Facing Death Without Fear: Psychedelics for End-of-Life Care
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For Christine “Cat” Parlee, who has stage IV metastatic melanoma, the Roots to Thrive program was a godsend. Not that she thinks it’ll save her life: The chance of surviving 5 years from advanced melanoma is about 15% to 20%, according to the American Cancer Society, and Parlee was diagnosed in 2017. But an innovative approach to group therapy at Roots to Thrive, based in Nanaimo, British Columbia, has helped her cope with this life-threatening condition.
Parlee’s health issues are complex. As if malignant skin cancer wasn’t enough, the 50-year-old Vancouver Islander also suffers from a condition called trigeminal neuralgia with anesthesia dolorosa. With this rare condition, she says, “emotional outbursts can literally cause me severe pain. So I got very good at suppressing my emotions.”
“But you don’t grow, you don’t grieve, or you don’t eventually accept the ending if you don’t process your fears,” she continues. Roots to Life has “allowed me to experience my own anger, fear — feeling like this is so unfair — without pain or panic attacks. … It is one of the hardest and at the same time most beautiful experiences I have ever had to put into words.”
A key ingredient in this experience is psilocybin, also known as magic mushrooms. Founded in 2019, non-profit organization Roots to Thrive is the first Canadian medical practice to legally use psychedelics, specifically psilocybin and ketamine, in group therapy for end-of-life patients. When combined with two other ingredients — a psychotherapist and a supportive patient community — the drugs have proven extremely effective in alleviating the suffering associated with an incurable diagnosis, according to Pamela Kryskow, MD, Roots to Thrive’s medical director.
“Once this safe community is established, a psilocybin mushroom session with the same group of people creates a healing container where patients can explore in depth their challenges while under the influence of the drug,” says Kryskow, who is also a clinical educator at the University of British Columbia and Associate Professor at Vancouver Island University.
“Once this safe community is established, a psilocybin mushroom session with the same group of people creates a healing container where patients can explore in depth their challenges while under the influence of the drug,” says Kryskow, who is also a clinical educator at the University of British Columbia and Associate Professor at Vancouver Island University.
Clinical Studies at Full Tilt
Research confirms the promise of psychedelics — from herbal psilocybin and DMT to synthetic MDMA (ecstasy) and LSD — for palliative and end-of-life patients. In 2016, a landmark study at NYU Grossman School of Medicine found that a single dose of psilocybin reduced depression, anxiety, and hopelessness in cancer patients. Recently, in a follow-up study, 80% of the same patients reported that the positive effects lasted 4½ years later. And more testing is underway.
“There are currently 113 clinical trials registered on clinicaltrials.gov,” says Paul Stamets, a mycologist whose 2020 book Fantastic Fungi is a companion to a popular Netflix documentary. “This is unprecedented and reflects the scientific justification for investigating the benefits of psilocybin across a wide range of mental health conditions.”
This research dates back to the 1950s, when psychiatrists like Humphry Osmond, who coined the word “psychedelic,” first experimented with LSD-enhanced psychotherapy. However, studies during this period were less rigorous by today’s standards, and in the United States they all but ceased with the signing of the Controlled Substances Act in 1970. But decades later, in 2014, Scientific American called for an end to the ban on psychedelics clinical trials. At this point, the country was in the midst of what psychiatrist Ben Sessa called a “psychedelic renaissance.”
Experimentation laws, which allow critically ill patients access to experimental drugs without waiting for FDA approval, have helped spur the surge in psychedelic research. Currently, 41 states have their own versions of these laws, which stand alongside the federal Right to Hear statute, which was enacted in 2018. Two states in particular have focused on psilocybin. In 2020, Oregon became the first company to legalize the therapeutic use of psychedelic mushrooms. Colorado voters recently followed suit and decriminalized magic mushrooms on Election Day 2022. This is expected to pave the way for similar changes in Colorado law banning other herbal psychedelics such as DMT, ibogaine, and certain forms of mescaline in June 2026.
How Psychedelics Work
As defined by the National Institutes of Health, psychedelics are potent psychoactive substances that alter cognition, altering the user’s mood and cognition by acting on neutral circuits in the brain involving the chemical serotonin. Much of this happens in the prefrontal cortex, the part of the brain that regulates how you feel and how you see the world. “Psychedelics, including psilocybin, are believed to all act on receptors called serotonin 2A,” said Charles Nemeroff, MD, PhD, chair of the Department of Psychiatry and Behavioral Sciences and co-director of the Center for Psychedelic Research and Therapy at Dell Medical School University of Texas at Austin.
Matthew W. Johnson, PhD, professor of psychiatry and behavioral sciences at Johns Hopkins University School of Medicine in Baltimore, describes activation of the serotonin receptor subtype as “the first step in the chain” that results in “changes in brain communication” during the psychedelic experience. “It’s likely that over the long term, the brain will look different in ways consistent with psychological and behavioral improvements,” he says, noting that psilocybin “acts more like psychotherapy than other psychiatric drugs.”
However, psychedelics work, they have been shown in certain circumstances to be an effective adjunct to the psychological support of patients at the end of life. In a recent study of more than 3,000 adults, the Johns Hopkins Center for Psychedelic and Consciousness Research found that taking these drugs under the right conditions made people less afraid of death, similar to a non-drug near-death experience has, which can reduce fear of mortality. The result, of course, can be a dramatic improvement in the quality of life for the terminally ill.
This is not to say that psychedelics are a panacea. Johnson points out, for example, that the therapy is particularly risky for patients with schizophrenia or severe heart disease. Assessing the risks requires more research, says Gregory A. Fonzo, PhD, assistant professor and co-director of the Center for Psychedelic Research and Therapy in the Department of Psychiatry and Behavioral Sciences at Dell Medical School. “Current studies are mainly focused on proving effectiveness,” he emphasizes. “However, future studies with larger numbers of participants are needed to identify individuals who are likely – and likely not – to respond well to this treatment.”
Separating the patient from the diagnosis
For those who respond well to psychedelic therapy, it is not just an individual experience. “Many patients report breakthroughs in family dynamics,” says Johnson. In some cases, this happens when “they start having more open conversations about a possible or impending death.”
There were other types of breakthroughs as well. “We have heard many reports of profound insights, transpersonal experiences, and rapid changes in patients’ moods and sense of self that occur during psychedelic experiences,” says Fonzo. “It is possible that the subsequent changes in their belief systems, their perceptions of themselves and others, and their general mood in these patients are key factors that favor benefit for conditions such as depression. However, more research is needed to confirm this.”
Clinical studies have even delved into the realm of spirituality. In 2021, a Johns Hopkins review of psychedelic research focusing on end-of-life and palliative care found that some psilocybin studies used a mystical experiential questionnaire designed to measure things like “a sense of oneness, awe, and authoritative truth… transcendence of to measure time/space and ineffability.”
But for many end-of-life patients, one of the most important benefits of therapy is more tangible: they see themselves as disconnected from their diagnosis. “These sessions usually result in altered narratives that a person carries about the cancer and about themselves,” Johnson says. “I think these patients are actually learning things about themselves and about life, and that’s what makes psilocybin different from other psychiatric drugs.”
Paradoxically, by helping terminal patients overcome their fear of death, psychedelic therapy often frees them to live more fulfilling lives. “[Patients] say they’ve healed old traumas they’ve been carrying around so they can be more present with their family and friends,” says Kryskow. “You can focus on having more fun and being more connected.”
Still, results vary, and Cat Parlee claims that every psychedelic experience is unique. “Mine changed me to the core of my DNA,” she says. Before signing up for Roots to Thrive, she said, “Just the thought of death gave me massive panic attacks.” But those days are over. Her advice to potential patients considering a similar program: “Be open. be vulnerable And no matter what you hear, leave your expectations at the door.”
