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How psychedelic drugs can help patients face death

Published in The New York Times Magazine on April 20, 2012.
Posted by Lauren Slater

Kan psilocybin hjelpe mot dødsangst?

Pam Sakudawas 55 when she found out she was dying. Shortly after having a tumor removed from her colon, the doctor said the words she feared the most: Stage 4; metastatic.

 

Sakuda was given 6 to 14 months to live. Determined to slow the progress of the insidious disease, she ran several miles every day, even during the grueling treatment regimens. Sakuda - who died in November 2006 - was by nature optimistic, eloquent and dignified, but her days grew darker as she neared death. Norbert Litzinger, Sakuda's husband, put it this way: “When you get your own death sentence you start to wonder: When? When? It got to the point where we couldn't make even the most mundane plans, because we didn't know if Pam would still be alive: a concert, dinner with friends. Would she still be here?”

Sakuda's fears grew, but at some point she learned of a study run by Charles Grob, a psychiatrist and researcher at Harbor-UCLA Medical Center. They administered psilocybin - an active component in magic mushrooms - to terminal cancer patients to see if it could reduce fear of death. Twenty-two months before she died, Sakuda became one of Grob's 12 subjects. When the research was done in 2008 - (and later published in Archives of General Psychiatry) - the results showed that administering psilocybin to terminally ill individuals was safe, while reducing the subjects' anxiety and depression.

Grob's interest in the power of psychedelics to lessen the sting of death is not just the obsession of a solitary researcher. Dr. John Halpern, director of the Laboratory for Integrative Psychiatry at McLean Hospital in Belmont Mass., a psychiatric training hospital for Harvard Medical School, used MDMA—also known as ecstasy—in an attempt to ease the end-of-life anxiety of two cancer patients in stage 4. In addition, there are two ongoing studies using psilocybin with terminal patients, one at New York University School of Medicine, led by Stephen Ross, and another at Johns Hopkins Bayview Medical Center, where Roland Griffiths has administered psilocybin to 22 cancer patients. "This research is in a very early stage", Grob told me earlier this month, "but we're getting consistently good results". 

Grob and his colleagues are part of a new scientific interest in the healing power of psychedelics. Michael Mithoefer has shown that MDMA is an effective treatment for severe PTSD Halpern has examined case studies of people with cluster headaches who took LSD, and reported that symptoms were greatly reduced. Psychedelics have also recently been tried as a treatment for alcoholism and other addictions.

Despite these investigations, Grob and other end-of-life researchers are cautious, distancing themselves as much as possible from the 1960s, when psychedelics were embraced by many and used in a number of controversial studies. Most people knew about the psilocybin project run by Timothy Leary. Grob described the widespread drug use that characterized the 60s as "out of control", and has the following to say about his own and others' current research: "We try to stay under the radar. We want to be the anti-Leary.” Halpern agreed. "We are serious, sober scientists" he told me.

Sakuda's terminal diagnosis, combined with her previous good health, made her an ideal subject for Grob's study. Beginning in January 2005, Grob and his research team gave Sakuda various psychological tests, including the Beck Depression Inventory and the Stai-Y Anxiety Scale to establish baseline measures of Sakuda's psychological state, as well as to rule out serious psychiatric illness. "We wanted mentally healthy people"; says Grob, "people whose depression and anxiety are not the result of mental illness, but rather a response to a terminal illness".

Sakuda was to participate in two sessions, one with psilocybin and one with niacin, an active placebo that can cause facial flushing. The study was double-blind, which meant that neither the researchers nor the subjects knew what was in the capsules being administered. On the day of his first session, Sakuda was ushered into a room that the researchers had decorated with soft fabrics and fresh flowers to create a calming environment in an otherwise cold hospital setting. Sakuda swallowed a capsule and lay back on the bed to wait. Grob had invited her to bring objects from home that had special meaning. "These objects personalize the session room, often making the patient think of loved ones or important life events," says Roland Griffiths of Johns Hopkins. Put somewhat clumsily, says Halpern, the idea is that with the help of psychedelics you can come to see this object in a different light. It can help bring back memories, it promotes introspection and it can be a touchstone, a grounding.”

Sakuda took pictures of his loved ones with him. She held them in her hands as she lay back on the bed. At her side were Grob and a research assistant, both of whom stayed with the subjects for the six- to seven-hour session. Sakuda knew that time would be set aside in the days and weeks afterward to process what would happen in the room. Black eyeshadow was placed over Sakuda's face and she was encouraged to focus inward. She was given headphones that played the sound of rushing rivers, staccatos and deep drumming. Every hour, Grob and the staff checked if everything was OK. They also measured her blood pressure. At one point, Grob observed Sakuda, her eyeshadow still draped over her face, begin to cry. Sakuda later told Grob that the tears came from an intense, empathetic understanding of what her spouse Norbert was going to feel when she died.

The legacy of Stanislav Grof

Grob's setup – the eyeshadows, the objects, the mysterious music, the floral aromas and the soft fabrics – were all taken from Stanislav Grof, a psychiatrist born in Prague and the very father of the study of psychedelic medicine for the dying. In the mid 60s — before words like acid, bong and deadhead transformed the American landscape, at a time when psychedelics weren't illegal because most people didn't know what they were — Grof began giving the drug to cancer patients at Spring Grove State Hospital near Baltimore, where he documented the effects.

Grof kept detailed notes on the countless psychedelic sessions, and in articles and books based on these sessions he described cancer patients wracked by fear, who under the influence of LSD or DPT experienced relief from the fear of dying - and not only during the psychedelic sessions, but for weeks and months afterwards. Grof continued his research into how psychedelics can help the dying until the culture caught up with him - the relentless US anti-drug laws. (Richard Nixon called Timothy Leary "the most dangerous man in America.") Funding for psychedelic studies disappeared, and Grof turned his attention to developing alternative methods for accessing higher states of consciousness. It is only now, decades later, that Grob and a handful of fellow researchers feel they can examine Grof's methods and results without risking their own reputations.

The impact

Norbert Litzinger remembers picking up his wife from the medical center after the first session, and seeing that the formerly deeply distressed woman was now "glowing from the inside out". Before Pam Sakuda died, she described her psilocybin experience on video: “I felt this lump of emotion welling up . . . almost like a unit,” Sakuda said as she spoke directly into the camera. “I started to cry... Everything was concentrated and came tumbling down, and then... it started to disappear and I started to look at it differently... I started to realize that all this negative fear and guilt was such a obstacle... to make the most of and enjoy the fresh time I have left.” Sakuda went on to explain that, under the influence of the psilocybin, she came to a very profound understanding that the now was a gift, and that this now was hers.

Two weeks after Sakuda's psilocybin session, Grob went through the depression and anxiety assessments again. Overall, he found that the subjects' scores one and three months after treatment "demonstrated a sustained reduction in anxiety" (published in The Archives of General Psychiatry). They also found that the subjects' scores on the Beck Depression Inventory dropped significantly at the six-month follow-up. "The dose of psilocybin we gave the subjects was relatively low compared to the doses in Stanislav Grof's studies. Grob told me. "Nevertheless, and even at this modest dose, the drug appears to alleviate anxiety and the fear of dying".

Laurie Reamer is a 48-year-old leukemia survivor. Before the leukemia, she was an anesthesiologist, and a committed agnostic who believed in "validity" and "reliability", the scientific method's path to truth. Reamer remembers the morning when all that changed, when, completely exhausted, she hit her leg on a railing and saw a bruise appear on her pale skin, that's when she knew something was terribly wrong. After that came the diagnosis, the bone marrow biopsies, the terrible trek towards a recovery that was tentative at best. I thought I was going to die. Reamer told me.

Reamer recovered from her leukemia - or rather, went into remission - but the disease and the brutal bone marrow treatments she underwent left deep, mental scars: a deep fear that the cancer would return made it difficult to feel joy in life. The disease was lurking around every corner, waiting to take her away. "When I was close to death, I wasn't that afraid of it" Reamer said, but once I went into remission, well, then I had intense fear and anxiety about relapse and death".

It was in the midst of this fear that one day in May 2010, Reamer learned about Griffith's study at Johns Hopkins. For years, Griffiths had been studying the effects of psilocybin on healthy volunteers. He wanted to see if certain doses of the drug could induce mystical states similar to those that occur spontaneously: think of Joan of Arc, or Paul on the road to Damascus. Griffiths says he and his research team found an ideal dosage level: 20 to 30 milligrams of psilocybin - which not only reliably stimulated "mystical insight", but also produced "sustained positive changes in attitude, mood and behavior" in the volunteers. Specifically, when Griffiths administered a psychological test called the "Death Transcendence Scale" at 1- and 14-month follow-ups, he saw subjects' scores increase on statements such as "death is not just an end but part of a process" and "my death does not end my personal existence".

"After transcendent experiences, people often have much less fear of death" says Griffiths. Fourteen months after participating in a psilocybin study published inThe Journal of Psychopharmacologylast year, 94 percent of subjects said it was one of the five most meaningful experiences of their lives; 39 percent said it was the most meaningful experience. Wondering if he could see the same attitude changes in terminally ill patients, he designed a study that gave subjects a high dose of psilocybin (higher than Grob had given) in one session, as well as a dose that varied from individual to individual in a session number two. Since the study was still ongoing, Griffiths did not want to discuss the exact amounts of the drug administered.

At the end of September 2010, Lauri Reamer took his first dose of psilocybin. "I pretty much just cried through that session" she says. Three weeks later, she went back to Johns Hopkins for her second dose. She remembers a lovely room with a large plush sofa. Griffiths entered and wished her luck. Reamer had pictures of her children, as well as items that reminded her of her recently deceased father. After swallowing the psilocybin capsule, Reamer sat with two study coordinators and looked at the artifacts. As she waited for the drug to take effect, she talked about what each item meant to her. "And then it happened" she told me. “I first sat up on the sofa and talked about my daughter's baby blanket, which I had brought with me, and then I lay down on my back. The lights were dimmed. I got dark eyeshadows. They put headphones on me and music started pouring into my ears. A little dark opera. Some choral music. Some mysterious music. There was also a bowl of grapes available; they were big juicy grapes", says Reamer, and she remembers the sweetness and freshness, as well as the small seeds.

As the drug took effect, Reamer lay and floated with the movements of the music. Reamer said that her mind became like a series of rooms, and she could go in and out of them with remarkable ease. In one room was the grief her father felt when Reamer contracted leukemia. In another room was the mother's grief, and in another, the children's. In yet another room, she found her father's experiences from raising her. “I was able to see things through his eyes, my mother's and through my children's; I could see how it had been for them when I was so sick.”

Reamer took the psilocybin around 09.00, and the effect lasted until around 4 p.m. That night she slept better than in a long time. The darkness finally stopped scaring her, and she was willing to go under, not because she knew she'd come back up, but because "under" wasn't as scary. Just why the fear of dying had subsided is difficult to explain: "I now have a distinct feeling that there is so much more" she says, "so many different states. I have the feeling that death is not the end, but only part of a process, a way of moving into another sphere, another way of being.”

After Reamer&#'s psilocybin experience, she divorced her husband. Eventually, she also stopped practicing medicine. She started meditating regularly and she bought a house. "I read somewhere that with my type of leukemia, even if I stay in remission, the most I have left is 15 or 20 years. So that's my reality. But after I die, well, there might be another phase. I believe so now.

Researchers acknowledge that it is not clear how psilocybin reduces a person's anxiety about death, not only during the journey, but for weeks and months afterwards. "It's a bit of a mystery" says Grob. "I don't really have a definitive answer as to why the drug relieves the fear of death, but we know that from time immemorial individuals who have transformative, spiritual experiences have gained a completely different view of themselves and the world around them, with the result that they remain in able to deal with their own death differently.”

One of the first major studies on psychedelics in modern times was conducted at Johns Hopkins University on a group of patients with life-threatening cancer. Two similar studies were conducted in 2011 and 2014 with 12 participants, so the aim here was to see if the results held up in a larger population (56 participants). All studies were double-blind and placebo-controlled. All participants had potentially life-threatening cancer diagnoses and marked symptoms of anxiety and/or depression. One group received a high dose of psilocybin, corresponding to 3.5 g of mushroom (P. Cubensis), and the placebo group received a low dose, corresponding to 0.25 g of mushroom. Before taking the medicine, they had an average of three preparatory meetings. There were two therapists present throughout the process and the room where the treatment took place was a "cozy" room with plants, pictures and a sofa where the participants had to lie. Following the medicine day, the participants had an average of six integration meetings, again with both therapists present.

The results were measured by asking both the participants themselves and other observers such as family, colleagues and friends. 62% reported that the high-dose experience was among the five most meaningful experiences they have had in their life, where experiences such as the birth of a child, death in close family, weddings and the like were on the list. 86% reported a moderate to high increase in quality of life, a figure that only decreased by 3.5% over six months. When measuring the reduction of symptoms for anxiety and depression, the results were 52-60% for the high-dose group compared to 12-16% for the placebo group.

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