November 5, 2021

November 3, 2021

Transitioning to Other Worlds: End of Life Care with Psychedelics

Can psychedelics support people at the end of their lives? Since as early as the 1960s, psychedelics have shown promising results in helping people faced with a terminal illness or grappling with the conclusion of physical existence to cope.

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Death is a part of life. It’s an inevitability and the only thing that’s promised to each one of us. While we know it’s coming, most people spend the larger part of life trying to postpone and ignore death. The fear of death keeps us from talking about and preparing for our time, ironically, making the process so much harder on individuals and their loved ones once the time comes. It comes down to taboo, fear of the unknown, the pain of loss.

Of course, that all depends on mindset. Different cultures have different perspectives on death, and everyone has their own expectations of what lies beyond the great divide. When it comes to that grim greeting, what if there were some kind of mind expanding tool that helps you prepare for the transition — one that could significantly alter your mindset of fear, powerlessness, and even individualism?

The Final Face-Off: Psychedelic-Assisted Therapy in Dying

Facing death can be a terrifying event. The anxiety of the unknown, the fear of pain, the burden of saying goodbye to your loved ones, and even the melancholy that you did not do enough with this lifetime can all be feelings that are hard to overcome. They can also lead to serious physical and mental health issues like depression, anxiety, inability to cope, loss of interest in activities. Does dying have to be this unpleasant?

For those living with terminal illnesses like cancer, such impacts and feelings can be unavoidable and seemingly impossible to cope with, especially when paired with the horror-story that was end-of-life care throughout the COVID-19 pandemic.

It's worth noting that, as it currently stands, the death rate worldwide is expected to rise from approximately 13 million deaths per year to 70 million deaths per year by the year 2030. And with that, researchers predict a 40% increase in the number of people seeking care in facilities that provide specialized medical services like hospice or palliative care. That sounds like a lot of fear, a lot of pain, and a lot of questions around whether the health care model will remain the same or change in order to support the increase in care demands. In that, we have to wonder about a reimagining of life, death, and that transition in between.

For us at MINDCURE, we're constantly wondering, how can care be improved?

Before we talk about the use of psychedelics in end-of-life care, let’s break down some terms.

What’s the Difference Between Palliative and Hospice?

Hospice care is a service that generally involves pain management for people who are expected to have less than 6 months to live. The most common types of hospice care are at home, with family members or professional caregivers providing support, or at a specialized center, and in nursing homes or hospitals. Rather than symptom management and treating a disease, hospice focuses on helping the individual specifically at end-of-life.

Palliative care is part of hospice care, but it is just one part. Palliative care is a program that aims to ease pain, while providing comfort and dignity for those with illnesses that are serious but not considered life-threatening at the moment, acting as an addition to help you and your loved ones deal with long-running ailments. This involves more symptom management than general hospice.

Your Health at the End

Numerous studies have shown that depression and anxiety are prevalent feelings for patients in hospice care and that traditional pharmacological treatments do not work rapidly enough.

Opioids are used around the clock in palliative care for the management of pain, with the potential for abuse and misuse. While administered by professionals, patients develop dependencies, which can negatively impact their quality of life. 

The good news is that since as early as the 1960s, clinicians have been studying the effects of a number of psychedelic substances like ketamine, MDMA, LSD, and psilocybin on patients living with these terminal illnesses and struggling to navigate palliative and hospice care alone. Psychedelics don’t necessarily eradicate pain or symptoms. They also involve low tolerance, so they can’t be used often. What they can do is improve one’s mindset, shift their understanding of life and death, remove the fear, and so much more. While comfort is the focus in end-of-life care, mental health suffers. Could psychedelics offer a solution?.

How Psychedelics Help Individuals During End-of-Life Care

Since the 1960s and now again with the resurgence of psychedelic research studies, these substances have demonstrated powerful results in clinical settings in their ability to help patients find peace and wealth while faced with treatment-resistant disorders like depression, anxiety, and addiction. 

Just last year, four terminally ill patients in Canada who were suffering from end-of-life anxiety were granted special exemption to use psychedelic therapy under the Section 56 exemption that allows for the use of a Controlled Substance if it’s believed to be necessary for medical or scientific purposes, or in public interest.  

In as little as five treatments, psilocybin has been shown to have persisting positive effects on attitude, mood, and behavior.

In another randomized controlled trial with psilocybin-assisted psychotherapy. Patients with cancer were able to reconcile with death, acknowledge cancer’s place in life, and emotionally uncouple from the disease. The therapy helped to facilitate a reconnection to life. 

While not in the same class as some psychedelics, ketamine is another substance that is currently being researched for similar purposes. Unlike other psychedelics, ketamine induces dissociative anesthesia, a trance-like state providing pain relief, sedation, and amnesia. In a 21-day study, 93% of patients suffering from depression in hospice care showed positive results after ketamine dosing with therapeutic results being defined after just one day.

One of the key findings of psychedelic research and end-of-life care is the ability for these substances to help bring on what is called ego death.

Ego death is essentially when an individual is able to shed learned teachings, ideologies, mindsets, and attitudes to reach a heightened sense of oneness with the world. One participant in a DMT study was quoted saying, “The sense that birth and death were just a transformation rather than an end was something that felt true.” 

The tides are slowly starting to turn to allow more patients this much needed treatment. It’s a long way from how society used to stand on the psychedelic debate.

A Little History of Psychedelics in End-of-Life Care

Palliative care itself is a relatively new idea. 

For thousands of years, dying was considered an inevitable outcome to living, and not as a distinct medical specialty or “challenge to be tackled using invasive technology or specialized health care teams.” In the Western context especially, the last 50 years have seen dying care become more and more clinical and medical than ever before.

Writer and philosopher Aldous Huxley noticed this transition when he too was faced with his first wife’s death in 1955 and then his own in 1963 (both used psychedelic substances to aid in their final journey). In a letter to psychiatrist Humphry Osmond, Huxley wrote, “My own experience with Maria convinced me that the living can do a great deal to make the passage easier for the dying, to raise the most purely physiological act of human existence to the level of consciousness and perhaps even of spirituality.”

Huxley and Osmond’s reflections on the art of dying and psychedelics were significant because they demonstrated a cultural ambivalence towards the mechanization of human healing. Contemporary oncologists, nurses, and social workers were also beginning to articulate similar concerns as they witnessed patients dying on hospital wards. 

What Does the Future Hold for Psychedelics? 

As the resurgence of research into psychedelic-assisted therapy specifically in the palliative and hospice space continues to grow thanks to advocacy, funding, and science, we hope to see more and more rhetoric on how psychedelics can make the walk towards the light that much easier.

Check out our research projects to understand more about the potential of psychedelics in mental health care.

Written by

Hayley Kirsh