate use is where experimental treatments begin migrating from research labs to the real world. For many, treatment with unapproved drugs could potentially hurt more than help. But for some, doing nothing is far worse. As one Canadian patient said after receiving psilocybin therapy, “The acknowledgment of the pain and anxiety that I have been suffering with means a lot… Psilocybin changed everything for me.”

*From the article here:

Compassionate Use - Psychedelic Therapy for Those Who Can’t Wait

“Obviously, bureaucracy is not a human being. People have compassion. Bureaucracies don’t always have compassion.

psychedelicreview.com

 

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Overcoming fear of death with psychedelics*

by Richard Schiffman | Scientific American | 1 Dec 2016

Johns Hopkins clinical pharmacologist Roland Griffiths talks about a major new study hinting at psychedelic drugs as therapeutic powerhouses.

In one of the largest and most rigorous clinical investigations of psychedelic drugs to date, researchers at Johns Hopkins University and New York University have found that a single dose of psilocybin—the psychoactive compound in “magic” mushrooms—substantially diminished depression and anxiety in patients with advanced cancer.

Psychedelics were the subject of a flurry of serious medical research in the 1960s, when many scientists believed some of the mind-bending compounds held tremendous therapeutic promise for treating a number of conditions including severe mental health problems and alcohol addiction. But flamboyant Harvard psychology professor Timothy Leary—one of the top scientists involved—started aggressively promoting LSD as a consciousness expansion tool for the masses, and the youth counterculture movement answered the call in a big way. Leary lost his job and eventually became an international fugitive. Virtually all legal research on psychedelics shuddered to a halt when federal drug policies hardened in the 1970s.

The decades-long research blackout ended in 1999 when Roland Griffiths of Johns Hopkins was among the first to initiate a new series of studies on psilocybin. Griffiths has been called the grandfather of the current psychedelics research renaissance, and a 21st-century pioneer in the field—but the soft-spoken investigator is no activist or shaman/showman in the mold of Leary. He’s a scientifically cautious clinical pharmacologist and author of more than 300 studies on mood-altering substances from coffee to ketamine.

Much of Griffiths’ fascination with psychedelics stems from his own mindfulness meditation practice, which he says sparked his interest in altered states of consciousness. When he started administering psilocybin to volunteers for his research, he was stunned that more than two-thirds of the participants rated their psychedelic journey one of the most important experiences of their lives.

Griffiths believes that psychedelics are not just tools for exploring the far reaches of the human mind. He says they show remarkable potential for treating conditions ranging from drug and alcohol dependence to depression and post-traumatic stress disorder.

Clinical pharmacologist Roland Griffiths.

They may also help relieve one of humanity’s cruelest agonies: the angst that stems from facing the inevitability of death. In research conducted collaboratively by Griffiths and Stephen Ross, clinical director of the NYU Langone Center of Excellence on Addiction, 80 patients with life-threatening cancer in Baltimore and New York City were given laboratory-synthesized psilocybin in a carefully monitored setting, and in conjunction with limited psychological counseling. More than three-quarters reported significant relief from depression and anxiety—improvements that remained during a follow-up survey conducted six months after taking the compound, according to the double-blind study published December 1 in The Journal of Psychopharmacology.

“It is simply unprecedented in psychiatry that a single dose of a medicine produces these kinds of dramatic and enduring results,” Ross says. He and Griffiths acknowledge that psychedelics may never be available on the drugstore shelf. But the scientists do envision a promising future for these substances in controlled clinical use. In a wide-ranging interview, Griffiths told Scientific American about the cancer study and his other work with psychedelics—a field that he says could eventually contribute to helping ensure our survival as a species.

What were your concerns going into the cancer study?

The volunteers came to us often highly stressed and demoralized by their illness and the often-grueling medical treatment. I felt very cautious at first, wondering if this might not re-wound people dealing with the painful questions of death and dying. How do we know that this kind of experience with this disorienting compound wouldn’t exacerbate that? It turns out that it doesn’t. It does just the opposite. The experience appears to be deeply meaningful spiritually and personally, and very healing in the context of people’s understanding of their illness and how they manage that going forward.

Could you describe your procedure?

We spent at least eight hours talking to people about their cancer, their anxiety, their concerns and so on to develop good rapport with them before the trial. During the sessions there was no specific psychological intervention—we were just inviting people to lie on the couch and explore their own inner experience.

What did your research subjects tell you about that experience?

There is something about the core of this experience that opens people up to the great mystery of what it is that we don’t know. It is not that everybody comes out of it and says, ‘Oh, now I believe in life after death.’ That needn’t be the case at all. But the psilocybin experience enables a sense of deeper meaning, and an understanding that in the largest frame everything is fine and that there is nothing to be fearful of. There is a buoyancy that comes of that which is quite remarkable. To see people who are so beaten down by this illness, and they start actually providing reassurance to the people who love them most, telling them ‘it is all okay and there is no need to worry’— when a dying person can provide that type of clarity for their caretakers, even we researchers are left with a sense of wonder.

Was this positive result universal?

We found that the response was dose-specific. The larger dose created a much larger response than the lower dose. We also found that the occurrence of mystical-type experiences is positively correlated with positive outcomes: Those who underwent them were more likely to have enduring, large-magnitude changes in depression and anxiety.

Did any of your volunteers experience difficulties?

There are potential risks associated with these compounds. We can protect against a lot of those risks, it seems, through the screening and preparation procedure in our medical setting. About 30 percent of our people reported some fear or discomfort arising sometime during the experience. If individuals are anxious, then we might say a few words, or hold their hand. It is really just grounding them in consensual reality, reminding them that they have taken psilocybin, that everything is going to be alright. Very often these short-lived experiences of psychological challenge can be cathartic and serve as doorways into personal meaning and transcendence—but not always.

Where do you go from here?

The Heffter Research Institute, which funded our study, has just opened a dialogue with the FDA (Food and Drug Administration) about initiating a phase 3 investigation. A phase 3 clinical trial is the gold standard for determining whether something is clinically efficacious and meets the standards that are necessary for it to be released as a pharmaceutical. Approval would be under very narrow and restrictive conditions initially. The drug might be controlled by a central pharmacy, which sends it to clinics that are authorized to administer psilocybin in this therapeutic context. So this is not writing a prescription and taking it home. The analogy would be more like an anesthetic being dispensed and managed by an anesthesiologist.

You are also currently conducting research on psilocybin and smoking.

We are using psilocybin in conjunction with cognitive behavioral therapy with cigarette smokers to see if these deeply meaningful experiences that can happen with psilocybin can be linked with the intention and commitment to quit smoking, among people who have failed repeatedly to do so. Earlier we ran an uncontrolled pilot study on that in 50 volunteers, in which we had 80 percent abstinence rates at six months. Now we are doing a controlled clinical trial in that population.

How do you account for your remarkable initial results?

People who have taken psilocybin appear to have more confidence in their ability to change their own behavior and to manage their addictions. Prior to this experience, quite often the individual feels that they have no freedom relative to their addiction, that they are hooked and they don’t have the capacity to change. But after an experience of this sort—which is like backing up and seeing the larger picture—they begin to ask themselves ‘Why would I think that I couldn’t stop cigarette smoking? Why would I think that this craving is so compelling that I have to give in to it?’ When the psilocybin is coupled with cognitive behavioral therapy, which is giving smokers tools and a framework to work on this, it appears to be very helpful.

You are also working with meditation practitioners. Are they having similar experiences?

We have done an unpublished study with beginning meditators. We found that psilocybin potentiates their engagement with their spiritual practice, and it appears to boost dispositional characteristics like gratitude, compassion, altruism, sensitivity to others and forgiveness. We were interested in whether the psilocybin used in conjunction with meditation could create sustained changes in people that were of social value. And that appears to be the case.

So it is actually changing personality?

Yes. That is really interesting because personality is considered to be a fixed characteristic; it is generally thought to be locked down in an individual by their early twenties. And yet here we are seeing significant increases in their “openness” and other pro-social dimensions of personality, which are also correlated with creativity, so this is truly surprising.

Do we know what is actually happening in the brain?

We are doing neuro-imaging studies. Dr. Robin Carhart-Harris’s group at Imperial College in London is also doing neuro-imaging studies. So it is an area of very active investigation. The effects are perhaps explained, at least initially, by changes in something [in the brain] called “the default mode network,” which is involved in self-referential processing [and in sustaining our sense of ego]. It turns out that this network is hyperactive in depression. Interestingly, in meditation it becomes quiescent, and also with psilocybin it becomes quiescent. This may correlate with the experience of clarity of coming into the present moment.

That is perhaps an explanation of the acute effects, but the enduring effects are much less clear, and I don’t think that we have a good handle on that at all. Undoubtedly it is going to be much more complex than just the default mode network, because of the vast interconnectedness of brain function.

What are the practical implications of this kind of neurological and therapeutic knowledge of psychedelics?

Ultimately it is not really about psychedelics. Science is going to take it beyond psychedelics when we start understanding the brain mechanisms underlying this and begin harnessing these for the benefit of humankind.

The core mystical experience is one of the interconnectedness of all people and things, the awareness that we are all in this together. It is precisely the lack of this sense of mutual caretaking that puts our species at risk right now, with climate change and the development of weaponry that can destroy life on the planet. So the answer is not that everybody needs to take psychedelics. It is to understand what mechanisms maximize these kinds of experiences, and to learn how to harness them so that we don’t end up annihilating ourselves.

*From the article here :

Psilocybin: A Journey Beyond the Fear of Death?

Johns Hopkins clinical pharmacologist Roland Griffiths talks about a major new study hinting at psychedelic drugs as therapeutic powerhouses

www.scientificamerican.com

 

[mr peabody]

New legal push aims to speed magic mushrooms to dying patients

by JoNel Aleccia | KHN | 24 Nov 2020

This month, Aggarwal, who works at the Advanced Integrative Medical Science Institute, known as AIMS, took the first step toward federal authorization of the substance in Washington state and perhaps across the nation. He submitted an application to manufacture psilocybin to the state’s Pharmacy Quality Assurance Commission, which would allow him to grow psilocybin mushrooms from spores at his clinic and administer them for therapeutic use.

Commission members haven’t yet reviewed the application, but Gordon MacCracken, an agency spokesperson, said there “would be a path” for possible license and use — if the application meets the requirements of state regulators and the federal Drug Enforcement Administration.

Currently, psilocybin use is illegal under federal law, classified as a Schedule 1 drug under the U.S. Controlled Substances Act, which applies to chemicals and substances with no accepted medical use and a high potential for abuse, such as heroin and LSD.

Recently, however, several U.S. cities and states have voted to decriminalize possession of small amounts of psilocybin. This month, Oregon became the first state to legalize psilocybin for regulated use in treating intractable mental health problems. The first patients will have access beginning in January 2023.

It’s part of a wider movement to rekindle acceptance of psilocybin, which was among psychedelic drugs vilified — and ultimately banned — after the legendary counterculture excesses of the 1960s and 1970s.

“I think a lot of those demons, those fears, have been metabolized in the 50 years since then,” Aggarwal said. “Not completely, but we’ve moved it along so that it’s safe to try again.”

He points to a growing body of evidence that finds that psilocybin can have significant and lasting effects on psychological distress. The Johns Hopkins Center for Psychedelic and Consciousness Research, launched this year, has published dozens of peer-reviewed studies based on two decades of research. They include studies confirming that psilocybin helped patients grappling with major depressive disorder, thoughts of suicide and the emotional repercussions of a cancer diagnosis.

Psilocybin therapy appears to work by chemically altering brain function in a way that temporarily affects a person’s ego, or sense of self. In essence, it plays on the out-of-body experiences made famous in portrayals of America’s psychedelic ’60s.

By getting out of their heads — and separating from all the fear and emotion surrounding death — people experience “being” as something distinct from their physical forms. That leads to a fundamental shift in perspective, said Dr. Ira Byock, a palliative care specialist and medical officer for the Institute for Human Caring at Providence St. Joseph Health.

“What psychedelics do is foster a frame shift from feeling helpless and hopeless and that life is not worth living to seeing that we are connected to other people and we are connected to a universe that has inherent connection,” he said.

“Along with that shift in perspective, there is very commonly a notable dissolution of the fear of dying, of nonexistence and of loss, and that’s just remarkable.”

The key is to offer the drugs under controlled conditions, in a quiet room supervised by a trained guide, Byock said. “It turned out they are exceedingly safe when used in a carefully screened, carefully guided situation with trained therapists,” he said. “Almost the opposite is true when used in an unprepared, unscreened population.”

Baldeschwiler is one of many cancer patients eager to undergo psilocybin therapy to help quell the psychic pain that can accompany a terminal illness. Advocates say the therapy appears to work by temporarily altering brain function in a way that affects a person’s sense of self, helping them separate from the fear and emotion surrounding death.

Baldeschwiler is one of several AIMS cancer patients eager to undergo psilocybin therapy. Another is Michal Bloom, 64, of Seattle, who was diagnosed in 2017 with stage 3 ovarian cancer. "The anxiety of living with the terminal disease is overwhelming," she said.

“It’s as if someone came up to you, put a gun to the back of your head, whispered, ‘I have a gun to your head and I’ll have a gun to your head for the rest of your life. I may pull the trigger, I may not,’” she said. “How do you live like that?”

Research shows that a single six-hour session of psilocybin therapy may be enough to quell that fear, Aggarwal said. “I’m really interested in a right-to-try approach because it’s really what we need for patients right now,” he said.

Under the state and federal laws, to be eligible for “right-to-try” status, a treatment must have completed a phase 1 clinical trial approved by the federal Food and Drug Administration, be part of active clinical trials and in ongoing development or production.

So far, psilocybin ticks all those boxes, Tucker said.

The FDA has granted “breakthrough therapy” status to psilocybin for use in U.S. clinical trials conducted by Compass Pathways, a psychedelic research group in Britain, and by the Usona Institute, a nonprofit medical research group in Wisconsin. More than three dozen trials are recruiting participants or completed, federal records show.

But access to the drug remains a hurdle. Though psychedelic mushrooms grow wild in the Pacific Northwest and underground sources of the drug are available, finding a legal supply is nearly impossible.

Tucker and Aggarwal asked Usona last summer for a supply of the synthetic psilocybin its researchers produce for clinical trials, but so far have received nothing. Penny Patterson, a Usona spokesperson, said there’s been no “definitive resolution” and that conversations are continuing.

"The firm’s reluctance may reflect a larger unease with employing right-to-try laws to speed use of psilocybin," said Dr. Anthony Back, a palliative care physician at the University of Washington.

Back supports the use of psilocybin for cancer patients and has even tried the drug to better understand the experience. But he said using psilocybin outside of formal clinical trials might endanger Usona’s ability to get traditional FDA approval. Adverse events may occur that will have to be reported to the FDA, an agency already watching the research closely.

“I can see why they’re hesitant, to be honest,” Back said. “I think right-to-try is an uphill battle.”

Still, Tucker and other advocates say it’s a battle worth fighting. End of Life Washington, a group focused on helping terminally ill patients use the state’s Death With Dignity Act, recently published a policy that supports psilocybin therapy as a form of palliative care. Other treatments for anxiety and depression, such as medication and counseling, may simply not be practical or effective at that point, said Judith Gordon, a psychologist and member of the group’s board of directors.

“When people are dying, they don’t have the time or the energy to do a lot of psychotherapy,” she said.

Baldeschwiler agrees. With perhaps less than two years to live, she wants access to any tool that can ease her pain. Immunotherapy has helped with the physical symptoms, dramatically shrinking the size of the tumor on her chest. Harder to treat has been the gnawing anxiety that she won’t see her 16-year-old daughter, Shea McGinnis, and 13-year-old son, Gibson McGinnis, become adults.

“They are beautiful children, good spirits,” she said. “To know I might not be around for them sucks. It’s really hard.”

New Legal Push Aims to Speed Magic Mushrooms to Dying Patients

A proposal in Washington state would use right-to-try laws to allow terminally ill patients access to psilocybin — the famed magic mushrooms of America’s psychedelic ’60s — to ease depression and a…

khn.org

 

[mr peabody]

Doulas Alua Arthur and Virginia Chang

End-of-life doulas help people die comfortably. In a pandemic, they're more important than ever

by Maria Morava and Scottie Andrew | CNN | 9 Mar 2021

Alua Arthur wasn't looking for death.

At 34, she was trying hard to stay alive. Clinical depression had forced a leave of absence from her job as a lawyer, and she was traveling on a bus in Cuba when it met her: A woman, only two years older than her, dying of uterine cancer.

The two sat and talked for the seven hours to the woman's destination, and then for seven more when she decided to skip her stop.

Their conversation was about the end of life. It was the first time, the woman told Arthur, that someone had spoken with her about her disease and the possibility of dying.

"I tried to put myself in her shoes," Arthur told CNN. "I was like, 'If depression kills me, then what would I have made of my life?'"

Her answer came after returning from the trip: She would make her life about death.

Now, nine years later, Arthur works as a death doula and founder of Going with Grace, an organization that helps ailing people and their families prepare for death.

Death doulas belong to an emerging field

A doula is an ancient Greek term meaning a female helper.

The term has been adopted in childbirth settings to mean a person who provides non-medical support to a woman during pregnancy and childbirth.

But another type of doula has emerged -- this time at the other end of life.

And although death doulas are not a new idea, they belong to a relatively new profession.

The International End of Life Doula Association (INELDA), a pioneering organization in the field, was founded in 2015 to certify, support and research end-of-life doulas and their fields of practice.

Henry Fersko-Weiss, co-founder of the association, told CNN there are at least 20 individuals and organizations training death doulas in the US -- and he believes the field is steadily growing.

"There are tens of thousands who have been taught doula work," he said. "The percentage of people who come to serve the dying as practicing death doulas has been increasing steadily."

And they do it all

A death doula's work could mean logistical planning for the before, during and after of death; conducting rituals or comforting practices; helping the dying person reflect on their life and values; and explaining the bodily functions of dying to caregivers.

But there are intangibles, too -- only understood by hearing the stories of caregivers.

When her sister was dying in 2018, Marcia Minunni told CNN that Virginia Chang, a certified end-of-life doula and founder of Till The Last doula services, was a caring, honest presence.

A presence that her sister, though known for keeping "boundaries and borders up," immediately let in to her final moments.

"Was it the softness of (Chang's) voice, or the quiet of her presence, or perhaps the willingness of her kindness?" Minunni wrote in a letter to Chang after her sister's death. "I remember that day as if it was yesterday."

Minunni said her sister's body would relax around Chang, who would read poetry to her.

She died with Rumi poems, Frank Sinatra playing over an iPad and her hand on her sister's knee.

"How comforting is that?" Minunni said, and added: "(Chang) didn't have to physically be there for that ... human voice is just as important as touch."

Doulas have had to get creative during the pandemic

As Covid-19 has estranged loved ones from their family members at death, so too has it estranged death doulas from the primary field of their work: the bedside.
The pandemic has limited many doula services to remote-only interaction.

"I think it's unfortunate that we can't be bedside, because it can be very helpful to have an objective, third party ... presence during a very intense emotional time," Chang told CNN. "During Covid-19, these emotions and the intensity is only heightened because of the isolation."

But doulas are making it work.

They have to, given the demand for their services has spiked in light of Covid-19.

Arthur said her workload has quadrupled -- and for this, she's had to get creative.

"Doulas at Going with Grace are using video calling to scan bodies or listen to breathing," she said. Logistically, they are creating Amazon carts to easily get families what they need after the death.

Some doulas, though, have shifted their focus to supporting caregivers.

Many people have become caregivers unexpectedly to loved ones suffering from the virus, or from illnesses that make the virus more lethal.

"We're hearing these numbers of people dead, which just sound like the most ridiculous numbers," Arthur said. "And we're forgetting that they are all somebody's mother, brother, sister, teacher ... while the numbers sound high, that means there's many more people who are grieving."

It's not the only crisis they're facing

It wasn't just the pandemic. 2020 was a year of grief in more ways than one.

Last summer, when Arthur was reviewing applications for her doula training course, an answer to a question she always asks -- about the last death the applicant had witnessed -- struck her.

"George Floyd," they wrote.

"That shook me to my core," Arthur said. "It brought into really sharp focus that people watched somebody die ... the trauma, the pain, the grief ... I think a lot of what we saw afterward, the protests, were a really strong grief response."

"A year of grief ultimately brought people face-to-face with mortality," Chang said, countering an American taboo around death.

"People woke up and said 'Hey, this is not the way we want to die,'" she said.

With this new social awareness, she sees opportunity even at the grief-ridden nexus of crises.

"What we're seeing is a healthcare movement occurring simultaneously with a social movement," she said. "And those have always been ... times of great change and awareness in our society."

"All people deserve to die with dignity," she said. "All people deserve to die with care."

End-of-life doulas help people die comfortably. In a pandemic, they're more important than ever

Just as doulas support mothers through birth, death, or end-of-life doulas support people who are preparing for death.

www.cnn.com

 

[mr peabody]

Altered states can help us face death with serenity*

by Sam Gandy | PSYCHE | 8 Dec 2020

One way or another, we will all approach the end of life, we are all terminal, and existential anxiety can be a burden long before this. Studies by terror management theory researchers have found that when death salience is aroused in people, they adapt their behaviour and increase their reliance on defence mechanisms such as denial. The cultural anthropologist Ernest Becker argued in The Denial of Death (1973) that human civilisation is ultimately a symbolic defence mechanism against the awareness of our finite existence. He suggested that ‘consciousness of death is the primary repression, not sexuality’ as Sigmund Freud had popularised. Unconscious denial of death can have a demoralising effect on an individual, potentially affecting loved ones and the community as a whole.

By not facing the issue of our mortality prior to our passing, we miss a unique opportunity, not only to reconcile with death and make peace with it, but also to gain a sense of levity and serenity that we can carry with us through our lives. But how can we overcome a fear of death that’s so deeply rooted in our culture?

Research is starting to reveal that certain states of consciousness can have a powerful and positive effect on how we perceive our own mortality. There’s a strong association between a decreased fear of death and undergoing a near-death experience (NDE), out-of-body experience (OBE), lucid dream and psychedelic experience.

During an NDE, people report several features such as a transcendence of time and space, a life review, feelings that the experience is ineffable and authentic, encounters with deceased loved ones, and deep feelings of love and peace. One of the core transformative features of the NDE is an out-of-body experience, which is also associated with psychedelic experiences but, unlike these other states, is something that can be induced through training and intent.

One doesn’t even need to have these experiences personally to benefit from them. A number of NDE researchers have noted profound changes in their own outlook following encounters with people who have had an NDE. As noted by one leading researcher, simply hearing or reading about NDEs can have a profound impact, acting as a ‘benign virus’. Research has revealed that this can yield significant changes in people’s spirituality and appreciation for both life and death.

The psychiatrist Elaine Drysdale, who works with terminally ill cancer patients in Canada, has heard countless reports of NDEs, and assures patients and their relatives that the experience of death itself isn’t as painful or frightening as it might appear. She now teaches medical students and palliative care staff about the benefits of near-death research, and argues that NDEs allow us to approach the unknown and death without framing things in a religious way – they’re inclusive, personal and occur in cultures all over the world.

An OBE is a transpersonal experience where you feel your ‘sense of self’ shift beyond your physical body, encountering beings and places that feel real. Unlike NDEs, OBEs can be induced willingly. This experience can also occur spontaneously in healthy people while they’re deeply relaxed, in hypnagogic states, on the cusp of sleep, and during meditation. Almost all OBEs have a positive impact, with experiencers commonly reporting a sense of serenity, mental clarity, awe and interconnectedness.

The experience can act as a motivating catalyst to further understand yourself, and is commonly associated with a reduced fear of death. As the American neuroscientist Sam Harris points out: ‘whether or not a person’s consciousness can actually be displaced is perhaps irrelevant; the point is it can seem to be.’ Distortion of embodiment can be disorientating, but disorientating to whom, if we experience that we aren’t solely the totality of our body? One core feature linking these various experiences is the feeling of transcending one’s primary identification with the physical body. The perspective-shifting power of this effect is supported by experiments showing that even a simulated OBE induced by immersive virtual reality can lessen death anxiety.

The experience of transcending the physical body is frequently tied to feelings of connecting to something larger than oneself. This is usually associated with the experience of awe, an emotional state commonly linked to NDEs, OBEs and psychedelic experiences. It’s also experienced by astronauts when viewing the Earth from space, referred to as the ‘overview effect.’ It conjures a cognitive shift of perceptual vastness, reframing one’s reality and place within it. This draws parallels with OBEs and NDEs, which appear to evoke a kind of ‘outerview effect’ when people glance back at their body and feel separate from it. This change of core identification from a limited body to a more expansive sense of self can radically curb existential anxiety.

These altered traits could be related to ego-dissolution, which is another important experiential component of transcendent experiences. Such experiences are reliably catalysed by psychedelics and characterised by a loss of subjective self-identity; in essence, a simulated dying or death and rebirth experience. Following its dissolution, there’s a blurring of the perceived boundaries between self and other. Deep feelings of unity, awe and interconnection can stem from this. This experience is strongly associated with the mystical-type experiences that psychedelics can elicit and appears to be an important part of how psychedelics can alleviate death anxiety. Psychedelic therapy might also invoke a sense of ritual – something that has largely been lost to Western culture, but is an important part of many Indigenous cultures, including those that employ psychedelic substances, such as psilocybin, shamanically.

The evidence of the efficacy for psilocybin in treating existential angst is arguably the strongest of any yet obtained in the field of psychedelic research, following clinical studies conducted by the University of California, Los Angeles, Johns Hopkins University in Baltimore and New York University (NYU) exploring psilocybin as a treatment for existential anxiety in terminally ill cancer patients. Follow-up research by NYU found sustained reductions in death anxiety 4.5 years after a single psilocybin session in the overwhelming majority of study participants. Psilocybin can also catalyse feelings of death transcendence in those who aren’t facing a terminal diagnosis. This is an unprecedented finding in the field of psychiatry.

In the words of Anthony P Bossis, a clinical assistant professor of psychiatry at the NYU School of Medicine and the former director of palliative care research for the NYU trial:

"While there have been advances in chemotherapies and pain management, there remains a paucity of therapies to address and relieve the emotional anguish experienced by the dying. The psychedelic therapy model represents a potential paradigm shift for the future of hospice and palliative care, providing a novel and effective therapy to relieve the emotional and spiritual distress so often experienced at the end of life. Not only can it offer emotional and spiritual healing for those facing their mortality, but it can also help their families who witness the relief of suffering in their loved one."

Another substance that reliably yields ego-dissolving transcendental experiences and might hold promise is ketamine. Numerous studies have found that the experiences it elicits are closest to the NDE, in phenomenological quality, of all substances examined. On the matter of authenticity of psychedelic insights, the veteran American psychedelic pharmacologist David Nichols had this to say: ‘If it gives them peace, if it helps them to die peacefully with their friends and family at their side, I don’t care if it’s real or an illusion.’

The psychiatrist Stanislav Grof has likely supervised more psychedelic therapy sessions than anyone else alive. He treated terminally ill cancer patients with psychedelic therapy as part of his work with the Maryland Psychiatric Research Center. He observed patients describing these sessions as invaluable experiential training for dying, with some reporting NDEs as their disease progressed, which they described as yielding very similar states of consciousness. Grof commented that:

" ‘dying before dying’ influences deeply the quality of life and the basic strategy of existence. It reduces irrational drives … and increases the ability to live in the present and to enjoy simple life activities. Another important consequence … is a radical opening to spirituality of a universal and non-denominational type."

One thing reported in association with NDEs, OBEs, lucid dreams (dreams in which the dreamer is aware that they’re dreaming) and psychedelics (such as ayahuasca) is encountering deceased loved ones. Whether or not one takes the view such experiences are illusionary or ‘real’ in some sense doesn’t take away from the therapeutic power of these encounters. The Holocaust survivor, financier and philanthropist George Sarlo had a life-changing encounter with ayahuasca in his 70s, during which he had a conversation with his dead father who told him why he hadn’t said goodbye before he was deported to a Nazi labour camp. In turn, feelings of depression that Sarlo had harboured for much of his life evaporated. Others report the resolution of relationship conflicts, feelings of relief, and a sense of closure after encountering a deceased relative. However, these extraordinary experiences aren’t new, as Tibetan Buddhists have been wilfully inducing both OBEs and lucid dreams as part of Dream Yoga practice for millennia, for the purpose of exploring the nature of reality and as preparation for death.

These can be powerful experiences, however they do vary in character. In a comparative study looking at lucid dreams and OBEs, Samantha Treasure found that encounters with figures in OBEs were felt to be more impactful and cathartic than in lucid dreams. While encounters with figures in lucid dreams were generally interpreted as a product of the dreamer’s own mind, figures in OBEs were perceived as more ‘life-like’ and autonomous. It’s this aspect of OBEs, in which the experiencer feels connected to something beyond the self, that appears to make them such an effective salve for existential dread.

These different experiences have their own benefits and drawbacks. While NDEs can be powerfully transformative, they have the distinct disadvantage of occurring when one is approaching death, or at least thinks one is, which incurs far too much risk to the individual. Psychedelics used in a supportive, therapeutic context certainly hold promise, however they require careful handling given their powerful effects, while also being illegal in much of the world. While roughly one in 10 people will experience a spontaneous OBE once in their life, only a minority will experience them numerous times. Like lucid dreaming, however, OBEs are something that can be induced with intent, and through practice. Given their profound psychological effect, OBEs might be the ideal treatment for death anxiety in the underfunded palliative care system.

Jon Underwood, the founder of the Death Café movement, inspired many to talk openly about death. He died suddenly of undiagnosed acute promyelocytic leukaemia at the age of 44 in June 2017. He said: "Time is different when you know you’re dying. Time matters. Minutes matter. Time is not to be wasted. Sometime – soon – there will be no more time."

Perhaps by embracing our impermanence through the use of altered states, we can also help to relieve the collective anaesthetic of death-denial. In doing so, we might empower ourselves and others to meet our shared mortality with peace and equanimity, awaken to our aliveness, and greet death like an old friend.

*From the article here :

Altered states can help us face death with serenity and levity | Psyche Ideas

Near-death and out-of-body experiences can help us embrace our impermanence, letting us live and face death with serenity

psyche.co

 

[mr peabody]

Compassionate Use – Psychedelic Therapy for those who can’t wait

by Abigail Calder, MSc | Psychedelic Science Review | 29 Dec 2020

“Obviously, bureaucracy is not a human being. People have compassion. Bureaucracies don’t always have compassion." - Spencer Hawkswell

For the moment, psychedelic-assisted therapy takes place primarily in clinical trials. Legal, widely accessible treatment is at least several years away, assuming these trials continue to find positive results. But for some of the most desperate patients, it is already here in the form of compassionate use.

What is Compassionate Use?

Compassionate use, also known as expanded access, allows severely ill patients to try an experimental treatment if conventional therapies fail them. Drug approval policies are slow, and there are good reasons for not rushing medicines to market prematurely. But while some patients can afford to wait, for others, it is now or never. Compassionate use acknowledges desperate patients’ suffering and allows them to legally access promising medicines that have not yet been fully approved. Certain countries currently allow compassionate use of LSD, MDMA, and psilocybin, with some doctors calling for these programs to expand as soon as possible.

“Mind-dissolving” Therapy with LSD

One country in the world allows legal LSD-assisted psychotherapy: LSD’s original birthplace. In Switzerland, LSD therapy has been quietly available to a small number of patients since 2015. Of course, there are limitations: patients must live in Switzerland, and they must attempt approved treatments first. Apart from that, psychiatrists use their professional judgment—and current science—to decide which patients will benefit most from LSD-assisted therapy.

The evidence in favor of LSD’s safety and efficacy is strongest for depression, alcohol abuse, and anxiety, especially anxiety associated with life-threatening diseases. The small sample sizes of many studies on LSD suggest restraint when interpreting the results. However, LSD’s effects closely resemble those of is closely related to psilocybin, which modern scientists have researched more heavily than LSD itself. This leads some psychiatrists to generalize promising results from psilocybin studies to LSD, although research should still investigate possible differences in efficacy between the two.

Switzerland is not only unique for offering LSD-assisted therapy; it also has its own treatment philosophy. In most clinical research today, patients receive one large dose of a psychedelic drug sandwiched between several drug-free therapy sessions. Switzerland, on the other hand, largely integrates them into psycholytic therapy.

“Psycholytic” means “mind-dissolving,” referring to the theory that psychedelics dissolve the mind’s defenses to the benefit of the therapeutic process. Rather than one large dose, psycholytic therapy uses multiple, often smaller doses embedded in conventional psychotherapy, starting at 30µg for LSD. According to Swiss psychiatrists, this allows patients to contact important issues in their lives quickly and have deeply spiritual experiences whose benefits extend beyond the therapy itself.

MDMA Therapy for PTSD

Of all the substances lifted by the rising tide of the current psychedelic renaissance, MDMA could gain approval first. Its ability to ease the processing of traumatic memories makes it particularly promising for treating post-traumatic stress disorder (PTSD). In one of several Phase 2 trials, 83% of patients no longer fulfilled clinical criteria for PTSD after receiving MDMA-assisted therapy, compared to 25% of patients who received non-pharmacological therapy. Another study found that 68% of patients were still cured one year after treatment – and many had previously had PTSD for over a decade.

Impressive data like this has convinced regulatory bodies in multiple countries to allow MDMA-assisted psychotherapy in special cases. Switzerland permits it according to the same regulations as for LSD, and Israel has also allowed 50 patients to receive MDMA treatment for PTSD outside of clinical trials. The United States, too, now has an expanded access program directed by MAPS. Researchers at MAPS hope this is just the beginning: they are aiming for widely available MDMA-assisted psychotherapy by 2023.

Psilocybin Therapy for end-of-life distress

Like MDMA, psilocybin-assisted therapy has strong data behind it which has begun to justify expanded access. Although psilocybin may be useful for a broad spectrum of mental health issues, one particularly well-established application is treating distress in patients with life-threatening diseases. In a landmark 2016 study of cancer patients with depression and anxiety, 80% of participants experienced clinically significant improvements that lasted for at least six months after psilocybin treatment. Over half of them no longer had depression or anxiety at all. Further studies have supported and expanded upon these findings.

Based on these impressive data and the urgency inherent in treating terminal patients, Canada has begun allowing compassionate use of psilocybin therapy. While initial permissions were limited to four terminal cancer patients, they will likely not be the last. And because someone must be competent to administer psilocybin therapy, Canada has granted 17 healthcare professionals access to psilocybin for use in their training. According to those therapists, patients should be led into psychedelic experiences by those familiar with the terrain.

Doctors appeal for greater access

While compassionate use of psychedelic therapy has been granted for a few patients in a few countries, some doctors are not satisfied with the pace of government approval. They argue that for patients with life-threatening diseases, the clock is running out, and indeed runs out for more people every day. To them, “life-threatening” does not only mean terminal illness: it also includes diseases with an elevated risk of suicide, like depression and PTSD. Their argument is simple: especially for treatment-resistant patients, the expected benefits far outweigh the risks, including the risks of doing nothing.

A recent policy paper, co-signed by several prominent doctors and scientists, focuses on the debilitating chronic pain condition of cluster headaches. Cluster headaches affect millions of people worldwide and rank among the worst pain known to humankind — right up there with childbirth and kidney stones. Nicknamed “suicide headaches” by patients, they can be excruciating enough to cause PTSD. They also share commonalities with other chronic conditions eligible for compassionate use: they increase the risk of suicide, current treatments aren’t always effective, and preliminary studies suggest that psychedelic drugs can help.

According to the signatories of the policy paper, this combination of patient need and promising safety and efficacy data should justify access to psilocybin therapy. To the chagrin of many patients and their doctors, it is not legally available outside of clinical trials, even for compassionate use.

Psychedelic therapy, once a strange and obscure research topic, may now have enough good data behind it to justify a small place in the medical system. Compassionate use is where experimental treatments begin migrating from research labs to the real world. For many, treatment with unapproved drugs could potentially hurt more than help. But for some, doing nothing is far worse. As one Canadian patient said after receiving psilocybin therapy, “The acknowledgment of the pain and anxiety that I have been suffering with means a lot… Psilocybin changed everything for me.”

*From the article here:

Compassionate Use - Psychedelic Therapy for Those Who Can’t Wait

“Obviously, bureaucracy is not a human being. People have compassion. Bureaucracies don’t always have compassion.

psychedelicreview.com

 

[mr peabody]

Evan Sola, PsyD, MDMA therapist in LTI study talks about his experiential training

MDMA and the trauma of life threatening illnesses*

by Phil Wolfson, MD | psychedelic.support | 24 Nov 2020

Thanks to the success of modern medicine, more people are surviving life threatening illnesses (LTIs) than ever before. This also means more people are living with trauma that results from surviving these conditions. Join Dr. Phil Wolfson as he explores the results of an MDMA-assisted clinical trial for people with life threatening illnesses, and how psychedelic therapy could help treat, and even prevent, PTSD-LTI.

Modern medicine is producing a vast and rapidly increasing population of survivors of life threatening illnesses (LTIs) due to its successes. Unfortunately, for many the cost of survival may well be trauma to mind as well as body. From its difficult commencement, the impact on patients may well be harmful–with the shock and life change of diagnosis, the ensuing treatment which may well be arduous and diminishing of capacities both physical and mental, through often long term treatment, and then recovery. The nature of the traumas induced vary in depth, and symptomatology, on spirit and relationships.

Our experience with 18 subjects with life-threatening illnesses who enrolled in an MDMA-assisted clinical trial led us to the conviction that it is essential for prevention of this trauma that beginning with diagnosis of the LTI there be implementation of psychosocial strategies. Support for patients and their dear ones during the course of the illness and its medical treatment extending through the recovery period needs to be provided.

It is just not enough to focus our medical skills on interventions for illness and to leave on the sidelines the impact on the human experience. Our study delineated the breadth and variety of the traumatic reactions which we have defined as a new Post Traumatic Stress Disorder—PTSD-LTI. Delineation of the plethora of symptoms that make for this diagnosis has been described as well as criteria for diagnosis.​

…we with our subjects were able to have significant impact on their traumatic residues, their fears for relapse and death…​

MAPS sponsored our unique Phase 2 study of anxiety as the primary marker for those with LTIs and a life expectancy of at least one year. Based on what may well be the most intensive psychotherapy with subjects who have trauma from life-threatening illnesses (LTI), with MDMA experiences as a fundamental part of the process, we with our subjects were able to have significant impact on their traumatic residues, their fears for relapse and death, and their struggle to make recoveries with full resumption of lives that had moved on—morphed from before their diagnosis and the sudden threat of protracted illnesses and death itself.

MDMA-assisted psychotherapy is a reciprocal process and as much as our subjects responded and changed, so did we as practitioners. In fact, we experienced profound changes in our awareness of illnesses multiplicity of manifestations, the causation and breadth of trauma and our own self concepts.

Over the course of the three years of this intensive and intense study, we experienced a progressive revelation of the traumatic nature of this diagnosis and its aftermath, and its various manifestations in cognition, motivation, affect, spirit, meaning, relationships, and view of self. Exposed to our subjects’ suffering and impacted ways of being and to their tension with potential recurrence of illness and death, we grew to be a unit for exploration and healing.

So many of our sessions were marked by strong emotions and we often experienced a unity with our subjects’ suffering and liberation from it. For the mind, heart and spirit are inseparable and the MDMA experience carries this at its center. There is joy in this work, meaning and connection that is far more possible to achieve in the long and deep sessions of MDMA work.​

MDMA-assisted psychotherapy is a reciprocal process and as much as our subjects responded and changed, so did we as practitioners.​

While anxiety was our primary marker for enrollment in our program and for measuring its outcome, trauma in its impact on our subjects, was the predominant cause of the suffering they experienced. And while our focus was on the specific causation of the LTI and its aftermath, earlier trauma also was an inevitable part of the work.

We used the STAI Trait measure in conformity with other studies of psychedelic-assisted psychotherapy. But if I were to do it again, and we are in the process of preparing a ketamine-assisted psychotherapy study of LTIs, I would and will pursue using assessments of trauma as the primary measure.

In the best sense of developing clarity about suffering with LTIs (and other forms of suffering) coming to the PTSD-LTI designation continues the expansion of psychology’s reclamation of trauma to its true status as the overwhelming cause of human distress and dysfunction. Sadly, that realization remains incomplete.

Near attitudinal blindness continues to the effects of traumas to humans caused by prejudice and culturally embedded formats–such as racism, sexism, caste, and class that are forms of domination; to war; refugee displacement; poverty and to illness. That myopia remains and limits our evolving view. Prevention of trauma remains the abiding issue for developing a healthy population instead of a wounded population—as per the World Health Organization.​

Prevention of trauma remains the abiding issue for developing a healthy population instead of a wounded population.​

Our view of trauma from within psychiatric diagnostic categories such as those for depression and anxiety tends to be only partially reflective of lives lived and affected by past and ongoing trauma. Focusing on limiting clusters of symptoms, diagnoses can be constraining conceptual structures that prevent clear views of the complex matrix of existence and the fullness of the expressions of suffering in their myriad aspects.

It is essential to turn to a comprehensive and phenomenological view of suffering–its prolongation beyond the intruding traumas that are immediately afflictive; an awareness of prolonged traumatization; developmental trauma; its diverse expression in diverse beings.

This enables the therapeutic conversations that give forth recognition and validation to trauma victims in need of understanding themselves and for being understood. This does and will engender the conscious connections that are healing in themselves and lead to the alleviation of suffering–to the extent we are able; and to the prospect for better caring of those who have been afflicted with traumas.​

What makes this so appealing has been the demonstration of efficacy in small Phase 2 studies with MDMA in PTSD; with psilocybin for LTIs, and now, ours, the first to test MDMA as a treatment for this indication.​

While attention to the experience of those facing death from LTIs has become a more prominent part of palliative care and hospice consciousness and there have come to bear a variety of psychotherapies, it is only in recent years that it has been possible for a resumption of clinical interest in the potential for psychedelic medicines–provided in an assisted psychotherapy format-to address PTSD-LTIs.

What makes this so appealing has been the demonstration of efficacy in small Phase 2 studies with MDMA in PTSD; with psilocybin for LTIs, and now, ours, the first to test MDMA as a treatment for this indication. Prior studies with psilocybin have demonstrated the value of peak experiences on PTSD-LTIs and reduction of anxiety and depression. MDMA as less of a hallucinogen and operating through a variety of means to promote empathic connection to oneself and others, offers a different modality for psychotherapy.

With its wide variety of manifestations, the treatment of PTSD-LTI is an individualized matter. Yet, clusters of concerns emerge from personality, family, history, morality, religiosity, culture, gender, class, ethnicity and more. ‘Taking stock’ as life is threatened is one common path. So too is ‘denial’, even until the very end. So too is the great fear of cessation and non-being. As well as: who we are; who we feel ourselves to have been; peace or dissatisfaction; love or rage; or the mishmash of it all. Confusion is common to us and it comes and goes.

The compassionate non-judgmental work of being a therapist in such a crucible is many sided—moving, frustrating, loving, opening, patient, persevering, available, self-reflective, resonant, orchestrating, social working, family system conscious, and above all respectful of the differentiation of each of us. It relies on assisting in the access to each of our own desires for healing, connection, and realization.

In essence, for PTSD-LTI patients, there is a relatively specific set of treatment outcomes that are desirable and are relevant to the diagnosis. These can be clustered as follows with ratings provided subjectively:​

• Did your experience help you with recovery from the emotional effects of being diagnosed and treated for a life-threatening illness?​
• Do you feel more vital?​
• Are you able to feel more pleasure?​
• Do you have a greater sense of peace?​
• Did your experience help you to connect and integrate with the important others in your life?​
• Did your experience help you with your fears of death and dying?​
• Did your experience help you think about and plan for what you consider your remaining life span?​
• Have you been able to find and give meaning to your remaining life?​
• Do you feel you have made peace with the possibility of having a limited future?​
• Have you been held by or found a spiritual or religious path?​
• Have you been helped in planning for future treatment options and for your ultimate death?​
• Do people in your life notice a difference in you in these ways and other ways?​

While the improvements as expressed by the assessment measures used in our study certainly indicate these issues being addressed, it was in the therapeutic work with our subjects over the many days of contact in which these concerns were delineated and assistance rendered. Our study highlights the need for more sensitive measures that reflect the manifestations of PTSD-LTI and allow for assessment of the benefits of treatments for this difficult state.

It also supports the benefit of an intensive psychotherapeutic approach applied within a brief therapy context. The six-month follow-up assessment and psychotherapy session validated the continuing impact of our MDMA-assisted psychotherapy and is in contrast to the usual 8-week evaluative period for antidepressant trials. It argues for the intensity of contact between therapists and subjects as a cost-effective process.​

It argues for the intensity of contact between therapists and subjects as a cost-effective process.​

MDMA-assisted psychotherapy provides a unique approach to conscious work with patients. With the prolonged sessions that last 6-8 hours, therapists are more available to patients and must present as human beings in greater fullness than in conventional work. Trained to be cautions of countertransference and working dyadically, interaction is more alive and fruitful. The therapeutic crucible is based on the reality testing that is forthcoming from this contact.

Under MDMA’s particular influence, an open mind ensues with the possibility of letting go of persistent traumatic embedded attitudes caused by the LTI impact. While MDMA is not significantly hallucinogenic, it is powerfully trance and reverie inducing.

Mind moves in both recollection and imagination and is freed from its usual constraints and inhibitions. It opens the floodgate of compassion for self and others and suffering is realized, contextualized and expressed. By reducing the alarm system’s traumatically induced hypervigilance and self-protective mechanisms, MDMA balanced with the presence of therapists and the nest that has been constructed with its down lining of the assurance of safety—unlocks the fear-shut awareness of suffering and its causes. The ensuing rush of the spring waters of healing and balancing a new gush forth.

Each person, in their particular idiosyncratic fashion, may well experience the restructuring of self and an awakening of view leading down new paths and resulting in the ripening of the fruit of new life. As if there has been an inherent internal force awaiting its liberation, its resumption of being the guide to life lived ethically and passionately, creatively and in connection.

Rarely do psychiatrists and therapists write or speak of the exhilaration of having the opportunity to work intensively with their patients. The success of our study is reflected in the deeply moving experience of working with our subjects as well as in the outcome measures.

To succeed in psychotherapy, therapists must find compassion, respect and understanding for their patients—at least to some extent. MDMA-assisted psychotherapy brought us into intimate contact with the deepest of life’s struggles. While maintaining a therapeutic stance, we also participated in the intimacy of a shared human experience that touches us all.

MDMA-assisted psychotherapy has this particular nature to it. It does not work in this manner for everyone—no therapy is universally successful or applicable to all the ways in which humans are dilemma-d. So, as we build the psychedelic psychotherapy toolbox, our potential for administering a broader range of experiences adds to our hopeful success rate in alleviating and ameliorating suffering.

The work with psilocybin for LTIs has demonstrated its utility in providing a hallucinogenic experience that benefits those suffering with PTSD-LTI. This occurs with a different therapeutic construction that is deeply experiential in its inner liberation, and not primarily of a psycholytic nature as is the case with MDMA. The nest is built, the therapeutic relationship is supportive and the experience/experiencer interaction does the liberating rectification relying on the ‘mystical experience’ of the journey. This is the elegantly performed process initiated decades ago with mushrooms and LSD.

Ketamine-assisted psychotherapy available as presently the only legal psychedelic is of yet another nature. It can be psycholytically applied at low doses that reduce defensiveness and create access somewhat in the same vein as MDMA, or with more robust doses creating a time-out from ordinary mind, ego dissolution and access to realities of new construction.

Freed from obsessions, daily concerns and debilitating moods, the journey is liberating and on return enables a reconstruction of self and the recognition that not all is suffering, despair and inevitable. Ketamine is a profound hallucinogen which when embedded in its particular format for therapeutic work is beneficial for all sorts of human predicaments. And marijuana deserves its place and the practice of marijuana-assisted psychotherapy is growing and as it is legal now in most states can be amalgamated with ketamine or stand on its own.​

All psychedelics tend to move a person into a spaciousness of mind that is meditative in nature given our separation from constraints, usual attitudes and prejudices.​

The intent of all psychedelic psychotherapies is to result in a reduction of out mental attachments and enable freedom to explore our lives without being so encumbered. All psychedelics tend to move a person into a spaciousness of mind that is meditative in nature given our separation from constraints, usual attitudes and prejudices.

Psychedelic experiences tend to enhance one’s ability to imagine, be fresh and creative. Integrated with daily practices and the active realization of our connectedness to all things and all beings, they tend to bring a person closer to each other and ourselves for lives lived in gratitude, sharing, love and community. It is up to us to realize their potential as we build our practices and learn the potentialities for the therapeutic application of psychedelic medicines.

In the psychedelic gladiator’s arena, confusion arises. A tendency to extol the virtues and superiority of one medicine over another conforms to the ‘ownership’ of the psychedelic pharma development of their uses for prescription. Money, fame, and first to the finish line motivation all create mystification.

In fact, all psychedelic medicines have potential for broad effects and broad applications. Head-to-head studies may occur but seem frivolous. The realms for the therapeutic applications of our medicines as they become available are nurtured by our understanding of our patients, their particularities, personalities and struggles and our knowledge of the best practices and the therapeutic prospects emerging form our work together. This is the best way to proceed!

*From the article here :

MDMA and Life Threatening Illnesses - A Commentary to Our Study

Join Dr. Phil Wolfson in exploring MDMA-assisted therapy for people with life-threatening illnesses and how psychedelic therapy helped.

psychedelic.support

 

[mr peabody]

How ‘Death Doulas’ provide aid at the end of life

End-of-life doulas support people emotionally, physically, spiritually and practically: sitting vigil, giving hand massages, making snacks.

by Abby Ellin | New York Times | 24 Jun 2021

As parents of a child with a progressive and potentially fatal illness, Maryanne and Nick O’Hara lived on hope. Hope that their daughter, Caitlin, who was diagnosed with cystic fibrosis at age 2, would prove the statistics wrong and live longer than the 46 years expected. Hope that she would receive the lung transplant she spent two and a half years waiting for in her early 30s. Hope that her body wouldn’t reject it.

That hope faded on Dec. 20, 2016, when Caitlin O’Hara died of a brain bleed at the University of Pittsburgh Medical Center, two days post-transplant. She was 33.

Shattered, her mother decided to try to give meaning to her grief. And so she signed up for a certificate program at the University of Vermont’s Larner College of Medicine to become an end-of-life doula, or “death doula,” working with individuals and families as they moved from this life into whatever is next. (The terms “end-of-life doula” and “death doula” are used interchangeably, though some find the latter a little too blunt.)

“In our culture, we go overboard preparing for birth, but (just) ‘hope for the best’ at the end of life,” said Ms. O’Hara, 62, who lives in Boston and Ashland, Mass., and is the author of “Little Matches: A Memoir of Grief and Light,” published in April. “The training was really a way of going even deeper into my own grief and realizing how I could take my own experience and help other people have a better end of life."

“I saw for myself how horrifying it is during a medical crisis and then after a death, to realize that life keeps going and needs attending to,” she continued. “As soon as Caitlin passed, suddenly it’s over and the person is gone and you have to deal with the business of living. A good doula will support you with that.”

The word “doula” comes from the Greek word meaning “woman who serves,” though most people associate it with someone who helps during birth to usher in life. In recent years, however, more people have come to recognize the need for as much assistance at the end of life as the start, part of the so-called death positivity movement that is gaining momentum in the United States and other countries. The movement, popularized by the mortician and writer Caitlin Doughty, encourages open discussion on death and dying and people’s feelings on mortality.

“The beginning of life and the end are so similar,” said Francesca Arnoldy, the lead instructor at UVM’s End-of-Life Doula program. “The intensity of it, the mystery, all of the unknowns. You have to relinquish your sense of control and agenda and ride it out, and be super attentive in the moment.”

Unlike hospice workers, doulas don’t get involved in medical issues. Rather, they support clients emotionally, physically, spiritually and practically, stepping in whenever needed. That could be a few days before someone dies, sitting vigil with them in their last hours, giving hand massages, making snacks. Or it could be months or even years earlier, after someone receives a terminal diagnosis, keeping them company, listening to their life stories or helping them craft autobiographies, planning funerals. Prices range from $25 an hour on up, although many, like Ms. O’Hara, do it voluntarily. And like Ms. O’Hara, many have signed on to help give new meaning to their own grief while helping others in the process.

More than 1,400 people have graduated from the UVM program since its inception in 2017. Coursework, which costs $800 for eight weeks, includes writing farewell letters to loved ones, crafting their own obituaries, completing legacy work or a “Life Story Project” with a trained volunteer, and starting or updating their own advance care planning files. The program also recently started a “StoryListening” research project in which mourners across the country are invited to share their stories of loss during the pandemic with a trained doula. At the end of the hourlong session, participants are given a recording of their own conversation.

Since its founding in 2018, the National End-of-Life Doula Alliance, a professional organization of end-of-life practitioners and trainers, has grown to nearly 800 members; membership nearly doubled in the last year, said its president, Angela Shook. Interest has increased in training programs with the International End-of-Life Doula Association, Doulagivers, and the Doula Program to Accompany and Comfort, a nonprofit run by a hospice social worker, Amy L. Levine.

Much of the growing interest in these programs has come from artists, actors, young people and restaurant workers who found themselves unemployed during the pandemic and recognized that they could still be of service.

“People were reaching out from a variety of different ages, younger than we would normally see, because they realized that people were dying in their age category, which doesn’t usually happen,” said Diane Button, 62, of San Francisco, a doula facilitator at UVM and a member of the Bay Area End-of-Life Doula Alliance, a collective of death workers. “It made them more aware of their own mortality and really made them want to plan and get their documents and advance directives in order.”

Rebecca Ryskalczyk, 32, a singer in Vergennes, Vt., had always felt “kind of comfortable” with death. She lost two cousins in a plane crash when she was 12 and a friend to suicide four years later. When Covid put her performing schedule on pause, she enrolled at UVM. Her goal is to let people know that they don’t have to be afraid of death; nor do they have to do it alone. “Being able to help advocate for someone and to spend the last moments of their life with them and help them stick to their plan when they may not be able to express that is an honor,” she said.

Before the pandemic, Kate Primeau, 35, also worked in the music industry. Last June, after her grandfather died of Covid-19, she began researching how to host a Zoom memorial and came across the concept of a death doula. “I felt a huge gap between the amount of grief everyone was feeling and the resources available,” she said. She got certified as an end-of-life doula through Alua Arthur’s company, Going with Grace, and also volunteers in a hospice program. “I can’t believe how much I’m geeking out over all this death education.”

During the pandemic, of course, doulas had to shift the way they worked. That was one of the main challenges: They couldn’t interact in person. So like the rest of the world, they resorted to Zoom calls and FaceTime. Families often reached out for their own healing.

“A lot are coming to me for ritual and ceremony when they can’t be with their loved one physically and they’re alone in the hospital room,” said Ash Canty, 34, of Eugene, Ore., who refers to himself as a “death walker.” “There’s a curiosity that wasn’t there prior to Covid. They’re wanting to know, ‘How do I make sense of this spiritually? How do I be with this? Because I’m really struggling.’”

As for Ms. O’Hara, who is also a novelist, she is primarily helping people write their life stories. Her training at UVM was “humbling.” “I went into it thinking ‘I’ve been a volunteer with people who are dying, I’ve lost my daughter, I’m an expert in grief,’” she said. But the longer she studied, the more she realized that she was only an expert in her grief.

“You really can’t tell anyone else how to grieve,” she said. “You can offer advice, but there’s no timeline for grief. As soon as people get a diagnosis, they’re grieving. Their way of life is over. Everyone has suffered some kind of grief with the pandemic, even if they haven’t lost a person.”

She believes that grief and joy can coexist. “My grief is never going to go away,” she said. “I wouldn’t want it to. Grief and joy and love — it’s all part of the same spectrum. I’m grieving because I loved someone so much.”

‘Death Doulas’ Provide Aid at the End of Life

End-of-life doulas support people emotionally, physically, spiritually and practically: sitting vigil, giving hand massages, making snacks.

www.nytimes.com

 

[mr peabody]

Can psychedelics relieve existential suffering?

by Kali Carrigan, MA | Psychedelic Science Review | 2 Mar 2021

Psychedelics may be a valuable aid when it’s time to take the ultimate journey.

Existential distress and death anxiety are common in patients nearing the end of life. While it can be difficult to define existential distress, common themes include a lack of meaning or purpose, loss of connectedness to others, thoughts about the dying process, loss of self, hope, autonomy, and temporality. These symptoms often occur in parallel with severe anxiety and depression and have been shown to decrease the quality of life of patients and their families, as well as increasing the desire to hasten death.

Particularly in the West, where dying practices have been largely secularized and institutionalized, and traditional sources of meaning such as religion and community are increasingly absent, the end of life has become characterised by fear, anxiety, and uncertainty.

Today, up to 40% of cancer patients entering full-term care meet the criteria for a mood disorder. However, current treatment options for existential suffering have been found to be inadequate at best. In the healthcare and palliative care system, existential anxiety is generally understood as a mental health issue and treated with psychotherapy, usually in conjunction with anti-depressants such as selective serotonin reuptake inhibitors (SSRIs) or antipsychotics such as haloperidol. However, these interventions are likely to produce adverse side-effects and relapse is common. In several studies, researchers have further failed to demonstrate a clear treatment effect of anti-depressants for major depressive disorder when compared to a placebo.​

Early studies using LSD and psilocybin for end-of-life anxiety​

The pressing need to find a more suitable therapeutic model for addressing the physical and psychological suffering which often accompanies the end of life is not new. The first known rigorous study using psychoactive substances to treat end-of-life distress was led by Eric Kast at the University of Chicago in the 1960s. Kast and his colleagues were interested in finding out whether LSD could reduce pain perception in terminal cancer patients. He found that not only did LSD lead to significant reductions in total pain when compared to other opioids in use at the time (Dilaudid and Demerol), but that patients also reported decreased anxiety and fear of death.

In order to look into these effects, Kast would go on to carry out two more follow-up studies, administering LSD to a total of 208 patients in terminal care. The results of these studies showed that LSD diminished pain perception acutely for up to two weeks, decreased depressed mood, fear of cancer diagnosis and death, and improved sleep and could elicit mystical-type experiences.

Between 1963 and 1970, inspired by Kast’s work, Stanislav Grof carried out a series of open-label trials using high doses of LSD (200-500 mcg oral) and dipropyltryptamine (DPT, 60-105 mg intramuscularly), another novel psychedelic of the time, as control.10 At around the same time, Walter Pahnke was assessing the impact of LSD-assisted psychotherapy in terminal cancer patients at the Sinai Hospital in Baltimore.11 Similarly to Kast, both research teams found that their participants showed dramatic improvements in anxiety, depression, isolation, and fear of death, and noted an unexpected correlation between the spontaneous mystical experiences provoked by LSD, and clinical improvements.

Regardless of the impressive results of these studies, following the passing of the Controlled Substances act in 1970 in the U.S, research with psychoactive substances in terminal care was largely abandoned for almost 40 years.​

The state of the art​

In recent years, several scholars have picked up the psychedelic torch where Grof and Panhke left off in the early 1970s. Their results continue to surpass expectations for the treatment of end-of-life anxiety.

In 2011, Charles Grob and colleagues carried out a pilot study to assess the safety and efficacy of psilocybin, a prodrug molecule found in hallucinogenic mushrooms, for the treatment of anxiety associated with a terminal cancer diagnosis.12 They monitored physiological functions (heart-rate, HR and blood pressure, BP) as well as a series of psychological measures using a battery of tests for depression, mood states, and anxiety in 12 participants. The data showed only minor elevations in HR and BP after psilocybin administration, but a sustained reduction in anxiety lasting over several weeks, proving psilocybin to be a safe and effective intervention, even in this frail population.

In 2016, Roland Griffiths and colleagues at Johns Hopkins University designed a randomized, double-blind, cross-over trial comparing the effects of low (1 or 3 mg/70 kg) and high (22 or 30 mg/70 kg) doses of psilocybin on a much larger sample, this time 51 cancer patients with terminal diagnoses. Corroborating the findings of Grob et al., this study found that at high-doses, psilocybin produced substantial decreases in both clinician and self-rated measures of depressed mood and anxiety, and also led to an increased quality of life, meaning, and optimism, and a lasting decrease in death anxiety.

Just last year, Agin-Liebes et al. carried out the first-ever long-term follow-up study on the effects of psilocybin therapy on patients with life-threatening cancer. They showed that 4.5 years after a psilocybin-assisted psychotherapy session, 60-80% of participants still met the criteria for clinically-significant antidepressant and anxiolytic responses. Furthermore, 71-100% rated their psilocybin experience as one of the most meaningful in their lives.​

Why are psychedelics so effective at treating existential anxiety?​

The mechanisms of action of classic psychedelics such as LSD and psilocybin for the treatment of existential distress are not well-understood. It has been suggested that improved cognitive flexibility and increases in trait openness following a mystical-type experience may play a role. There is something quite intuitive in comparing the psychedelic experience to the dying experience, however, in that both comprise of “a journey to new realms of consciousness” as described by Timothy Leary in The Psychedelic Experience.

Psychedelics may help people relieve death anxiety by allowing the dying person to access, as Walter Pahnke proposed in the 1960s “untapped ranges of human consciousness, providing a sense of security which transcends even death.” And it is in that sense of security, which seems so absent today, that researchers may find some answers to the difficult existential questions which everyone must face one day.

Can Psilocybin and LSD Relieve Existential Suffering?

Psychedelics may be a valuable aid when it’s time to take the ultimate journey.

psychedelicreview.com

 

[mr peabody]

The doctor advocating LSD for the dying

by Eugene Robinson

The good doctor is irked. In a very gentle way, but still.

“I think it was Confucius who said that the beginning of wisdom is to call things by their correct name,” says Dr. Ira Byock, 67, founder and chief medical director at the Providence St. Joseph Health Institute for Human Caring in Torrance, California. “So to be perfectly grammatically correct and to be absolutely legit, let’s focus on the adverbs and the adjectives, since what we’re really talking about is Dying Well.”

Which is exactly where throats start to get cleared and the death-phobic among us try to edge toward the exits. Because no matter the fact that each and every person alive to read this must one day perish, none of us wants to perish. Particularly not in misery and solitude. “I’ve had patients who have literally said to me that they’d rather be pushed down a flight of stairs,” intones Byock, “than have to face a future of crap care in some facility at the end of their lives.”

But Byock is not in the euthanasia camp — dying quicker doesn’t mean dying better. His pitch, instead: a menu of a few different things, the most compelling being “psychedelic-assisted therapies.”

Studies show about 25 percent of Medicare spending gets poured into caring for people in their last year of living — which would add up to $175 billion last year. That number is catching the eyes of cost-cutting politicians. All this penny-pinching has caused Byock to turn a jaundiced eye to the spate of now-legal physician-assisted death states: California, Colorado, the District of Columbia, Hawaii, Montana, Oregon, Vermont and Washington. “I call it Physician-Hastened Death,” says Byock. “And why the rush to hustle the old and the sick into the hereafter? Excuse me if it just seems a little too convenient to me.”

Byock’s New Jersey roots, played through the betraying trace of an accent, are even more in evidence as he inveighs, not without flashes of humor, against dying badly and too soon. Working one of his first physician gigs after med school in a rural Montana emergency room for about 14 years, Byock created a clinical assessment tool that measured the quality of life for people who are suffering.

His prescriptions for the medical-industrial complex now include listening to patients, formulating care plans for disease and symptom treatments, helping them sleep, helping them move their bowels, addressing family needs and perhaps most importantly training doctors to do this early. So medical schools have to teach about caring for seriously ill or dying people up to and including the ethics of decision making, and should face financial penalties if they fail to do so. “Most med schools dedicate one month for pregnancy care even if the doctors in question won’t end up delivering babies,” Byock says. ”But 70 percent of physicians will be seeing sick or dying people.”

Byock talks about learning to listen, being sensitive to older patient needs — and then comes the needle-scratching-across-the record moment when he brings up psychedelics.

“I’m a child of the ’60s,” Byock laughs. “And there are legitimate medical uses of psychedelics when we’re talking about end-of-life wellbeing issues.” With an eye to easing pain and creating comfort, Byock turns to the early, legal uses of psychedelics as an adjunct to therapy, as well as the recent and well-publicized benefits of using psychedelics to mitigate PTSD.

Elizabeth Wong, a Northern California nurse and Byock fan who is training to be an end-of-life doula, points to "controlled studies that show psychedelics having lasting effects for up to six months on anxiety issues. It’s real science.” As legalization of medical and recreational marijuana has made clear, this is less of a traditional Democratic/Republican divide, says the committed progressive Byock, but more of which stakeholders win and which will lose.

Losing? If the Dying Well’ers were to succeed, pharmaceutical companies and medical equipment manufacturers would take a hit. A contingent of pro-lifers under the aegis of the American Life League has blasted Byock’s work as “stealth euthanasia,” a charge Byock believes is risible. And winning? Nurses’ aides, nursing homes, hospices, long-term care facilities and pretty much anybody who expects to be dying.

“I think you’ll need more than a scorecard to get people to change their minds about this,” says senior care worker Josefine Nauckhoff. “Or at the very least America will have to take seriously those magical, mystical countries that have figured this out.”

Like? “Canada,” Byock says. “They’re taking this seriously, with an emphasis on hospice centers, senior care facilities and addressing end-of-life issues as though they were both real and manageable.:

Byock is pushing the U.S. to follow suit via his indefatigable advocacy in the wellness community, faith-based Catholic initiatives, books, conferences for reimagining the end of life and even the Death Over Dinner movement, where people bite the bullet, as well as biscuits, and talk seriously about death.

A movement is evident in the growing number of related books, death cafés, conferences, efforts at real legislative change and hospitals that are dealing on their own. In 2016, three-quarters of all U.S. hospitals had a palliative care team — focusing on improving quality of life for those with serious illnesses — up from one-quarter of hospitals in 2000, according to the Center to Advance Palliative Care.

“This is not just about avoiding suffering,” Byock said. “I’m in it for the joy. But, I mean, we’re all going to die. Best we do so the best ways we can.”

Byock and an ad hoc group of like-minded experts propose the following public policy planks to improve end-of-life care:

- Raise training standards for physicians, nurses and allied clinicians in geriatrics, palliative care and related topics.

- Establish minimum program standards for “palliative care” (disciplines, staffing, services, hours).

- Require palliative care consultation before high-risk surgery or low-yield treatments for patients with advanced age or physiologic frailty.

- Eliminate the requirement to forego disease treatments to receive hospice care for comfort, quality of life and family support.

- Long-term care: Require adequate staffing of nurses and aides.

- Long-term care: Require living wages and benefits for aide-level workers.

- Annually revoke licenses of nursing homes in lowest 10 percent of quality and resident safety scores.

- Award new licenses only to nursing homes qualifying as Greenhouse, Planetree or Beatitude-style models.

Going Out on a High: The Doctor Advocating LSD for the Dying

Dr. Ira Byock advocates a formula to make the last few years of living suck a little less.

www.ozy.com

 

[mr peabody]

What I’ve learned over a lifetime of caring for the dying

by Lynn Hallarman | New York Times | 11 Aug 2021

Dr. Hallarman is a former director of palliative care at Stony Brook University Hospital in New York and a consultant to the National Center for Equitable Care for Elders based at Harvard University.

While I slept in my home, my mother lay dying on the bathroom floor in her home in another state. She was not alone. Her longtime professional home health aide was by her side, propping her up with a hastily grabbed pillow and holding her hand.

Because I am a palliative care physician, I had been preparing myself and my family for the moment of her death for a long time. My mother, after all, was 92 and frail, and had dementia. At this point in her life, it would come down to the place where she would die and who was there in her last moments.

My experience as a physician — a professional life spent mainly tending to the dying — and as a daughter who navigated my mother’s last years with chronic illness, has kept me alert to the national conversations now taking place about the role of professional caregiving as essential health care.

Some of the hardest conversations I have in my work involve telling families managing the debilitating chronic illness of a loved one at home that they are essentially on their own. Most do not realize that medical insurance does not pay for long-term home care. Though the aides themselves are typically paid little, for-profit agencies can drive the cost of a home health aide to roughly $4,500 a month. And the demand for quality home care services is expected to explode over the next decade.

A report using data from 1995 to 2014 showed that nearly half of Americans turning 65, about 48 percent, will require some form of paid long-term care to keep them in their homes and communities. Most of the current workable solutions to what is commonly called a caregiver crisis are carried out at the state level in isolation from one another, often with thin margins and underfunded mandates. What’s missing is a national partnership that prioritizes funding for community-based elder care services.

I learned the value of direct-care workers as health care providers during my years as a hospice director in a nursing home. The term direct-care work generally applies to a broad range of professional caregiving activities that can take place in hospitals, nursing homes or at home. Direct-care workers can assist with meal preparation, bathing, dressing, mobility and an array of daily life activities. The work is intimate and exhausting. Physical care demands can be arduous.

The hospice team discussions we held — which included the nurse, social worker, chaplain, nurse’s aide (another name for a direct-care worker) and me — always relied on what we learned from the nurse’s aide. They were the ones who spent the most time at the bedside and could supply details that might otherwise have been missed: changes in pain, new confusion, uneaten meals.

One particularly wonderful aide, Mike, who was nearly six and a half feet tall, spent most of his day ducking in and out of patient rooms addressing the needs of each person he visited. He bathed, dressed, fed and lifted these dying men and women with the practiced skills of someone who’d spent years at the bedside. Every person in his charge had a clean mouth, brushed hair and trimmed fingernails. His height and strength allowed for gentle lifts, especially handy for checking backsides for bedsores. The patients trusted him. He greatly improved the quality of their lives, and he made me a better doctor.

While nurses and other frontline professionals have always understood the importance of excellent bedside care delivered by a trained direct-care worker, the health care system itself has been slow to recognize their value. The care that Mike and others like him deliver in hospitals, nursing homes and home settings is often done without recognition. Mike was also a natural leader and teacher, yet the nursing home environment in which he worked allowed no pathway for him to rise professionally as a direct-care worker. Home health aides in particular can expect, in general, a minimum-wage salary, poor benefits, limited training and no way to bargain collectively.

Mom understood the value of professional caregiving. As she liked to say, jokingly, her home care aides kept her from the tyranny of her children. Also, my family knew professional caregiving would allow our mother to stay in her home, where her independence could be supported and her dignity preserved. But we were lucky: We had the finances to pay for a caregiver. And we knew that we could honor our mother’s wishes to stay at home only with a lot of help.

Recent congressional legislative proposals attempt to tackle the issue of paying for and obtaining professional home care. The Better Care Better Jobs Act, for instance, is meant to jump-start repairs to a largely ad hoc network of caregiving services for frail elders and disabled people. It would provide funds to expand access to state Medicaid home- and community-based services. Another health policy proposal, the WISH Act, closes the funding gap for future care for working families by creating a public option using a small payroll deduction.

But none of these approaches would be enough to recruit and sustain a direct-care work force if care work itself remains undervalued. These professional caregivers are and always have been essential workers; they deserve fair wages, improved benefits and better training. To achieve this, we need to insist that the health care system, including insurers, recognizes professional caregiving as actual health care.

In her last months, my mother became eligible for a home hospice program. Finally, we had what was missing before — a medical plan coordinated in partnership with us and her long-term home care aides. A clear pathway was crucial for our family peace at this time because Mom’s death occurred during the Covid-19 pandemic, making her care situation even more complicated.

The night Mom died, her aide, who had been with her for years, was at her side until the end, giving her precisely the care she needed.

Lynn Hallarman, M.D., is a former director of palliative care at Stony Brook University Hospital in New York and now works as a consultant to the National Center for Equitable Care for Elders based at Harvard University.

Opinion | What I’ve Learned Over a Lifetime of Caring for the Dying

As a doctor who cares for the dying, I know that direct-care aides are invaluable to patients and their families. We need to honor the work they do.

www.nytimes.com

 

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Death and psychedelics: How science is reviving this ancient connection

by Nick Jikomes, PhD | Leafly | 5 Oct 2021

In November 1963, the writer and psychedelic explorer Aldous Huxley laid in bed, unable to speak. He was dying of cancer. One of his final acts was to pass a handwritten note to his wife Laura.

His famous last words: “LSD, 100 µg, intramuscular.” It was Huxley’s dying wish: a large dose of acid, please. Laura Huxley fulfilled the request twice during her husband’s final hours.

First synthesized 25 years before Huxley’s death, LSD was still legal in 1963. Scientists were studying it as a potential treatment for alcoholism and other ailments, as well as investigating its similarity to other psychedelics. It wasn’t until 1968 that the federal government outlawed these drugs due to their association with the cultural turbulence of the 1960s.

Today, several decades later, terminal cancer patients are once again taking psychedelics. This time around the drugs are being administered by doctors and scientists in controlled settings—and they are not microdoses. The results of this research have been nothing short of remarkable.

Laura and Aldous Huxley in 1956

Laura Archera Huxley, 40-year-old musician and filmmaker, and husband Aldous Huxley, 61-year-old British novelist, pictured at their Hollywood home in Hollywood in 1956. On his deathbed seven years later, Huxley asked his wife for a massive dose of LSD.​

Alleviating anxiety and despair​

Terminal patients often suffer from feelings of intense anxiety and despair after receiving their diagnoses. For many, this is just too much to bear. The overall suicide risk for these patients is double or more compared to the general population, with suicide typically occurring in the first year after diagnosis.
​

Terminal patients have twice the suicide risk of the general public. Psychedelics may help reduce their fear and suffering. ​

That’s where psychedelic therapy may help. After a single large dose of psilocybin, taken in a curated space and supervised by a pair of doctors, many patients report feeling reborn. It’s not that the underlying physical disease has been cured. Rather, the drug prompts a shift in the theme of their emotional self-narrative—from anxiety and despair to acceptance and gratitude.

It may seem curious to think about psychedelic drugs, often associated with hippies and the Grateful Dead, as clinical-grade tools for overcoming our primordial aversion to death. But maybe it shouldn’t be. Maybe this is only surprising if your window of historical perspective is too narrow. Maybe these “novel findings” are, in a sense, a return to somewhere we’ve been before.​

Psychedelics at the dawn of civilization​

In late 2020 I spoke to Brian Muraresku, author of The Immortality Key: The Secret History of the Religion With No Name, about the use of psychoactive plant medicine throughout antiquity. Our podcast conversation covers this history in more detail, but it’s clear that humanity’s relationship with psychoactive plants extends back at least to ancient Greece—if not further. It’s hard to look at prehistoric cave paintings like the Tassili mushroom figure and not wonder if psychedelics played a part in their creation.

Western philosophy may have developed with help from psychedelics as well. In Plato’s well-known allegory of the cave, a group of prisoners live chained to a cave wall, seeing nothing but the shadows of objects projected onto it by fire. The shadows are their reality; they know nothing outside of it. Philosophers, Plato states, are like prisoners freed from the cave. They know the shadows are mere reflections, and they aim to understand deeper levels of reality.

Was Plato tripping?

If that sounds like someone who’s explored those deeper levels with psychedelic assistance…well, maybe it was. In his book, Brian Muraresku explores the significance of the Eleusinian Mysteries, secret ceremonies that involved death and rebirth. For centuries, philosophers and mystics traveled to the Greek town of Eleusis to partake in a ritual that involved an elixir known as pharmakon athanasias, “the drug of immortality.”
​

“Within the toolkit of the archaic techniques of ecstasy–plant medicine just being one among many–something you find again and again, in Ancient Greece and other traditional societies, is this sense that to ‘die’ in this lifetime, or achieve a sense of timelessness in the here and now, is the real trick.” -Brian Muraresku​

Contemporary archaeologists, digging outside Eleusis, have unearthed ancient chalices containing a residue of beer and Ergotized grain. Ergot is a fungus that grows on grain. It produces alkaloids similar to LSD. It’s possible, then, that influential thinkers like Plato were inspired by genuine psychedelic experiences.

This connection between psychedelics and death didn’t end with Eleusis. It survived, often repressed and hidden from view, right through the time of Aldous Huxley.​

The connection re-emerges in the 1960s​

In the 1960s, Timothy Leary co-wrote a book called The Psychedelic Experience: A manual based on the Tibetan Book of the Dead. Leary, the exiled Harvard professor and psychedelic guru, dedicated the book, “with profound admiration and gratitude,” to Aldous Huxley. It opens with a passage from The Doors of Perception, Huxley’s essay on the psychedelic experience. Huxley is asked if he can fix his attention on what the Tibetan Book of the Dead calls the Clear Light. He answers "Yes, but only if there were somebody there to tell me about the Clear Light.”

It couldn’t be done alone. "That’s the point of the Tibetan ritual," he says: "You need “somebody sitting there all the time telling you what’s what.”

Huxley was describing a trip sitter, someone who guides a person along their psychedelic journey. "Sometimes it’s an ayauasquero in the heart of the Amazon. Sometimes it’s a doctor holding your hand in a hospital."

Timothy Leary, shown at home in California in 1979.​

Seeking rebirth within the mind​

In his book, Leary grounded Eastern spiritual concepts in the understanding of neurology we had at the time. The states of consciousness achieved by meditation masters and those induced by three hits of Orange Sunshine, he wrote, may actually be the same. Both involve dissolving the ego (“death”) and allowing it to recrystallize as the default mode of consciousness returns (“rebirth”).

Leary wasn’t talking about magic. Scientists know these as “non-ordinary brain states,” inducible by rigorous attentional practice (meditation), pharmacological intervention (psychedelics), and organic decay (dying).

The ability of psychedelics to induce these remarkable brain states may also be why they’re showing such promise in alleviating the very ordinary fear of death.​

Today’s psychedelic treatments: Coping with death​

So what, exactly, has recent research on psilocybin as an end-of-life anxiety treatment involved?

A few small studies have seen psilocybin administered to dozens of cancer patients. They’ve been conducted in a randomized, double-blind, placebo-controlled fashion. In general, a large majority of patients showed sustained, clinically significant reductions in measures of psychosocial stress and increased levels of overall well-being.

For example, in one study, 80% of the patients found that a single dose of psilocybin quickly relieved their distress. Remarkably, in some patients that positive effect lasted for more than six months.

Sprouting new physical connections​

What’s going on at the neuronal level to produce those changes? We don’t know for sure, but some preclinical research has given us a hint. Both psilocybin and LSD have been shown to induce rapid and lasting antidepressant effects in lab animals.
​

Early studies hint at how psychedelics may produce positive changes in the brain. ​

Early indications are that psychedelics may allow brain circuits to rapidly sprout new physical connections. This is exciting, but again: These are non-human studies, and it’s early.

It’s gratifying to see any of these studies happening, frankly. This is research that’s been stalled by the Schedule I status of psychedelics for half a century. Much of this work requires obtaining a special federal waiver to study banned substances, which slows progress.​

Potential help for end-of-life patients​

Fortunately, the FDA recently designated psilocybin therapy as a “breakthrough therapy” and the DEA has proposed increasing the supply of psilocybin for research. This should speed up the rate at which we understand the clinical efficacy of psilocybin and related psychedelics.

Here’s more good news: In terms of psilocybin’s efficacy as a treatment for end-of-life anxiety, larger human trials are already underway.

Dr. Stephen Ross, one of the field’s leading researchers, has described the significance of this work: “If larger clinical trials prove successful, then we could ultimately have available a safe, effective, and inexpensive medication—dispensed under strict control—to alleviate the distress that increases suicide rates among cancer patients.”​

Huxley: Ahead of his time​

In one sense, Aldous Huxley was ahead of his time. More than a half-century before today’s renaissance in psychedelic research, his own experiences had evidently brought him to the conclusion that the best way to experience death was in a psychedelic trance.

In another sense, though, Huxley was one in a long line of creators stretching back to ancient Greek philosophers and perhaps even to prehistoric cave artists. They may all have used psychedelics to catalyze their outward creativity and comfort their inner distress.

Huxley titled his famous introspective essay, The Doors of Perception, after a quote from the English poet, William Blake: “If the doors of perception were cleansed everything would appear to us as it is, infinite.”

We will never know what he experienced in the final hours before his death, after handing that note to his wife. I like to think that for him, the last breath seemed to last forever.

Death and psychedelics: How science is reviving this ancient connection

New research finds psychedelics can ease our fear of death. But the connections between the mind and mortality stretch back thousands of years.

www.leafly.com

 

[mr peabody]

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Death and family healing with psilocybin: A conversation with Dennis McKenna

by Wesley Thoricatha | Psychedelic Times

One of the great lessons that psychedelics are known for revealing is how profoundly connected we are with the natural world, but nature is not just the sum of all living things- it is the dynamic process of life, death, and rebirth. The kingdom of Fungi, which contains the psychedelic mushrooms such as Psilocybe cubensis, happens to play a critical role in the decomposition process, turning dead plants, animals, and even humans into fertile, nutrient-rich soil which gives rise to new life. Is it a coincidence that these master decomposers may have something incredibly valuable to teach us about death, not just in ecosystems but also in the minds of the curious humans who consume them?

Brothers Dennis and Terence McKenna were early apostles of psychedelic mushrooms, and did much to bring them into mainstream cultural awareness with their classic book on mushroom cultivation: Psilocybin – Magic Mushroom Grower’s Guide. While Terence, the great bard, would go on to spread the legendary psychedelic meme of the “heroic dose”- 5 dried grams of psilocybin mushrooms taken in complete darkness; his brother Dennis was a founding member of the Heffter Research Institute which has published research on psilocybin’s uncanny ability to treat depression and anxiety in terminally-ill cancer patients. We spoke with Dennis recently about what mushrooms have to teach us about dying with dignity, and how much greater that could be than fighting and fearing death until the very end.

Thank you again for speaking with us Dennis. What do you believe is wrong with how we currently treat death and dying in the medical world?

Biomedicine has got all sorts of problems, but one of the major ones is that we don’t do death well. We just don’t. For a physician to say their patient has died is to say that they failed, and that’s not always true. Sometimes the most merciful thing is to let a person die with dignity. Nobody lives forever, and eventually medicine is going to fail, unless we get immortality worked out, but I don’t think that would be a good thing frankly. Medicine has got to get beyond this idea of survival at all costs at the sacrifice of quality of life and dignity- that’s not the point of medicine. The point of medicine is to do what you can within limits and when the times comes, and let it go. Substances like psilocybin can be integrated in a compassionate and useful way if we can come to terms with the idea that people deserve to die a beautiful death, if we can accept that concept.

What makes psilocybin particularly good at dealing with death?

Psilocybin is kind of the perfect medicine for hospice situations. It’s non-toxic and people can be quite ill and yet tolerate high doses because it’s very compatible with human metabolism. It’s perfect for people in terminal states, and I hope that eventually we will be using it far more often for these sorts of situations.

People who are in a terminal state are often very anxious about dying, they are totally focused on it and can’t really get away from that stress. When they undergo psilocybin therapy what that does for them based on post-session interviews is they all say the same thing, ‘I realized there was no point in worrying about death, I’m alive now, I’m not dead, so let’s focus on that. When death comes it will come, but it’s not something I can stop or control.’ That’s the therapeutic breakthrough that psilocybin offers, and we don’t necessarily need a drug to realize this but many people seem to need it.

What would the ideal use of psilocybin in a hospice scenario look like?

What I would love to see is whole families coming together at a hospice center for a shared psilocybin experience before someone is too ill to interact. Can you imagine how cool that would be, and how healing that would be for everyone in the family? Psilocybin puts you in a state where you can actually say things to each other that maybe you could never say before. In my own experience with death, my brother and my mother and my father all dead, and all difficult situations in the terminal stages, it’s just very hard sometimes to express yourself. You want so much to be able to say something to a family member but you just can’t do it because this static in the system that builds up over years and years. I think psilocybin can and will be incredibly healing for people in these situations. That is a revolution in medicine if you can change attitudes towards death. I think the potential is very much there.

I can definitely see that. People so often carry around guilt and regrets related to what they never got to say to loved ones before they died, and that makes mourning so much harder. In a retreat situation like you describe with family, all of that would come out and then some. I can imagine people being able to embrace the situation in a really healthy way, both the dying person and their family.

Just to be able to actually communicate directly to the person and say ‘I forgive you, and if I hurt you, I’m sorry’… that can resolve so much. When that is not resolved, you carry it inside and it eats away at you. When a person is gone, they’re gone, so we might as well use the present moment to come to terms with things. I’ve also seen this happen with ayahuasca in the retreats I do. Ayahuasca is not the ideal medicine for people that are dying because it can be hard on you physically, much harder than psilocybin, but in many situations I’ve had families come, like a father and a couple of kids. They are not dying but they’re at that point where the kids are grown up and they are entering into a new kind of relationship. I’ve seen amazing reconciliations happen. They carried all these conflicts over the years, and it’s not that they all go away immediately, but after the ceremonies they can relate to each other in a much more honest way. The shared psychedelic experience facilitates communication, and I’ve seen a lot of good effects come out of that.

Death and Family Healing with Psilocybin: A Conversation with Dennis McKenna - Psychedelic Times

Legendary psychedelic researcher Dennis Mckenna reveals how the process of death and dying could be greatly improved through the use of psilocybin therapy.

psychedelictimes.com

 

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Can psychedelics help us cross over?*

by Davis Jay Brown

Some of the most valuable and promising research that's been conducted with psychedelics has been in the area of treating the terminally ill.

From 1967 to 1972, studies with terminal cancer patients by Stanislav Grof and colleagues showed that LSD combined with psychotherapy could alleviate symptoms of depression, tension, anxiety, sleep disturbances, psychological withdrawal, and even severe physical pain that was resistant to opiates.

It also improved communication between the patients and their loved ones.

Considering that the dying process is probably the most universally feared of all human experiences, that the death of loved ones causes more suffering in this world than anything else, and that death appears to be an inevitable fact of nature - it seems like it might be a good idea to pay attention to what researchers have learned about how psychedelics can help to ease the dying process.

The Tibetan Book of the Dead - a religious manual about how to navigate through post-corporeal space, which is read to Tibetan Buddhists as they're dying - is also known for its uncanny parallels to the psychedelic experience.

Many believe that psychedelic experiences can not only give us insight into what happens after we die, but that they actually model or simulate the afterlife experience to a certain extent.

Researcher Rick Strassman's studies at the University of New Mexico with the psychedelic DMT, and physician Karl Jansen's work with the dissociative psychedelic ketamine, may provide evidence for the type of biochemical and psychological changes that occur in the brain when we're dying, as they appear to simulate some important features of the near-death experience.

When I asked Rick how he thought the DMT experience is related to the near-death experience, he replied, "I hypothesize that DMT levels rise with the stress associated with near-death experiences, and mediate some of the more 'psychedelic' features of this state."

For many, death is the hardest thing to face about life, to accept that our time here is temporary. People successfully ignore thinking about this for much of their lives, but I think it's vital to always remember that every moment is sacred, each second precious.

Maybe there are wonderful new and everlasting adventures awaiting us after we die. After experiencing the powerful mind-altering perspective the psychedelic experience, it's hard for me to believe that consciousness doesn't continue on in some form - but of course this could all be a magnificent illusion.

However, despite the ever-mysterious metaphysical truth hiding inside us about the ultimate source of consciousness, the dying process itself appears to be significantly eased by psychedelic therapy. So we can all be thankful for this, and rejoice that these promising therapies are once again being explored by modern medicine.

The final subject in the first clinical LSD study since 1972 completed his last experimental therapy session on May 26, 2011. This was the first clinical LSD study in over 35 years. Santa Cruz-based MAPS sponsored the research, which began in 2008, by Swiss psychiatrist Peter Gasser.

Gasser's LSD study was conducted in Switzerland, where LSD was discovered in 1943 by Albert Hofmann. The study examined how LSD-assisted psychotherapy effects the anxiety associated with suffering from an advanced, life-threatening illness. There were twelve subjects in the study with advanced-stage cancer and other serious illnesses.

Researchers found that LSD-assisted psychotherapy has the extraordinary ability to help many people overcome their fear of death, and this is probably a major contributing factor in why the drug can be so profoundly helpful to people facing a life-threatening illness.

When asked if there was something psychedelics could teach us about death, philosopher Richard Alpert replied, "Yes, absolutely. One quote stands out in my mind. It was from a nurse who was dying of cancer and had just taken LSD. She said, "I know I'm dying of this deadly disease, but look at the beauty of the universe."

*From the article here :

Can Psychedelic Drugs Help Us to Die Gratefully? - MAPS

Originally appearing here . When acclaimed novelist and philosopher Aldous Huxley was dying, his final words were: “LSD, 100 micrograms I.M.” Huxley’s wife Laura complied with his wishes, and the celebrated author of Brave New World crossed over...

maps.org

 

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Mitigating fear of death with psychedelics*​

by Sabrina Eisenberg, MS | Psychedelic Science Review | 14 Sep 2021

Researchers suggest that the benefits of psychedelic treatment are mediated by a reduction in death anxiety and existential distress.

While there is evidence for the therapeutic effects of psychedelics, there is less so on the front of how they produce such effects. One common thread between psychedelics and mental illness is underlying themes of death and death anxiety, which led Moreton and colleagues to speculate a potential mediating relationship.

There are some psychopathologies for which the link to death anxiety may seem obvious; Panic attacks and panic disorder, for example, often involve a fear of heart attack or a sudden feeling of danger. Death anxiety also correlates with generalized anxiety disorder, social anxiety disorder, alcohol use disorder, and depressive disorder. Other research has found evidence for causality rooted in increased participant anxious and phobic behavior when primed with mortality salience or the awareness that death is inevitable.

The underlying fear of death remains unaddressed by many existing mental health treatments, contributing to their continuation. While psychedelics have been found to reduce death anxiety, particularly in cases of terminal illness, there is less existing evidence on how they complete that goal.

How psychedelics address death anxiety

To this end, Moreton et al. suggested a variation of the following five factors: (1) forced confrontations with mortality, (2) reduced focus on the self, (3) shifting metaphysical beliefs about human consciousness, (4) amplified religious faith, and (5) increased feelings of connectedness and meaning-making. The impact of any of these factors, much like the psychedelic experience itself, depends on the individual in question, as well as the set and setting of the session. The remainder of this article will break down each factor and how they are proposed to accomplish the hypothesized mediation.

First, confronting death anxiety, much like exposure therapy, is thought to reduce the fear of dying over time. Moreton et al. proposed that psychedelics in particular provide a unique opportunity to confront fears of death, including the central role of ego dissolution.8 This living experience of death transcends traditional therapeutic exposure to mortality-related thoughts. Surrender to the psychedelic experience mimics that of surrender to near-death experiences, which have been found to provoke attitude changes and decrease fear of death.

Second, Moreton et al. said that reduced focus on the self applies to mortality, as it is an egocentric concern. When psychedelics put the universe into perspective, the self and its concerns feel small.

Third, when an individual experiences ego death, it introduces the idea that there is an existence beyond our known physical experience of life and death. Whether or not this is true or can be proven outside of the psychedelic session, it can lead to the belief that consciousness transcends death. This has been found to present as long-term agreement with statements such as, “death is a transition to something even greater than life” post-psilocybin treatment. Transcending death may reduce anxiety induced by death as a final destination, thereby combatting fear-based mental illness.

Fourth, psychedelics often induce religious images. These can align with one’s religious beliefs or traditions other than their own. Individuals may feel that they saw God, or possibly feel they are God. Religiosity can, in turn, reduce effects of mortality salience, including distress. Given this effect, Moreton et al. hypothesized that psychedelic-induced religious experiences can buffer against distress related to the death anxiety that underlies many mental illnesses.

Fifth, and last, psychedelics promote a feeling of oneness with the universe, natural world, and fellow human beings. As with ego death, the idea that a person is not bound by their physical form and can live on through other sources resembles a “symbolic immortality.” It may seem likely that feeling connected to the world increases the meaning one assigns to different aspects of their life. In fact, people rate their psychedelic experience as among the most meaningful in their life. Furthermore, meaning in life acts as a buffer to death anxiety and effects of mortality salience.

Conclusion

As psychedelic research evolves, scientists will continue to study how they invoke beneficial therapeutic effects. The relation of death anxiety to both psychedelics and mental health has led researchers to postulate it as a possible mechanism through which the two interact; however, there is a lack of experiments testing death anxiety as a causal variable. The authors, therefore, urge that their presented hypothesis and reasoning justify future research to this end. Regardless, psychedelics remain complex and multifaceted substances, and these suggestions are to be studied in accordance with other potential proposed mechanisms, at least until research further clarifies the picture.

*From the article here :

Fear of Death Impacts Quality of Life-How Psychedelics Can Help

Researchers suggest that the benefits of psychedelic treatment are mediated by a reduction in death anxiety and existential distress.

psychedelicreview.com

 

[mr peabody]

Single dose of psilocybin found to relieve anxiety and depression in patients with advanced cancer*

NYU Langone Medical Center School of Medicine | Technology Networks

When combined with psychological counseling, a single dose of a mind-altering compound contained in psychedelic mushrooms significantly lessens mental anguish in distressed cancer patients for months at a time, according to results of a clinical trial led by researchers at NYU Langone Medical Center.

Published in the Journal of Psychopharmacology, the study showed that one-time treatment with the hallucinogenic drug psilocybin—whose use required federal waivers because it is a banned substance—quickly brought relief from distress that then lasted for more than six months in 80 percent of the 29 study subjects monitored, based on clinical evaluation scores for anxiety and depression.

The NYU Langone-led study was published side by side with a similar study from Johns Hopkins. Study results were also endorsed in 11 accompanying editorials from leading experts in psychiatry, addiction, and palliative care. (See more on the Johns Hopkins research as presented at the annual meeting of the American College of Neuropsychopharmacology, Dec. 2015)

"Our results represent the strongest evidence to date of a clinical benefit from psilocybin therapy, with the potential to transform care for patients with cancer-related psychological distress," says study lead investigator Stephen Ross, MD, director of substance abuse services in the Department of Psychiatry at NYU Langone.

"If larger clinical trials prove successful, then we could ultimately have available a safe, effective, and inexpensive medication—dispensed under strict control—to alleviate the distress that increases suicide rates among cancer patients," says Ross, also an associate professor of psychiatry at NYU School of Medicine.

Study co-investigator Jeffrey Guss, MD, a clinical assistant professor of psychiatry at NYU Langone, notes that psilocybin has been studied for decades and has an established safety profile. Study participants, he says, experienced no serious negative effects, such as hospitalization or more serious mental health conditions.

Although the neurological benefits of psilocybin are not completely understood, it has been proven to activate parts of the brain also impacted by the signaling chemical serotonin, which is known to control mood and anxiety. Serotonin imbalances have also been linked to depression.

For the study, half of the participants were randomly assigned to receive a 0.3 milligrams per kilogram dose of psilocybin while the rest received a vitamin placebo (250 milligrams of niacin) known to produce a "rush" that mimics a hallucinogenic drug experience.

Approximately half way through the study's monitoring period (after seven weeks), all participants switched treatments. Those who initially received psilocybin took a single dose of placebo, and those who first took niacin, then received psilocybin. Neither patients nor researchers knew who had first received psilocybin or placebo. Guss says, "The randomization, placebo control, and double-blind procedures maximized the validity of the study results."

One of the key findings was that improvements in clinical evaluation scores for anxiety and depression lasted for the remainder of the study's extended monitoring period—specifically, eight months for those who took psilocybin first.

All patients in the study—mostly women age 22 to 75 who are or were patients at the Perlmutter Cancer Center of NYU Langone—had either advanced breast, gastrointestinal, or blood cancers and had been diagnosed as suffering from serious psychological distress related to their disease. All patients, who volunteered to be part of the study, were provided with tailored counseling from a psychiatrist, psychologist, nurse or social worker, and were monitored for side effects and improvements in their mental state.

Co-investigator Anthony Bossis, PhD, a clinical assistant professor of psychiatry at NYU Langone, says patients also reported post-psilocybin improvements in their quality of life: going out more, greater energy, getting along better with family members, and doing well at work. Several also reported variations of spirituality, unusual peacefulness, and increased feelings of altruism.

"Our study showed that psilocybin facilitated experiences that drove reductions in psychological distress," says Bossis. "And if it's true for cancer care, then it could apply to other stressful medical conditions."

Bossis cautions that patients should not consume psilocybin on their own or without supervision by a physician and a trained counselor. He also says "Psilocybin therapy may not work for everyone, and some groups, such as people with schizophrenia, as well as adolescents, should not be treated with it."

*From the article here :

Single dose of hallucinogenic drug psilocybin relieves anxiety and depression in patients with advanced cancer

When combined with psychological counseling, a single dose of a mind-altering compound contained in psychedelic mushrooms significantly lessens mental anguish in distressed cancer patients for months at a time, according to results of a clinical trial led by researchers at NYU Langone Medical...

www.technologynetworks.com

 

[mr peabody]

Psychedelics: The new frontier in end-of-life care*

by Jim Parker | November 5, 2021

Psychedelic medicines may represent a new frontier for end-of-life care, as well as psychiatric treatment. While these substances — including LSD, MDMA, psilocybin and ketamine, among others — remain illegal, grass roots support for decriminalization or medical use is growing. Meanwhile, venture capitalists and other investors are spending billions to get on the ground floor of what could become a new health care industry.

Much of the research and discussion on medical use of psychedelics has focused on care at the end of life. Interest in the potential medical benefits of these substances became widespread during the 1960s, but research all but stopped after they were criminalized through federal legislation in 1970. The first inklings of a resurgence began in the late 1990s, and momentum has picked up during the last decade.

“The evidence is just so compelling, and we have very little in terms of tools in our medical bag to be able to help people who are suffering from existential distress, anxiety and depression related to a serious illness diagnosis,” Shoshana Ungerleider, M.D., internist at Crossover Health in San Francisco, founder of the organization End Well, said. “We want people to be able to live fully until they die. If psychedelics given in a controlled therapeutic environment with trained clinicians who can help them do that, then these medicines should be more widely available.”

End Well recently produced a conference on the subject of psychedelic medicine for dying patients.

The body of scientific literature on psychedelics for dying patients continues to advance. Johns Hopkins Medicine in 2019 established a Center for Psychedelic and Consciousness Research backed by $17 million in grants.

Researchers have identified a number of clinical benefits, including reduction of anxiety, depression and improved acceptance of mortality, according to a 2019 literature review in the journal Current Oncology. The paper cited studies indicating that the most commonly used psychedelic drugs have no tissue toxicity, do not interfere with liver function, have few interactions with other medications and carry no long-term physical effects. Common side effects tend to be short in duration, such as nausea and vomiting or disruption of visual or spatial orientation.

Patients who use psychedelic medicines often report what researchers commonly describe as a “mystical experience,” involving a feeling of unity, sacredness, deeply-felt positive mood, transcendence of space and time, and other effects that study participants found difficult to verbalize, according to the Current Oncology paper.

“This can be transformative for people with anyone who is wracked with trauma, grief, loss or extreme states of suffering,” Sunil Aggarwal, M.D., co-founder, co-director and practitioner at the Advanced Integrative Medical Science (AIMS) Institute in Seattle, told Hospice News. “There’s also evidence that these substances can also reduce physical pain.”

Aggarwal is a board-certified hospice and palliative care physician and a past chair of the American Academy of Hospice and Palliative Medicine (AAHPM).

All psychedelics are illegal at the federal level and in most states. Oregon in 2020 became the first in the union to remove criminal penalties for all illegal drugs and is now in the process of establishing the nation’s first state-licensed psilocybin-assisted therapy system.

More action has been happening at the local level, with communities such as Washington, D.C., Denver, Ann Arbor, Mich., three Massachusetts cities, and Santa Cruz and Oakland in California voting to decriminalize some psychedelics and permit medical use. Some of these regions are now considering statewide decriminalization.
Connecticut and Texas each have laws on the books that created work groups to study the medical use of psilocybin, MDMA and ketamine. Legislatures in Hawaii, Iowa, Maine, Missouri, Vermont and New York state are currently mulling decriminalization or medical use bills.

In late July, Rep. Alexandria Ocasio-Cortez (D-N.Y.) reintroduced an amendment to remove federal barriers to research the therapeutic potential of psychedelic substances. The U.S. House of Representatives quickly shot down the legislation, though it garnered more support this round than the previous time it was introduced.

“We quite a few years off from having enough trained therapists and a policy pathway for which these can be made more widely available in a controlled therapeutic setting,” Ungerleider said. “There’s just so much interest right now among patients and among family members to learn more about this. All health care professionals need to have an understanding of where we’re at with psychedelics.”

Interest in psychedelics has transcended the research space and entered the business world. The familiar adage, “follow the money,” frequently provides good indicators of which way the wind is blowing.

The psychedelics industry is expected to bring in more than $6.85 billion by 2027, Forbes reported. Many of these investors are seeking to reproduce the lucrative results of the cannabis industry that emerged in the wake of legalization among a number of states. A recent report indicated that 36 states and four territories allow use of medical cannabis products, according to the National Conference of State Legislatures.

The largest investors in psychedelics include the venture capital firms Conscious Fund, Explorer Equity Group and Pala Santo. Earlier this year, Florida-based cannabis and psychedelics attorney Dustin Robinson co-founded Iter Investments, a new venture capital group focused on that sector.

A United Kingdom-based psychedelics-focused pharmaceutical company, Compass Pathways (NASDAQ: CMPS), went public in Sept. 2020 and is now worth an estimated $1.2 billion.

“There’s a unique opportunity to be able to go ahead and develop and commercialize [psychedelics] to a much larger patient population,” health care investor and venture capitalist Andrew Lee told Hospice News. “It’ll be interesting to see how natural pharmaceuticals might work. There’s the nonprofit, sacred path, the pharma path and the botanical drug sort of path. The most important thing is that this is another tool in the toolbox for treating a number of conditions.”

*From the article here :

Psychedelics Could Be New Frontier in End-of-Life Care - Hospice News

Psychedelic medicines may represent a new frontier for end-of-life care, as well as psychiatric treatment. While these substances — including LSD, MDMA,

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