• Psychedelic Medicine

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The Trip Treatment

by Michael Pollan | The New Yorker | 2 Feb 2015

In 2010, Patrick Mettes, a 54-year old television news director being treated for a cancer of the bile ducts, read an article on the front page of the Times that would change his death. His diagnosis had come three years earlier, shortly after his wife, Lisa, noticed that the whites of his eyes had turned yellow. By 2010, the cancer had spread to Patrick's lungs and he was buckling under the weight of a debilitating chemotherapy regimen and the growing fear that he might not survive. The article, headlined Hallucinogens Have Doctors Tuning in Again, mentioned clinical trials at several universities, including N.Y.U., in which psilocybin was being administered to cancer patients in an effort to relieve their anxiety and existential distress. One of the researchers was quoted as saying that, "under the influence of the hallucinogen, individuals transcend their primary identification with their bodies and experience ego-free states . . . and return with a new perspective and profound acceptance." Patrick had never taken a psychedelic drug, but he immediately wanted to volunteer. Lisa was against the idea. "I didn't want there to be an easy way out," she recently told me. "I wanted him to fight."

Patrick made the call anyway and, after filling out some forms and answering a long list of questions, was accepted into the trial. Since hallucinogens can sometimes bring to the surface latent psychological problems, researchers try to weed out volunteers at high risk by asking questions about drug use and whether there is a family history of schizophrenia or bipolar disorder. After the screening, Mettes was assigned to a therapist named Anthony Bossis, a bearded, bearish psychologist in his mid-fifties, with a specialty in palliative care. Bossis is a co-principal investigator for the N.Y.U. trial.

After four meetings with Bossis, Mettes was scheduled for two dosings, one of them an active placebo (in this case, a high dose of niacin, which can produce a tingling sensation), and the other a pill containing the psilocybin. Both sessions, Mettes was told, would take place in a room decorated to look more like a living room than like a medical office, with a comfortable couch, landscape paintings on the wall, and, on the shelves, books of art and mythology, along with various aboriginal and spiritual tchotchkes, including a Buddha and a glazed ceramic mushroom. During each session, which would last the better part of a day, Mettes would lie on the couch wearing an eye mask and listening through headphones to a carefully curated playlist. Bossis and a second therapist would be there throughout, saying little but being available to help should he run into any trouble.

I met Bossis last year in the N.Y.U. treatment room, along with his colleague Stephen Ross, an associate professor of psychiatry at N.Y.U.s medical school, who directs the ongoing psilocybin trials. Ross, who is in his forties, was dressed in a suit and could pass for a banker. He is also the director of the substance-abuse division at Bellevue, and he told me that he had known little about psychedelics drugs that produce radical changes in consciousness, including hallucinations, until a colleague happened to mention that, in the nineteen-sixties, LSD had been used successfully to treat alcoholics. Ross did some research and was astounded at what he found.

I felt a little like an archeologist unearthing a completely buried body of knowledge, he said. Beginning in the 1950s, psychedelics were used to treat a wide variety of conditions, including alcoholism and end-of-life anxiety. The American Psychiatric Association held meetings centered on LSD. Some of the best minds in psychiatry had seriously studied these compounds in therapeutic models, with government funding, Ross said.

As I chatted with Tony Bossis and Stephen Ross in the treatment room at N.Y.U., their excitement about the results was evident. According to Ross, cancer patients receiving just a single dose of psilocybin experienced immediate and dramatic reductions in anxiety and depression, improvements that were sustained for at least six months. The data are still being analyzed and have not yet been submitted to a journal for peer review, but the researchers expect to publish later this year.

"I thought the first ten or twenty people were plants, that they must be faking it, Ross told me. They were saying things like, "I understand love is the most powerful force on the planet, or I had an encounter with my cancer, this black cloud of smoke." People who had been palpably scared of death, they lost their fear. The fact that a drug given once can have such an effect for so long is an unprecedented finding. We have never had anything like it in the psychiatric field.

I was surprised to hear such unguarded enthusiasm from a scientist, and a substance-abuse specialist, about a street drug that, since 1970, has been classified by the government as having no accepted medical use and a high potential for abuse. But the support for renewed research on psychedelics is widespread among medical experts. I'm personally biased in favor of these type of studies, Thomas R. Insel, the director of the National Institute of Mental Health (N.I.M.H.) and a neuroscientist, told me. If it proves useful to people who are really suffering, we should look at it. Just because it is a psychedelic doesn't disqualify it in our eyes. Nora Volkow, the director of the National Institute on Drug Abuse (nida), emphasized that it is important to remind people that experimenting with drugs of abuse outside a research setting can produce serious harms.

Many researchers I spoke with described their findings with excitement, some using words like mind-blowing. Bossis said, "People don't realize how few tools we have in psychiatry to address existential distress. Xanax isn't the answer. So how can we not explore this, if it can recalibrate how we die?"

In follow-up discussions with Bossis, Patrick Mettes spoke of his body and his cancer as a type of illusion and how there might be something beyond this physical body. It also became clear that, psychologically, at least, Mettes was doing remarkably well: he was meditating regularly, felt he had become better able to live in the present, and described loving his wife even more. In a session in March, two months after his journey, Bossis noted that Mettes reports feeling the happiest in his life.

As a scientific phenomenon, if you can create conditions in which seventy per cent of people will say they have had one of the five most meaningful experiences of their lives? To a scientist, that's just incredible, said Griffiths.

https://www.newyorker.com/magazine/2...trip-treatment
 
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What if psychedelics could revolutionize the way we die?*

by Bruce Tobin | The Conversation | 25 Nov 2018https://theconversation.com/profiles/bruce-tobin-575756

My story begins eight years ago, when I was approached by my first client requesting that I supervise her in a therapeutic session with a psychedelic medicine.

She had debilitating depression and anxiety brought on by a breast cancer diagnosis. Although she had survived her cancer, she couldn’t shake her terrible emotional distress. She had tried therapists, pills and a residential program. Nothing had worked.

Then she came across stories in the media about research at UCLA using psilocybin (the active ingredient in magic mushrooms) with cancer patients suffering from what was called “end-of-life distress” and how this new treatment was showing really promising results.

She was desperate to try it for herself.

Well, as a licensed therapist and academic, could I help this woman? Reading the research literature, I learned that psychedelic research was becoming well-developed as a treatment for the psycho-spiritual depression and “existential anxiety” that often accompany the diagnosis of a life-threatening illness.

I also found myself in a bind: The science was telling me that psilocybin is the treatment most likely to benefit patients with existential anxiety when other treatments have failed; my ethical code from the B.C. Association of Clinical Counsellors tells me to act to my client’s benefit; federal law forbids me to use this treatment.

This is why, together with colleagues in the Therapeutic Psilocybin for Canadians project, I filed an application with Health Canada in January 2017, seeking a so-called “Section 56 exemption” — to permit us to provide psilocybin-assisted psychotherapy to patients with terminal cancer.

Immediate decrease in death anxiety

Recent research at Johns Hopkins Medical Centre and New York University indicates that treatment of this end-of-life distress with psilocybin-assisted psychotherapy is safe and effective.

The research indicated it led to immediate, substantial and sustained decreases in depression, death anxiety, cancer-related demoralization and hopelessness.

It resulted in increased quality of life, life meaning and optimism. And these changes had persisted at a six-month follow-up.

Patients attributed improved attitudes about life and death, self, relationships and spirituality to the psilocybin experience, along with better well-being, life satisfaction and mood.

It is heartening to see research moving into Phase 3 clinical trials that will involve many more research participants. However, the foreseeable future for Canadians who need this game-changing therapy is not especially rosy.

At our current rate of progress, it may well still be years before psilocybin successfully completes Phase 3 trials and becomes available as an orthodox medicine.

Therapists risk criminal penalties

In the meantime, many Canadians with terminal cancer are also suffering from end-of-life distress, and are in dire need of relief — now.

They face serious and life-threatening illness. Their condition is terminal, so concerns about long-term effects of psilocybin are not relevant. They suffer from serious end-of-life psychological distress (anxiety and depression) to the point that it interferes with their other medical treatments. And this distress has not successfully responded to other treatments.

Psilocybin is currently a restricted drug, meaning that therapists risk criminal penalties if they aid or abet its possession. That means that we cannot recommend or encourage its use.

My professional Code of Ethics, however, states that our ethical duty is to act in a way that serves our clients’ “best interests.” The service we provide has to be “for the client’s benefit.” We must “take care to maximize benefits and minimize potential harm.”

A compassionate, humanitarian death

I agree with the Canadian medical establishment that, in ordinary circumstances, new medicines should be made available to Canadians only when they have successfully completed Phase 3 clinical trials.

But I contend that the patients described here are not in ordinary circumstances. They have terminal cancer. All other treatments have failed them; they have nothing left to lose. They have the right to die; surely they have the right to try!

These patients deserve access to a still-experimental but promising medicine on compassionate and humanitarian grounds. Because of their extraordinary medical straits, psilocybin now for them represents a reasonable medical choice; it is necessary to them for a medical purpose.

Our application to Health Canada seeking a “Section 56 exemption” will be ruled on very shortly.

We fully expect that it will be denied — for political, not scientific reasons. Justin Trudeau’s Liberal government is likely in no mood to loosen up on psychedelics before the dust from the legalization of cannabis has fully settled. I think the government would like it if someone else made that decision.

Violation of our rights and freedoms

If our application is denied, we intend to file for a judicial review, and if necessary, a lawsuit in Federal Court challenging that denial.

We believe that prohibition of access to psilocybin for a legitimate medical purpose violates a citizen’s Canadian Charter of Rights and Freedoms Section 7 right to “life, liberty and security of person.”

This clause has already been interpreted by the Supreme Court to imply that a citizen has the right to autonomy in making health-care decisions. Charter-based arguments have already led to success in three recent landmark medical cannabis cases.

We argue that what applies to cannabis also applies to psilocybin:

The prohibition of … cannabis “limits the liberty of medical users by foreclosing reasonable medical choices through the threat of criminal prosecution. Similarly, by forcing a person to choose between a legal but inadequate treatment and an illegal but more effective one, the law also infringes on security of person.” Supreme Court of Canada, R. v. Smith, 2015

One thing that unites all of us human beings is that we will die. Imagine if, when our time comes, we could all have the option to die peacefully, with acceptance, without anxiety.

*From the article here :
http://theconversation.com/what-if-psychedelics-could-revolutionize-the-way-you-die-105124
 
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DMT studies shine light on near death experiences*

by John Chavez | Psychedelic Times | Oct 3, 2019

DMT is an abbreviation for the chemical dimethyltryptamine. This compound is most well known for its psychedelic properties and transformative effects following inhalation. The popularity of discussion surrounding DMT has continued to grow following the release of Dr. Rick Strassman’s book and documentary titled DMT: The Spirit Molecule over a decade ago. In the book, Strassman documents his journey regarding DMT research he did at the University of New Mexico in the early 1990’s. He would also publish some of his hypotheses regarding the role of DMT in inducing mystical experiences, as well as its origin within the mammalian body. In more recent times, former heavyweight boxing champion Mike Tyson has created a new surge of interest in DMT, following an ESPN interview discussing his experiences following ingestion of 5-MEO-DMT.

In June 2019, a research team at the University of Michigan published their findings from a study measuring endogenous DMT in the journal Scientific Reports. The definition of the word endogenous means “to originate within an organism.” Unlike the visionary states induced by psychedelics such as LSD, psilocybin, ayahuasca — DMT (and 5-MEO-DMT) do not need to be ingested in order to occur within the human body. DMT occurs naturally within humans, a fact that’s been known by the scientific community since the 1970’s. It was initially thought that DMT was the likely biochemical culprit for brain disorders relating to hallucinations, but inconsistent lab measurements in patients and control groups led this hypothesis to be discarded.

Over the past several decades, conflicting data and discord within the scientific community regarding endogenous DMT led some to question whether this compound was even capable of being produced in the human brain. The predominant theory of many scientists was that the lungs acted as the dominant source of DMT in the human body. The recent DMT studies at the University of Michigan, led by neuroscientist Dr. Jimo Borjigin, would change the discussion altogether. Researchers found that the circulating brain levels of DMT in normal, waking experimental animals (rats) to be within the same levels as the common neurotransmitters serotonin, dopamine, and norepinephrine. The study also measured whether the human brain contains the same two enzymes (in vitro) necessary to make DMT in the manner that experimental animals did (in vivo). The research team found that the human brain does in fact contain these same two enzymes (INMT/AADC). When asked whether this recent animal study proves that humans produce DMT in the brain, Dr. Borjigin stated, “All reasonable people would agree that if human brains are found to express both enzymes, it is highly likely that DMT is made in the human brain.”

When asked whether there is any evidence to suggest that rats produce any biochemicals that humans do not produce, Dr. Borjigin stated, “Usually when you go up the evolutionary tree, it is higher order animals such as humans that have something that rats don’t have and it doesn’t go the other way around. Especially being that both rats and humans are mammals. So my answer is no, not as far as I know. There are genes and proteins found in humans, but not mice or rats but not the other way around.”

The implications of these DMT studies are far-reaching, being that much of the speculation regarding endogenous DMT has long been focused on visionary states such as near-death experiences (NDE’s), mystical experiences from meditation, and dreaming. However, this recent data alludes to the likelihood that DMT plays a key role in normal human consciousness and our perception of reality.

DMT and near-death experiences

While this recent study did not shine any light on DMT’s relationship to near-death experiences (NDE’s), previous studies have suggested that it may play an important role. A 2015 study measured changes in the levels of neurotransmitter release in the brain prior, during, and immediately following cardiac arrest. In this study, researchers observed increases of the neurotransmitter serotonin by as much as 7,000% in the brain immediately following the moment of death. Similar dramatic increases were observed for numerous other neurotransmitters. Based on the data of the recent DMT studies showcasing similar levels to common neurotransmitters, it would seemingly be a reasonable hypothesis that DMT likely plays a role in modulating a NDE.

In the recent University of Michigan DMT study, researchers observed a nearly 300% increase of DMT in the visual cortex 15 to 30 minutes following cardiac arrest. While many interpret these findings as proof that the visions induced during near death experiences are likely generated by an increase of DMT in the brain, Dr. Borjigin states, “Some interpret our data as DMT being linked to NDE’s which is not my intention or the goal of the study; but clearly a lot of people are interested in the study because of that potential link. However, for DMT-NDE to be linked, we would have to do the same exact study we did in our 2015 PNAS paper where we monitored neurotransmitter release at 60 second intervals and measured the amounts of neurotransmitters released… and it was a huge amount.”

Brain waves

Electroencephalography (EEG) measurement records the oscillations (brain waves) of brain electric potentials acquired from electrodes placed on the scalp. Brain waves are generally believed to coincide with different states of alertness and awareness. The different types of brain waves are as follows (listed from slowest to fastest): delta, theta, alpha, beta, and gamma. Delta is the range observed during non-dream sleep while theta is correlated with deep meditation and hypnosis. Alpha is generally considered to be predominant during relaxation while beta is the dominant brain wave pattern observed during normal wakefulness and alertness. Gamma is considered to involve increased processing speed and a greater level of awareness.

In 2013, Dr. Borjigin and her research team would perform the first EEG study of brain activity during the moment of death. Up until this time, much of the scientific community hypothesized that brain activity would be markedly suppressed during cardiac arrest. However, this study produced surprising results that observed a significant surge of gamma waves 30 seconds following cardiac arrest that were global, highly coherent, and at levels exceeding waking consciousness.

While not directly related, there has also been a consistent observation of increased gamma wave measurement following the ingestion of LSD, psilocybin, ayahuasca, DMT, and 5-MEO-DMT. Additional data observing increased gamma wave activity during REM sleep (dreaming), meditation, electrically induced lucid dreaming, and hypnosis has also been generated by independent researchers. This has led to speculation that gamma waves provide a potential oscillatory correlate to endogenous DMT upregulation in the brain. When asked about the correlation of endogenous DMT and gamma wave increase, Dr. Borjigin stated, “It’s possible. I guess until we do the experiment we’re not sure, we don’t know. There’s a possibility that those two are linked. We could test it by doing an EEG of an animal specifically bred to be completely deficient in DMT and check to see if gamma waves are altered.”

So what to make of all this information?

If DMT is created within the human brain at the same level as common neurotransmitters, does that mean that our perception is inherently illusory?

One might postulate that if a person were to ingest magic mushrooms or LSD, the subsequent effects of the chemicals would induce illusions of “things happening” that aren’t truly happening. But what does this mean in light of the brain producing its own psychedelic compound on a constant basis? Neuroscientist Dr. Anil Seth has a popular TED talk on YouTube titled, “Your Brain Hallucinates Your Conscious Reality.” In this presentation, Seth gives examples in which humans utilize patterns of recognition to form a perception of reality. He stated, “We don’t just passively perceive the world, we actively generate it. The world we experience comes as much if not more from the inside out as from the outside in.” This recent study produced by the University of Michigan seems to have provided a biochemical basis for Dr. Seth’s notion that the “brain hallucinates conscious reality.”

If reality is indeed a “hallucination,” perhaps the visions reported from near-death experiences are as real as anything else humans perceive during “normal” states of perception. Further research must take place in order to better understand the nature of reality and DMT’s role in it. Dr. Borjigin and her team are leading the charge in terms of exploring the biological correlates of extreme moments of perception. Unfortunately, NIH funding has been scarce for this field of research. It’s unfortunate, as these DMT studies generate compelling data to help provide nothing less than a framework for the underlying truth of reality. If you’re interested in helping her research ventures and providing financial support to these extremely interesting studies, you can do so by donating directly to her lab here.

 
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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. We need to 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.

 
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How psychedelics could reduce existential distress for end-of-life patients

By Hannah Nie | The Varsity | 10 Nov 2019

In conversation with Dr. Daniel Rosenbaum on the clinical promise of psychedelics in Canada.

Psychedelics — substances that cause dramatic changes in thought and perception — could play a unique role in alleviating existential distress in patients with life-threatening illnesses like cancer, according to a recent review.

A University of Toronto-affiliated paper has explored the potential of psychedelic medication to improve patients’ quality of life and alleviate suffering in end-of-life care.

Facing existential distress in end-of-life care

“Existential distress relates to the kinds of concerns people often have as they face end-of-life, or cancer recurrence,” said Dr. Daniel Rosenbaum, one of the article’s co-authors, in an interview with The Varsity.

The feelings of hopelessness, demoralization, and burden associated with existential distress can cause depression, anxiety, and significantly reduced quality of life in patients facing life-threatening illnesses.

Some psychotherapies have been developed to treat existential distress and help end-of-life patients restore their sense of dignity and meaning in life; however, no medication or pill currently exists for alleviating this form of suffering — until recently as research has shown promising potential in psychedelic therapies.

Classic psychedelics include various compounds that bind to and activate 5-HT2A receptors in the brain, such as psilocybin — which is found in certain mushrooms — and lysergic acid diethylamide, also known as LSD. They can induce mystical, transcendent experiences and deep feelings of positivity, which makes them ideal to treat existential distress, according to Rosenbaum.

How psychedelics could address this problem

Studies from as early as the 1950s have suggested potential applications of psychedelics in psychotherapy. However, research has been bogged down by challenges in designing methodologies that could test the efficacy of psychedelic medicines.

There were also ethical and safety issues — some studies were completed without informed consent, and caused lasting harm to participants. By the mid-’70s, these issues, combined with controversy around the spread of recreational psychedelic use, caused most of the research in this area to be discontinued.

A ‘psychedelic renaissance’ is breaking this decades-long gap in research, accompanied by contemporary methodologies that strive to overcome the shortfalls of their predecessors. For example, today’s studies recognize the importance of components such as psychotherapy sessions before and after the drug treatment, as well as the creation of a safe and comfortable environment for the treatment sessions.

These factors can be crucial to how patients respond to the treatment and as such, must be carefully managed.

Modern studies on the promise of psychedelics

Notably, two studies from Johns Hopkins University and New York University found that psilocybin therapy reduced anxiety and depression levels in patients with life-threatening cancers and various psychiatric disorders. Patients also reported other beneficial effects, such as a reconnection to life, increased confidence, and acknowledgement of cancer’s place in life.

The treatment caused some temporary increases in heart rate and blood pressure, but these were generally well-tolerated and did not appear to cause any severely adverse symptoms. Careful participant screening in most contemporary research also helps to ensure that participants do not have any family history or personal predisposition for psychosis, and are able to undergo the treatment safely.

Moreover, the benefits of psychedelic therapy were shown to have an immediate and lasting impact. Beneficial effects were sustained for six months or longer after a single treatment. The drug’s rapid onset may also be advantageous compared to conventional antidepressant medications, which may take several weeks to have an effect.

“If someone is suffering from profound depression or anxiety, we may not have sufficient time for the alleviation of certain kinds of suffering with conventional medication treatments,” Rosenbaum said.

Next steps of psychedelic research

Further research in psychedelic-assisted therapy is underway at various institutions in Canada and around the world. A trial at the Princess Margaret Cancer Centre in Toronto is currently studying the treatment of depression in palliative care patients using intranasal ketamine.

MDMA-assisted psychotherapy for the treatment of post-traumatic stress disorder is another area of interest, with research ongoing at Ryerson University and a multi-site study from the Multidisciplinary Association for Psychedelic Studies taking place in cities across the United States, Israel, and Canada, including studies in Vancouver and Montreal.

“It’s an exciting time for the field in Canada,” Rosenbaum said. “I think, in the coming years, we will start to see a number of new trials.”

 
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Can psychedelics aid in hospice and palliative care?

The word “psychedelics” can carry a lot of misconceptions, especially when it’s used in a medical context. Some may find their possible side effects, addictive nature, and popularity as recreational drugs make them unfit to be used to treat medical conditions. However, research has started to show otherwise.

More recently, alternative methods of pain and symptom management have been gaining popularity in terminally ill patients. For example, a Swiss doctor has found that LSD can help reduce anxiety in patients with terminal cancer – and other studies have used psilocybin for the same purpose.

Although the use of psychedelics to aid hospice and palliative patients has yet to hit the mainstream, knowing alternative options and their benefits can help families to decide what treatment is best for their loved one. Should they find themselves looking into psychedelics as a potential addition to their hospice treatment plan, there’s power in knowing how these drugs could help patients live their best lives.

Coping with emotional pain and distress

When someone receives a difficult diagnosis, the initial emotions can be hard to process. Many patients feel intense anxiety or depression when they’re forced to confront their current condition. The Canadian National Palliative Care Survey found that nearly 44% of palliative patients suffered from some form of depression.

Research dating back to the 60’s, sponsored by the National Institute of Mental Health, shows the potential of psychedelics to aid hospice patients in coping with their anxiety and depression. When drugs such as psilocybin, MDMA, and ketamine are administered under medical supervision, they have shown to be safe and efficient in alleviating these symptoms.

Psilocybin, a naturally occurring psychedelic compound found in some species of mushrooms, helped 80% of patients feel a decrease in depressed and anxious moods in a double-blind trial at Johns Hopkins University. David Nutt, professor of neuropsychopharmacology at Imperial College London, has found that MDMA can help patients with PTSD open up about their trauma.

Although these psychedelics have become mainstream because of their recreational use, there are benefits that can help to ease the hearts and minds of hospice and palliative patients when carefully and thoughtfully administered under medical supervision.

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Easing physical discomfort

Chemotherapy and other aggressive treatments can leave patients feeling nauseous, fatigued, and unable to eat or sleep. Cannabis is known for its healing qualities and its ability to help ease chronic pain — cannabidiol (CBD) and (THC) — are the components in cannabis that contain those qualities.

As more states legalize medical marijuana, the social acceptance of cannabis has continued to increase. When it comes to hospice and palliative care, studies and trials have shown the positive effects that controlled cannabis use can bring to patients with chronic pain or terminal illnesses.

In a summary of randomized controlled trials, patients with HIV/AIDS saw a comparable increase in caloric intake and half of the patients felt a 30% reduction in pain ratings when given oral THC or smoked cannabis. Other studies highlight the versatility of cannabis as a healing agent — it can be smoked, ingested orally, or applied topically for varying patient needs.

Though 33 states have legalized medical marijuana, there can be legal and moral challenges when offering cannabis as a medical aid to hospice and palliative patients — cannabis is still considered a Schedule I substance, and is federally illegal.

Replacing medications and managing side effects

It’s not uncommon for palliative patients to be on long-term opioids to help manage chronic pain. Cannabis can be a more natural option for pain management, and has been introduced in palliative care to help patients lower their opioid dosage. Incorporating cannabis as a complementary treatment option can help patients find the best and most comfortable treatment plan for their diagnosis.

Similar results were found in a study published by the European Journal of Internal Medicine. The observational study set out to identify the benefits of cannabis use for cancer patients over a six-month period in Israel. When the study concluded, 36% of patients had stopped taking opioids altogether, and 9.9% had decreased their dosage as a result.

It should come as no surprise that cannabis has side effects as well. Incorporating cannabis into palliative care treatments can cause patients to experience paranoia or disorientation, and can become psychologically addictive.

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Harnessing spirituality and beyond

Similar to struggles with anxiety and depression, patients can struggle with their sense of spirituality and thoughts of death. Clinical case studies and research have detected a pattern in the therapeutic benefits of psychedelics. Patients have reported heightened cognitive clarity and emotional receptivity. Experiences vary between patients, but often the use of psychedelics under medical supervision has brought terminally ill patients an eye-opening existential experience.

Different psychedelics are associated with different experiences and spiritual outcomes. Entheogens, like psilocybin and LSD, can help patients shift their perspective or their relationship with the world. Empathogens, such as MDMA, can assist patients in feeling empathy and openness.

If these seem like viable options for your loved one, there are options out there. In May of 2018, the Right to Try Act was signed into law. This gives qualifying terminally ill patients access to medications that haven’t received FDA approval.

Researchers are continuing to investigate and question the role that psychedelics and alternative treatments could play in bettering the lives of hospice and palliative patients. No matter what treatment method you seek, it’s best to be informed and choose the right method for your personal, spiritual, and financial needs.

 
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How psychedelics are helping cancer patients fend off despair

Researchers are giving psychedelics to cancer patients to help alleviate their despair — and it’s working.

On a bone-chilling morning in February last year, Nick Fernandez bundled up and took the subway from his Manhattan apartment to the Bluestone Center for Clinical Research, which is located in an art deco-style building on the Lower East Side. A 27-year-old graduate student in psychology with dark, wavy hair and delicate, bird-like features, Fernandez was excited and nervous. He had eaten a light breakfast consisting of a bagel and industrial-strength coffee in preparation for another journey he was about to take. Fernandez had signed up to be a subject in a New York University study into the use of psilocybin to relieve mental anguish in people with terminal or recurrent cancer.

Fernandez hoped that the drug would lift the shroud of melancholy and free-floating anxiety that had enveloped him ever since he was diagnosed with leukemia in 2004 during his senior year in high school. Two and a half years of almost continuous chemotherapy vanquished the disease, but left him drained and traumatized. The former soccer star dropped more than 50 lbs from an already lean frame. ‘It was pretty brutal and forces you to grow up fast," said Fernandez, who became intensely interested in spiritual philosophy during this period, and went on to dabble in psychedelics in college. For years afterward, every sneeze and sniffle, every day that he felt tired or out of sorts, filled him with an unshakeable dread that the cancer had returned. When he heard the study mentioned on a radio show, he immediately signed up.

Jeffrey Guss and Erin Zerbo, the two NYU psychiatrists who would quietly monitor Fernandez’s progress throughout the day, greeted him when he arrived. After they took his vital signs, Fernandez changed into sweat pants and a shirt, and settled into a converted dental exam room that had been transformed into a hippie-style sanctum: tricked out with fresh flowers and fruits, a comfy sofa littered with plush pillows, Buddhist and shamanistic totems, and a high-tech sound system. Stephen Ross, an associate professor of psychiatry at NYU and the lead investigator for the study, made a brief appearance in the trip room. He was holding a glass vial that had been retrieved earlier that morning from a massive safe located inside a high-security storage room. It contained a single white capsule, and no one could be sure if it was a placebo – a dummy pill – or a 30 milligram dose of synthesized psilocybin.

‘Good luck,’ Ross said, handing Fernandez the pill, which he washed down with water that he drank from a large antique chalice. Then he slipped on the headphones, put on a face mask to block out the light, lay down on the couch and waited.

About an hour later, as the drug began to take effect, the blackness inside his head turned into an onrushing cascade of white dots that swiftly morphed into a kaleidoscope of geometric patterns – gears, stars, triangles, trapezoids – in all the colours of the rainbow. He started to hear an insistent voice in his head, telling him over and over: "I’m going to show you what I can do." Fernandez slowly suspended his skepticism and reluctantly surrendered to the experience. What he perceived to be his spirit guide took him on a Marley’s ghost-style journey, with stops at his own funeral, a hellish place littered with skulls that smelled of death where he was in excruciating pain. Once his agony reached an almost unbearable crescendo, his spirit guide catapulted him through hundreds of light years of space, allowing him to escape the pain. "I went into this mystical state, and this intense visual palate took over my mind," Fernandez said.

He suddenly found himself in Grand Central Terminal, which was filled with hundreds of people he knew dressed in tuxedos and ball gowns, dancing happily to symphonic music. He spied his girlfriend, Claire, across the dance floor. They walked towards each other and embraced, which filled him with intense feelings of bliss and joy. Soon he was again catapulted, down into the sewers of the city, and then to the top of the Empire State Building where he serenely surveyed the city just as dawn broke its rosy glow over the skyscrapers.

The spirit guide took him from there to a cave in the forest where he went shopping for another body, but the only body to be had was his own. This realization gave Fernandez a new appreciation of his body, and all it had been through: the workouts, the swims, the bike rides, the sickness when the cancer cells had taken over, and the chemotherapy drugs that had destroyed them. "For the first time in my life, I felt like there was a creator of the universe, a force greater than myself, and that I should be kind and loving," he said. "Something inside me snapped and I experienced a profound psychic shift that made me realise all my anxieties, defenses and insecurities weren’t something to worry about."

The insights gleaned under the influence of psilocybin often lead to lasting changes because participants seem to experience spiritual awakenings and substantial shifts in their perceptions of the world. When Gina Baker underwent a psilocybin session, like Nick Fernandez, at NYU, she was riddled with constant worries that her ovarian cancer would return. The anxiety, along with her tough childhood, had caused her to lose control of her emotional eating, but during her psychedelic session, she was able to get past both.

"I spent my entire life feeling like an outsider and that the world was a hostile place," said the 67-year-old Brooklyn native. "But under the influence of the drug, I saw my fear as a big black mass and I felt like I was going to be eaten alive. And then suddenly, the fear just disappeared and I felt enveloped in intense love, more deep and profound than I have ever felt, and not just for my family and dear friends but I felt at one with the universe. It was a moment of complete peace and lack of self consciousness." These changes in her perceptions endured. ‘"It liberated me from my anxieties, I stopped overeating, and I even made a whole new group of friends in my neighborhood, something I never would have done before,’ she said. ‘It was a transformative experience."

"When people are diagnosed with cancer, their lives can become constricted. They sometimes cope with terror and sadness by shutting down – they start to die before they actually do die,"
said Guss. "But with psychedelics, there is a flood of information, making people feel less like shutting down and more awake and alive."

https://aeon.co/essays/how-psychedelics-are-helping-cancer-patients-fend-off-despair
 
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NYU Langone Medical Center

Immediate reduction in depression and anxiety seen in patients with advanced cancer after a single dose of psilocybin

By Sarah Boseley

A single dose of psilocybin can lift the anxiety and depression experienced by people with advanced cancer for six months or even longer, two new studies show.

Researchers involved in the two trials in the United States say the results are remarkable. The volunteers had profoundly meaningful and spiritual experiences? which made most of them rethink life and death, ended their despair and brought about lasting improvement in the quality of their lives.

The results of the research are published in the Journal of Psychopharmacology together with no less than ten commentaries from leading scientists in the fields of psychiatry and palliative care, who all back further research. While the effects of magic mushrooms have been of interest to psychiatry since the 1950s, the classification of all psychedelics in the US as schedule 1 drugs in the 1970s, in the wake of the Vietnam war and the rise of recreational drug use in the hippy counter-culture, has erected daunting legal and financial obstacles to running trials.

"I think it is a big deal both in terms of the findings and in terms of the history and what it represents. It was part of psychiatry and vanished and now its been brought back," said Dr Stephen Ross, director of addiction psychiatry at NYU Langone Medical Center and lead investigator of the study that was based there.

"Around 40-50% of newly diagnosed cancer patients suffer some sort of depression or anxiety. Antidepressants have little effect, particularly on the existential, depression that can lead some to feel their lives are meaningless and contemplate suicide."

The main findings of the NYU study, which involved 29 patients, and the larger one from Johns Hopkins University with 51 patients. "That a single dose of the medication can lead to immediate reduction in the depression and anxiety caused by cancer, and that the effect can last up to eight months, is unprecedented," said Ross. "We don't have anything like it."

The results of the studies were very similar, with around 80% of the patients attributing moderately or greatly improved well-being or life satisfaction to a single high dose of the drug, given with psychotherapy support.

Professor Roland Griffiths, of the departments of psychiatry and neuroscience who led the study at Johns Hopkins University school of medicine, said he did not expect the findings, which he described as remarkable. "I am bred as a sceptic. I was sceptical at the outset that this drug could produce long-lasting changes," he said. "These were people facing the deepest existential questions that humans can encounter - what is the nature of life and death, the meaning of life."

"But the results were similar to those they had found in earlier studies in healthy volunteers. In spite of their unique vulnerability and the mood disruption that the illness and contemplation of their death has prompted, these participants have the same kind of experiences, that are deeply meaningful, spiritually significant and producing enduring positive changes in life and mood and behavior,"
he said.

"Patients describe the experiences as re-organizational," said Griffiths. "Some in the field had used the term mystical, which he thought was unfortunate. It sounds unscientific. It sounds like were postulating mechanisms other than neuroscience and I'm certainly not making that claim."

"Psilocybin activates a sub-type of serotonin receptor in the brain. Our brains are hard-wired to have these kinds of experiences - these alterations of consciousness. We have endogenous chemicals in our brain. We have a little system that, when you tickle it, it produces these altered states that have been described as spiritual states, mystical states in different religious branches
."

"They are defined by a sense of oneness, people feel that their separation between the personal ego and the outside world is sort of dissolved and they feel that they are part of some continuous energy or consciousness in the universe. Patients can feel sort of transported to a different dimension of reality, sort of like a waking dream."

"Some patients describe seeing images from their childhood and very commonly, scenes or images from a confrontation with cancer,"
he said. "The doctors warn patients that it may happen and not to be scared, but to embrace it and pass through it," he said.

The commentators writing in the journal include two past presidents of the American Psychiatric Association, the past president of the European College of Neuropsychopharmacology, a previous deputy director of the Office of USA National Drug Control Policy and a previous head of the UK Medicines and Healthcare Regulatory Authority.

The journal editor, Professor David Nutt, was himself involved in a small trial of psilocybin in a dozen people with severe depression in the UK in May. The ten commentators in the journal, he writes in an editorial, "All essentially say the same thing: its time to take psychedelic treatments in psychiatry and oncology seriously, as we did in the 1950s and 1960s."

"Much more research needs to be done,"
he writes. "But the key point is that all agree we are now in an exciting new phase of psychedelic psychopharmacology that needs to be encouraged not impeded."

"The studies were funded by the Heffter Research Institute in the USA. These findings, the most profound to date in the medical use of psilocybin, indicate it could be more effective at treating serious psychiatric diseases than traditional pharmaceutical approaches, and without having to take a medication every day,"
said medical director George Greer.

https://www.theguardian.com/society...t-psilocybin-can-lift-depression-studies-show
 
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Single dose of psilocybin reduces depression and anxiety for a year in cancer patients

NYU | Neuroscience News | 2 Feb 2020

A single dose of the psychedelic psilocybin reduces depression, anxiety, and feelings of hopelessness in cancer patients for 12 months after the drug is administered.

Following up on their landmark 2016 study, researchers at NYU Grossman School of Medicine found that a one-time, single-dose treatment of psilocybin, a compound found in psychedelic mushrooms, combined with psychotherapy appears to be associated with significant improvements in emotional and existential distress in cancer patients. These effects persisted nearly five years after the drug was administered.

In the original study, published in the Journal of Psychopharmacology, psilocybin produced immediate, substantial, and sustained improvements in anxiety and depression and led to decreases in cancer-related demoralization and hopelessness, improved spiritual well-being, and increased quality of life. At the final 6.5-month follow-up assessment, psilocybin was associated with enduring antianxiety and antidepressant effects. Approximately 60 percent to 80 percent of participants continued with clinically significant reductions in depression or anxiety, sustained benefits in existential distress and quality of life, as well as improved attitudes toward death.

The present study, publishing online Jan. 28 in the same journal, is a long-term follow-up (with assessments at about 3 years and 4.5 years following single-dose psilocybin administration) of a subset of participants from the original trial. The study reports on sustained reductions in anxiety, depression, hopelessness, demoralization, and death anxiety at both follow-up points.

Approximately 60 percent to 80 percent of participants met criteria for clinically significant antidepressant or anxiolytic responses at the 4.5 year follow-up. Participants overwhelmingly (71 to 100 percent) attributed positive life changes to the psilocybin-assisted therapy experience and rated it among the most personally meaningful and spiritually significant experiences of their lives.

“Adding to evidence dating back as early as the 1950s, our findings strongly suggest that psilocybin therapy is a promising means of improving the emotional, psychological, and spiritual well-being of patients with life-threatening cancer,” says the 2016 parent study’s lead investigator, Stephen Ross, MD, an associate professor of psychiatry in the Department of Psychiatry at NYU Langone Health. “This approach has the potential to produce a paradigm shift in the psychological and existential care of patients with cancer, especially those with terminal illness.”

"An alternative means of treating cancer-related anxiety and depression is urgently needed,"
said Ross. According to statistics from several sources, close to 40 percent of the global population will be diagnosed with cancer in their lifetime, with a third of those individuals developing anxiety, depression, and other forms of distress as a result. These conditions, experts say, are associated with poorer quality of life, increased rates of suicide, and lowered survival rate. Unfortunately, conventional pharmacologic treatment methods like antidepressants work for less than half of cancer patients and tend to not work any better than placebos. In addition, "they have no effect whatsoever on existential distress and death anxiety, which commonly accompany a cancer diagnosis and are linked to a hastened desire for death and increased suicidality," says Ross.

The researchers say psilocybin may provide a useful tool for enhancing the effectiveness of psychotherapy and ultimately relieving these symptoms. Although the precise mechanisms are not fully understood, experts believe that the drug can make the brain more flexible and receptive to new ideas and thought patterns. In addition, previous research indicates that the drug targets a network of the brain, the default mode network, which becomes activated when we engage in self-reflection and mind wandering, and which helps to create our sense of self and sense of coherent narrative identity. In patients with anxiety and depression, this network becomes hyperactive and is associated with rumination, worry, and rigid thinking. Psilocybin appears to acutely shift activity in this network and helps people to take a more broadened perspective on their behaviors and lives.

How the original research and follow-up were conducted

For the original study, the NYU Langone team provided 29 cancer patients with nine psychotherapy sessions, as well a single dose of either psilocybin or an active placebo, niacin, which can produce a physical flush sensation that mimics a psychedelic drug experience. After seven weeks, all participants swapped treatments and were monitored with clinical outcome measures for anxiety, depression, and existential distress, among other factors.

Although researchers found that the treatment’s antianxiety and antidepressant qualities persisted 6.5 months after the intervention, little was known of the drug’s effectiveness in the long term. The new follow-up study is the longest-spanning exploration of psilocybin’s effects on cancer-related psychiatric distress to date, the study authors say.

“These results may shed light on how the positive effects of a single dose of psilocybin persist for so long,” says Gabby Agin-Liebes, PhD candidate, lead investigator and lead author of the long-term follow-up study, and co-author of the 2016 parent study. “The drug seems to facilitate a deep, meaningful experience that stays with a person and can fundamentally change his or her mindset and outlook,” she says.

Agin-Liebes, who is pursuing her PhD in clinical psychology at Palo Alto University in California, cautions that psilocybin does not inherently lead to positive therapeutic effects when used in isolation, and in uncontrolled, recreational settings, and “should be taken in a controlled and psychologically safe setting, preferably in conjunction with counseling from trained mental health practitioners or facilitators,” she adds.

Next, the researchers plan to expand this research with larger trials in patients from diverse socioeconomic and ethnic groups who have advanced cancer-related psychiatric and existential distress.

“This could profoundly transform the psycho-oncologic care of patients with cancer, and importantly could be used in hospice settings to help terminally ill cancer patients approach death with improved emotional and spiritual well-being,” says Ross.

 
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Princess Margaret Cancer Center

The 'remarkable' impact of ketamine in cancer palliative care*

by Kate Johnson | MedScape | 27 Jan 2020

Like many in her field, Toronto psychiatrist Madeline Li, MD, PhD, was skeptical when one of her psychiatry residents suggested they launch a study into the effects of ketamine for depression in cancer palliative care.

But now, after treating about 15 patients, she's a convert.

"When I saw what it did, it was remarkable," said the clinician-scientist in the Department of Supportive Care at the Princess Margaret Cancer Center in Toronto, Canada.

Today, she is running the only registered study to investigate ketamine specifically for the treatment of depression in cancer patients.

Although the team has recruited only five patients so far, they have all had remarkable results," she reported. "Within 1 hour of the first dose, they feel different, and they're not even sure how to describe that. I have been so surprised."

The study aims to enroll 20 patients to assess feasibility for a randomized, placebo-controlled trial.

In the meantime, on the basis of her observations, Li has started offering ketamine to her other cancer patients with moderate to severe depression. "I've now tried it on maybe 10 outpatients off label, and it's worked for maybe six of them, so not all of them."

One of the patients for whom it worked was Jim Newman, 78. His reaction to ketamine was a game changer, says his wife, Louise Roberge.

Jim had esophageal cancer, and an emergency esophagectomy in October 2018 left him unable to eat, drink, or even swallow, she told Medscape Medical News.

"He came out of the hospital with an estimated 8 to 13 months to live, and he's now lived 14 months," she said, smiling. "He's beaten the odds."

However, during those months, her husband sank into a fatigue-fueled depression,” she said. Two rounds of chemotherapy left him so sick that he abandoned the treatment, and his previously active lifestyle was snatched away. Skiing, golfing, tennis, fishing ― all were out of reach. "When Dr Li offered ketamine, we thought, what is there to lose?" she said.

She never imagined how much they would gain.

"I got my husband back," she said, flipping through the photos of this past summer on their boat, his day out on the golf course, and the fish he caught with his buddy.

"Even after the first half dose at the hospital...what a big difference," she said, laughing. She described how Jim's veil of depression lifted and how he looked up and spoke to her.

Jim agrees that the drug was transformative. "The reaction I had almost instantly ― and it was almost instantly ― was that I didn't seem to be depressed," he told Medscape Medical News.

"I don't really remember what I was like before, but I know I started off very negative," he said. In fact, he had sought and gained approval to receive Medical Aid in Dying (MAID), an option which he subsequently postponed after starting the ketamine regimen.

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Off-label use of ketamine

Ketamine is an old drug. It was initially approved by the US Food and Drug Administration (FDA) in 1970 as an anesthetic agent that was administered intravenously or intramuscularly for use in diagnostic and surgical procedures. It is now available generically.

It is used off label in the treatment of resistant depression and intractable pain and was recently assessed for the treatment of problem drinking, as reported by Medscape Medical News.

In addition, it is a drug of abuse that is popular on the club scene. It is often referred to on the street as Special K.

A new product, esketamine (Spravato, Janssen), which is an enantiomer of ketamine that is administered intranasally, was approved by the FDA last year for treatment-resistant depression, although that approval raised some concerns among experts.

Speaking to Medscape Medical News, Li suggested that ketamine may have a unique potential particularly for cancer-related depression.

"Often in palliative care, people's life expectancy isn't long enough for a standard antidepressant to take effect. You need something rapidly acting," she explained.

Another clinician in this field agrees. Also in Toronto, and less than an hour away from Li's clinic, another team is using ketamine to treat persons who have psychiatric disorders. Since June 2018 at the Canadian Rapid Treatment Center of Excellence, ketamine infusion therapy has been offered to patients with major depressive disorder, bipolar disorder, posttraumatic stress disorder, or obsessive compulsive disorder.

The center is headed by Roger McIntyre, MD, who is also professor of psychiatry and pharmacology at the University of Toronto and is head of the Mood Disorders Psychopharmacology Unit at the University Health Network, Toronto.

He told Medscape Medical News that he is convinced of the benefits of ketamine in this patient population ― which could easily include palliative cancer patients.

"It's a very interesting and appropriate area," he said in an interview. "People who are palliative need treatments that are not just effective but treatments that are extremely fast. Time is not on their side, and ketamine can work in 1 to 2 days. The other thing is that in the palliative care setting, a lot of these people also have pain, and ketamine has been used for decades to treat pain. So there's a couple of reasons right there why it is entirely appropriate."

Unique delivery

Although others have delivered ketamine intravenously, Li has devised a unique way of delivering it via a nasal atomiser.

"The FDA has approved a nasal dose of esketamine, but if you look at the studies, esketamine is not as good as ketamine," she said. "As part of my study, we use an atomizer, and we draw up the solution that is used intravenously and we spray it intranasally."

Patients on the hospital palliative cancer ward are eligible for the study if they have moderate to severe depression. They are treated on days 1, 5, and 7 with a starting dose of 50 mg administered intranasally. The dose is escalated to 50–100 mg and then to 100–150 mg.

On day 8, the primary outcome is assessed using the Montgomery-Åsberg Depression Rating Scale (MADRS). Treatment is then stopped.

"Another primary objective is to see how long the effect lasts, so we measure the MADRS again on day 10 and 14, and we generally see depression returning by day 14, at which point patients have the option of continuing if they want," said Li.

Most patients end up with a twice-weekly dose, with sustained effects.

"That's the piece that I find so convincing," said Li. "It's not like giving them cocaine and they feel better for a few hours. There's actually a sustained benefit over several days."

The results are not just quantitative, she added.

"It's qualitatively where I am just so impressed with the impact of this medication. Family members will say, 'I haven't seen him or her look like this in months. They're so much more relaxed, they're smiling all the time, they have so much more energy.' It's the family members who notice it and tell me, 'This is miraculous. It's a marked improvement.' "

In the current "psychedelic renaissance," ketamine has so far stayed off the radar for palliative care depression, partly because it is normally administered via intravenous infusion over a number of hours ― which tends to be too invasive for this frail patient population ― but mostly because it has largely been overshadowed by the more classic psychedelic psilocybin.

A few small studies that have examined psilocybin for the treatment of depression in cancer patients have shown impressive results, with some suggesting it is a game changer.

There is likely a role for both of these drugs in the treatment of cancer-related depression, because the drugs are very different chemically and produce very different results.

"The classic psychedelics, including psilocybin, work at the serotonin receptor, while ketamine works at the NMDA [N-methyl-D-aspartate] receptor," explained Daniel Rosenbaum, MD, a University of Toronto psychiatry resident. He is the lead author of a recent review of the topic entitled "Psychedelics for Psychological and Existential Distress in Palliative and Cancer Care" (Curr Oncol . 2019;26:225–226).

"The benefits of classic psychedelics such as psilocybin are that they trigger 'mystical-type experiences,' " he explained.

"Mystical-type experiences are characterized by core features of unity, a noetic quality (the sense of encountering 'ultimate reality'), sacredness, deeply-felt positive mood, transcendence of space and time, and ineffability (that is, the sense that the experience cannot be adequately described using words)," he writes in his review.

In contrast, ketamine given in antidepressant doses results in 'mostly ordinary consciousness,' " he continues.

"People will say they feel a little floaty, but it's not an out-of-body dissociative experience or anything like what's described with psilocybin," said Li. "They are not high, they have not had some deeper connection with the earth or the afterlife – and the next morning they are as surprised as their family about how much better they're feeling."

And while a psilocybin "trip" takes many hours and is combined with drug-assisted psychotherapy, the ketamine treatment involves just a squirt up each nostril.

"I think the target is different," Li said of the two drugs. "Ketamine is actually an antidepressant, but psilocybin is targeting existential distress ― there is something about a transcendent experience that can make you less afraid of dying."

What she has found interesting, however, is that ketamine has also helped some of her patients with facing death. Whereas some, like Jim, have postponed their option for MAID after taking ketamine, others have embraced it.

"For some people, once their depression lifts, they actually think more clearly and feel less guilty about their decision to go ahead with it," she said. "I had one patient who was approved for MAID but was worried about setting a date because her family was against it, and she felt guilty about choosing to leave them earlier than she needed to. After we removed the depression with ketamine, she felt, 'This isn't the quality of life I want. I'm really, really sure of it now. My family is going to lose me anyway, and their grief won't be different whether I go through MAID or naturally, and so I am setting a date.' "

Li hopes her current feasibility study will lead to a randomized trial, although so far it has recruited only five patients, which is the same number as the only other study that investigated ketamine (a single oral dose) in cancer depression. That study was terminated early in 2014 after 2 years and slow accrual, but the results were less positive than what Li is seeing.

"I wish I had information that would be helpful," commented the lead investigator of that study, Robert Bright, MD, from the Mayo Clinic in Scottsdale, Arizona. "One patient became nauseous and vomited the administrated dose soon after taking it. No one had any psychotic or dissociative reactions, and I did not see anyone with remarkable improvement. The blinding was never broken, so I don't know who got placebo vs ketamine."

*From the article here :
 
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Pilot study of psilocybin treatment for anxiety in patients with advanced-stage cancer

Grob, Danforth, Chopra, Hagerty, McKay, Halberstadt, Greer

In recent years, there has been a growing awareness that the psychological,spiritual,and existential crises often encountered by patients with cancer and their families need to be addressed more vigorously. From the late 1950s to the early 1970s, research was carried out exploring the use of psychedelics to treat the existential anxiety, despair, and isolation often associated with advanced-stage cancer. Those studies described critically ill individuals undergoing psychospiritual epiphanies, often with powerful and sustained improvement in mood and anxiety as well as diminished need for narcotic pain medication. Despite these promising results, there has been no follow-up research.

Today, the medical value of psychedelics is again being examined in formal psychiatric settings. One substance under investigation is psilocybin, occurs in nature in various species of mushrooms. Psilocybin is rapidly metabolized to psilocin, which is a potent agonist at seroton in 5-HT1A/2A/2C receptors, with 5-HT2A receptor activation directly correlated with human psychedelic activity. Psilocybin was studied during the 1960s to establish its psychopharmacological profile; it was found to be active orally at around 10 mg, with stronger effects at higher doses, and to have a 4- to 6-hour duration of experience. Psychological effects were similar to those of LSD, with psilocybin considered to be more strongly visual, less emotionally intense, and more euphoric, with fewer panic reactions and less chance of paranoia than LSD.

Recent clinical examinations of psilocybin have indicated that it is not hazardous to physical health. Positron emission tomographic studies have demonstrated that psilocybin produces a global increase in the cerebral metabolic rate of glucose, most markedly in the frontomedial and frontolateral cortex, anterior cingulate, and temporomedial cortex. These changes are correlated with measures of psychological state and are consistent with potential neurobiological substrates of major mental illnesses.

In one recent study, 36 healthy volunteers received a high dose (30 mg/70 kg) of psilocybin with no sustained deleterious physiological or psychological effects. The investigators corroborated previous findings that psilocybin could reliably catalyze mystical experiences leading to significant and lasting improvements in the quality of life. In another study, the effects of psilocybin were examined in patients with severe, refractory obsessive-compulsive disorder. Researchers concluded that psilocybin is safe and well tolerated in subjects with obsessive-compulsive disorder and may be associated with “robust acute reductions” in core obsessive-compulsive disorder symptoms, although there was no clear dose-response relationship.

During the first wave of psychedelic research, from the 1950s through the early 1970s, investigators who administered psychedelics to patients with end-stage cancers reported results that included improved mood and reduced anxiety, even in those with profound psycho-logical demoralization. The present study is the first in more than 35 years to explore the potential utility of a psilocybin treatment model for patients with reactive anxiety associated with advanced-stage cancer.

The initial goals of this research project were to establish feasibility and safety for a psychedelic treatment model in patients with advanced-stage cancer and anxiety. Following discussion with federal and state regulatory agencies as well as hospital institutional review board and research committees, a modest 0.2-mg/kg psilocybin dose was chosen. Although not comparable to higher doses of psychedelics administered in the past to severely ill patients, the dose used here was still believed capable of inducing an alteration of consciousness with potential therapeutic benefit while optimizing patient safety. Determining safe parameters with this novel treatment paradigm is critical to establishing a strong foundation for this field of study that would allow for future investigations.

Consistent with previous research, we found no untoward cardiovascular sequelae in our subject population. Minor HR and BP elevations after psilocybin administration were evidence only of a mild sympathomimetic effect. Holter monitoring did not identify increased cardiac arrhythmias in comparison with niacin placebo, even in subjects who presented with some baseline cardiac arrhythmia. Niacin may acutely lower BP through vasodilation but had minimal effects on BP and HR in our subjects, except for a reduction in diastolic BP that was noted 1 hour after administration of niacin. This transient effect may have contributed to our detection of a significant psilocybin effect at that time but cannot explain the significant effects of psilocybin over the subsequent intervals because the initial niacin-induced reduction of diastolic BP did not persist. We also observed no adverse psychological effects from the treatment. All subjects tolerated the treatment sessions well, with no indication of severe anxiety or a “bad trip.” The fact that psilocybin produced only modest effects on the anxious ego dissolution scale of the 5D-ASC confirmed this conclusion.

When psychedelics were administered to patients with terminal cancer in the 1960s and early 1970s, the occurrence of a profound psychospiritual experience was correlated with therapeutic outcome. Such transcendent states of consciousness are usually associated with higher doses of psychedelics, so our expectation of demonstrating efficacy was limited. Common themes reported by subjects included examining how their illness had impacted their lives, relationships with family and close friends, and a sense of ontological security. In addition, subjects reported powerful empathic cathexis to close friends and family members and examined how they wished to address their limited life expectancy. In monthly follow-up discussions, subjects reflected on insights and new perspectives gained during their psilocybin treatment.

Although we used a within-subject, double-blind, placebo-controlled design, the drug order was almost always apparent to subjects and investigators whether the treatment was psilocybin or placebo. In fact, one consistent subject critique of the study was that the placebo sessions were perceived as far less worthwhile than those with psilocybin. Many of the subjects suggested that future protocols provide the opportunity for a second psilocybin session several weeks after the first. The general consensus among subjects was that a follow-up experience with psilocybin would reinforce and extend the perceived therapeutic effects of the initial session.

Future studies also will need to address the issue of controlling for a placebo effect that might otherwise be attributed to the active treatment. Given the subjects’ grave prognosis and limited life expectancy, we decided to provide all subjects with an opportunity to experience the experimental medicine and to serve as their own control. Although we believed that to be the ethical course to take, given the life circumstances subjects were encountering, the protocol design contains some inherent limitations. A better experimental design might incorporate an independent control group, receiving only either placebo treatment or a conventional psychopharmacological intervention. Although there is no question that the extensive attention paid to the subjects influenced outcomes, the unique qualities of the psilocybin experience in facilitating strong therapeutic bonds and ameliorating underlying psychological demoralization are important factors worthy of further exploration.

Another limitation of this study was variability in the extent of contact with subjects after treatment. A minimum contact of 1 hour monthly was established, but variability in additional ad hoc communication depended n the needs and wishes of the subjects, some of whom were near death compared with others who were more functional. Despite the limitations, this study demonstrates that the careful and controlled use of psilocybin may provide an alternative model for the treatment of conditions that are often minimally responsive to conventional therapies, including the profound existential anxiety and despair that often accompany advanced-stage cancers. A recent review from the psilocybin research group at Johns Hopkins University describes the critical components necessary for ensuring subject safety in psychedelic research.

Taking into account these essential provisions for optimizing safety as well as adhering to strict ethical standards of conduct for treatment facilitators, the results provided herein indicate the safety and promise of continued investigations into the range of medical effects of psychedelic compounds such as psilocybin.

 
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Psychedelics in palliative care

by Mellody Hayes | Scientific American | 20 Mar 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, also known as ecstasy or molly, 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.

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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.

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Mellody Hayes

Mellody Hayes, MD is the CEO of Ceremony Health. She is a graduate of Harvard College and of the University of California, San Francisco, medical school and anesthesiology residency. She is a physician-writer, spiritual teacher, public speaker and a Voices of Our Nation Arts Foundation alumna.

 
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Psychedelic drugs can improve the quality of life - and death

by Abbie Rosner | Forbes | 6 May 2020

Even before COVID-19 set off a global tsunami of anxiety and depression, psychedelic drugs were already showing exciting promise for treating these and other intractable mental health conditions.

Compass Pathway’s recent raise of $80M to expand research into the clinical uses of psilocybin only affirms that no coronavirus is going to dampen efforts to make these treatments legal and widely accessible. If anything, the need for an effective answer to COVID-era angst makes this work even more urgent.

Especially for Baby Boomers and their elders, developments in the psychedelic space are worthwhile following, particularly because of their potential to radically improve quality of life, up to its inevitable end.

Older Americans suffer disproportionately from chronic pain and its attendant ailments, anxiety, depression and insomnia. In the search for relief, they consume more pharmaceutical drugs than perhaps any comparable cohort on this planet.

Psychedelic therapies to treat mental health conditions offer a radical departure from current pharmaceutical models that wed individuals in a lifelong bond of drug-taking. Instead, the psychedelic therapy modalities currently under investigation combine a limited number of treatment sessions with a psychedelic substance, sandwiched between intensive pre- and post-treatment therapy sessions. The ideal, and realistic, outcome from this course of treatment is not mere symptom control but durable remission.

Indeed, these studies are finding that, in clinically significant numbers, recipients of a single course of psychedelic therapy report the experience to be life-changing, and enduring over time.

Christian Angermayer, founder of ATAI Life Sciences which is the largest shareholder in Compass Pathways, envisions a day when psychedelic treatments are fully integrated into the healthcare system and covered by insurers. And if that seems like a hippie’s fantasy, the mainstreaming of psychedelics is actually well on its way to becoming a reality.

The right conditions

The study of psychedelic drugs has been ongoing since the 1940s, launched by Albert Hoffmann’s serendipitous discovery of LSD. Not knowing exactly what to do with this new drug, Hoffman and others began to investigate psychedelics to treat alcoholism and other mental health conditions, with very promising findings. But when dropping acid in the 1960s became a counterculture rite of passage, an enraged President Nixon lashed out with the War on Drugs, and psychedelic research became its collateral damage. After over a decade hiatus, researchers quietly picked the thread up once again, this time determined not to let cultural distractions derail their efforts.

Their success is now evident in the new green rush of non-profits and companies that are making impressive strides in developing and commercializing psychedelic drug-based therapies, mainly focused on mental health. For a traumatized world, this movement offers tangible hope that depression, anxiety, PTSD and other ubiquitous mental health issues may, for the first time, be treated in a meaningful and effective way.

The challenges for bringing psychedelic drugs like LSD and psilocybin, which are currently federally illegal substances, to patients are not trivial. Fortunately, this time around, the set and setting appear to be optimal for psychedelic drug development to move forward. Bolstered by strong preliminary research findings, the entities working to bring psychedelic drugs to market enjoy the cooperation of the FDA and a critical mass of philanthropic and investor funding.

The positive preliminary outcomes of clinical studies by MAPS using MDMA to treat PTSD, and Compass Pathways for psilocybin therapy for treatment-resistant depression, have convinced the FDA to grant them Breakthrough Therapy Designation, acknowledging that they “may demonstrate substantial improvement over existing therapies.” The enlistment of the FDA to the cause is a major milestone towards bringing psychedelic drugs to the mainstream.

Psychedelics for depression

Psilocybin – a psychedelic compound produced by certain “magic” mushrooms – is the study material used by Compass Pathways in their multi-center Phase IIb study of treatment-resistant depression. Angermayer likens psilocybin to a broad-spectrum antibiotic because of its potentially wide-ranging effects, which could extend to treating anxiety and addiction, among other conditions.

Considered milder – and less controversial - than LSD, a psilocybin “trip” lasts around six hours, compared to what can be double that amount or longer with LSD. With two therapists accompanying the patient through the experience, this is already a weighty commitment of time, emotional and financial resources.

The Compass-sponsored study is currently recruiting participants at 20 sites around the world, including seven in the US and 1 in Canada.

Psychedelics for end-of-life anxiety

Already in the 1960s researchers were interested in seeing if psychedelic drug treatment could alleviate existential distress in terminal cancer patients. This line of research was picked up 35 years later by Dr. Charles Grob, whose 2011 pilot study of psilocybin treatment for terminal cancer patients found significant enduring reductions in anxiety and improvement in mood at a six-month follow up.

In the landmark book “How to Change Your Mind” author Michael Pollan movingly describes the insights of cancer patients who participated in a subsequent psilocybin study conducted at NYU:

“I was being told (without words) not to worry about the cancer … it’s minor in the scheme of things … simply an imperfection of your humanity and that the more important matter … the real work to be done is before you. Again, love.”

Another participant described driving away her fear with anger, which was replaced by “overwhelming love” and that in spite of being “a solid atheist”, she felt “bathed in God’s love.”

We all face the end of life

Even if we aren’t coping with a life-threatening diagnosis, who wouldn’t want to have an experience that might help approach the inevitable end with equanimity and grace?

When international travel was still an option, psychedelic experiences could be arranged at retreat centers in Jamaica, the Netherlands, and even Peru. But even without travel restrictions, the high price tag for these mind-expanding trips left them out of reach for most.

Perhaps one day, when psilocybin therapies are FDA approved and covered by insurance, psychotherapists will have enough experience working with them that they become a routine form of treatment not only for depression, but for end-of-life distress as well.

In the meantime, the importance of access to this type of transformational experience cannot be underestimated. Just consider the insight of the NYU end-of-life study participant:

“…everyone deserved to have this experience… that if everyone did, no one could ever do harm to another again … wars would be impossible to wage.”

And if older adults with depression, end-of-life anxiety, and even just general malaise can replace those feelings with joy and a sense of purpose, leading up to a conscious transition, that can be a trip well worth taking.

 
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Psychedelic drug eases cancer patients' distress long term

by Amy Norton | U.S. News & World Report

A single dose of the psychedelic ingredient in "magic mushrooms" may bring long-lasting relief to cancer patients who suffer anxiety and depression, a new, small study suggests.

Researchers found that of 15 patients who'd received a one-time treatment with psilocybin, most were still showing "clinically significant" improvements in anxiety and depression four years later.

The study, published Jan. 28 in the Journal of Psychopharmacology, is a follow-up to one reported in 2016. That trial involved 29 cancer patients with psychiatric distress who received a single dose of psilocybin. Most responded quickly, with effects that lasted up to six months.

These latest findings suggest there can be ongoing benefits from what many study patients described as a "life-changing experience," the researchers said.

"It can come off as sounding like voodoo," said lead researcher Dr. Stephen Ross, an associate professor of psychiatry at NYU Langone Health, in New York City.

And, the truth is, no one is sure exactly how psilocybin works to lift entrenched anxiety and depression -- including the kind of "existential distress" that can plague people with a life-threatening disease.

Magic mushrooms have long been used recreationally for their hallucinogenic effects -- meaning they alter users' perceptions of their surroundings, and their own thoughts and feelings. That could end badly -- if people mistakenly think they can fly, for instance.

"But given in a controlled medical setting, psilocybin may help people with psychological distress 'get out of that scared, stuck place,'" Ross said,

"It's not that the drug is "magic" or a "cure," he stressed. "For one, not everyone benefits. Plus, the patients in this study also received psychotherapy."

"I don't think you can just give psilocybin alone,"
Ross said. "We definitely see this as psilocybin-assisted therapy."

And it's a therapy you cannot yet find at your local doctor's office. Psilocybin is illegal in the United States, and researchers need permission to use it in studies.

But a growing number of institutions are doing just that. NYU, Johns Hopkins, the University of California and other universities are currently studying psilocybin-assisted therapy for conditions such as eating disorders, addiction and major depression.

Medical research into psychedelics like psilocybin and LSD began in the 1950s, and then famously ended after a surge in recreational use by the 1960s "counterculture."

"Research stopped because of the sociopolitical context and street use -- not because the science wasn't there," said Matthew Johnson, associate director of the university's Center for Psychedelic and Consciousness Research.

He stressed that no one is suggesting people self-treat their mental health symptoms with mushrooms. "With recreational use, there's the risk of engaging in dangerous behavior," Johnson said.

"In the research setting, we're not only minimizing the risks, but also trying to maximize the benefits," he explained.

"I wouldn't expect these positive results from people using psilocybin on their own," Johnson said.

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As for the mechanisms behind psilocybin, research points to a correlation between patients' perceptions of "mystical experiences" while on the drug and their symptom improvement. Those experiences, Johnson explained, can refer to a feeling of transcending the ego or, for the religiously inclined, feeling closer to God.

"The experience seems to, in essence, allow some people "to do their own self-analysis," Johnson said.

What about effects on the brain? There is evidence, according to Ross and his colleagues, that psilocybin alters activity in the brain's default mode network, which turns on when we engage in self-reflection. But in people with depression or anxiety, that same network can be hyperactive and associated with worry and ruminating.

More research is needed to understand what's happening in the brain, Johnson said. Even more importantly, results from larger, rigorous studies are necessary to prove psilocybin is effective as medicine.

A limitation of the current study, Ross said, is that all patients eventually received psilocybin, so there was no true "control" group.

And patients in the follow-up study were people who were still alive several years after a cancer diagnosis, most of whom were in full or partial remission. It's always possible, Ross said, that they would be feeling good even if they'd never received psilocybin.

He noted, however, that cancer survivors frequently suffer from lingering anxiety and fear. But of the 15 patients in this study, 60% to 80% were meeting the criteria for a "clinically meaningful" improvement in their anxiety or depression four years out.

"And nearly all still described their psilocybin experience as one of the most personally or spiritually meaningful ones of their lives," Ross said.

 
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Palliative Canadians endure punishing delays in health minister's approval of psilocybin mushrooms

GlobalNewswire | 17 Jun 2020

Pressure grows on Health Minister, Patty Hajdu, as palliative Canadians wait for the Health Minister’s response to their Section 56 applications regarding access to psilocybin mushrooms on compassionate grounds. TheraPsil, a Canadian BC-based non-profit coalition of healthcare professionals, patients and advocates, has expanded its program and is now inviting Ontario patients to come forward for support of their section 56 applications.

For information about TheraPsil's program, visit the TheraPsil website.

TheraPsil has supported and is aware of at least 4 dying Canadians who have applied directly to the Health Minister for access to psilocybin-assisted therapy to treat their end-of-life distress. Two of the four palliative patients have come forward to share their stories and encourage others in their position to to explore their options.

One patient, Saskatchewan resident Thomas Hartle was diagnosed with colon cancer in April, 2016, and exhausted all other treatment options.

“As you can imagine, this obviously causes quite a bit of anxiety,” Thomas told us. “There isn’t anything any doctor can tell me or any pill they can give me that can say that everything will definitely be ok after you die. But the research shows that psilocybin may be able to help me with the ‘end of life distress’. So, I have submitted a section 56 application to Patty Hajdu asking for an exemption to use psilocybin with my doctor and therapist. I have asked her to respond to my application by June 25th so I may live out my remaining time in peace.”

Laurie says;

“I think it’s so wrong that people don't have access to this drug. People are living with anxiety and emotional pain and studies show that psilocybin helps. Why are we not allowing people to have this drug but allow them to have other drugs that are so harmful? We have given people the right to die, but I'm not there yet. What about living? I believe I should have the right to live without anxiety and fear, to be able to enjoy whatever time I have left. Psilocybin can do that for me and for other Canadians who are dealing with the same issues.”

Everyday without a response increases a patient's suffering. Here is what one of the applicants’ doctors, Crosbie Watler MD, had to say;

“My Patient has been waiting an excess of 8 weeks for a response from the Hon. Health Minister. This is unacceptable. No dying Canadian should have to reach to the highest levels of government to ask for legal access to a mushroom, just to be ignored. Patients have the right to die in Canada, so surely we must be able to give them the right to try a plant-based medicine that has been proven with clinical research to be a safe and effective treatment option.”

All eyes are now on the Minister of Health, to respond to patient applications.

 
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How a psychedelic drug helps cancer patients overcome end-of-life anxiety

by Robin Marantz Henig | NPR

The brilliantly-colored shapes reminded Carol Vincent of fluorescent deep-sea creatures, and they floated past her languidly. She was overwhelmed by their beauty — and then suddenly, as if in a dream, she was out somewhere in deep space instead. "Oh, wow," she thought, overwhelmed all over again. She had been an amateur skydiver in her youth, but this sensation didn't come with any sense of speeding or falling or even having a body at all. She was just hovering there, gazing at the universe.

Vincent was having a psychedelic experience, taking part in one of the two studies just published that look at whether cancer patients like her could overcome their death-related anxiety and depression with a single dose of psilocybin.

It turned out they could, according to the studies, conducted at New York University and Johns Hopkins and reported this week in the Journal of Psychopharmacology. NYU and Hopkins scientists gave synthetic psilocybin, the hallucinogenic component of "magic mushrooms," to a combined total of 80 people with advanced cancer suffering from depression, anxiety, and "existential angst." At follow-up six months or more later, two-thirds of the subjects said their anxiety and depression had pretty much disappeared after a single dose.

"And about 80 percent said the psilocybin experience was "among the most personally meaningful of their lives," Roland Griffiths, a professor of psychiatry and leader of the Hopkins team, said in an interview.

That's how it was for Vincent, one of the volunteers in Griffiths' study. By the time she found her way to Hopkins in 2014, Vincent, now 61, had been living for six years with a time bomb of a diagnosis: follicular non-Hodgkin's lymphoma, which she was told was incurable. It was asymptomatic at the time except for a few enlarged lymph nodes, but was expected to start growing at some undefined future date; when it did, Vincent would have to start chemotherapy just to keep it in check. By 2014, still symptom-free, Vincent had grown moderately anxious, depressed, and wary, on continual high alert for signs that the cancer growth had finally begun.

"The anvil over your head, the constant surveillance of your health — it takes a toll," says Vincent, who owns an advertising agency in Victoria, British Columbia. She found herself thinking, "What's the point of this? All I'm doing is waiting for the lymphoma. There was no sense of being able to look forward to something." When she wasn't worrying about her cancer, she was worrying about her son, then in his mid-20s and going through a difficult time. What would happen to him if she died?

Participating in the psilocybin study, she says, was the first thing she'd looked forward to in years.

The experiment involved two treatments with psilocybin, roughly one month apart — one at a dose high enough to bring on a markedly altered state of consciousness, the other at a very low dose to serve as a control. It's difficult to design an experiment like this to compare treatment with an actual placebo, since it's obvious to everyone when a psychedelic experience is underway.

The NYU study used a design similar to Hopkins' but with an "active placebo," the B vitamin niacin, instead of very-low-dose psilocybin as the control. Niacin speeds up heart rate but doesn't have any psychedelic effect. In both studies it was random whether a volunteer got the dose or the control first, but everyone got both, and the order seemed to make no difference in the outcome.

Vincent had to travel from her home in Victoria to Baltimore for the sessions; her travel costs were covered by the Heffter Research Institute, the New Mexico nonprofit that funded both studies. She spent the day before each treatment with the two Hopkins staffers who would be her "guides" during the psilocybin trip. They helped her anticipate some of the emotional issues — the kind of baggage everyone has — that might come to the fore during the experience.

The guides told Vincent that she might encounter some hallucinations that were frightening, and that she shouldn't try to run away from them. "If you see scary stuff," they told her, "just open up and walk right in."

They repeated that line the following day — "just open up and walk right in" — when Vincent returned to Hopkins at 9 a.m., having eaten a light breakfast. The treatment took place in a hospital room designed to feel as homey as possible. "It felt like your first apartment after college, circa 1970," she says, with a beige couch, a couple of armchairs and some abstract art on the wall.

Vincent was given the pill in a ceramic chalice, and in about 20 minutes she started to feel woozy. She lay down on the couch, put on some eye shades and headphones to block out exterior sights and sounds, and focused on what was happening inside her head. The headphones delivered a carefully-chosen playlist of Western classical music, from Bach and Beethoven to Barber's "Adagio for Strings," interspersed with some sitar music and Buddhist chants. Vincent recalled the music as mostly soothing or uplifting, though occasionally there were some brooding pieces in a minor key that led her images to a darker place.

With the music as background, Vincent started to experience a sequence of vivid hallucinations that took her from the deep sea to vast outer space. Listening to her describe it is like listening to anyone describe a dream — it's a disjointed series of scenes, for which the intensity and meaning can be hard to convey.

She remembered seeing neon geometric shapes, a gold shield spelling out the name Jesus, a whole series of cartoon characters — a fish, a rabbit, a horse, a pirate ship, a castle, a crab, a superhero in a cape — and at some point she entered a crystal cave encrusted with prisms. "It was crazy how overwhelmed by the beauty I was," she says, sometimes to the point of weeping. "Everything I was looking at was so spectacular."

At one point she heard herself laughing in her son's voice, in her brother's voice, and in the voices of other family members. The cartoon characters kept appearing in the midst of all that spectacular beauty, especially the "comical crab" that emerged two more times. She saw a frightening black vault, which she thought might contain something terrifying. But remembering her guides' advice to "just open up and walk right in," she investigated, and found that the only thing inside it was herself.

When the experience was over, about six hours after it began, the guides sent Vincent back to the hotel with her son, who had accompanied her to Baltimore, and asked her to write down what she'd visualized and what she thought about it.

Griffiths had at first been worried about giving psychedelics to cancer patients like Vincent, fearing they might actually become even more afraid of death by taking "a look into the existential void."

But even though some research participants did have moments of panic in which they thought they were losing their minds or were about to die, he said the guides were always able to settle them down, and never had to resort to the antipsychotic drugs they had on hand for emergencies. (The NYU guides never had to use theirs, either.)

Many subjects came away feeling uplifted, Griffiths says, talking about "a sense of unity," feeling part of "an interconnected whole." He adds that even people who are atheists, as Vincent is, described the feeling as precious, meaningful or even sacred.

"The reasons for the power and persistence of psilocybin's impact are still a big mystery," according to Griffiths. "That's what makes this research, frankly, so exciting," he says. "There's so much that's unknown, and it holds the promise for really understanding the nature of human meaning-making and consciousness."

He says he looks forward to using psilocybin in other patient populations, not just people with terminal diagnoses, to help answer larger existential questions that are "so critical to our experience as human organisms."

Two and a half years after the psychedelic experience, Carol Vincent is still symptom-free, but she's not as terrified of the "anvil" hanging over her, no longer waiting in dread for the cancer to show itself. "I didn't get answers to questions like, 'Where are you, God?' or 'Why did I get cancer?' " she says. What she got instead, she says, was the realization that all the "fears and worries that take up so much of my mental real estate turn out to be really insignificant in the context of the big picture of the universe."

This insight was heightened by one small detail of her psilocybin trip, which has stayed with her all this time: that little cartoon crab that floated into her vision along with the other animated characters.

"I saw that crab three times," Vincent says. The crab, she later realized, is the astrological sign of cancer — the disease that terrified her, and also the sign that both her son and her mother were born under. These were the three things in her life that she cared about, and worried over, most deeply, she says. "And here they were, appearing as comic relief."

 
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Psychedelic researcher once again paves the way with historic psilocybin study for end of life patients

by Ann Harrison | LUCID | 3 Aug 2020

Dr. Charles Grob has been quietly pushing the envelope of psychedelic psychiatry and scholarship for decades.

A Lundquist Institute investigator and Professor of Psychiatry and Bio-Behavioral Sciences at the UCLA School of Medicine, Grob is also the Director of the Division of Child and Adolescent Psychiatry at Harbor-UCLA Medical Center.

Risking his own reputation in the medical community to conduct research that was at one time considered taboo, Grob carried forward the promising studies of the 1960’s and 1970’s which suggested that psychedelic substances had the potential to reduce the pain and anxiety of people approaching death.

Working in a modest office on the grounds of a county hospital in Los Angeles where he runs a mental health clinic for children and adolescents, Grob stepped up to continue meticulous clinical investigations to study the safety and feasibility of psychedelic medications.

Grob and his colleagues at the Harbor-UCLA Medical Center conducted pioneering research into the use of psilocybin as a mental health treatment for terminally ill cancer patients. Published in 2011 in the Archives of General Psychiatry, their Pilot Study of Psilocybin Treatment for Anxiety in Patients With Advanced-Stage Cancer was the first to show that psilocybin had a dramatic effect on the existential distress of people nearing death, improving their quality of life and offering psychospiritual epiphanies.

This early pilot study pointed the way for two following groundbreaking clinical trials published in 2016 that showed the promise of psychedelics to relieve emotional suffering at the end of life.

One set of clinical trials was led by Anthony P. Bossis, PhD, Clinical Assistant Professor of Psychiatry at New York University School of Medicine, and his fellow researchers at New York University. The second was carried out by Dr. Roland Griffiths and a team of researchers at Johns Hopkins University. Both investigations showed that psilocybin reduced anxiety and depression for patients with terminal cancer.

Grob is now practicing telemedicine due to the Covid-19 pandemic, but he and his fellow investigators continue the quest for a deeper understanding of how psychedelics can support people at the end of life.

The Lundquist Institute for Biomedical Innovation announced last month that Grob and Bossis will lead a new multi-site clinical trial to study the effectiveness and safety of psilocybin to treat terminally ill people with psychological distress.

The new clinical trial will be funded by an anonymous $1.75 million donation to The Lundquist Institute. The funds will also be used to develop education and outreach programs on the use of psilocybin for palliative care, a medical specialty that focuses on relieving suffering and improving the quality of life for people with a serious illness.

The Lundquist Institute study will be the first to investigate a psychedelic substance for palliative care and the first to conduct new clinical trials to move the findings of the 2016 trials forward. This research comes at a critical time as a wave of emerging companies and organizations are investigating the use of psychedelics for mental health treatments.

“We don’t die well in America and have few approaches to relieve end-of-life emotional suffering,” says Bossis in a statement from The Lundquist Institute. “Clinical research has demonstrated that psychedelic-generated mystical experience dramatically reduces depression, anxiety, and demoralization in end-of-life existential distress and can improve quality of life and a sense of personal meaning.”

Founded in 1952, the Torrance-CA-based nonprofit Lundquist Institute, supports more than 120 principal investigators working on over 1,000 research studies. The Lundquist Institute created the training for and coined the term “paramedics,” developed human growth hormone, and was involved in the early development of the profession of Nurse Practitioner. It is academically affiliated with the David Geffen School of Medicine at UCLA and works in partnership with the Harbor-UCLA Medical Center.

The editor of two influential books on psychedelics, Hallucinogens: A Reader and Higher Wisdom: Eminent Elders Explore the Continuing Impact of Psychedelics, Grob and co-editor Jim Grigsby will release in February 2021 the Handbook of Medical Hallucinogens, the first formal academic textbook on the topic of hallucinogens and psychedelics.

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Dr. Charles Grob

Grob spoke with Lucid News to reflect on The Lundquist Institute study and the history of research into the use of psychedelic substances for treating the mental health needs of people with terminal illness :

A $1.75 anonymous donation is significant. Who donated the funds for this study?

Dr. Charles S. Grob: I am sworn to secrecy. My lips are sealed. I haven’t even told my wife or daughter.

What makes The Lundquist Institute research unique in the study of psychedelic substances?

What makes this study different from preceding studies is that it has broadened the patient population, it will take place in palliative care settings, and it will train practitioners. There has been a strong level of interest in investigating the palliative treatment model at national and international palliative care conferences. We will be training different palliative care practitioners including doctors, nurses, chaplins, social workers and psychologists.

What also makes this research different is that in the pioneering investigations with psychedelics in the 1960’s and in the modern era, we looked at individuals with advanced cancer. In this study, we are opening it up to people with many additional medical illnesses that might be fatal and who are already enrolled in palliative programs.

When will the study start and how will it be structured?

I think it will start early next spring. We need to still finalize our protocols and submit them to regulatory agencies and go through an Institutional Review Board (IRB) presentation next spring or next summer. It will be a double-bind placebo controlled study and we have budgeted for 60 subjects, but we have been advised to estimate about 80 subjects.

We are not advocating that people use psychedelics in the dying process. The study subjects must have an estimated life expectancy of six months and a palliative care diagnosis for an illness that could lead to a potentially fatal outcome. The study will take place at four to five different sites around the U.S. using the same methodology, the same entry criteria, and the same outcome measures. I would imagine five to six researchers at each site. I can’t confirm the sites at this time.

Another potential complication is this strange world we live in with Covid. How are we going to administer psychedelic treatment in the age of Covid-19? This is going to be challenging because we will be in relatively close proximity to study subjects for many hours. We could be in a small space. Society needs to be in a much healthier place to do this kind of study and go through all the hurdles. I’m sure we will work this out and other groups working with psychedelics will work this out.

Why is this study needed now?

The study of psychedelic substances has gone from a small field to expanding rapidly into something that at times feels over the top. I am concerned that proper attention to establishing safety parameters – and the importance of that in this context – may not be a priority for some investigators. It’s good to see enthusiasm for this research, but people implementing these studies need to prioritize the need for safety and established ethical standards. I have written a paper with other researchers on the need for strong ethical standards and safety parameters which we will publish this year.

Is this study historically significant?

Yes. This is the first study of this sort since the 1960s or early 1970s. In the 1960’s, this was one of the most promising areas for psychedelic-assisted treatment. In the early 1960’s, Dr. Eric Kast, a pain specialist at the Chicago Medical School, conducted research administering LSD to hospital patients in chronic pain and recorded positive effects in pain reduction, improved mood, outlook and quality of life with less fear of death. This research was followed up by Walter Pahnke, Stanislav Grof, and Bill Richards who did work in the late 1960’s and early 1970s finding dramatic effects with the improvement of anxiety and the reduction of pain.

They found that the strongest predictor of positive therapeutic outcome was, during the course of the session, the patient having a powerful psychospiritual epiphany. Humphry Osmond, in the late 1950’s, also found that this predicted the best outcomes while studying the use of psychedelics to treat people with alcohol dependency.

Why did this research stop moving forward after the initial studies in the 1960’s and 1970’s?

The psychedelic research in the 60s and 70s was not halted due lack of positive outcomes or the safety of the research. It was stopped for cultural and political reasons. It got conflated with the culture wars of the 60’s and was identified with a politically active counterculture. In the 60’s, the divisiveness became a cultural divide and psychedelics became a sacrament for the counterculture. You were on one side or the other side.

Some leaders like Timothy Leary, who was a brilliant researcher, also had a penchant for being very provocative and the compounds were eventually considered too hot to handle. There was no approved research in the U.S. from the early 1970s to the early 1990s, when our team conducted the first clinical study with MDMA. Our Phase 1 study of MDMA was also around the same time as Rick Strassman’s investigation of DMT and Deborah Mash’s study of ibogaine. These three studies were the first approved investigations of psychedelics since the late 1960s and early 1970s.

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Dr. Charles Grob with Albert Hoffman

What has changed culturally that has allowed this research to continue now?

The Archives of General Psychiatry, which published our pilot study in 2011, accepts a miniscule number of papers. Why did they accept ours? They recognized that psychiatry needs new and novel and more effective treatment models and after decades of quiescence, the world we live in has changed and investigating psychedelics has once again become accepted and respected. Our values have changed and we have a more mature manner in which this research is recognized. In the 60’s it was brand new and it took the culture by surprise.

By the late 1990s and the early 2000’s, we had weathered the tempest and were in a more open and receptive phase. There was recognition that conventional treatments in psychiatry are sometimes helpful, but sometimes lacking in efficacy. As healers and scientists, it is important to objectively examine new and novel treatments for people who do not get substantial relief from conventional treatments.

What researchers most influenced your work with psychedelic substances?

We were the first to work with an advanced cancer population and we basically took Stanislav Grof’s work and investigations from that era and adapted it, modernizing the protocol and changing some of the criteria. But the inspiration came from the pioneering research of Grof and Walter Pahnke, Gary Fisher, Bill Richards and others.

Those who came before these investigators were the true experts and authorities on psychedelic plants. The indigenous people throughout the world knew the plant life in their geographic areas and used these plants for healing and divination and spiritual purposes. I would like to credit not only the prior generation of investigators, but the indigenous people who have been historically mistreated. They kept the tradition of plant hallucinogens alive and concealed them from the Spanish and Portugese invaders.

What has most influenced your thinking about the dying process?

My views began forming early. Before I pursued my training in psychiatry and internal medicine, I grew up in a household where my father was a prominent internist. I grew up in that medical world and observed with patients and family members that the dying process is often associated with very severe psychological pain, isolation, alienation and existential distress.

I encountered Grof’s work in the early 1970s and his case reports of working with individuals not just undergoing physical suffering, but also psychological and psychospiritual pain and anguish. I would look at patients on medical floors and say, “there has got to be a better way.”

Aldous Huxley also had a beautiful image in his novel Island of how these compounds might help the passage from life to death. Grof’s work was very encouraging. I took his message to heart as I got my credentials and training and waited for a time to again do feasible human research with compounds that had been taboo for a long time.

What role do you see psychedelics playing in the future of palliative care?

We can see how they could endow palliatieve practitioners with additional tools. We developed our study with Dr. Ira Byock, a former director of palliative medicine at Dartmouth-Hitchcock Medical Center. He is a palliative care practitioner who really made a significant contribution to the evolution of Tony’s [Bossis] and my thinking on that issue. He helped us to embark on this study.

What else should we know about this study?

I’ve worked for 27 years with The Lundquist Institute and the Harbor-UCLA Medical Center. They have always been very collegial and supported research ideas that in some quarters were considered taboo. I explained our rationale and safety parameters and they heard me out. They knew I could be trusted to conduct the early MDMA and psilocybin research and take the data back to UCLA and Lundquist.

Although we have received a very generous grant for this study, it’s only half of what we think we will need in the bank to get this research off the ground. If a research program already has funding, it is easier for other funders to make generous donations. That is what we hope will happen here.

 
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Canada approves psilocybin treatment for terminally-ill cancer patients

by Jesse Klein | Reality Sandwich | 11 Aug 2020

The barriers against psychedelics as medicine are slowly coming down, brick by brick. Last week, Canada’s Minister of Health, Patty Hajdu, took a center-stage role in the most recent dismantling. She approved the use of psilocybin to help ease anxiety and depression for four terminally ill cancer patients.

The approval comes after a series of wins for the psychedelic community over the past five years. Respected institutions like MAPS and Johns Hopkins University set out to conduct research studies of MDMA for post-traumatic stress disorder (PTSD), thus removing a brick in the metaphorical barrier. The FDA took out another stone when it approved a new ketamine derivative for depression therapy last year. Michael Pollan’s 2018 hit book, How to Change Your Mind, disassembled an entire section of the wall. It took studies about psilocybin and LSD’s ability to help the terminally ill mainstream.

In 2016, Johns Hopkins Medical School conducted a randomized double-blind trial on patients with life-threatening cancer. Patients showed a sustained 80 percent decrease in anxiety and depression from a high dose of psilocybin. And a 2020 follow-up at Palo Alto University confirmed the effects. Last September, Johns Hopkins University also launched the Center for Psychedelic and Consciousness Research. It’s the first psychedelic research center in the United States.

Meaningful and science-based change

Each one of these events and studies helped cities, such as Oakland and Denver, decriminalize psychedelic mushrooms. And Hajdu’s exemption, made under Section 56 of Canada’s Drug and Substances Act, is one more step along the path to legalization of these long-stigmatized chemicals. This marked the first time an exemption like this has been granted that wasn’t under the umbrella of a clinical research trial.

The patients submitted their plea to the Canadian Health Department in April with the help of TheraPsil, a nonprofit organization that advocates for psychedelic use in end-of-life care.

“Although it has taken a long time we are impressed with their willingness to listen to patients who have not been heard and to shift focus and policy to accommodate their interests and protect their needs,” Dr. Bruce Tobin, Founder and Chairman of TheraPsil, said in a press release.

While the patients had to wait over 100 days for a decision, they were relieved and grateful at the outcome.

One of the applicants, Laurie Brooks, spoke out in the same press release. “The acknowledgment of the pain and anxiety that I have been suffering with means a lot to me…. I am feeling quite emotional today as a result. I hope this is just the beginning and that soon all Canadians will be able to access psilocybin, for therapeutic use, to help with the pain they are experiencing, without having to petition the government for months to gain permission.”

Thomas Hartle, another applicant, said he was ready to move onto the next phase of his healing.

There is more evidence and precedent to call upon when future breaks in policy are needed. The publication of more research, and the granting of more exemptions and access to psychedelic treatment, are sure to follow.

Jesse Klein
Jesse Klein is a science and outdoor reporter based in the Bay Area. She has written for VICE, New Scientist, Inside the Jar and many other national publications. Her background in neuroscience and experience as business journalist informs her reporting as she dives deep into the science, policy and business of drugs and psychedelics. See more of her writing at jesseerynklein.com.

 
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D.C. resident with an operation growing psilocybin mushrooms.

Are Canadians ready to accept psychedelics in palliative care?

by Erika Dyck | The Globe and Mail | 11 Oct 2020

In August, 2020, Health Canada granted a special exemption to allow four terminally ill patients to take psilocybin. Psilocybin is not legally sold in Canada. In illegal markets it circulates as magic mushrooms, but researchers suggest that psychedelic drugs such as psilocybin have therapeutic potential for easing anxieties, particularly those associated with dying.

Saskatoon resident, 52-year-old Thomas Hartle, who has stage four terminal colon cancer, took psilocybin, under the direction of psychologist Bruce Tobin, with permission from Health Canada. Psychedelic researchers suggest that these drugs help to reduce anxiety, among other benefits that are currently being studied in clinical trials. News reports suggested that Mr. Hartle had a somewhat frightening experience – maybe even a “bad trip.” But, Mr. Hartle’s own view was that it had a remarkable effect on his anxieties about dying. He is grateful for relief he gained from the experience, and now looks forward to his remaining time with his family.

Mr. Hartle’s story is in many ways remarkable, but it aligns with a longer history of psychedelics in Canada.

Psilocybin became famous in the 1950s when husband and wife team Valentina Pavlovna and Gordon Wasson participated in an Indigenous mushroom ceremony in 1955, and later published their findings in Life magazine. Some Indigenous groups have a long history of using plant medicines, some of which were later described as psychedelic.

The word psychedelic was coined in 1957 by psychiatrist Humphry Osmond, a British-trained researcher who conducted internationally significant experiments with drugs including LSD and mescaline (from the peyote cactus) in Saskatchewan in the 1950s, including working with the Native American Church. Famously, Mr. Osmond introduced mescaline to writer Aldous Huxley. Mr. Huxley later gave mescaline to his wife, Maria, as she suffered from late stages of breast cancer. His second wife, Laura, gave Mr. Huxley LSD as he succumbed to his own cancer diagnosis in 1963. Even before the concept of palliative care had been introduced, these early pioneers of psychedelic research recognized the potential for easing the anxieties associated with dying by helping to provide an emotional, psychological, and at times spiritual experience.

Psychedelic research ended in the 1960s due to a combination of scientific, political and cultural backlash, including concerns about psychedelics causing negative effects – flashbacks, bad trips and violent outbursts. Health Canada, like the U.S. Food and Drug Administration, placed restrictions on scientific experimentation and over time psychedelics became better known as recreational drugs. The recreational use and abuse contributed to the popular assumption that psychedelics had no medicinal value.

Medical research historically, and today, maintains that these drugs have been unfairly blamed for causing psychological and physical damage. Clinical trials reveal that psychedelics are not addictive, and do not produce harms in adults, though most researchers recommend that psychedelics should be taken in a therapeutic setting only, with qualified supervision. In the case of Thomas Hartle, he was monitored at all times by a qualified therapist familiar with psychedelic treatments.

The recent allowance from Health Canada signals a change in that view. It brings Canada into a growing international conversation about the revitalization of psychedelics, both in research and as a viable mental health treatment option. New psychedelic research units, including two currently in Canada and dozens now in the United States and Europe, are beginning to challenge the prohibition on psychedelics and resurrect some of the historical arguments about the benefits of psychedelics for mental health.

On the surface, the psychedelic renaissance may indicate a collective frustration with the current state of mental health treatments. Daily use pharmaceuticals are expensive, whether for individuals or health care systems. Rates of mental illness have gone up, not down since the dramatic introduction of psychopharmaceuticals in the 1950s. Opiate-based pain relief has created a new set of problems with addiction, overdose, and off-label use.

Psychedelics, whether in the 1950s or now, are often directed as a single-use therapy. They offer a consciousness-raising or pain-confronting approach, not an experience that is necessarily to be repeated, and not an approach meant to dampen or numb pain but to address it through confrontation. In some ways, this approach is an entirely different way of thinking about mental anguish.

Palliative care has also emerged as a hot spot in our health care system. Another Canadian innovation, palliative care units were the idea of Montreal urologist Balfour Mount, who coined the word itself. The development of palliative care and dedicated hospital spaces for dying have helped generate a conversation around dying with dignity, something that can be extended to include the use of psychedelics for terminally ill patients.

We live in a country that pioneered psychedelics as well as palliative care, and one that prioritizes universal health care. Given this legacy, it is fitting that we should explore investments in health care options that combine elements of reconciliation, universality, and dignity.

Erika Dyck is a professor and a Canada Research Chair in the history of health and social justice at the University of Saskatchewan. She is the author of Psychedelic Psychiatry: LSD from Clinic to Campus.

 
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Can psychedelics help us face our fear of death?

by Abbie Rosner | DoubleBlind | 14 Dec 2020

There are no treatments available to help people cope with dying. Are psychedelics the answer?

For all its inevitability, death in our society is still dreaded and feared—an unspeakable adversary to be fought at all costs. But as baby boomers begin to cross the threshold into old age, they are increasingly inclined to reject those assumptions. And just as consciousness-expanding drugs once helped boomers envision a radical new culture of youth, they may now light the way to a more expansive and gracious approach to the end of life.

Even before COVID-19, many boomers found what our society offers the elderly—profligate prescription of pharmaceutical drugs, medical procedures that extend life without quality of life, and the isolation of long-term care facilities—to be profoundly unappealing.

But an emerging “death positive” movement reflects a growing willingness to approach our transitioning with eyes wide open, as a destined milestone in the cycle of life. Hospice care and death doulas champion the idea that passing can be planned for and honored with dignity, surrounded by loved ones and imbued with meaning. And it may not be long before a psychedelic experience will be included in the preparations leading up to our final days.

Spiritual teacher and end-of-life pioneer, Ram Dass, saw death not only as our greatest challenge but also our greatest spiritual opportunity. And he suggested that, "as we prepare for the “final passage,” we would be better served by allowing nature, rather than ego, to guide us through the process.”

For Ram Dass, that fundamental shift away from ego and toward the essence of awareness was facilitated with psychedelics. He wrote eloquently about this transition:

"Prior to my first experience with psychedelics, I had identified with that which dies—the ego. The ego is who I think I am. Now, I identify much more with who I really am—the Soul. As long as you identify with that which dies, there is always fear of death. What our ego fears is the cessation of its own existence… I realized that the essence of my Being—and the essence of my awareness—is beyond death."

"On the scientific front, early psychedelic researchers like Eric Kast came to a similar conclusion. They observed, for example, that in advanced-stage cancer patients, the obliteration of ego, induced by LSD, not only significantly reduced their perception of pain, but could also gave rise to a spiritual experience that fundamentally transformed their attitudes toward their impending death."


Subsequent work by Stanislav Grof and Walter Pahnke drew out the mystical, transpersonal and transcendental aspects underlying these profound psychic shifts. Observing how commonly patients in their studies reported experiencing death, rebirth, and feelings of cosmic unity, Grof observed:

"Fear of their own physiological demise diminished, they became open to the possibility of consciousness existing after clinical death, and tended to view the process of dying as an adventure in consciousness rather than the ultimate biological disaster."

After coming to a halt in the late 1970s, the study of psychedelic therapy for end of life anxiety was eventually resumed by investigators at UCLA, NYU, and Johns Hopkins, among others, and continues to this day. Often, these studies are conducted in partnership with private companies who foresee a vast demand for these therapies to treat all types of anxiety and other mental health issues rampant in our troubled world.

Yet even without a fatal illness, every one of us has a terminal diagnosis—death—and anxiety over its inevitability is the ultimate existential crisis. Whether we approach our inevitable demise with fear and angst, spiritual reverence or simply a healthy curiosity, there is strong evidence that psychedelic therapy can help us reach that milestone with equanimity and grace.

So ideally, shouldn’t access to such an experience be available to anyone who wants it?

For now, LSD, psilocybin, and most psychedelic drugs are still federally prohibited Schedule 1 drugs, hence US citizens wanting to legally undergo psychedelic therapy with any of these substances must travel to one of the many psychedelic retreat centers in Latin America or Europe. And while there is an extensive network of underground therapists in the United States who work with psychedelics, currently the only way one can legally receive facilitated psychedelic therapy for end-of-life processing in this country is to be enrolled in a clinical trial. (Although, that will soon change for Oregonians, who legalized psilocybin therapy at the ballot box in November.)

In more progressive Canada, however, a small group of terminal cancer patients, supported by TheraPsil, a non-profit advocacy group, recently prevailed over the health ministry to authorize their treatment with psilocybin. This past August, 52-year-old Thomas Hartle, the first Canadian to receive the therapy, described its immediate effects:

“To experience the lack of anxiety I have had this week is beyond words. It’s amazing. I have no idea how long this particular benefit will last, but so long as it’s here, it’s really, really amazing and good.”

Back in the US, with MDMA and psilocybin both recognized by the FDA as breakthrough therapies (for treatment-resistant PTSD and depression, respectively), the rescheduling of these drugs for medical use is looking more feasible by the day. And soon, a passport may not be necessary for a guided therapeutic trip.

The recent opening of ketamine clinics in Canada and the US is laying the groundwork for psychedelic clinics. Only time will tell whether “curiosity about death” will be an acceptable rationale for doctors to prescribe psychedelics “off-label,” meaning for conditions the FDA has not explicitly designated.

But with cosmic serendipity, baby boomers might just be poised to become the first generation of Americans that will be able to integrate a psychedelic experience as a prelude to the end of their lives. And from the way Ram Dass describes it, the opportunity must be extraordinary:

“Making peace with death and being fully in the moment allows you to lose yourself in love—in the love of the beauty and awe of God made manifest, in loving yourself and everything else, the suffering, the pain, the joy…At the moment of death, you are surrendering and being cradled in the arms of God. If we let go lightly, we go out into the Light, toward the One, toward God. What grace!”

 
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