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    Can psychedelic drugs help us to accept death?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    *From the article here: https://webcache.googleusercontent.c...:PrVLMYd6RbAJ:
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    Dr. Oscar Janiger, M.D.

    Preparing for the final passage: Dr. Oscar Janiger, M.D.

    In the early 80s, Albert Hofmann said he had to introduce me to one of the most interesting people he had ever met, who also possessed one of the most amazing libraries he had ever seen. From our auspicious introduction to the moment of his passing, Dr. Oscar Janiger, affectionately known as Oz, and I remained dear friends, passing countless hours together in conversation at each of our homes and on several exploration-vacations.

    Oz was one of the original pioneers of LSD research, focusing on its effects on creativity, consciousness, and therapeutic use. Working in the era when LSD was still legal, he administered LSD to an estimated 1,000 people in guided sessions from 1954 to 1962. His many volunteers included such notables as Anais Nin, Aldous Huxley, Cary Grant and Jack Nicholson. A prolific researcher, Oz maintained extensive files, which still provide an unparalleled and largely untapped resource for the study of the creative and therapeutic effects of LSD.

    Oz was one of the world’s greatest conversationalists and storytellers. Oz would pepper his many stories with jokes that almost always offered a pithy insight into human nature. His Santa Monica house, which also served as his private practice office, was always open, a manifestation of Oz’s approach to life. One could walk in, day or night, and more often than not meet and converse with an exceptionally interesting person, many of who became immediate friends.

    Oz always stressed that it was important to maintain an attitude of inquisitiveness and openness to the world. He had a remarkable ability to be both non-judgmental about people and at the same time quickly and clearly see and understand the core nature of their being. During the course of his life he helped and saved the lives of numerous persons through his psychiatric practice and friendship.

    In this article, written to address the subject of death and dying, it is worth noting that some two hundred family, close friends and associates attended his private memorial, in testimony to the effect he had on so many lives. In my remarks on that occasion, I mentioned some Oz-ism’s, as I refer to his freely shared pearls of wisdom. Amongst them, “when taking medicine, take plenty,” “find your optimum sleep/awake cycle,” and most relevant to this discussion, nothing that wise men have written or said prepares one for the approach of one’s death.” As Oz himself reached a point where he could see death on the horizon, he experienced what he described as one of the worst, if not the worst, experiences of his life. On February 17, 2001, six months before his own death, he awoke to find his wife Kathleen lying dead next to him. The experience affected him deeply and drove home to him his impending fate in a way that nothing else could.

    Perhaps in a premonition of writing this article, I made some notes at the time of our discussions during a holiday dinner on December 12, 1999, about a year and a half before his death. Oz was reflecting on his now all-consuming experience of the later stages of Old Age, an aspect of the process of dying that he found himself poorly prepared to deal with. What follows in the next two paragraphs is a paraphrasing of his words from that evening’s discussion.

    Old Age, at least in the West, is treated as a disease. There was nothing he had found in Western culture, nor in the various teachings of many otherwise more enlightened cultures, that prepared one for the onset of Old Age, and the changes that occur during the final period of life. From the people Oz had spoken to, or whose writings he had read during the course of his uniquely rich life, from disciples of Eastern metaphysical systems to the Dalai Lama himself, none had enunciated anything that would help one prepare for the effects of late Old Age. Nothing had prepared him for the effect of waking up and realizing he now lacked sufficient energy to carry out daily intentions, to work on the projects that had been the mainstay of his life, and to help the patients he had devoted much of his life to serving. Especially in the West, one no longer has the authority that one once had.

    Where one once served, he or she must now be served. It is in many ways a complete reversal of one’s prior existence. Students of Eastern teachings seem to rely on being to carry them through this period, but even they can only meditate or bask in the ecstasy of pure being for so long, as one still has a foot in existence. Many teachings and religions attempt to prepare one for death and the possibility of “something more,” but what about the preparation for Old Age? Preparation on all levels: from having sufficient material resources to provide for one’s physical care, to the spiritual resources that enable one to gracefully navigate through each precious day, knowing it is one of your last–is sorely lacking from any source.

    When discussing death with his friends, Oz never expressed fear about dying, but he was concerned about how he would die. He did not want to be in pain, and had made preparations to ensure that. He also did not want to die alone, and had asked his dearest friends to be at his side when the moment arrived. Oz believed in something beyond death. He explained that at death we transition to another plane of being, so when the moment came, he was prepared to accept this next stage. Three days before his death, he confided to his long time friend, Michael Levy, that he was “really tired, tired of being ill, and was no longer getting any gratification from life.” In the early hours of August 14, 2001, a small group of family and friends gathered around Oz in his private hospital room, maintaining a vigil of warmth and compassion, friendship and love, as he moved nearer and nearer to his final transition. In the hours before his passing, we became aware of his final conscious act as a researcher. Not one to miss an opportunity for exploration of consciousness and being, Oz was determined to depart in the tradition established by his friend and colleague Aldous Huxley. Oz had taken 100 micrograms of LSD.

    While it is highly unlikely we will receive any reports from Oz about his last experiment, we can gather implications of the effect the LSD had on him from three incidents we observed during his final hours. Oz had previously asked his dear friend Vijali Hamilton, to be by his side when he passed away, and her report of what occurred in his last few hours is worthy of note. “I will always remember those moments when he became conscious and he was looking into my eyes for such a long time. I felt it was a profound communication and a preparation for him letting go.”

    Shortly after that, sensing the time was near, I gave Oz a goodbye kiss on the forehead. Then, as Oz’s son Robbie and I were both gazing into his face, leaning over him so as to be able to see the nuances of expression on his face, a smile formed across Oz’s face as he emitted a palpable glow of warmth and joy. He then grabbed Michael Levy’s hand, squeezing it so hard Michael thought Oz would crush it. Michael closed his eyes and experienced a vision of a spirit going through him, flying through a green English-like field, over a stonewall, into a giant green forest, and then suddenly disappearing into a radiant blue sky. Michael opened his eyes to see Oz’s final exhalation.

    We knew then that his last experiment was a success and he had moved on in peace to “another plane.” I was then moved to begin Tibetan chanting as calm and light emanated from the core of Oz’s being, and the room filled with an ethereal stillness. In honoring the memory of an extraordinary being, we can only hope that the honesty and openness with which he shared the experiences of his final days, can serve as a stimulus to awaken us to the preparation necessary to weather the months, days, and hours before our own final voyage.

    Other elders, who have communicated their wisdom on life’s end, usually focus their attention on preparations for the moment of death itself. Oz, on the other hand, focused attention on the stage between the end of Old Age and death, a critical period in everyone’s life when our physical powers diminish, but we still have sufficient intention to engage in conscious action. He understood that what we do during that time is an individual choice. So rather than give specifics of how to handle this period, he illuminated our awareness to help us distinguish and prepare for this time, short for some, longer for others, that falls between the end of Old Age and the moment of death. For Oz, this final period preceding death was one of, it not the, most critical times in his life, and for the gift of sharing that wisdom, we owe a debt of everlasting gratitude to Oz.

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    The Trip Treatment

    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.
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    A conversation with Stanislav Grof

    by David Jay Brown

    David: How can LSD psychotherapy be helpful for someone facing a terminal illness?

    Stan: Psychedelic therapy revealed a wide array of previously unknown therapeutic mechanisms, but the most profound positive changes happened in connection with mystical experiences. We were very impressed with what you could do with very difficult conditions, like chronic alcoholism and narcotic drug abuse. But the most interesting and the most moving study that we did at the Maryland Psychiatric Research Center was the one that involved terminal cancer patients. We found out that if these patients had powerful experiences of psychospiritual death/rebirth and cosmic unity, it profoundly changed their emotional condition and it took away their fear of death. It made it possible for them to spend the rest of their lives living one day at a time. We also found out that in many patients LSD had very profound effect on pain, even pain that didn’t respond to narcotics.

    David: What do you personally think happens to consciousness after death?

    Stan: I have had experiences in my psychedelic sessions – quite a few of them – when I was sure I was in the same territory that we enter after death. In several of my sessions, I was absolutely certain that it had already happened and I was surprised when I came back, when I ended up in the situation where I took the substance. So the experience of being in a bardo in these experiences is extremely convincing. We now also have many clinical observations suggesting that consciousness can operate independently of the brain, the prime example being out-of-body experiences in near-death situations. Some out-of-body experiences can happen to people not only when they are in a state of cardiac death, but also when they are brain dead. Cardiologist Michael Sabom described a patient he calls Pam, who had a major aneurysm on the basilar artery and had to undergo a risky operation. In order to operate on her, they had to basically freeze her brain to the point that she stopped producing brain waves. And, at the same time, she had one of the most powerful out-of-body experiences ever observed, with accurate perception of the environment; following her operation, she was able to give an accurate description of the operation and to draw the instruments they were using. So what these observations suggest is that consciousness can operate independently of our body when we are alive, which makes it fairly plausible that something like that is possible after our body is dead. So both the experiential evidence from my own sessions, and what you find in the thanatological literature, certainly suggest that survival of consciousness after death is a very real possibility.
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    From an interview with Roland Griffiths, Ph.D.

    By David Jay Brown with Louise Reitman

    David: Have you seen anything in your sessions that influenced your understanding of, or perspective on, death?

    Roland: The hallmark feature of the mystical experience, that we can now occasion with high probability, is this sense of the interconnectedness of all things, a sense of unity. That sense of unity is often accompanied by a sense of sacredness, of openheartedness or love, a noetic quality suggesting that this experience is more real than everyday waking consciousness. I believe that the experience of unity is of key importance to understanding the potential existential shifts that people can undergo after having these kinds of experiences.

    Within the domain of the psychology of religion, scholars have described two variations of this experience of unity – something called “introverted mystical experience” and another called “extroverted mystical experience.” The extroverted version of this sense of unity was assessed by items in one of the spiritual questionnaires that we used, the Hood Mysticism Scale. I’ll read you a couple of items. One is, “An experience in which I felt that all things were alive.” Some of the others are: “An experience in which all things seem to be aware.” “Realized the oneness of myself with all things.” “An experience where all things seemed to be conscious.” “An experience where all things seemed to be unified into a single whole.” “An experience in which I felt nothing was really dead.”

    So this feature of mystical experiences points toward the nature of consciousness, and an intuition that consciousness is alive and pervades everything. From there, it is not a great stretch to contemplate the possibility of the continuity of consciousness – or, more traditionally, immortal soul. Such an experience can break down a restrictive sense of being defined by your body, in a total materialistic framework. So I think that it’s these subtle and not-so-subtle perceptual shifts that could be at the core to rearranging someone’s attitude about death.

    David: Is this why you think that psychedelics can be helpful in assisting people with the dying process?

    Roland: It’s common for people who have profound mystical-type experiences to report very positive changes in attitudes about themselves, their lives, and their relationships with others. People report shifts in a core sense of self. Positive changes in mood are common, along with shifts toward altruism, like being more sensitive to the needs of others, and feeling a greater need to be of service to others. It is not difficult to imagine that such attitudinal shifts flow directly from the sense of unity and other features of the mystical experience – a profound sense of the interconnectedness of all things packaged in a benevolent framework of a sense of sacredness, deep reverence, openhearted love and a noetic quality of truth. So it’s quite plausible that the primary mystical experience not only underlies changes in attitude toward death specifically, but also changes attitudes about self, life, and other people in a way that’s dramatically uplifting.

    David: What sort of promise do you see for the future of psilocybin research?

    Roland: I’m trained as a scientist, so I’m very interested in all of the scientific questions that can be asked of this experience. I’m interested in the neuropharmacology of the experience. I’m interested in the psychological and physiological determinants of this kind of experience. And then I’m interested in the consequence of this kind of experience – not only for healthy volunteers, but also for distressed individuals who might have a therapeutic or clinical benefit. Now, whether or not unpacking those scientific questions will lead to approval of psilocybin as a therapeutic drug, I don’t know – and, in some ways, it’s not important one way or another.

    For me, what’s most important is understanding the mechanisms that occasion these kinds of experiences. So I will not argue the future is with psilocybin per se. But it does appear to be an amazingly interesting tool for unlocking these mysteries of human consciousness. As we get a better understanding of the underlying neuropharmacology and neurophysiology, it may be that better compounds or nonpharmacological techniques can be developed that occasion these experiences with even higher probability than we can right now with psilocybin.

    Frankly, I can’t think of anything more important to be studying. As I’ve said, the core feature of the mystical experience is this strong sense of the interconnectedness of all things, where there’s a rising sense of not only self-confidence and clarity, but of communal responsibility – of altruism and social justice – a felt sense of the Golden Rule: to do unto others as you would have them do unto you. And those kinds of sensibilities are at the core of all of the world’s religious, ethical, and spiritual traditions. Understanding the nature of these effects, and their consequences, may be key to the survival of our species.

    David: That was precisely the point that I was trying to make when I edited the MAPS Bulletin about ecology and psychedelics. Psychedelics have played such an important role in inspiring people to become more ecological aware.

    Roland: Yes, that follows from the altruistic sensibility that may flow from these types of experiences. Ecology can become a big deal with these experiences. If you really experience the interconnectedness of all things and the consciousness that pervades all things, then you have to take care of other people and the planet, right? And to bring this back around to death and dying, if everything is conscious, then death and dying may not be so frightening. There is a big and mysterious story here.
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    Harbor-UCLA cancer anxiety research with psilocybin: An interview with Alicia Danforth

    by David Jay Brown

    Alicia Danforth worked on the cancer anxiety research study with psilocybin at the Harbor-UCLA Medical Center with psychiatric researcher Charles Grob, M.D.

    David: Have you seen anything in your research that influenced your perspective on death and dying?

    Alicia: One of our subjects had been living with cancer for awhile. She had been dealing with a cancer that had gradually become more severe. She was a very optimistic woman who had a lot of deep spiritual beliefs and practices. She hadn’t acknowledged to herself yet that this cancer would eventually take her life, probably sooner rather than later. She was able to talk freely about how that realization had come to her during the psilocybin session. It was really powerful to share that experience with her. She reconciled with the idea that she was going to die from her cancer, and she hadn’t previously come to that conclusion.

    As advice to anybody who is going to be doing this kind of research, I suggest not assuming that you know what people will choose, and don’t assume that just because they have a diagnosis of stage-IV cancer that they have accepted the diagnosis as terminal. Journalists will do that sometimes. They’ll describe participants in a study as “terminal cancer patients”
    or as “cancer victims,” but the participants may not have accepted that prognosis yet. It’s always more appropriate to use the terms advanced-stage cancer or metastatic cancer. Not everyone who participated in the study had concluded that their cancer would be terminal.

    This brings up an important point. I had to be mindful about clarifying the purpose of the experimental treatment. There were times—and it was always difficult to accept—when some individuals were unable to conceal harbored desires for a miracle cure for the cancer. I had to be diligent about confirming with them that this was a psychiatric study for anxiety and that we were not attempting to treat the cancer. Some participants would hear that disclaimer and, maybe rightfully so, say something like, “Yes, but if my mood improves I may be able to live a little bit longer. Or I might have a better quality of life that will make my body stronger, so that I can survive a little longer.” I didn’t try to suppress that perspective if someone already had it. Responsible researchers have to be very clear about what they are attempting to influence in experimental cancer anxiety studies with psychedelics.

    The only thing that I can attest to is what some participants reported about improved quality of life for their remaining time. A few speculated with questions such as, “Did I outlive my prognosis? Did I live longer than the doctors expected me to because I did this?” We couldn’t draw any conclusions, but we did have participants talk about how the time they did have left was improved in a variety of ways.

    Because it was my first time working with this population, I had naively assumed that everybody in the study was signing up because they were scared of dying and that concerns about mortality would be foremost. ...I learned...that we have a choice to make meaning as long as we’re alive, and that the moment of death can be a peaceful transition. I thought that people were afraid of the pain, or that they were afraid because they didn’t know what to expect after death. With people who had accepted that they were going to die, there often were more immediate concerns that they were seeking support for. One example would be improving the quality of their relationship with their significant other.

    For some of our participants, the anxiety that they were experiencing with the cancer was having a detrimental effect on their relationships. Because they were so consumed with anxiety, they were tense and agitated all the time—which led to a lot of bickering and friction with their partners. Some subjects attributed improved relationships to the psilocybin experience. They said it helped them to let go of some of that anxiety that was overwhelming every aspect of their personal lives.

    I’ve learned that it is possible to have a cancer diagnosis and not fear death. Fearing the dying process, the pain, the saying goodbye... of course, that’s natural. But it is possible to not fear death, at least for periods of time, after a cancer diagnosis. If you’re afraid to go to the dentist, then you’re going to be afraid of dying, but the quality of what is actually frightening when facing death, that perspective is what shifted for me. The insight I gained was that the time between receiving a diagnosis of a terminal illness and the moment of death can be much more than just waiting for death and enduring physical and emotional pain. It does not have to be wasted time. I learned that human beings are capable of finding meaning in their lives and extending love to others until they draw their last breath. That final period, the last chapter in a biography, can be profoundly transformational and have deep, deep meaning, if a person does the work. Or it can be a time full of terror, regret, and distancing from people you’re close to. What I learned was that we have a choice to make meaning as long as we’re alive and that the moment of death can be a peaceful transition. And psychedelics can play a supportive role in finding that deep meaning and sense of peace.
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    Peter Gasser

    The Ultimate Journey: An interview with Peter Gasser

    By David Jay Brown

    In 2008, Swiss psychiatrist Peter Gasser, M.D., became the first medical researcher in the world to obtain government approval to do therapeutic research with LSD. This was the first government-approved LSD study since Stanislav Grof was forced to shut down his research in 1972. Gasser’s LSD/end-of-life anxiety study was sponsored by MAPS.

    David: Can you talk a little about how you started doing LSD research, and what it feels like to be the first researcher to receive government approval to do human studies with LSD in thirty-five years?

    Peter: In January, 2006–around the time that we held the symposium for Albert Hofmann’s 100th birthday celebration–Rick Doblin and I were walking through the snowy Swiss mountains. While we were walking, Rick said that he thought that it would be great to do research with LSD again, as MAPS had just successfully launched studies with MDMA. After speaking with Rick, I began the process of gaining approval and meeting all the requirements. Getting a license to work with LSD felt like a great honor. It also filled me with a sense of hope, as this means the end of a thirty-five year Ice Age, where all therapeutic research with LSD was totally blocked.

    David: What have you learned from Stanislav Grof’s work that helps you conduct your own research?

    Peter: When some friends of mine discovered that I would be working with people who were seriously ill, or possibly dying, they gave me a warning. They told me that they thought that this would be too heavy of an emotional burden for me. However, one friend also recommended that I read Stan Grof’s book The Ultimate Journey, which I wasn’t familiar with at the time. Grof’s book taught me to have an open, natural, and interested attitude towards the patients in this study. At that time I had no special training in psycho-oncology [the psychological aspects of cancer], although I had had some experience over the years working with people suffering from life-threatening diseases.

    From Grof’s book The Ultimate Journey, I learned that the issues that people faced in his studies were basically the same issues of our common human condition, only in a different intensity and priority. Grof’s book is a rich treasure chest, filled with cultural, historical, philosophical, and religious links that help us to understand the individual psychological process. Like Carl Gustav Jung, Grof is an author with an extremely broad background of knowledge about the history of mankind, in all it’s shapes. He is capable of linking the individual process with the collective process–which may be a great comfort and relief, especially for dying people.

    David: What kind of process and struggles did you have to go through to get your LSD study approved?

    Peter: During the approval process for the study, there were two critical questions that needed to be addressed. The first one was: Is it possible to convince the Ethics Committee that the potential risk of LSD-assisted psychotherapy is not higher than in other drug research studies, and that the potential benefits that could be gained from this study make it worth doing? As you can imagine, the answer to this questions can’t be obtained with any kind of mathematical precision, and rather depends upon the attitudes and prejudices of the members of the committee. Ethical decisions are always decisions of personal judgment, even if they rely on a clear and rational decision process. Fortunately, the Ethics Committee was able to discuss the question of LSD-assisted therapy in an open manner, and after much discussion, finally, it was decided that yes, such work could be done.

    The second question was: Will the authorities at the Ministry of Health be influenced by political processes that might inhibit an approval of our study? It was satisfying to learn that their work was based on legal, ethical, and scientific requirements. I am convinced that Kairos, the Greek God of the opportune moment, was lending a hand, as something that brings together and orchestrates so many factors, and results in a success like this, must have played a role. It was greatly satisfying for everyone involved in this study that Albert Hofmann was still alive when the research began. He witnessed that steps were being taken to help develop LSD into what it only sometimes was, a medicine.

    David: Can you share an anecdote or two from your studies, and talk a little about how your subjects are responding to the LSD-assisted psychotherapy?

    Peter: Since we have a placebo-controlled design–and because of the obvious inherent difficulties involved with giving inactive placebos to subjects in psychedelic drug studies–the placebo patients also receive a very low dose of the active drug, which is 20 micrograms of LSD. Albert Hofmann said that he was convinced that even a low dose of 20 micrograms was enough to create a psychic effect in people–and he was right. One patient (who received placebo) reported that he had a very realistic impression that the floor of the room we were in opened up and the devil appeared. Although this scene was quite short, it was very naturalistic.

    Of course, the 200 microgram verum dose that the experimental subjects get is much more powerful and longer lasting. I was very touched when one subject, a 57 years old man suffering from metastatic gastric cancer, reported his LSD session. It was his first session in the study, as well as the first experience with psychedelics in his life. He went out of his body, and had the experience of flying like a bird, which was very fulfilling for him. Then he flew up higher and higher, until he met his dead father. The patient had had a difficult relationship with his father, who withdraw from conflictual situations in the family, leaving the patient alone with his overwhelming mother.

    Although his father had died a long time ago, the patient was full of criticism and reproach towards him. However, his encounter on LSD was very different. He felt free. It was just two men meeting at the same level, without any father/son dynamics. The patient loved feeling the closeness, and there was no longer any feeling of building up an inner wall when he thought of him. Later the subject said that he thought that in his process of dying it was very important for him to meet with his father at his place, where the dead people are, and to feel their vicinity without any fear or negative feelings.

    David: Have you seen anything in your sessions that influenced your understanding of, or perspective on, death?

    Peter: For me, one of the most satisfying aspects of my work in this study comes from my encounter with the patients. People who are going to die automatically put more emphasis on the “here and now.” They search and long for intensity and open awareness right now, not in some distant future which might not exist. This is what makes working with these people so rich.

    David: What sort of promise do you see for the future of LSD research?

    Peter: My mission is to show that LSD-assisted psychotherapy is safe and effective, so that we can plan further studies based on that result. This is not something new for insiders, but it would be new to much of the world. I absolutely believe that LSD has broad potential for healing and relief.

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    The most convincing argument for legalizing psychedelics

    I have a profound fear of death. It's not bad enough to cause serious depression or anxiety. But it is bad enough to make me avoid thinking about the possibility of dying — to avoid a mini existential crisis in my mind.

    But it turns out there may be a better cure for this fear than simply not thinking about it. It's not yoga, a new therapy program, or a medicine currently on the (legal) market. It's psychedelic drugs — LSD, ibogaine, and psilocybin, which is found in magic mushrooms.

    This is the case for legalizing psychedelics. Although the drugs have gotten some media attention in recent years for helping cancer patients deal with their fear of death and helping people quit smoking, there's also a similar potential boon for the nonmedical, even recreational psychedelic user. As psychedelics get a renewed look by researchers, they're finding that the substances may improve almost anyone's mood and quality of life — as long as they're taken in the right setting, typically a controlled environment.

    This isn't something that even drug policy reformers are comfortable calling for yet. "There's not any political momentum for that right now," Jag Davies, who focuses on psychedelic research at the Drug Policy Alliance, said, citing the general public's views of psychedelics as extremely dangerous — close to drugs like crack cocaine, heroin, and meth.

    But it's an idea that experts and researchers are taking more seriously. And while the studies are new and ongoing, and a national regulatory model for legal psychedelics is practically nonexistent, the available research is very promising — enough to reconsider the demonization and prohibition of these potentially amazing drugs.

    Psychedelics' potentially huge benefit: ego death

    The most remarkable potential benefit of psychedelics is what's called "ego death," an experience in which people lose their sense of self-identity and, as a result, are able to detach themselves from worldly concerns like a fear of death, addiction, and anxiety over temporary — perhaps exaggerated — life events.

    When people take a potent dose of a psychedelic, they can experience spiritual, psychedelic trips that can make them feel like they're transcending their own bodies and even time and space. This, in turn, gives people a lot of perspective — if they can see themselves as a small part of a much broader universe, it's a lot easier for them to discard personal, relatively insignificant and inconsequential concerns about their own lives and death.

    That may sound like pseudoscience. And the research on psychedelics is so early that scientists don't fully grasp how it works. But it's a concept that's been found in some medical trials, and something that many people who've tried psychedelics can vouch for experiencing. It's one of the reasons why preliminary, small studies and research from the 1950s and '60s found psychedelics can treat — and maybe cure — addiction, anxiety, and obsessive-compulsive disorder.

    Charles Grob, a UCLA professor of psychiatry and pediatrics who studies psychedelics, conducted a study that gave psilocybin to late-stage cancer patients. "The reports I got back from the subjects, from their partners, from their families were very positive — that the experience was of great value, and it helped them regain a sense of purpose, a sense of meaning to their life," he told me in 2014. "The quality of their lives notably improved."

    In a fantastic look at the research, Michael Pollan at the New Yorker captured the phenomenon through the stories of cancer patients who participated in psychedelic trials:

    Death looms large in the journeys taken by the cancer patients. A woman I'll call Deborah Ames, a breast-cancer survivor in her sixties (she asked not to be identified), described zipping through space until she arrived at the wall of a crematorium and realized, with a fright, "I've died and now I'm going to be cremated. The next thing I know, I'm below the ground in this gorgeous forest, deep woods, loamy and brown. There are roots all around me and I'm seeing the trees growing, and I'm part of them. It didn't feel sad or happy, just natural, contented, peaceful. I wasn't gone. I was part of the earth." Several patients described edging up to the precipice of death and looking over to the other side. Tammy Burgess, given a diagnosis of ovarian cancer at fifty-five, found herself gazing across "the great plain of consciousness. It was very serene and beautiful. I felt alone but I could reach out and touch anyone I'd ever known. When my time came, that's where my life would go once it left me and that was O.K."

    But Mark Kleiman, a drug policy expert at New York University's Marron Institute, noted that these benefits don't apply only to terminally ill patients. The studies conducted so far have found benefits that apply to anyone: a reduced fear of death, greater psychological openness, and increased life satisfaction.

    "It's not required to have a disease to be afraid of dying," Kleiman said. "But it's probably an undesirable condition if you have the alternative available. And there's now some evidence that these experiences can make the person less afraid to die."

    Kleiman added, "The obvious application is people who are currently dying with a terminal diagnosis. But being born is a terminal diagnosis. And people's lives might be better if they live out of the valley of the shadow of death."

    Again, the current research on all of this is early, with much of the science still relying on studies from the '50s and '60s. But the most recent preliminary findings are promising enough that experts like Kleiman are cautiously considering how to build a model that would let people take these potentially beneficial drugs legally.

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    Ann and Alexander Shulgin

    Taking psychedelics to ease anxiety over a terminal diagnosis

    Sheila, a 57-year-old patient diagnosed six months earlier with terminal cancer sat in my office, twisting Kleenex in her fingers. “Sherry, my anxiety is off the charts.”

    In addition to our once-a-week sessions, she had a loving family, was in a support group for people with cancer, and taking Prozac. None of this made much of a dent on her mounting emotional turmoil. She said, “I’m really desperate. What do you think of psychedelic drugs to help with my terror of dying?”

    It was a fair question. Not surprisingly, 40 percent of cancer patients suffer from psychological torment linked to their diagnosis. In the ‘50s and ‘60s studies were done on the efficacy of psilocybin as a therapeutic tool to help people come to terms with their imminent death. By the early ‘70s this research fell into disfavor, as psychedelics were increasingly associated with the counter culture movement.

    A 2011 Pilot study on psilocybin for anxiety in patients with advanced-stage cancer renewed interest in this treatment, as it seemed to result in reduced anxiety and improved moods for the participants, with no adverse effects reported. A NYU study published in 2016 of 29 patients suffering from end of life anxiety and depression found, in conjunction with therapy that a single moderate dose of psilocybin produced positive psychological changes. Another study at John Hopkins, also published in 2016, involving 51 cancer patients also produced good results.

    This research suggests that one dose of psilocybin can potentially be more effective than pharmaceutical drugs at easing anxiety and depression in people with fatal illnesses. Study participants reported experiencing spiritual breakthroughs that help them better cope with being delivered what might be a death sentence. Dr. Stephen Ross, who directed the NYU study, has been quoted as saying, “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 seen anything like it in the psychiatric field.”

    Dinah Bazar decided to take part in Ross’s study after she began experiencing her worst anxiety two years after going into remission for ovarian cancer. During college, she’d had a bad mescaline trip but years later, felt a closely monitored clinical trial would be safe.

    In 2016, the then 69-year-old wrote about her experience of taking a single dose of psilocybin while sitting in a peaceful room at NYU in an article for “At first it was terrifying, as though I were tumbling through space, or on a ship in a stormy sea.” Soon though she began to feel as though she were floating in the music emanating from her headphones. She described feeling “bathed in love and it was overwhelming, amazing, wonderful. I kept floating and floating.”

    The powerful feeling of inner peace and love lingered for weeks and best yet, the fear and anxiety were “completely removed.” Subsequently, when she felt ill and feared a potential recurrence of cancer, rather than diving into a pit of helplessness and fear, she remained relatively centered.

    It is fitting that anxiety, which is all about fear of losing control, is “controlled” only by ceding control, at least temporarily. Dinah’s voluntarily submitting to the onslaught of images and emotions allowed her to drop down to and retain a deeper truth: We cannot always prevent stressful events, just control our actions and reactions to those stressors.

    However promising the NYU and John Hopkins studies appear, they are preliminary. Psilocybin is not FDA approved. Herbert Kleber, director of the substance-abuse division at Columbia University, has offered cautionary praise for the scientific investigations of psilocybin and end of life anxiety. The psychiatrist has been quoted as noting both that sample sizes in the studies are small, and that it is essential to have an experienced guide in the room to ensure the experience for the patient is productive, not terrifying. (Dinah reported having NYU researchers at her side during the whole experience.)

    When my patient Sheila asked whether she should go this route to help ease her fears, my job wasn’t to tell her what to do. Rather, my task was to guide her on how to research the available information on this option – pros and cons – and help her sort through her feelings.

    At one point she asked, “Sherry, if you were in my shoes, what would you do?”

    I answered truthfully, “I would likely do what you are doing – not rule it out of hand and not dive into it instantly either. But yes, there is nothing to lose by looking into it.”

    Sheila hasn’t taken a decision on whether or not to make the leap. During our most recent session, she said, “Just knowing psilocybin is out there has helped me feel more balanced.”
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    Amanda Feilding

    Studies find that psilocybin radically improves the well-being and positivity of terminally ill cancer patients

    In a ground-breaking development in the field of psychiatry, two new studies published in the Journal of Psychopharmacology show that a single dose of psilocybin, a powerful, naturally occurring psychedelic compound found in magic mushroom, can radically improve the well-being and positivity of terminally ill cancer patients.

    The research, completed at NYU and Johns Hopkins University, gave participants diagnosed with advanced cancer a moderate to high dose of psilocybin in a controlled environment with psychological support from highly qualified guides. Results demonstrated immediate and marked reductions in the levels of anxiety and depression that, remarkably, still persisted 6 months later in 80 per cent of the participants.

    End-of-life care presently consists of counseling and pharmaceutical treatments, such as antidepressants, to quell feelings of isolation, depression and anxiety commonly associated with a diagnosis of terminal illness. However most medications, along with psychotherapy, can take months to start working and are not effective for all patients. Commonly prescribed drugs such as benzodiazepines may be addictive and can have other unpleasant side effects.

    This approach, known as psychedelic-assisted psychotherapy makes use of the magic mushroom ingredient psilocybin. Studies over the last decade have shown that giving people psychedelics, with the support of psychotherapy, can provide fundamental and enduring changes much quicker than counseling alone.

    In some ways, I feel that I am better equipped to deal with what life throws at me, and to appreciate the good things. I am grateful to be alive in a way that I didnt know I could be, said Eddie Marritz, a participant in the NYU study. It is a kind of gratitude that is ineffable. I am much more focused on this moment.

    This research adds to the growing collection of evidence of psychedelics therapeutic potential and indicates a significant development of an exciting new model of mental health treatment. Scientists are discovering that psychedelics change consciousness in a way that has the potential to revolutionise the field of psychiatry.

    The most interesting and remarkable finding is that a single dose of psilocybin, which lasts four to six hours, produced enduring decreases in depression and anxiety symptoms, and this may represent a fascinating new model for treating some psychiatric conditions, said Dr Roland Griffiths, lead investigator at Johns Hopkins.

    As larger Phase III clinical trials are conducted, further investigating the positive effects psychedelics like psilocybin can have on mental illnesses, it is clear that this new model could help countless people worldwide who are seeking a long-term solution for their psychological suffering.

    The approach highlighted today, known as psychedelic-assisted psychotherapy makes use of the magic mushroom ingredient psilocybin. Various studies have shown that giving people psychedelics, with the support of psychotherapy, can provide fundamental and enduring changes much quicker than counseling alone.


    Psilocybin and end-of-life anxiety*

    Like MDMA, psilocybin targets serotonin receptors. Also like MDMA, the effects of psilocybin seem to stem from patients’ experiences when their consciousness is altered. But instead of undergoing psychotherapy during the acute psilocybin experience, researchers encourage patients receiving psilocybin to focus inwardly and process their experience with a therapist afterward.

    “The best treatment outcomes are with those subjects who, during the course of the psilocybin session, had what they described as a profound psychospiritual epiphany,” says Charles Grob, a professor of psychiatry and pediatrics at the UCLA School of Medicine, and chief of child and adolescent psychiatry at Harbor-UCLA Medical Center.

    Cigarette smokers given psilocybin report that the drug helps them understand their nicotine craving. That makes them able to quit more successfully when they’re also undergoing a cognitive behavioral therapy program for tobacco addiction, Griffiths says.

    For people diagnosed with cancer and struggling with the existential fears associated with dying, “It’s harder to say what the nature of the attitude shifts are,” Griffiths says. “But it seems to be an increased sense of wonder and openness to the mystery of life and death. In spite of the tragedy that they’re dying, they might see that there’s something beautiful and organic about the process.”

    *From the article here:
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    Practicing Death with 5-MeO-DMT

    Marti was a bright, optimistic, attractive 40-year-old woman when she first entered a support group for cancer patients that I facilitated at the Center for Attitudinal Healing in Tiburon, California. It wasn’t until a few years later that her illness wrought its devastation on her body and her spirit. During that time we had become friends, and she became interested in my shamanic work outside the center.

    When her death was imminent, she became quite frightened and anxious. I shared with her my experiences with 5-MeO-DMT, with which I had been working for a number of years, and which might be helpful to her in dealing with her concerns and the challenges to come.

    I told her it was a “spiritual medicine” from the Amazon, used shamanically by indigenous peoples there to contact the spirit world. Indigenous cultures typically use 5-MeO-DMT as a snuff, although on some occasions they use it as an admixture to ayahuasca. Rather than making a snuff, contemporary users prefer to vaporize extracts of 5-MeO from plants and inhale the smoke.

    She became especially interested in it when I mentioned that I called it “'death practice energy medicine' because it helped people work with the letting-go process, something she would face in the all-too-near future, and opened them up to the reality underlying the physical world — the world," as William Blake put it, "where “energy is total delight.”

    My first practice

    The first time I took 5-MeO-DMT, I was with Terence McKenna in his home in Occidental with two other friends in 1985. I went first; I inhaled the smoke. When the medicine came on, time, space, and ordinary consciousness were totally obliterated.

    At warp speed I shot down a hyperspace energy tunnel in full panic that this time I had gone too far — I was dying and there was nothing I could do to stop it. I knew I would never see my family again, never enjoy a sunrise, and never again walk in the mountains or forests that always filled me with joy. I tried to stretch my arms and legs out to the sides of the tunnel to slow down, but alas, I had no arms or legs. I had no body, just energy of what previously had been me, zooming toward infinity.

    Realizing there was nothing I could do, I surrendered to my fate with the thought, I can’t stop this, so I might as well be totally present and get as much from it as I can, right up until the moment when I die. At that precise instant, I went into a state of total bliss.

    A gentle explosion of white-gold light evaporated all notions of past, present, future, shape, form, identity, and space. There was only infinite, pulsating “all-ness” of ecstatic energy — a cosmic organism of joy that just kept exploding into a sea of infinite emptiness, devoid of materiality but filled with love. This was the cosmic conscious state referred to by the mystics of all religions around the world as god/goddess/holy spirit/the mysterium tremendum.

    After 10 immeasurable minutes, parts of my psyche that had been blasted into the far reaches of the cosmos gradually began floating back into awareness. I could see sections of my ego identity slowly appear from the vast distances of far-off space, heading toward what was my body, lying there on the rug, beginning to recompose itself. After another 10 minutes I was back to baseline here but with a new relationship to death, to dying, to letting go.

    The peace-filled channel

    I have been working with physical death in one way or another since my rude introduction into the teaching of impermanence, just months before my fourth birthday, when my father died. As an adult I received a Ph.D. in psychology and went on to help start the second hospice program in the United States. Then I helped start the Center for Attitudinal Healing, where I worked with children and adults with cancer for 32 years.

    Over this time I sat bedside with numerous children and adults, witnessing their final moments. All too often I saw that anxiety and fear, along with a resistance to let go, created intense struggle for the departing person and increased anguish for attending family and friends. My job in being there, enlightened by my death-practice work with the energy medicine, was to serve as a labor coach, helping the natural letting-go process to happen as smoothly as possible, thereby birthing the person “back home” into the infinite cosmos from whence he came, an existence of pure consciousness, pure light, pure love.

    My 5-MeO-DMT journey experience with letting go and entering cosmic bliss allowed me to remain peaceful no matter what was happening, as I knew that the key was surrendering into the underlying reality of oneness with all. Thus, I was able to be a peace-filled channel for the love and light that awaited each dying person when he finally did release. This function seemed to help the dying person, as well as others in the room, to feel more trustful of what was taking place and release into it with more peace and ease.

    My experiences with other psychedelics (including peyote, psilocybin, and ayahuasca) and other life-threatened individuals over the years, and working with indigenous healers in Mexico and the Amazon, has repeatedly evidenced how the letting-go process with mind-altering substances — when used responsibly in supportive settings with experienced guides — allows the journeyer to exercise what I call the “surrender muscles.” It creates an opportunity to do vital preparation work for the ultimate letting-go journey when physically dying by strengthening the letting-go process.

    The dynamics of letting go

    A key dynamic for a fruitful and transformational psychedelic journey is releasing control and surrendering into mystery — and allowing the experience to unfold. In doing so, journeyers learn about the cartography of altered space; they learn about levels of consciousness and being beyond the physical self and the identity of ego. They experience an aspect of their being that is transcendent of whom and what they thought they were; they learn of the cosmic self. This experience not only brings more comfort and ease with the altered states that frequently accompany physical death, along with an ability to navigate within them, but it also provides a sense of inner peace and serenity.

    The practice builds confidence that whatever is dying is okay, for they are about to enter a state of blissful oneness with all that has been, is now, and will forever be. Thus, they feel comforted that they will not be separated from the loved ones they seemingly are leaving behind. The practice suggests that the love they share does not die with their physical bodies, for they experience themselves as more than the physical containers that house their life spirit for the time of their life walk upon Mother Earth.

    Marti, the cancer patient mentioned earlier, was eager to try the energy medicine after we talked about the experience and how it might prove helpful in defusing her fear and anxiety about death. We set up a time and safe setting, she arranged for a mutual friend to be there as an additional support person, and we went forward with our plan.

    On the day of the journey, we met in her home. I first set the stage for sacred space by placing her spiritual objects and pictures in a circle around her. I then invited her to speak her intentions for the journey and her gratitude, after which I said a prayer that used her spiritual notions of deity. Marti inhaled the smoke, held it for the required 45 seconds, and then collapsed backwards onto the pillows laid out for her journey. Her eyes rolled backward in her head; her body shook uncontrollably. Then she was totally still.

    “Oh, my God. Oh, my God. Oh, my God,”
    she mumbled. “Oh, my God. I can’t believe it. I can’t believe it.” A gloriously serene smile appeared on her face, now softened in a way I had never seen before. Marti lay peacefully on her back for another 20 minutes before she opened her eyes. Blinking, she looked at her friend and me, at the room, then back to me.

    “I saw God,”
    she said. “I really did. I saw God. It was unbelievable, but it happened. Death is okay now. I know I will be okay, that I will be with God, with everyone. It’s all love; it’s all light. We are all together! Thank you, Tom. Thank you so much. I can’t believe this medicine. What a gift. You have to share it with others!”

    The future of the practice

    Marti died peacefully one week after her energy medicine journey. I have seen similar results with scores of others, helping them ease their fear of death and dying and what happens after death. I can’t help but believe how helpful this work could be with others who seek to exercise their surrender muscles in preparation for their physical death and/or for spiritually enhanced living.

    The indigenous peoples with whom I have studied consider these agents as having a guiding and healing spirit, as being alive, a wisdom elder, a sacred sacramental gift from the spirit world. They must be approached only with the utmost respect, reverence, and humility. It is easy for our materially based, sensation-seeking culture to abuse these substances, and when that occurs, great harm can result. These substances are not for everyone. Most certainly they are contraindicated for people with high blood pressure, heart problems, seizure history, or those on any kind of psychoactive medications, as well as those suffering from any kind of mental illness. A trained guide who knows the territory also is necessary, along with a safe and secure setting, and creating sacred space in alignment with the journeyer’s belief system and intentions.

    It is my hope that federal regulations will allow these substances to be used responsibly by qualified practitioners, who can conduct research to validate the potential of these substances to create a sustainable world; one that is peaceful, loving, and just and that is built on the recognition brought forth by the journeys — that all of creation is interwoven in an invisible web of love that is truly the essence of our being.
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    David Nichols, Ph.D

    Research with Psychedelic Psychotherapy for Dying Patients: The Inspiration for the Founding of the Heffter Research Institute

    by David Nichols, Ph.D

    You might ask yourself , “What does a scientist at a major Midwestern university know about psychedelics, death, and dying?” I was on a panel with Tim Leary many years ago at a conference on psychedelics and when I started my remarks I said, “I am a reductionist scientist.” Tim immediately leaned forward, looked at me, and said, “Well, David, you aren’t a reductionist scientist all the time.” I quipped back, “Yes, but no one is supposed to know that.”

    I find it impossible to be completely reductionist in my out look when I have seen so many things that cannot be explained by conventional science. For example, my first wife had a number of paranormal experiences that I witnessed first hand. Soon after we were married, she awakened from a dream where a small girl had come to her, leading her to the scene of an auto accident where she and her mother had been killed, asking for help to save her father. The next morning we found that such an accident had occurred at the same time as she had been having the “dream,” and in exactly the spot as in the dream. A mother and her young daughter had been killed, and the father was in intensive care in a local hospital. As another example, in a vivid dream late one summer her deceased paternal grandmother came to her and told her that she was coming back “on the 19th at 6 am.” She awoke from the dream and told me about it. Her father had cancer that had been progressing for some time, but at that moment he was holding his own. He died several months later on October 19th at 6 am. I witnessed these events, and many similar others, first-hand. How can science explain things like that?

    I began my graduate studies in the fall of 1969, specifically to study psychedelics (or psychotomimetics, as we were forced to call them then). While I was a student, however, Congress passed the Controlled Substances Act of 1970; a future studying psychedelics now seemed very remote. Nevertheless, I continued to work in this field, believing that someday things might turn around.

    You may study the chemistry and pharmacology of psychedelics, but you cannot read only science; the cultural and sociological issues are too large. As a scientist, I felt I couldn’t study these substances in a sterile environment, without appreciating the impact that my work might have on society. Being somewhat culturally disconnected by living in the Midwest, however, the literature I read was hit or miss. The “summer of love” was not something in the news in Cincinnati, Ohio. I was fortunate, however, to stumble upon the work of Eric Kast, who first discovered the remarkable effects of LSD in dying patients. It was natural then to find the subsequent work of Kurland, Grof, et al. in Maryland, who had expanded Kast’s seminal findings in their studies of psychedelics in terminal patients. Reading the excellent books by Stan Grof, and the parallels between psychedelic peak experiences and the so-called “near-death experience” reinforced my belief that psychedelics represented powerful tools to help in understanding death and dying. I was convinced that this research needed to be continued. Yet, as a Ph.D., and not an M.D., there seemed not much I could do except follow the chemistry and pharmacology of these amazing substances... and hope.

    In the mid-1980s, I made the acquaintance of a psychology professor at Purdue who had lost a son to a drug overdose and as a result had become very interested in death and dying. He offered a course every other year on the subject, and invited me to present a lecture on the use of psychedelics in dying patients. I eagerly agreed, and it was always fun to see the shock and amazement on the faces of the students, most of who were in the nursing program, when I introduced the subject of giving LSD to terminal patients. By the end of the hour, however, they were excited and full of questions.

    As time went on, I became more and more frustrated by my own lack of qualifications to do clinical research, and by the fact that no one who was qualified had picked up the ball. In a meeting at Esalen in 1984, I recall asking Oz Janiger why he and others who had been pioneers hadn’t tried to restart research, but his reply to me was dismissive; that I just didn’t understand how badly they had all suffered. It baffled me that folks who had seen the presumed therapeutic effects of psychedelics first hand, and who had extolled their virtues, could just give up like that. I really did not understand.

    So, for years I went to scientific meetings, and in the evenings sat over beers with colleagues who would listen, bemoaning the fact that no one was doing clinical research on psychedelics. I would argue that it wasn’t impossible; you just needed private money to do it. Everyone seemed to have the misconception that it wasn’t possible, but I countered that no one who was qualified had really tried. There were many important players in the community who didn’t believe me, but I remained convinced that if you had qualified researchers you could restart clinical research. The proof of principle finally came as I worked with Rick Strassman, who became the first clinician in more than twenty years to give a psychedelic to humans under an FDA-approved protocol. Even then, Daniel X. Freedman, then the head of psychiatry at UCLA who was a mentor for the project, counseled Rick to “Forget about therapy. Just measure physiological parameters.” It was good advice for getting research funding and publication in a solid journal, but of course avoided the most interesting issues, many of which could finally be explored in Rick’s book DMT: The Spirit Molecule.

    As I sat over a beer sometime around 1990 telling the same story for the umpteenth time, it suddenly occurred to me that I might ultimately be sitting in a rocking chair many years hence, old and decrepit, telling the same old story; still waiting for someone else to take the initiative. I was spurred to action by that thought and contacted a number of psychiatrist and neuroscientist colleagues and friends and said, “Let’s do it.” The rest, as they say, is history... or nearly so. We became the Heffter Research Institute, and incorporated in 1993. It is gratifying to see that the Heffter Institute has now been instrumental in initiating and supporting a study of psilocybin in OCD, and three clinical studies of psilocybin in cancer patients, dreams that motivated me to found the Institute in the first place. But how do psychedelics work? We have a modest but robust basic clinical neuroscience program in Zurich under the very capable direction of Dr. Franz Vollenweider to find out. Finally, it seems that things are moving. It has taken longer than I originally thought, but as they say, “better late than never.” What a journey for a reductionist scientist from the Midwest!
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    Taking psychedelics seriously

    Palliative care clinicians occasionally encounter patients with emotional, existential, or spiritual suffering, which persists despite optimal existing treatments. Such suffering may rob people of a sense that life is worth living. Data from Oregon show that most terminally people who obtain prescriptions to intentionally end their lives are motivated by non-physical suffering. This paper overviews the history of this class of drugs and their therapeutic potential. Clinical cautions, adverse reactions, and important steps related to safe administration of psychedelics are presented, emphasizing careful patient screening, preparation, setting and supervision.

    Even with an expanding evidence base confirming safety and benefits, political, regulatory, and industry issues impose challenges to the legitimate use of psychedelics. The federal expanded access program and right-to-try laws in multiple states provide precendents for giving terminally ill patients access to medications that have not yet earned FDA approval. Given the prevalence of persistent suffering and growing acceptance of physician-hastened death as a medical response, it is time to revisit the legitimate therapeutic use of psychedelics.

    Recently published studies in peer-reviewed journals and high-profile articles in the New Yorker, New York Times, and Wall Street Journal, have rekindled professional and public interest in the therapeutic use of psychedelic drugs. It is easy to understand the enthusiasm. The magazine and newspaper articles include accounts of patients with profound depression, demoralization associated with terminal illness, and anxiety related to PTSD, who experienced remarkable improvements, including some who had previously considered suicide.

    Nevertheless, psychiatric and palliative care clinicians who care for profoundly depressed, anxious, and seriously ill patients have every reason to be skeptical. As people become more mentally or physically ill and established treatments remain insufficiently effective, patients' susceptibility increases. Physicians play an important role in protecting vulnerable patients from spurious, nonevidence-based miracle cures, as well as from scientifically grounded, but overly zealous burdensome treatments that are certain to do more harm than good.

    An abundance of caution should be accorded psychedelics. However, given the extent of emotional and existential suffering that palliative care clinicians encounter in the patients we serve, these medications deserve serious consideration by our field. Specialty palliative care teams serve the sickest patients in our health systems and communities. It is, therefore, not surprising that we occasionally encounter incurably ill people whose suffering persists despite all available evidence-based treatments.

    In treating pain and other physical distress, established treatment protocols guide escalations of doses and combinations of analgesics and co-analgesic medications. When a patient is dying and physical pain, dyspnea, seizures, or agitated delirium persists and causes intolerable suffering, as a last resort, comfort can reliably be achieved with proportionate sedation.

    However, not all suffering is based solely in physical distress. Palliative care clinicians and teams also encounter patients whose misery is rooted in emotional, social, existential, or spiritual distress. Cancer, heart failure, liver failure, and ALS or motor neuron disease are among the diseases that can result in a progression of personal losses: Of feeling in control. Of taking care of one's self. Of contributing to others. Of enjoyment. Of meaning and purpose. Ultimately, some ill people say they have lost any reason to go on living.

    People who are incurably ill and living with progressive disease-related disabilities can experience anxiety, depression, and demoralization. Psychotherapy alone and drug treatments for such syndromes are often insufficient. Medications for depression may take weeks to become effective or prove ineffective. Antidepressants and anxiolytics carry side effects that can include mental slowing and confusion. These adverse effects are particularly common and hazardous in patients with advanced physical illness, who are also at risk of polypharmacy, multidrug interactions, and concomitant disequilibrium and falls. When nonphysical suffering persists despite prudent approaches, published, evidence-based guidelines are limited.

    Severe psychological and existential suffering can rob people of feeling that life is worth living. A sense of unending helplessness and hopelessness compels some to consider ending their lives. Suicide rates have risen 24% over the past two decades and are highest among middle-aged and elderly adults, particularly men who may suffer most from feelings of dependency. Public health data from Oregon show that since implementation of the Death with Dignity Act, the large majority of patients who received prescriptions for lethal drugs were motivated by nonphysical suffering. Current or fear of future pain contributed in just 26.4% of cases, while loss of autonomy, decreased ability to enjoy life, and loss of dignity most often brought these people to contemplate hastening their deaths.

    While psychedelic experiences vary significantly from one individual to another, those interviewed commonly express attributes including heightened clarity and confidence about their personal values and priorities, and a renewed or enhanced recognition of intrinsic meaning and value of life. People often voice a sense of exhilaration, insight, and strengthened connection to others, as well as a richer sense of relationship with nature or God. People who take psychedelics with an intention of spiritual introspection often report that the drugs opened windows into deeper realms of existential experience. In safe and supportive environments, these effects typically induce a state of wonder, conceptual frame shift, expanded capacity for love, and an intensified sense of connection. Patients living with medical conditions that had robbed them of hope or reason to live may experience a transformative shift in perspective and experience of inherent meaning, value, and worth.

    For most of these drugs, a single six to eight-hour session or short series of sessions suffices. Alleviation of anxiety and depression may persist for weeks to months and, for some, proves permanent. Exceptions to this treatment pattern include protocols of daily low-dose ketamine for depression and recent nonmedical reports of daily or every third day micro-dosing of LSD.

    Faced with novel therapies with reported clinical benefits that seem too good to be true, skepticism is warranted to protect vulnerable patients from harm. Cynicism, however, may prove more dangerous still. Unscientific bias and nihilistic assumptions can keep effective treatments from people who desperately need them.

    Despite the controversial history of psychedelic medications, palliative specialists who care for patients with serious medical conditions and common, difficult-to-treat nonphysical suffering have a duty to explore these hopeful, potentially life-preserving treatments. Against the backdrop of physician-hastened death becoming legal in five states, expanded research of clinical psychedelics must proceed.

    In reexamining the use of psychedelics in pharmaco-assisted therapy, we must not allow preconceptions, politics, or puritanism to prevent suffering people, who are now considered helpless and hopeless, from receiving promising, at times life-saving, treatments.
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    Therapist striving to give end-of-life cancer patients magic mushrooms in a clinical setting

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    Now that Canadian governments are in the business of selling bongs and rolling papers, I have to admit, no outcome seems off-limits.
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    Can magic mushrooms help us come to terms with death?

    Promising research suggests psychedelic experiences could be the future of palliative care.

    In 2016, researchers from New York University blindfolded a handful of terminally ill cancer patients and gave them a potent dose of psilocybin. The 29 patients had volunteered to take part in the medical experiment for somewhat comprehensible reasons: they were unable to handle the certainty of their own deaths.

    At the same time, Johns Hopkins University was conducting a similar experiment. Volunteers were given psilocybin, isolated in a room with a purpose-built playlist, and carefully monitored by a pair of psychotherapists. The idea of both studies was that maybe a hallucinogenic could play a positive role in the context of palliative treatment. By giving a terminally ill person just one intense, psychedelic trip, could we maybe alleviate some of that crushing end-of-life anxiety? Anyone who has achieved a sense of clarity and inner peace with recreational drugs will get the idea.

    This is a completely different way of working with people, clinical psychologist Dr Stephen Bright tells VICE. What we try to do in palliative care at the moment is to relieve the pain and suffering as much as possible by giving people pain medication. But morphine is not going to take away their anxiety or their depression.

    As vice president of Australia's Psychedelic Research In Science and Medicine association, Dr Bright has been keeping a well-trained eye on the progress of these studies overseas. And much to his delight, the results have so far been decisive.

    Subjects showed a significant and enduring reduction in anxiety, depression, and existential distress. In a follow-up assessment some six months after the treatment, 70 percent of the patients from the NYU trial later reflected on the psilocybin experience as one of the top five most spiritually significant experiences of their entire lives, while 87 percent reported increased life satisfaction overall.

    A research paper published in the Journal of Psychopharmacology attributes a large part of these therapeutic outcomes to the so-called mystical experience of psilocybin, which it defines as encountering a profound sense of unity, transcendence of time and space, and a deeply felt positive mood, infused with a renewed sense of purpose and meaning. That is one way of putting it. But the potential palliative benefits of the drug become slightly less abstract when we consider the effect psilocybin has on the way we see the world.

    The mystical experiences associated with drugs like psilocybin and LSD most likely stem from their influence on the Default Mode Network of the brain, that is, the neural network that allows certain parts of our brain to communicate while simultaneously cancelling out crosstalk from other parts. The DNS is important to our everyday functioning, as it keeps us focused on the things that are immediately relevant, like, say, the article you are reading, and sidelines those things that are not.

    Dr Bright explains that psilocybin disables the default mode network, thus opening the lines of communication between different parts of the brain that would never normally cross talk. Hence the mystical experience, which he says may provide people with a completely different perspective on their situation and bring into focus those things that humans typically tend to repress or pass over. And counted among those, of course, is the biggest downer of all: our own inescapable demise.

    It is almost taboo in Western culture to talk about death, says Dr Bright. And I think that part of the problem that people in these studies are having is, coming to grips with the idea of death because of the way the subject is treated in society.

    The partners of these patients may not want to talk about it, and they may not want to bring it up. But after the psilocybin experience, they feel a sense that there is something else out there, and they are more likely then to talk heart-to-heart and have that meaningful conversation.

    A not insignificant aspect of psilocybin's palliative benefits, then, might be the way in which it allows us to reach an understanding of death by facing it head on: to look it in the eye for the very first time and accept it for what it is. As far as psychiatrist Nigel Strauss is concerned, that makes this kind of research invaluable. After all, if we can truly help people come to terms with their own death, then we might just be able to dissuade them from wanting to take their own life.

    One of the things that makes a life good is the acceptance of death, says Dr Strauss. In fact, we as a society should be thinking about death much more, because it is an inevitable part of our existence.

    Strauss is well-versed in the subjects of psychedelic research and death. Just last year he had a paper published in the Australian Medical Journal which looked at the relationship between psilocybin-assisted psychotherapy and euthanasia.

    There has been a lot of conversation that I think misses the point, he says bluntly. For many of these people, pain is not the big factor. What the majority of people are requesting is early death or instant death because they are not coping with the thought of having to die in the next several months. They just can't accept that they are going to die.

    Strauss cites studies conducted in parts of Europe, where assisted dying is legal, which indicate that more people request euthanasia on psychological grounds than physical ones. The way he sees it, palliative psilocybin could assuage the psychological weight that comes with a terminal diagnosis, and give a small flicker of hope to those who might otherwise want to short-circuit the process of dying.

    Hopefully a number of people who would have that treatment would then say 'No, I can see what is happening. I feel a lot better and more positive, and even though I am dying, I don't want to use euthanasia: I want to use the next couple of months to come to terms with everything and everybody.'

    By having the psilocybin experience they can see death in a whole different way and they are much more comfortable with it.

    If the research so far is anything to go by, there is a more optimistic way to think about the end of our lives, and psychedelics may well be the key to unlocking that.

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    How psychedelic drugs are helping cancer patients face death

    By Lauren Slater

    Pam Sakuda was 55 when she found out she was dying. Shortly after having a tumor removed from her colon, she heard the doctors dreaded words: Stage 4; metastatic. Sakuda was given 6 to 14 months to live. Determined to slow her diseases insidious course, she ran several miles every day, even during her grueling treatment regimens. By nature upbeat, articulate and dignified, Sakuda, who died in November 2006, outlasting everyone's expectations by living for four years, was alarmed when anxiety and depression came to claim her after she passed the 14-month mark, her days darkening as she grew closer to her biological demise. Norbert Litzinger, Sakuda's husband, explained it this way:

    "When you pass your own death sentence by, you start to wonder: When? When? It got to the point where we couldn't make even the most mundane plans, because we didn't know if Pam would still be alive at that time, a concert, dinner with friends; would she still be here for that? "When" came to claim the couples life completely, their anxiety building as they waited for the final day."

    As her fears intensified, Sakuda learned of a study being conducted by Charles Grob, a psychiatrist and researcher at Harbor-U.C.L.A. Medical Center who was administering psilocybin to end-stage cancer patients to see if it could reduce their fear of death. Twenty-two months before she died, Sakuda became one of Grobs 12 subjects. When the research was completed the results showed that administering psilocybin to terminally ill subjects could be done safely while reducing the subjects anxiety and depression about their impending deaths.

    Sakuda's terminal diagnosis, combined with her otherwise perfect health, made her an ideal subject for Grob's study. Beginning in January 2005, Grob and his research team gave Sakuda various psychological tests, including the Beck Depression Inventory and the Stai-Y anxiety scale to establish baseline measures of Sakuda's psychological state and to rule out any severe psychiatric illness.

    "We wanted psychologically healthy people,"
    Grob says, "people whose depressions and anxieties are not the result of mental illness, but rather," he explained, "a response to a devastating disease."

    Sakuda would take part in two sessions, one with psilocybin, one with niacin, an active placebo that can cause some flushing in the face. The study was double blind, which meant that neither the researchers nor the subjects knew what was in the capsules being administered. On the day of her first session, Sakuda was led into a room that researchers had transformed with flowing fabrics and fresh flowers to help create a soothing environment in an otherwise cold hospital setting. Sakuda swallowed a capsule and lay back on the bed to wait. Grob had invited her, as researchers do with all their subjects, to bring objects from home that had special significance.

    "These objects often personalize the session room for the volunteer and often prompt the patient to think about loved ones or important life events
    ," Roland Griffiths, of Johns Hopkins, says.

    "The thinking is that with the aid of the psychedelic, you may come to see the object in a different light. It may help bring back memories; it promotes introspection, it can be a touchstone, it can be grounding," Halpern says.

    Sakuda brought a few pictures of loved ones, which, Grob recalled, she clutched in her hands as she lay back on the bed. By her side were Grob and one of his research assistants, both of whom stayed with the subjects for the six-to-seven-hour treatment session. Sakuda knew that there would be time set aside in the days and weeks following when she would meet with Grob and his team to process what would happen in that room. Black eye shades were draped over Sakuda's face, encouraging her to look inward. She was given headphones. Music was piped in: the sounds of rivers rushing, sweet staccatos, deep drumming. Each hour, Grob and his staff checked in with Sakuda, as they did with every subject, asking if all was O.K. and taking her blood pressure. At one point, Grob observed that Sakuda, with the eye shades draped over her face, began to cry. Later on, Sakuda would reveal to Grob that the source of her tears was a keen empathetic understanding of what her spouse, Norbert, would feel when she died.

    Norbert Litzinger remembers picking up his wife from the medical center after her first session and seeing that this deeply distressed woman was now glowing from the inside out. Before Pam Sakuda died, she described her psilocybin experience on video: I felt this lump of emotions welling up . . . almost like an entity, Sakuda said, as she spoke straight into the camera. "I started to cry. . . Everything was concentrated and came welling up and then . . . it started to dissipate, and I started to look at it differently. . . I began to realize that all of this negative fear and guilt was such a hindrance . . . to making the most of and enjoying the healthy time that I'm having." Sakuda went on to explain that, under the influence of the psilocybin, she came to a very visceral understanding that there was a present, a now, and that it was hers to have.

    Two weeks after Sakuda's psilocybin session, Grob re-administered the depression and anxiety assessments. Over all among his subjects, he found that their scores on the anxiety scale at one and three months after treatment demonstrated a sustained reduction in anxiety, the researchers wrote in The Archives of General Psychiatry. They also found that their subjects scores on the Beck Depression Inventory dropped significantly at the six-month follow-up.

    "The dose of psilocybin that we gave our subjects was relatively low in comparison to the doses in Stanislav Grof's studies," Grob told me. "Nevertheless, and even with this modest dose, it appears the drug can relieve the angst and fear of the dying."
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    Psychedelic mushrooms could cure anxiety for cancer patients

    When O.M. was 21 he was diagnosed with Hodgkins lymphoma. He was a pre-med student at the time. His first reaction was denial, followed by an overwhelming and lasting anxiety, as described in an Atlantic article by Roc Morin. Even after six rounds of chemotherapy helped O.M. kick the cancer, he was plagued with a devastating fear that the disease might return. He checked his lymph nodes so often to see if they'd grown that he developed callouses on his neck.

    He experienced this debilitating end-of-life anxiety from the moment he was diagnosed until the day he ingested psilocybin, extracted from hallucinogenic mushrooms, while laying on a psychiatrists couch during a New York University study. O.M. is one of 35 study participants, all of whom suffered from severe anxiety due to cancer.

    The double-blind, placebo-controlled pilot study, which is still ongoing, looks at the potentials for psilocybin to treat anxiety and other psychological distress stemming from advanced cancer. The second half of the study will look at the effect of psilocybin on pain perception, depression, existential/psychospiritual distress, attitudes toward disease progression, quality of life, and spiritual/mystical states of consciousness.

    O.M. told the Atlantic that when he ate the mushrooms, it was like a switch went on.

    "I went from being anxious to analyzing my anxiety from the outside," he said. "I realized that nothing was actually happening to me objectively. It was real because I let it become real. And, right when I had that thought, I saw a cloud of black smoke come out of my body and float away."

    Gabrielle Agin-Liebes, the research manager for the NYU study, told the Atlantic that "O.M. had one of the highest possible anxiety ratings possible prior to the study. The day following his treatment, O.M. scored a zero. He had absolutely no anxiety, and stayed that way for seven months following the treatment."

    As Morin's Atlantic article notes, psilocybin was used for medicinal purposes for centuries by indigenous peoples before Western Christian globalization stomped out its mainstream usage. In the wake of WWII, hallucinogens-as-medicine made a comeback among psychiatrists. When psychoactive substances gained recreational popularity as street drugs, the Nixon administration waged its war on drugs, passing the Controlled Substances Act of 1970. Psilocybin was given restrictive Schedule I classification along with LSD, cannabis and other psychoactive substances. Nixon's war on drugs still rages on today, filling prisons with nonviolent drug offenders and targeting minority populations.

    1970s-era policies have also suppressed most research of psychedelics for decades, but thanks to the efforts of determined scientists and research groups like the Multidisciplinary Association for Psychedelic Studies (MAPS), government-approved human studies of controlled psychedelic substances are breaking ground again. While the federal government still deems them dangerous and void of medical purpose, research continues to reveal a promising medical potential of most psychoactive Schedule I substances to treat issues ranging from pain and anxiety to addiction and cancer.

    A recent FDA-approved study looked at LSD in the treatment of end-of-life anxiety. It was the first controlled study of LSD in humans in 40 years, and the results were overwhelmingly positive, with every patient reporting reduced anxiety and no negative side effects.

    The NYU psilocybin study is not the first of its kind. Charles Grob conducted a study with similar outcome measures at Harbor-UCLA. However, the NYU study uses higher doses of psilocybin and examines 32 subjects instead of the 12 Grob examined. The results of the current psilocybin study are still being examined, but principal investigator Stephen Ross told the Atlantic that, the vast majority of their patients have exhibited an immediate and sustained reduction in anxiety. Consistent with similar studies involving psilocybin, approximately three-fourths of the participants rate their experience with the drug as being one of the top five most significant events of their lives.

    O.M. was among the overwhelming success cases.

    "At the hospital they gave me Xanax for anxiety," he told the Atlantic. "Xanax doesnt get rid of your anxiety. Xanax tells you not to feel it for a while until it stops working and you take the next pill. The beauty of psilocybin is: its not medication. You're not taking it and it solves your problem. You take it and you solve your problem yourself."
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    New research into end-of-life therapy

    The first new study, by Stephen Ross and colleagues in New York, recruited 29 people with cancer that was causing them anxiety and depression. Half the participants were given a moderate dose of psilocybin (0.3mg/kg), and the other half were given an active placebo (niacin). All the participants then attended an 8-hour long session of psychotherapy by two clinical therapists.

    One day after the session, participants who had received psilocybin had significant reductions in anxiety and depression scores compared to the active placebo group. This positive change in the participant’s mental state was maintained for 26 weeks following the therapy session. In addition to the clinically significant changes, psilocybin produced feelings of spirituality, well-being, and satisfaction.

    The second study, by Roland Griffiths and colleagues in Baltimore, involved 51 cancer patients with clinical anxiety or depression. The participants were split into 2 groups, and all were given psilocybin in a calm environment with two trained support monitors present. One group was given a low dose of psilocybin (3mg) and the other was given a high dose (30mg).

    Five weeks after the experience, the participants in the high-dose group had significantly reduced depression and anxiety scores, and these positive effects lasted for at least 6 months following the session. Participants reported the experience as being extremely meaningful, spiritual, and improving their feeling of wellbeing.

    Neither study reported any harm associated with psychedelics when administered in a controlled, therapeutic environment. The results are incredibly promising, considering these studies are with reasonably sized groups and show clinically significant benefits. In fact, the effects of psilocybin on depression appear to be much greater than typical antidepressants.

    What does this new research mean?

    Many of us know someone who is suffering from a severe illness. And it’s likely that most of those people are experiencing distress or anxiety at the thought of leaving their loved ones behind. Maybe they’re being given antidepressants by their doctor – but these are most often SSRIs, which are only moderately effective, require frequent doses, and produce horrible side effects. Typical antidepressants also don’t address the problem. They treat end-of-life anxiety as a chemical imbalance and don’t take into account the sufferer’s personal and spiritual issues.

    Psychedelics appear to out-perform pharmaceutical drugs like SSRIs. Single doses of psilocybin showed a greater improvement in depression scores than typical antidepressants, lasting for months. Perhaps more importantly, patients often reported that they had experienced life-changing and meaningful spiritual experiences. They saw the root of their anxiety, and it enabled them to come to terms with death.

    This is a profound finding. Taken in the right setting, with the right support, psychedelics could help all of us come to terms with our own mortality. They could help us learn to accept our fate and live more fulfilling lives. Especially for those suffering from terrible illness, this could be a beautiful gift.

    If anyone in our society deserves all possible care and comfort, it’s people suffering from a life-threatening disease. It seems deeply wrong to withhold potential palliative care from them. We should always be searching for ways to alleviate that fear wherever possible – and psychedelics could be part of the solution.
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    The role of psychedelics in palliative care reconsidered: The case for psilocybin

    Benjamin Kelmendi, Philip Corlett, Mohini Ranganathan, Cyril D’Souza, John H Krystal

    Psychiatric research with classic hallucinogens has enjoyed a resurgence of late. While studies performed in the late 1960s and early 1970s with LSD and psilocybin demonstrated therapeutic promise by producing a rapid and sustained reduction in anxiety, improvement in mood, and enhanced quality of life in patients with terminal cancer, a fuller exploration of their use in palliative medicine was curtailed by the establishment of a strict federal regulatory environment. Now, after decades of research inactivity, the potential of psychedelics to alleviate the distress associated with a terminal illness has been significantly advanced by the results of two recent studies investigating the efficacy of psilocybin in the treatment of anxiety and depression in patients with life-threatening cancer. Using double-blind, placebo-controlled, crossover designs, the studies conducted at Johns Hopkins University (JHU) and New York University (NYU) were methodologically rigorous and broad in the scope of their outcome variables. Both studies demonstrated that a single-dose of psilocybin can produce both an acute and enduring reduction in depression symptoms, anxiety, and existential distress in patients with life-threatening cancer.

    That the studies replicated one another is a source of confidence in their findings. However, there were also informative differences between the studies. The group at JHU investigated the effects of a very low dose versus high dose of psilocybin administered five weeks apart in 51 patients diagnosed with life-threatening cancer and suffering with symptoms of depression and/or anxiety. The group at NYU compared the effect of high-dose psilocybin with niacin in 29 patients, and both groups received targeted psychotherapy. All patients were screened and prepared for the study intervention through several meetings with staff who established rapport and provided an understanding of the range of altered states of consciousness that might be encountered during their treatment sessions. The psilocybin experience was well tolerated by all patients, and there were no serious medical or psychological adverse events.

    Both studies evaluated a broad range of outcome measures, including the common measures of anxiety and depression, as well as quality of life, spirituality, and mystical experiences. In the Griffiths trial, high-dose psilocybin produced large and sustained decreases in clinician- and patient-rated measures of depressed mood and anxiety, along with increases in quality of life, life meaning and optimism, and decreases in anxiety related to death. In the NYU trial, psilocybin produced rapid, substantial, and enduring reductions in cancer-related anxiety and depression, improved quality of life, increased spiritual well-being, and improved measures of existential distress, and was associated with improved attitudes toward death. At follow-up at six-and-a-half months, the initial robust clinical effects observed after the administration of a single dose of psilocybin endured in 60–80% of the patients, and when patients were asked to reflect on what they thought of their psilocybin session, 52% and 70% rated the psilocybin experience as the singular or top 5 most spiritually significant, or the singular or top 5 most personally meaningful experience of their entire lives, respectively, while 87% reported increased life- satisfaction or well-being attributed to the experience. The findings that single-dose psilocybin can produce acute and sustained improvements in cancer-related anxiety and depression is perhaps the most important and novel finding of the two studies, and add to and extend the findings of a similarly designed trial in patients with terminal cancer where a single low dose of psilocybin showed non-significant trends for benefit compared with placebo.

    In both studies, mediation analysis indicates that the mystical experience was a significant mediator of the effects of psilocybin dose on therapeutic outcomes. Mystical experience is defined as encountering a profound sense of unity, transcendence of time and space, deeply felt positive mood, noetic quality (sense of understanding), ineffability, transiency, and paradoxicality infused with a renewed sense of purpose and meaning. Further evidence for the role of the mystical experience and/or higher doses in therapeutic outcomes comes from two open-label trials for addiction where the mystical experience was correlated with improved smoking cessation and drinking outcomes. Furthermore, Carhart-Harris et al. recently investigated the safety and efficacy of psilocybin in treatment-resistant depression, and showed that a higher dose correlated with a better treatment outcome. The association between psychedelic-induced mystical experience and therapeutic outcome, while not new, requires further exploration, as when induced under optimal conditions and in a controlled setting, it could provide a valuable therapeutic intervention for disorders that are otherwise difficult to treat.

    Although not the primary aim of these studies, directionality of the relationship between the pharmacology of the drug, mystical experiences, and clinical outcome remains inconclusive. We do not know for certain whether these mystical experiences are a cause, consequence or corollary of the anxiolytic effect or unconstrained cognition. For instance, it is possible that mystical experiences associated with psilocybin serve as a measure of adequate drug effects rather than mediating an antidepressant and/or anxiolytic effect. Perhaps future studies could shed some light on this relationship by employing other drugs, such Salvinorin A and other kappa opioid receptor agonists, capable of producing perceptual alterations and mystical experiences similar to serotonergic hallucinogens but pharmacologically different. Also intriguing is whether the psychoactive effects of psilocybin influence its efficacy through, not yet fully understood, psychological mechanisms that continue to exert their effect well beyond the acute pharmacological effects. Rapid alleviation in mood is also reported with a single administration of ketamine, a dissociative anesthetic known to occasion mystical experiences. However, the antidepressant effects are relatively transient and typically disappear after a week. Moreover, not all the psychotropic substances that induce dissociative and/or mystical experiences produce an acute and enduring clinical benefit. Is there a differentially unique characteristic about the pharmacology of psilocybin and its enduring clinical effects compared with other serotonin receptor (5-HT2A) agonists such as DMT or DPT?

    Imaging studies in healthy controls indicate that psilocybin decreases blood flow to regions of the brain regions collectively known as the default mode network (DMN) and promotes unconstrained cognition. Increase in metabolic activity in the DMN has been associated with increase in ruminative thinking and has been implicated in depression and anxiety but normalized by a range of effective treatments. One theoretical framework that might link mystical experiences to a new, more positive outlook through changes in brain function is Predictive Processing. This theory posits that the brain is a prediction machine and its hierarchically organized neuroanatomy is geared toward predicting future inputs based on prior experiences. Any mismatches or prediction errors can gather new learning based in their precision. We have previously argued that psychotomimetic drugs may induce their psychedelic or mystical effects by altering the balance between predictions and prediction errors such that errors are registered inappropriately and perceptual inferences become deranged. These experiences can gather new learning, expanding the possibility space for future inferences. This may be reflected in the significantly elevated trait openness, which persists for 14 months following a single infusion of psilocybin. Future work will need to discern how and why these drugs can have psychotomimetic effects in some individuals and antidepressant effects in others. The environmental setting and individual’s baseline are clearly crucial to the effects a psychedelic drug can have. Thus expectations and environments may enhance the drug’s potential to foster religious and spiritual experiences. In his book Heaven and Hell, Aldous Huxley observes, “Many schizophrenics have their times of heavenly happiness; but the fact that they do not know when, if ever, they will return to the reassuring banality of everyday experiences causes even heaven to seem appalling.”

    These studies have demonstrated a critical advancement in this field. Psilocybin may offer a novel and potentially valuable approach for addressing the psychological suffering of dying often observed in this patient population, particularly given the limited efficacy of extant treatments. These studies also raise a number of important questions that warrant further research. How necessary are the acute psychedelic effects of psilocybin for its antidepressant and anxiolytic effects? What are the predictors of beneficial effects and adverse effects? Would moderate doses have similar effects? How specific are the effects? For a single dose of a drug to have effects that are still detectable six months later opens a new era of potential psychopharmacological treatments. But it also begs the question about what is/are the mechanism/s underlying the sustained beneficial clinical effects of psilocybin.
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    What if psychedelics could revolutionize the way you die?

    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.
    Last edited by mr peabody; 01-12-2018 at 20:42.
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    Can psychedelic drugs play a role in palliative care?

    Psychedelic drugs are agents that may assist a person in approaching existential issues. They enjoy a rich history in ancient, non-Western cultures and, more recently, in psychiatric research of the 1960s. After a 40-year hiatus, international trials are now underway to revisit the role of psychedelic drugs in assisting patients with terminal cancer to explore – and resolve – anxiety-inducing existential issues surrounding their illness.

    Classical psychedelic drugs include the agents LSD and psilocybin. Another class of drugs, the entactogens, includes the agent MDMA (ecstasy). Contemporary researchers are asking whether the unique psychotropic qualities of these drugs can be useful as adjuncts to psychotherapy in reducing the burden of anxiety and pain for palliative care patients.

    ● Contemporary researchers are asking whether the unique psychotropic qualities of psychedelic drugs can be useful as adjuncts to psychotherapy in reducing the burden of anxiety and pain for palliative care patients.

    ● The classical psychedelics LSD and psilocybin may offer the user an experience of self-reflection through exposure to personal existential issues.

    ● MDMA is a particularly useful drug for patients experiencing anxiety associated with the process of dying.

    ● Currently, four scientific studies into psychedelic agents are underway, in the USA and in Switzerland.

    ● Today’s medical psychedelic community looks beyond the sensationalist stories of the past to a more balanced, objective and evidence-based approach to psychedelic drugs.

    Contemporary research consistently demonstrates that the use of LSD and psilocybin present no demonstrable physiological concerns and no risk of dependency.

    For the past 40 years, there has been a relative absence of research into psychedelic compounds. However, they are currently enjoying a renaissance in medical research.

    Death as an existential process

    It is well recognised that the issue of death tends to be repressed in the Western culture. We frequently over-medicalise death at the expense of acknowledging its emotional aspects, tending to focus more on delaying it rather than on improving the quality of the remaining days of life. The risk of developing a diagnosis-associated adjustment disorder is significant. Using a structured, problem-focused approach, psychological therapy partially addresses elements of depression and anxiety associated with adjustment disorder. However, to what extent does this address an individual’s fears about the existential issue of death?

    In contrast to the Western model, many indigenous cultures embrace or even celebrate death as an important existential transition. Some cultures employ psychedelic plants as sacraments in a psychotherapeutic context. Examples include the Native Americans’ use of the peyote, the Mexicans’ use of psilocybin, the Amazonians’ use of ayahuasca, the West Africans’ use of iboga, and the use of cannabis for religious purposes in India, the West Indies and East Africa. These psychedelic-assisted ceremonies are lead by a shaman – a respected tribal leader with the combined status of a healer, doctor and priest. Their use is very different from the Western version of recreational drug abuse. Instead, they offer a powerful group experience, which has a profoundly cohesive and positive effect on the individual and their community.

    Psychedelics and the existential

    A common experience with psychedelic drugs is that of symbolic death or rebirth. The indigenous use of psilocybin may provide a symbolic experience of what it is to die, thus ‘giving one a realisation of life’s impermanence, and providing an insight into the transcendent nature of consciousness.’ In this context, the shaman can be seen as an agent assisting the process of dying. A recent study at Harvard explored the spiritual phenomenon frequently reported by users of psychedelic drugs. In a double-blind study, participants were given psilocybin or a placebo and rated their experience of spiritual feelings, giving a fascinating objectivity to the well-established existential experiences described by users of psychedelic drugs.

    The issue of spirituality often sits uncomfortably with many doctors, as it does not fit readily into the medical model. Nevertheless, the broader concept of existential issues, especially when faced with imminent death, may be more readily embraced by scientists within a less spiritual and wider psychological context. The psychedelic drugs can be recognised, therefore, as organic agents, well placed to address this fundamental psychological need.

    The psychedelic researcher Stanislav Grof has explored the possibility of improving the Western approach to death and dying by describing how psychedelics can play a role in assisting individuals to better understand these existential aspects. This has much in common with the modern concept of having a death plan, just as pregnant women often have a birth plan.

    LSD was frequently noted to reduce an individual’s fear of death The role of psychedelic drugs in palliative care For 20 years, following the discovery of the psychedelic properties of LSD in the 1940s by Dr Albert Hofmann, the newly developed drug was studied as an adjunct to psychotherapy for many psychiatric conditions on more than 40,000 patients. The drug showed particular promise in treating anxiety disorders and was frequently noted to reduce an individual’s fear of death.

    This was further studied by the anaesthetist Eric Kast, who was interested in whether LSD’s ability to distort body image could reduce the perception of pain. He compared the analgesic effects of LSD with two commonly used opiate analgesics and found it superior to both in relieving pain. In further studies, he went on to explore LSD’s ability to induce a spiritual-type experience that allowed terminally ill patients to better identify with the emotional aspects of dying, to improve their sleep and reduce their anxiety for many weeks after the initial treatment.

    Contemporary research

    Contemporary psychedelic research draws on some of the principles of Kast’s work. These studies have many similarities in their design.

    ● Participants have a diagnosis of cancer and have developed a secondary anxiety disorder that has been previously unsuccessfully treated with traditional methods – such as anxiolytic medication or traditional psychotherapy.

    ● The studies employ a combination of non- drug and drug-assisted psychotherapy sessions. Initially, there are several non-drug sessions, so that the patient and therapist can build up a rapport, and during which baseline psychiatric assessment scales are completed. Then, two drug/placebo sessions are conducted, spaced several weeks apart, and followed up by further supportive, non- drug sessions.

    ● During the drug sessions, the patient is initially encouraged to lie down, wearing an eye mask. The psychotherapy is largely non-directed, with the therapist encouraging the patient to free associations. Music is frequently employed to assist the process.

    ● Despite the very low risks involved, physiological data is measured throughout the experimental sessions, which take place within a general hospital environment where emergency facilities are available.

    ● Attention is paid to fostering a favourable ‘set and setting’. That is, participants are adequately informed about the nature of the psychedelic experience and the environment for the sessions is relaxed and comforting.

    ● Psychological data is collected to measure depression, pain and anxiety at baseline, during sessions and at several months’ follow-up. Most of the studies also include a component measuring quality-of-life factors.

    Learning from ancient history

    Many of these studies have been decades in the planning. The ethical considerations restricting this kind of research are vast. The past history of abuse and damage to individuals and society from the misuse of recreational drugs are undeniable. Today’s medical psychedelic community looks beyond this to a more balanced, objective and evidence-based approach to psychedelic drugs.

    It appears that there is a lot the medical profession can learn from the ancient history of non-Western cultures about improving the manner in which we approach death, and psychedelic drugs may have an important role to play in this lesson. If there is a possibility that these fascinating chemicals could safely and effectively relieve the suffering of those with terminal illness, then we owe it to them to carry out this research.

    There is a lot the medical profession can learn from the ancient history of non-Western cultures about improving the manner in which we approach death.
    Last edited by mr peabody; 06-12-2018 at 01:29.
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    Doctor advocating LSD for the dying

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

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


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

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

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

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

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

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

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

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

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


    We need to revolutionize end-of-life care

    When Victoria Chang’s mother was diagnosed with pulmonary fibrosis, she didn’t have a single person she felt she could turn to. Six years earlier, her father had a stroke that led to significant neurological changes, and now the young poet realized she alone would have to care for them both. None of her friends had sick or elderly parents, so she felt completely isolated.

    What followed was a decade of navigating America’s imperfect end-of-life health care system, without much guidance from the doctors and specialists she so frequently encountered. When asked what she would have done differently over the course of the stressful years, Chang says, frankly, “Everything.”

    “Everything was a learning curve, everything new,” she says, noting how she wished there had been more help for people like her. “Emotions were high, and we needed a case manager or a consultant or something. Hospice seemed to help, but in the end, there was only so much they could do.”

    Chang’s experience caring for seriously ill loved ones is sadly not unique. Thanks to a combination of denial, a lack of know-how and flawed systems, most Americans don’t have the support they need when it comes to end-of-life care. According to a study by the California HealthCare Foundation:


    A majority of those surveyed had not even communicated their end-of-life wishes to the loved one they would want making decisions on their behalf. That’s where Dr. Ira Byock, chief medical officer of the Institute for Human Caring at Providence St. Joseph Health, comes in. A renowned expert in palliative care and the author of The Four Things That Matter Most: A Book About Living and The Best Care Possible, Byock wants to reimagine health care as a more personal, approachable system. He wants to boost the person-to-person communication and eradicate denial — an approach he and his colleagues call Whole Person Care.

    “Whole Person Care attends not just to your medical problems, but to your personal priorities, values and preferences,” explains Byock. “You are someone with bodily needs but also have emotional, relational, social and spiritual parts of your life, all of which need to be attended to.”

    This perspective may not seem all that radical, but it is clearly not the current practice. "American medicine is good in that it’s a “problem-based system,” Byock says. “It is organized around your problem list on your chart. Everything we do, by design, responds to a problem on your list.” But life isn’t just a set of problems to be solved; patients have lives that extend well beyond the walls of hospitals and waiting rooms. Health care, in Byock’s opinion, should address this reality at all stages of life.

    Perhaps most importantly, Whole Person Care includes patients’ families at every level of care. Byock emphasizes the significance of the familial role in a patient’s comfort, as well as the ripple effects of a single individual’s illness on loved ones and their network of relationships. “Whenever one person gets a serious diagnosis, everyone who loves that person shares in the illness. It’s a family and community issue.”

    Chang, for one, can attest to the need for a system like Whole Person Care. “Looking back, I can’t remember the past decade because I was so busy helping everyone around me,” she says.

    When asked what advice she would give to those caring for a family member or spouse dealing with a serious illness, Chang emphasizes the importance of self-care and finding community support in whatever form that might take. "Remember that it is OK to think about yourself and to take care of yourself,” she says. “Seek out groups to share with and to get emotional support. I only did this toward the end when I started reading about and writing to people on the pulmonary fibrosis foundation website. Those forums saved my life.” She also encourages folks in similar positions to consider their options, including daycare, homecare and facilities, and weigh the pros and cons of each.

    Byock also encourages those faced with these situations to manage their own health: “People can experience wellbeing even in the midst of serious illness.”
    Last edited by mr peabody; 09-12-2018 at 13:48.
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  23. Collapse Details
    Bluelighter mr peabody's Avatar
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    Aug 2016
    Frostbite Falls, MN
    Psilocybin found to ease end-of-life anxiety

    By David Biello

    UCLA psychiatrist Charles Grob and his colleagues enlisted 12 cancer patients between June 2004 and May 2008. All suffered from fatal cancers, ranging from breast cancer to multiple myeloma, as well as acute stress disorder, generalized anxiety disorder, anxiety disorder due to cancer, or adjustment disorder with anxiety. All agreed to take a moderate dose of psilocybin to see if the psychedelic drug might offer some relief from their fear of death and disease.

    The unusual decision to have each patient serve as both a subjects and then as a control, rather than having two separate groups, one treated with psilocybin and one with niacin, was taken because the researchers believed that to be the ethical course to take, given the life circumstances subjects were encountering, (i.e. imminent demise). In other words, Grob and his colleagues felt that all the terminally ill patients should be allowed to experience any potential benefit from the psilocybin treatment. The patients were brought into the hospital, hooked up to a heart monitor and settled in a room decorated with fabric wall hangings and fresh flowers. Headphones played music of their choice. At 10:00 AM on the day of a treatment, each of the 12 patients in the study individually swallowed the appropriate dosage of psilocybin as a pill. Researchers then measured various vitals and checked on their status every hour thereafter until the psychedelic experience was over, roughly six hours later.

    Eight of the 12 subjects had previous experience with psychedelics, either in the past year or as far back as 30 years ago. Though heart rate and blood pressure climbed as a result of taking the drug, none reported a bad trip and most enjoyed a significant reduction in end-of-life anxiety between one and three months after treatment, as measured by various psychiatric questionnaires. Their depression eased as well, a change that was sustained as much as six months later for those who survived that long. Unfortunately, the psilocybin, at this dose anyway, did nothing for physical pain.

    The patients generally reported that the medication helped them to examine their lives and determine how they wished to address their limited life expectancy. Unfortunately, as of publication of the research, 10 of the 12 subjects have died. But the research suggests that using psychedelic drugs such as psilocybin may help to ease the existential anxiety and despair that modern medicine has largely found no other way to treat.

    Last edited by mr peabody; Yesterday at 13:31.
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