A Trip for Terminal Patients

Originally appearing here. For patients diagnosed with a terminal illness, the end of their physical days can be wrought with anxiety, depression, and fear. Now, these patients may have more options for relieving this emotional stress, and it falls somewhere in between Nancy Reagan (“Just Say No!”) and Timothy Leary (“the most dangerous man in America” per Richard Nixon). Sixty years ago, research into the effects of psychedelic drugs was accepted — and, dare I say, frequent — among certain institutions and researchers. But, with the rise in the recreational use of drugs and the growth of the anti-drug campaigns, all that was brought to an end by the 1970s. Now, a generation later, scientists are slowly re-opening those doors to find new ways to treat terminally ill patients, who often have paralyzing, debilitating fears about their own mortality. A study in the Archives of General Psychiatry reported, in 2011, that psilocybin — the active component of magic mushrooms — was safe and effective at reducing anxiety and depression about death when given to terminally ill cancer patients. The psilocybin lead to decreased anxiety and depression for months after the treatment, though it is not clear how the effects lasted so long. The research is all part of a larger effort to study the effects of psychedelic drugs under rigorous controlled, scientific processes. MDMA (also known as Ecstasy) has been shown to be effective for severe post traumatic stress disorder and LSD can reduce symptoms of chronic cluster headaches. Psychedelic drugs have also been evaluated in treating addictions, including alcoholism. Scientists have not identified the precise mechanism of action of psychedelics in anxiety and depression yet, but the effects are probably related to an “unrestrained consciousness” that allows patients to be introspective and a disassociation of sensation and perception. Also, the drugs may deactivate the parts of the brain that are overactive in anxiety and depression, according to functional MRI studies. Further, since the treatments are all administered in a controlled, safe environment, and patients know the expectations and desired outcomes ahead of time, the patients are able to balance experiencing emotions that they would otherwise be unable to face. Anecdotally, the small numbers of patients who have taken these psychedelic trips report positive outcomes. But, a handful of patients does not make a sufficient scientific sample, especially when it comes to illegal and illicit drugs. While most people — healthcare providers and the lay public – would argue that more can be done to ease end-of-life suffering, both physical and emotional, many would stop short of advocating psychedelic drugs. Arguably, the risk of causing long-term health effects or producing a new drug addict is negligible under these circumstances. And, under these circumstances, there is no risk of contaminated street drugs or pushy drug dealers that terminally ill patients have to contend with. But, that does not mean the drugs should appear in our mainstream armamentarium of anti-anxiety and antidepressant drugs. Currently, psychedelic and hallucination-inspiring drugs are classified as Schedule I controlled substances by the FDA, meaning that they have no medicinal use and cannot be prescribed or dispensed in the United States. If this were to change, it could open the door to the misuse and abuse of very dangerous drugs. More research into how and why these drugs produce their effects could help scientists develop similar, safer compounds to treat patients with serious conditions refractory to other therapies, but we’re a long way from the Brave New World that Aldous Huxley wanted in which psychedelic experiences are part of our mainstream culture. References Bouso JC, Doblin R, Farré M, Alcázar MA, & Gómez-Jarabo G (2008). MDMA-assisted psychotherapy using low doses in a small sample of women with chronic posttraumatic stress disorder. Journal of psychoactive drugs, 40 (3), 225-36 PMID: 19004414 Carhart-Harris RL, Erritzoe D, Williams T, Stone JM, Reed LJ, Colasanti A, Tyacke RJ, Leech R, Malizia AL, Murphy K, Hobden P, Evans J, Feilding A, Wise RG, & Nutt DJ (2012). Neural correlates of the psychedelic state as determined by fMRI studies with psilocybin. Proceedings of the National Academy of Sciences of the United States of America, 109 (6), 2138-43 PMID: 22308440 Grob CS, Danforth AL, Chopra GS, Hagerty M, McKay CR, Halberstadt AL, & Greer GR (2011). Pilot study of psilocybin treatment for anxiety in patients with advanced-stage cancer. Archives of general psychiatry, 68 (1), 71-8 PMID: 20819978 Johansen PØ, & Krebs TS (2009). How could MDMA (ecstasy) help anxiety disorders? A neurobiological rationale. Journal of psychopharmacology (Oxford, England), 23 (4), 389-91 PMID: 19273493 Mithoefer MC, Wagner MT, Mithoefer AT, Jerome L, & Doblin R (2011). The safety and efficacy of {+/-}3,4-methylenedioxymethamphetamine-assisted psychotherapy in subjects with chronic, treatment-resistant posttraumatic stress disorder: the first randomized controlled pilot study. Journal of psychopharmacology (Oxford, England), 25 (4), 439-52 PMID: 20643699 Slater L. How psychedelic drugs can help patients face death. NY Times. April 20, 2012. Brain Blogger explores how patients may soon have more options for relieving the anxiety and stress that often comes with life-threatening illnesses. Researchers around the world working with MAPS and the Heffter Research Institute are finding ways to use psychedelics as part of a growing set of tools for treating end-of-life anxiety.