Psychedelic medicines in palliative care
Coping with a terminal diagnosis is extremely difficult & can lead to anxiety & depression. Could psychedelic medicines help certain patients find comfort in their end-of-life journey?
Yesterday, my Botanical Medicine and Health students and I had the great pleasure of learning about the utility of psychedelic medicines for palliative care from a guest lecture by Ali J. Zarrabi, MD—an Assistant Professor in the Department of Family and Preventive Medicine at Emory University School of Medicine. Dr. Zarrabi is a supportive and palliative care specialist providing physical, emotional, and spiritual care for patients living with serious illness. He is a member of the Cancer Prevention and Control research program at Winship Cancer Institute. He is the palliative medicine clerkship director for the hematology/oncology fellowship program.
Death is never an easy subject to broach, but it is, at the same time, a certainty in the cycle of life. It is a reality that each one of us will have to face someday. Personally, it’s not something I like to think about. Yet, if I were to receive a terminal or serious illness diagnosis, I’d hope to receive treatment from a palliative care specialist like Dr. Zarrabi. I touch on some of the major lessons he shared in class here.
What is palliative care?
Palliative care is a specialized form of medical care for people living with a serious illness. The focus is on improving the patient's and their family's quality of life.
What are psychedelics?
Dr. Zarrabi divides them into two general categories:
“Classic” or serotonergic psychedelics. These exert mind-manifesting or consciousness-altering effects through activation of serotonin receptors [serotonin 2A (5HT2A)]
Psilocybin (“magic” mushrooms)
LSD (lysergic acid diethylamide)
Mescaline (from the Peyote and San Pedro cactus)
DMT (dimethyl tryptamine)
Non-classic psychedelics
Ketamine
Ibogaine
MDMA (3,4-methylenedioxymethamphetamine)
Cannabis (at extremely high doses)
What is psychedelic assisted psychotherapy (PAP)?
Today, medical studies on the efficacy of psychedelics are often conducted in conjunction with some form of psychotherapy. This may include:
Therapeutic presence
Supportive psychotherapy (empathetic presence)
Group supportive-expressive psychotherapy
Psychedelic-assisted psychotherapy (PAP) is the medically supervised use of psychedelic agents in psychotherapy programs. Thus far, clinical results have been largely promising in terms of safety and efficacy.
PAP is typically delivered in the controlled setting of a treatment room in a medical facility, with patients monitored by a clinical care team. The treatment rooms may be designed to have a soothing aesthetic, and music is used to assist in the mental journey. During PAP, it is common for patients to report an experience that is intensely spiritual, religious, or mystical. Many, including atheists and agnostics, liken it to meeting God. For some, the experience can be traumatic and yet freeing; some even experience death (in a metaphysical sense). At the end of the treatment, some patients facing a terminal diagnosis report less anxiety about the prospect of dying. While clinical research is ongoing, I am impressed by the anecdotal evidence of improving quality of life for terminal patients with PAP therapy.
Where is psychedelic research happening in the USA?
Over the past several years, there has been an exciting movement in the medical sciences to evaluate the safety and efficacy of these ancient therapies. Here are just a few of the major research centers that have launched rigorous programs in psychedelics research:
Emory University Center for Psychedelics and Spirituality, Atlanta, GA
Spiritual Health has partnered with the Emory Department of Psychiatry and Behavioral Sciences to found a center that focuses on a psycho-spiritual model for psychedelic-assisted psychotherapy utilizing spiritual health clinicians and mental health clinicians as co-therapists. Their mission is to push the frontier of psychological and spiritual health through the research, practice, and training of psychedelic-assisted psychotherapy.
Johns Hopkins Center for Psychedelic and Consciousness Research, Baltimore, MD
Their mission is to answer the most important questions in psychedelic research, therapy, and clinical education, and broaden the field of psychedelic science in collaboration with the best multi-disciplinary scientists in the world.
MGH Center for the Neuroscience of Psychedelics, Boston, MA
The Center brings together leaders in psychiatry, chemical neurobiology, and neuroimaging. Their research studies aim to understand how psychedelics facilitate changes in brain structure and function, with an initial focus on psilocybin for patients with treatment-resistant depression.
UC Berkley Center for the Science of Psychedelics, Berkley, CA
Founded in 2020, the UC Berkeley Center for the Science of Psychedelics (BCSP) is an academic center focused on psychedelic research, training, and public education. In addition to their research program, they offer a certificate in psychedelic facilitation that prepares professionals working in a variety of fields to include psychedelics in their work.
Yale Psychedelic Science Group, New Haven, CT
The Yale Psychedelic Science Group (YPSG) was established in January 2016 as a resident interest group and interdisciplinary forum where clinicians and scholars from across Yale can learn about and discuss the rapidly re-emerging field of psychedelic science and therapeutics in an academically rigorous manner.
Upcoming event this Saturday!
Want to learn more about the intersection of spiritual health and brain health? The Emory University Center for Psychedelics and Spirituality is hosting the Science on Spiritual Health Symposium 2023 this Saturday, April 1st! Registration is required! There are options for live stream or in-person attendance.
Date: April 1st, 2023
Time: 8:30 a.m. - 5:30 p.m. (EST)
In-person:
Register here.
Location: Auditorium, Woodruff Health Science Admin Build., 1440 Clifton Rd NE, Atlanta, GA 30322
Cost: $25, which includes lunch
Live stream:
Register here.
Cost: free!
What this means for you
If you or a loved one is facing a difficult decision about end-of-life care, talk to your doctors to ask about options available for palliative medicine in your area. PAP is just one form of palliative care currently being explored in clinical trials. There are many natural options to consider in managing physical symptoms of illness, including medical cannabis, psychotherapy, and various integrative health approaches.
The psychedelic substances used in PAP are still federally listed as Schedule 1 drugs, though some states (Colorado and Oregon) are creating pathways for regulated access to psilocybin. There are some dangers to using these substances without the oversight of a qualified medical provider, especially if you are dealing with other physical illnesses or are at risk of underlying psychiatric conditions. If you are interested in PAP, ask your doctor about opportunities to participate in clinical trials. For example, there are several clinical trials on psilocybin enrolling patients through doctor referrals for alcohol or drug addiction, post-traumatic stress disorder, depression, and obsessive compulsive disorder, as reported here at clinicaltrials.gov. Patients in these trials typically receive robust psychiatric evaluations as part of the enrollment process to ensure this treatment option is appropriate for them.
Yours in health, Dr. Quave
Cassandra L. Quave, Ph.D. is a disabled writer, speaker, podcast host, wife, mother, explorer, ethnobotanist, and professor at Emory University School of Medicine. She teaches college courses and leads a group of research scientists studying medicinal plants to find new life-saving drugs from nature. She hosts the Foodie Pharmacology podcast and writes the Nature’s Pharmacy newsletter to share the science behind natural medicines. To support her effort, consider a paid or founding subscription, with founding members receiving an autographed 1st edition hardcover copy of her book, The Plant Hunter.