The title of his talk, Psychedelic Research: Implications for Palliative Care and End-of-Life Existential Distress, was intriguing, and so we climbed the hill to McGill’s McIntyre Medical building last month to listen to Anthony Bossis.
We wondered: can psychedelic drugs such as psilocybin or LSD be beneficial as we enter the final phase of our lives, especially if we face terminal illness?
Bossis, a clinical psychologist and Clinical Assistant Professor of Psychiatry at the NYU School of Medicine, is in a good position to answer because he has extensive experience in palliative care and was co-lead investigator of a pioneering study for NYU, completed in 2016. It was a double blind, placebo-controlled, crossover trial, involving 29 patients with cancer-related anxiety and depression.
They were screened and randomly selected for a single-dose of psilocybin, also known as magic mushrooms, or a placebo. The study found that those who were given psilocybin, showed “immediate, substantial, and sustained improvements in anxiety and depression and led to decreases in cancer-related demoralization and hopelessness, improved spiritual wellbeing, and increased quality of life.”
And that single dose appeared to have had a lasting effect: more than 6 1/2 months later, Bossis reported, researchers found that the psilocybin ingested was associated with enduring anti-depressive effects because 60-80 per cent of participants continued to display clinically significant reductions in depression or anxiety.
They also displayed “sustained benefits in existential distress and quality of life” and improved attitudes toward death. The study concluded that, in conjunction with psychotherapy, “single moderate-dose psilocybin produced rapid, robust and enduring anxiolytic (anxiety inhibiting) and anti-depressant effects in patients with cancer-related psychological distress.”
Bossis told his audience, mainly medical and other students, that the trial and the medical community’s interest “is not about the drug per se, it’s about the experiences they generate.”
That experience can include “a profound sense of transcending time and space” which can have a positive palliative effect on a patient who is dying and whose body is beginning to fail and will soon not function. Bossis cited similar research in 2016 at Johns Hopkins University School of Medicine that found that a dose of psilocybin can significantly reduce anxiety, depression and other forms of emotional distress in patients.
Four in five of the 51 patients in that study, all of whom had been diagnosed with life-threatening cancers, continued to show decreased feelings of depression and anxiety about the prospect of dying six months after the final treatment. About 67 percent said the drug-induced effect was one of their most meaningful life experiences.
Based on these and other studies, Bossis contrasted the apparently lasting and positive effects on depression and anxiety and sense of well being – even five years after participants took that single dose of psilocybin, as at least one study has shown with a patient in remission – with common anti-depressant medication usually taken daily.
“These medicines you take once and the experience has been transformative,” he said. He told his audience he was not advocating legalization of psilocybin, only continuing research into its therapeutic use in a controlled and supervised context. In the U.S. and Canada, possessing, selling or transporting psilocybin mushrooms without a prescription or license is an indictable offence.
As far as risks go in using the substance, Bossis, in an interview with the McGill Faculty of Medicine, noted that in his research experience, “When the individual is carefully screened and the experience is embedded within an interpersonally supportive psychotherapeutic period of preparation and integration, there have been no serious adverse effects.”
When psilocybin is taken recreationally without proper screening, “the risk of panic, anxiety, and other adverse effects is heightened.”