Psilocybin and advanced cancer anxiety.
Subject: Hallucinogenic drugs (Dosage and administration)
Hallucinogenic drugs (Patient outcomes)
Anxiety (Risk factors)
Anxiety (Drug therapy)
Cancer (Care and treatment)
Cancer (Methods)
Cancer (Patient outcomes)
Author: Klotter, Jule
Pub Date: 08/01/2012
Publication: Name: Townsend Letter Publisher: The Townsend Letter Group Audience: General; Professional Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2012 The Townsend Letter Group ISSN: 1940-5464
Issue: Date: August-Sept, 2012 Source Issue: 349-350
Product: Product Code: 8000432 Cancer Therapy NAICS Code: 621 Ambulatory Health Care Services
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 303012874
Full Text: Beginning in the late 1950s, scientists began investigating hallucinogens as treatments for existential anxiety, despair, and isolation associated with advanced-stage cancer. The results were promising. Patients had "psychospiritual epiphanies" that often resulted in a sustained decrease in anxiety, improved mood, and less need for narcotic pain medication. But the war on hallucinogens, which started in the early 1970s, prevented further research.

In 2011, Dr. Charles S. Grob and colleagues published the first study in over 35 years to assess the use of psilocybin as a treatment for reactive anxiety in patients with advanced-stage cancer. Psilocybin, found in hallucinogenic mushrooms, produces psychological effects similar to those of LSD (lysergic acid diethylamide) but with less chance of paranoia and fewer panic reactions. This double-blind, placebo-controlled study involved 12 patients with advanced-stage cancer and anxiety. Patients acted as their own control.

During two separate sessions, patients were given either a "moderate dose" (0.2 mg/kg) of psilocybin or 250 mg of niacin as a placebo. The six-hour sessions took place in a comfortable room decorated with fabric wait hangings and fresh flowers on a hospital clinical research unit. After taking the capsule containing psilocybin or niacin, the patient put on eyeshades, lay in bed, and listened to preselected music via headphones. Staff encouraged them to remain in bed for the first few hours. Treatment staff remained with the patient for the entire six-hour period to give support if needed. In addition, staff performed hourly check-ins, asking how the patient was doing and taking heart rate and blood pressure measurements. Monthly follow-ups for six months revealed decreasing anxiety after the psilocybin session.

Blinding for this study was ineffective. Most of the subjects and investigators could tell the difference between psilocybin sessions and niacin sessions. Subjects considered the niacin placebo "far less worthwhile." The authors say, "Many of the subjects suggested that future protocols provide the opportunity for a second psilocybin session several weeks after the first. The general consensus among subjects was that a follow-up experience with psilocybin would reinforce and extend the perceived therapeutic effects of the initial session."

The value of psilocybin treatment lies in its ability to help patients transcend ego and body identification. Patients report connecting with a "larger state of consciousness in which their personal worries and insecurities [vanish]," according to a New York Times article by John Tierney. "'It was a whole personality shift for me," Dr. Clark Martin, a retired clinical psychologist with depression linked to kidney cancer, told Tierney. "'I wasn't any longer attached to my performance and trying to control things. I could see that the really good things in life will happen if you just show up and share your natural enthusiasms with people. You have a feeling of attunement with other people." Tierney reports that he interviewed many patients who considered their treatment session with psilocybin "among the most meaningful events" of their lives.

After decades of repression, the federal government is now giving permission to use psychedelics in controlled clinical experiments, according to Tierney. Several large universities are now researching therapeutic use of hallucinogens with financial support from private sources such as the Heffter Research Institute and MAPS, the Multidisciplinary Association for Psychedelic Studies.

Grob CS, Danforth AL, Chopra GS, et al. Pilot study of psilocybin treatment for anxiety in patients with advanced-stage cancer. Arch Gen Psychiatry. January 3, 2011;68(1):71-78. Available at http://archpsyc.jamanetwork.com/article.aspx?doi=10.1001/archgenpsychiatry.2010.116. Accessed May 21, 2012.

Tierney J. Seeking medical uses, doctors tune back in to hallucinogens. New York Times. April 12, 2010;A1, A17.

briefed by Jule Klotter

jule@townsendletter.com
Gale Copyright: Copyright 2012 Gale, Cengage Learning. All rights reserved.