Psilocybin for anxiety in terminal patients

Charles Grob and his colleagues at UCLA-Harbor report in the current Archives of General Psychiatry that a low-to-moderate dose of psilocybin, the active ingredient in “magic” mushrooms, can relieve anxiety, improve mood, and reduce the desire for narcotic pain-relievers in patients with terminal cancer. The finding isn’t very surprising, but the facts that the regulatory machinery allowed it to be conducted and that a major journal was willing to publish the results are two more straws in the wind. After forty years, the taboo on hallucinogen-benefits research is slowly fading.

The study only involved twelve patients, largely because the Institutional Review Board insisted on such stringent inclusion and exclusion criteria that the researchers were basically restricted to dying subjects who were otherwise perfectly healthy. The attempt to “blind” the subjects and therapists to whether they were getting the active drug or a placebo mostly failed. So it’s possible that they didn’t really feel less anxious, they were merely fooled into thinking that they felt less anxious. (Clinicia, the Double-Blind Goddess of Drug Research, is a jealous goddess, and her worshippers tend toward fanaticism.)

But there’s certainly plenty here to justify getting aggressive about this line of research, given that anxiety in terminal patients doesn’t usually respond to the standard array of psychiatric interventions.

At some point, the hospice movement is going to get behind the use of hallucinogens to palliate terminal diagnoses. Then you’ll see the dam break for real.

Here’s a video made by one of the subjects, Pam Sakuda:

In my view, the fact that it will take at least another five years before patients have legal access to a safe procedure that might improve their dying is an outrage. “First, do no harm” is a good rule; isn’t withholding beneficial treatment harmful? But that’s just me: I’ve always been the impatient type.

Author: Mark Kleiman

Professor of Public Policy at the NYU Marron Institute for Urban Management and editor of the Journal of Drug Policy Analysis. Teaches about the methods of policy analysis about drug abuse control and crime control policy, working out the implications of two principles: that swift and certain sanctions don't have to be severe to be effective, and that well-designed threats usually don't have to be carried out. Books: Drugs and Drug Policy: What Everyone Needs to Know (with Jonathan Caulkins and Angela Hawken) When Brute Force Fails: How to Have Less Crime and Less Punishment (Princeton, 2009; named one of the "books of the year" by The Economist Against Excess: Drug Policy for Results (Basic, 1993) Marijuana: Costs of Abuse, Costs of Control (Greenwood, 1989) UCLA Homepage Curriculum Vitae Contact:

9 thoughts on “Psilocybin for anxiety in terminal patients”

  1. You're the impatient type but you'd rather not monkeywrench our nation's cannabis policy by supporting Prop 19? Baloney.

  2. "Doing Harm" is an active sense. When first coming to an accident, or a sick person's aid, your first instinct should be to look, observe, understand. You can do more damage aiding a person with an injured spine.

    It's the 'first' part that you should honor, as part of the process.

  3. When I suffered a very serious neck injury–my first experience with the depths of the medical establishment–I quickly learned that "erring on the side of caution," to very many doctors, means making sure that someone, somewhere, isn't copping a buzz–better to let a patient languish in pain that to risk that!

    I once had to call the hospital at 3am, wake the poor resident (or whatever he was) associated with my doctor, and drive down there to receive a prescription–which I then had to take down to the hospital pharmacy–for one, single Vicodin tablet to relieve the agony of a massively herniated disk. (Fortunately, not all doctors turned out to be like this.)

    Anyway; don't hold your breath on the legalization of 'shrooms…

  4. The study used a crossover design, with each person having one dose of psilocybin and one dose of niacin, in random order. Of interest is that eight of the twelve patients had precious experience with at least one hallucinogen, making it more likely that they could tell the niacin from the psilocybin. It also makes it likely that the people who enrolled in the study were able to tolerate the psychedelic experience without adverse effects; people who had previous bad experiences with hallucinogens were unlikely to enroll in the study. In addition, the study excluded anyone with a major psychiatric diagnosis.

    I wonder if the hook for wider use might have something to do with cost control; if the use of a few mushrooms means that large expenditures on anxiolytic medication are avoided, that could get some bean counters interested. Or the death panels, if you prefer.

  5. Hm, it looks like Warren Drugs is using the same approach to Pseudonym generation that I took most of a decade ago …

  6. Warren Drugs: I'm impatient for good things to happen. I'm also impatient with b.s. Prop. 19 is b.s., as I've argued at length. It promises revenue it can't deliver and creates a "regulatory" mechanism that can't actually regulate anything. Other than that, it's brilliant. That's what happens when you get laws written by pollsters rather than experts.

  7. Also, there is a difference between unrestricted legalization of a previously illegal drug, and licensed use for research and treatment by people who know what they are doing and are able to handle unexpected effects. Mushrooms and LSD and MDMA could move in this direction first, with decisions about greater liberalization taken up later.

  8. None of your impatience with the cannabis status quo comes through in your writing, then. Instead you offer a steady stream of pox-on-both-your-houses third-way-ism. You seem to be completely blind to the politics of changing cannabis policy – it's either catalyze it now or wait ten years for a supermajority of the electorate to find the end of prohibition palatable. Prop 19 may be a crock as far as the revenue goes, but it will give Mexico the spine to suggest that the US stop shunting its demand problem on them. Prop 19 may stink for California, but there are 49 other states (and no shortage of foreign countries) that can experiment with better policies. Your willingness to wait another ten years for federal cannabis prohibition to fall means that you're just fine with have another 7,000,000 needless arrests, which are disproportionately of minorities, and another, say, 40,000 dead Mexicans. You also are willing to let all these lives go to waste during the next ten years on the frankly very small chance that your policy will be the one that gets enacted nationally. What is that called, vanity?

  9. I've heard about positive results having been found in treating sever migraines with LSD.

    But I guess my main concern would be in side effects, specifically psychiatric. I'm not sure what the research says but I know from personal experience that mind-altering drugs can exacerbate feelings of depression or paranoia. My guess is this is something that could be controlled for, but I'm interested in what the risk is.

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