In August 2020, four terminally-ill patients were granted permission to use psychedelic therapy in Canada. They were given psilocybin, the hallucinogenic component of what are popularly called “magic mushrooms,” to ease their anxieties and depression towards the end of their lives.
So how does psychedelic therapy work, and why is it being used for end-of-life care?
Psilocybin is just one type of psychedelic therapy that has piqued the interest of medical researchers since the 1950s. However, there has been a historical reluctance to adopt these therapies for mental health in end-of-life care, also known as palliative care.
End-of-life care involves helping someone remain comfortable, and physicians will use palliative practices to alleviate things like pain and shortness of breath, as well as provide support through death for patients with life-threatening conditions.
James Downar, MD, is a researcher and head of the palliative care division at the University of Ottawa. “To palliate is to cloak,” he explained in an interview with The Pigeon. “When we palliate a symptom, we are soothing or easing [it].”
Doctors choose this course of treatment when a condition is deemed unfixable. “There are times when you can’t actually fix the problem—but you may be able to reduce the effect it has on a person,” he said.
Downar explains that there are many kinds of suffering that may occur because of an incurable condition, including physical, mental, and existential.
According to Downar, existential distress occurs when a person is robbed of the ability to do the things that give their life purpose. When a person is given a terminal diagnosis, this feeling of loss takes on an air of permanence.
“You think to yourself, ‘Well I’m going to die, I know I’m going to die,’” he explained. “’The cause of my loss of purpose is permanent […] I’m basically just waiting out the rest of my time until a complication takes me away.’”
Existential suffering is where psychedelics hold the most potential for good, he said.
The challenge with existential suffering is that there is no reliable therapy to treat it. “People have tried a number of approaches,” he explains. “None of them have been all that effective.”
Outside of popular culture, however, psychedelics have undergone a long journey to be considered for use in palliative care. Researchers began investigating the therapeutic potential of the drugs as early as the 1950s, but that work was largely halted until recently.
In the recent cases of four terminally ill patients, they were prescribed psilocybin. However, psilocybin is just one of many substances that fall under the psychedelic umbrella. Others in this category include lysergic acid diethylamide, better known as LSD, and mescaline.
While each substance has a unique origin, they all have similar effects on the mind. When taken in high doses, they can have strong effects on a person’s perception of the world. Users might experience hallucinations and confused senses, such as hearing colours or seeing sounds. People can also experience what is commonly known as a “bad trip,” which can manifest as intense fear or paranoia.
These substances have also been known to induce rich, spiritual-like experiences. In the 1950s and early 1960s, users of psychedelics would often report feelings of connection, love, and compassion for others