Spring 2010 Vol. 20, No. 1 Special Edition: Psychedelics, Death and Dying
I first became aware of the potential value of a carefully controlled psychedelic treatment model for the existential anxiety, despair and demoralization of advanced cancer over 37 years ago when I had the opportunity to hear Stanislav Grof present his pioneering research findings at a meeting of the Association of Humanistic Psychology in New York City. His efforts, as well as the work of other early investigators, including Walter Pahnke, William Richards, Eric Kast, and Gary Fisher, were the original inspiration for the investigation we conducted over the last several years. While the protracted lull in research activity has been disconcerting, and no doubt reflective of long-standing societal resistance to exploring the clinical value of carefully conducted studies of the potential of psychedelics to facilitate psychological healing, it is gratifying that we are once again able to move forward with sanctioned investigations utilizing state of the art research methods.
From 2004 to 2008, our research group at HarborUCLA Medical Center conducted a double-blind, placebo-controlled investigation examining the safety and efficacy of psilocybin as a treatment for advanced-cancer anxiety. A total of twelve subjects were studied, all of whom tolerated the experimental treatment without adverse effects. We cannot present our formal data analysis at this time, given that our manuscript is currently undergoing peer review at a “high impact” psychiatric journal. However, we can say that our findings are supportive of our hypothesis and encourage further investigations of this long-neglected field.
The study proceeded smoothly, but recruitment of subjects proved to be more challenging than anticipated, leading to the longer than expected duration of the project. We did receive numerous inquiries from prospective subjects, but quickly learned that the logistical challenges of screening, preparation and participating in two treatment sessions in our Clinical Research Center at Harbor-UCLA were often too arduous for individuals grappling with the end-stage of devastating medical illness. It also took longer than anticipated to establish productive referral networks. Surprisingly, and in spite of initial expectations to the contrary, we never established a sustained and productive liaison with oncologists for referrals. We did achieve greater success, however, with referrals of new subjects from a local wellness center as well as through word of mouth from subjects who had already gone through the experimental treatment protocol and who had shared with friends and acquaintances their experiences participating in the study.
Another unexpected occurrence was that eleven of our twelve volunteers recruited for participation in the study were women. A number of men with advanced-stage cancer called us over time to inquire about the study, but many of them were either too ill and close to the end of their lives to participate or they could not overcome other logistical hurdles preventing their participation, including living too far from the hospital.
Examining the prior psychiatric literature of psychedelic research with advanced-stage cancer patients in the 1960s and early 1970s, it was apparent that the best clinical outcomes were in subjects who had had a mystical or transpersonal experience during their treatment session. As higher dosages are more likely to induce such experiences, we were initially disappointed that we were approved to use a relatively moderate dose of psilocybin, and not the higher dose we initially had requested. Nevertheless, even though our subjects did not report inner experiences consistent with classical mystical encounters, they did have psycho-spiritual epiphanies, along with powerful autobiographic insights, that were of significant value in establishing heightened levels of emotional well-being. It will be interesting in the future to compare both the content of experiences at different dosages of psilocybin as well as the longer-term impact on psychological outcome.
We were interested in examining for therapeutic outcome. However, the primary goals of our study were to establish feasibility and acceptable safety parameters. In that regard, we achieved a significant degree of success. Facing no end of obstacles along the way, we were able to obtain all necessary regulatory and hospital approvals, raise the essential funding, and conduct and complete all elements of the study. And, with a participant population that had been carefully screened and prepared for their psilocybin experience, and within the context of a state of the art clinical research unit possessing all requisite monitoring of medical and psychiatric status, all of our participants weathered the experience without any evidence of harm or adverse effects.
Establishing a foundation of feasibility and safety is the necessary first step for further studies and development of this long-neglected field. To that end, we were delighted that Roland Griffiths at Johns Hopkins and Stephen Ross at New York University recently initiated two new research investigations on the potential value of psilocybin treatment for cancer anxiety. Along with what we hope will be future efforts on the part of our research group atHarbor-UCLA, these projects over time should be able to study the requisite number of subjects necessary to determine statistically significant therapeutic efficacy.
Acknowledgments are due to the members of our community whose support, generosity and expertise have been critical to the successful conduct and completion of this study. Throughout, we have perceived our work as a collective effort, a necessary perspective allowing us to maintain a sense of balance and humility. Finally, I would like to express my heartfelt appreciation for our twelve subjects, whose remarkable courage and strength were an inspiration to all of us who worked with them. Even though ten of our twelve subjects have by this writing passed away, their memory and immeasurable contributions live on. Working with them as they examined the course of their lives, and in many cases as they prepared to die, was an honor and a reminder of the importance of this work. It was their hope, and ours, that this study will help open the doors to further investigations designed to explore the potential value of psychedelic medicines to alleviate suffering and to remind us of who we are.