What Psilocybin Could Mean for End-of-Life Care

July 18, 2019

For over three decades, Anthony Bossis has been interested in religion, mysticism, end-of-life experiences, and palliative care—which addresses the needs and comfort of the terminally ill.

“There’s really a paucity of measures to help those people who are suffering with the emotional distress that comes at the end of life,” says Bossis, a clinical psychologist and clinical assistant professor of psychiatry at the New York University School of Medicine. He was co-principal investigator, director of palliative care, and a “session guide” for the NYU Psilocybin Cancer Anxiety Project, a FDA-approved clinical trial, the results of which were published in 2016. The preliminary trial, involving 29 patients, investigated the efficacy of psilocybin—the active psychotropic ingredient in “magic” mushrooms—for improving distress and other states in people with cancer. Bossis is currently working on further research to explore this potential treatment.

What are the main takeaways from the cancer patient study?

The findings showed that anxiety and depression were reduced greatly immediately after the medicine session. Psilocybin produced immediate, significant, and sustained improvements in both anxiety and depression. And about 80% of those people showed sustained benefits nearly seven months later. We’re going to continue to track those people going forward. That was remarkable and hadn’t been seen before.

We also saw reductions in a measure called demoralization, which is a very common and deep source of suffering for people at the end of life. Both demoralization and hopelessness were improved immediately after the medicine session. Up to 70% of the people reported that the experience was either the single most or in the top five most meaningful experiences of their lifetime, which is somewhat stunning to hear. Almost 90% reported that it improved life satisfaction. That was important.

We don’t die well in America and it’s really kind of the final taboo, it’s something we don’t speak about. There’s so many people who suffer enormously and there aren’t enough tools to address that end-of-life distress. So these results show people having a single experience and having anxiety, depression, and a host of existential measures reduced.

During the sessions, how much talk therapy is there? Is it mostly silent?

So let me put it in context. Three or four weeks prior to the session, we get to know the person quite well and review their life history, their intentions for being in the study, get to know their family and their relational life, and how cancer has affected them. We also provide guidelines for the session itself and what to possibly expect, although we can never predict what will actually happen. One of the purposes of all that is to develop a sense of trust and rapport with the participant, which has been shown to act as a buffer against any adverse effects in terms of anxiety and the possible panic during the experiences. That’s really very important.

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In the session itself, there’s very little talking if it goes well. The person comes in early in the morning, takes the capsule around 9 a.m., wears eye-shades and headphones–and the purpose of that is to encourage the person to look inwards into consciousness and the experience versus being distracted by external consensus realities. So they are fully in the experience. The music provides kind of a backdrop for it and is very important for many people’s experiences.

Two guides, typically a male and a female, are there with them the entire time. The participant is laying down on a couch that’s made into a bed for the day, with eye shades and headphones, under the covers. We provide assurance as needed as they go into what could be complicated and challenging experiences. But most of the day we’re saying very little—we recommend keeping talking to a minimum.

Then, of course, the next day and the week following we talk a lot about the experience.

What are some of the common themes that showed up in the participants’ experiences?

The things that we hear from the participants are kind of the eternal truths. We hear about the importance of forgiveness, people’s experiences of love, love and kindness towards others. Many of them speak of this larger universal love that I like to call agape—from the Greek—that they say seems like some kind of organizing principle of the universe.

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