Psychedelic Therapy

When her doctors told Pam Sakuda that her cancer had metastasized and there was nothing left to do, the fear of death overwhelmed her.

“You no longer have this life ahead of you that you planned for,” she recounted in a video interview before her death in 2006. “You’re basically living in fear. … It paralyzes the good life you’re living at the moment.”

That’s why Sakuda turned to hallucinogens.

Hoping to “find a way to achieve peace,” in 2004 she participated in a pilot study conducted by psychiatrist Charles Grob at the Harbor-UCLA Medical Center in Los Angeles. Grob coupled Sakuda’s regular talk therapy treatments with a one-time dose of psilocybin, the active ingredient of psychedelic mushrooms, best known as a hallmark of the hippie experience. The Food and Drug Administration has more recently approved psilocybin for use in pilot clinical trials to treat end-of-life distress.

Sakuda believed the drug helped her regain an appreciation of life. “It allows you to release other feelings and explore other ways you might feel,” she said. “I began to realize all this negative fear was a hindrance to making the most of and enjoying the healthy time that I’m having — however long it may be.”

She wasn’t alone. In the 12 patients he treated with psilocybin, Grob found preliminary evidence of reduced anxiety and improved mood and quality of life, and an indication that these benefits were sustained over several months.

In order to expand on Grob’s work, psychiatrists at John Hopkins University and New York University are currently recruiting patients for similar studies. Through studies like these, scientists have embarked on a wave of research that holds the promise of novel ways to treat psychological distress and a new understanding of our brains.

“It does seem the very, very powerful experience allows individuals to come away with greater peace of mind,” said Grob, who plans to publish his results this year.

According to Stephen Ross, who runs the New York University study, doctors have no standard procedures to treat a patient’s end-of-life distress, and this anxiety is often ignored.

“As doctors, we’re good at saving lives,” said Ross. “But we have not learned the art of helping patients have a good death.”

A 2007 study published by the American Cancer Society found that up to 50 percent of patients with advanced or terminal cancer are diagnosed with a major psychiatric disorder, and less than half of those with depressive symptoms receive any psychiatric medication. New treatment models could go a long way to help the over 500,000 Americans expected to die this year of cancer.

According to the researchers, psilocybin can achieve in one session what might otherwise take months or years, time some of these patients may not have.

Psilocybin binds to two types of serotonin receptors in the brain that are highly associated with mood and anxiety. Even more interesting to psychiatrists, brain imaging studies from the Heffter Research Center in Switzerland show that the drug appears to affect areas of the brain thought to mediate consciousness and spiritual feelings.

The effects of psilocybin last about four to six hours, during which time the subjects’ brain activity resembles that of people in spiritual states, such as meditating monks. Like people who practice meditation, the patients in the psilocybin trials reported feelings such as a greater connectedness to others, relief from fear and anxiety, and the ability to internalize their limited time as opportunities for personal growth.

Patients on psilocybin “are in touch with deeper parts of their psyche that they normally aren’t in touch with,” Ross said. “They’re able to make certain connections they wouldn’t normally make.”

Yet the drug’s mechanism is not fully understood, leaving the long term risks unclear. According to David Shurtleff, director of basic neuroscience at the National Institute of Drug Abuse in Bethesda, Maryland, the drug’s effect is greatly variable, and it should only be taken under controlled settings. However, unlike other drugs, evidence points to a low abuse potential. Psilocybin does not appear to be physically addictive, as rats will not self-administer it like they do with nicotine, alcohol, and cocaine.

In fact, based on the initial positive results of the end-of-life distress studies, Ross and other researchers want to test psilocybin to treat tobacco, alcohol, and narcotics addictions. “Addicts have this compulsive, hollowed out relationship only with the drug and nothing else,” said Ross. “Psilocybin may help their lives gain meaning, direction, intention, and connection.”

Ultimately, scientists hope these studies will help elucidate the neurobiology of spirituality. “The fact that we have neural tissue that allow for these experiences shows us that the brain evolved to have spiritual experiences,” Ross said. “These agents let us know about different reward pathways other than pleasure.”

For now, these researchers plan that by 2012, at least 80 terminal cancer patients will have been treated with psilocybin. Provided positive results, the next step would be a larger multisite trial involving hundreds of patients.

However, the drug’s illicit status will make securing funding for a larger study difficult, and Grob and his colleagues hope that with time more doctors will see the value in their work.

“We’re not trying to create a social movement,” he said. “We’re just trying to do good science and see if treatments might come out that might help people.”