Psychedelics in Palliative Care: Revealing and healing end-of-life distress

Written by guest writer Abbie Rosner

For palliative care physician Lou Lukas, alleviating patients’ physical discomfort is the easy part. But when it comes to easing the existential fear, anxiety, and depression catalyzed by a terminal diagnosis, administering opioids and anti-depressants can dull—but not relieve—the root cause of the pain.  

“We simply haven’t had the tools that can make a transformative impact in a timeframe appropriate for people coming to terms with the end of their lives.”  

And yet, such a tool may now exist—as evidenced by hundreds of individuals with terminal illnesses whose lives, and deaths, were positively transformed after participating in clinical trials of psychedelic-assisted therapy.   

The remarkable capacity of psychedelic-assisted therapy to profoundly and positively change attitudes about the meaning of life and death, in some, has been known for decades. Yet the illegality of psychedelic substances (such as psilocybin, LSD, and MDMA) has meant that, until now, sanctioned access to psychedelic-assisted therapy in the US was limited to participants in clinical trials.  

But in light of the compelling research findings, even the FDA recognizes the therapeutic potential of psychedelics. In the past several years the FDA has granted breakthrough therapy status to psilocybin and MDMA, the former for treatment-resistant depression and major depression, and the latter for severe PTSD. Industry observers expect that, within several years, therapy with these drugs will be federally legal and widely available.    

When that happens, psychedelic-assisted therapy may take its place as the long-missing component in the palliative care toolkit. For those providing and receiving palliative care, this development promises to be a game-changer.  

“Instead of giving people medications to reduce their consciousness, we’ll actually be doing the opposite.” 

That’s why Lukas is so excited about introducing psychedelic-assisted therapy into her practice. “Instead of giving people medications to reduce their consciousness, we’ll actually be doing the opposite.”  

A history of psychedelics for meaning-making at the end of life 

Going back to pre-history, humans around the globe have used psychedelic compounds derived from locally sourced plants and fungi to access and make sense of non-mortal realms. Here in the West, however, our society was introduced to psychedelics via the lab of the Sandoz pharmaceutical company, when Albert Hoffman first isolated LSD in 1938.   

The capacity of this powerful and enigmatic new drug to alleviate anxiety around the end of life was stumbled upon by accident in the early 1960s when a Chicago physician named Eric Kast launched a study with patients with advanced-stage cancer to see if LSD had analgesic properties. After receiving the experimental drug, not only did the study participants report less pain, but astonishingly, they also described no longer fearing death.  

Subsequently, LSD and psilocybin were integrated into a new psychotherapeutic approach developed by Walter Pahnke, Bill Richards and Stanislav Grof at Spring Grove Hospital (later the Maryland Psychiatric Research Center). From 1963-76, about a hundred cancer patients reported relief from existential distress after experiencing this new form of treatment.  

Even as the backlash to psychedelics in the 1970s led to the shut-down of virtually all research into these compounds, the Baltimore group continued to offer psychedelic-assisted therapy with mixed, but overall highly positive outcomes. Ultimately, the last experimental dose of psilocybin in the US was administered to a cancer patient by Bill Richards in 1976, before all research into these compounds entered an almost two-decade hiatus.  

When it was once again possible to conduct clinical studies with psychedelics, Charles Grob at UCLA picked up the thread of the Baltimore team with a study that re-affirmed the safety and effectiveness of psilocybin for treating existential distress in the terminally ill. This was followed by two landmark studies at NYU and Johns Hopkins showing that the most meaningful and enduring positive changes of attitudes about death in the terminally ill correlated to having experienced features of a “mystical-type experience.” 

In case after case, study participants described being enveloped in an all-knowing, all-loving force.  

In case after case, study participants described being enveloped in an all-knowing, all-loving force which left them feeling less anxiety and greater peace in the face of their impending death. These experiences of unity and transcendence carry all the hallmarks of mystical experiences described by religious mystics throughout the ages.   

The Palliadelic approach 

For Lou Lukas, the potential of a psychedelic experience in a palliative care environment became viscerally apparent after she volunteered in a Johns Hopkins study examining the effects of psilocybin on new and experienced meditators.  

After her two psilocybin experiences, she realized, “I was able to have so much more presence and clarity with patients. I could say with total conviction that, despite the fact that you are dying, all is well. This is part of the natural cycle of things. And actually be of comfort.” 

Lukas recently coined the term “Palliadelic” to describe a new therapeutic approach that both reveals and alleviates the core causes of suffering.   

“Even if we can’t do anything about the fact that a life is ending, the Palliadelic approach says that there is a way to reduce the suffering. And it’s not by giving people medications to take the pain away or to reduce their consciousness so they don’t notice it. But by actually doing the opposite… We move the veils away from the mind so that you can see what causes the suffering and allow your natural healing to take place. So you’re not hiding the suffering, you’re healing it.” 

For her Palliadelic practice, Lukas is currently offering psychedelic-assisted therapy with ketamine. But in 2023, she will be launching a study examining psilocybin-assisted psychotherapy for patients with pancreatic cancer. “Pancreatic cancer is often diagnosed late, and many people often live less than a year after diagnosis. By using these powerful experiences, we may be able to replace anxiety and depression with clarity and connection so people can live fully, regardless of how much time they have.” 

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For more information on Lou Lukas and the Palliadelic approach, see palliadelic.org 

Abbie Rosner is a journalist who follows the fast-paced psychedelic space, with a special interest on how these drugs are meeting the health and wellness needs of the aging population. She is currently working on a book about psychedelics and meaning-making towards the end of life.