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2018 ; 21
(4
): 417-421
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Taking Psychedelics Seriously
#MMPMID29356590
Byock I
J Palliat Med
2018[Apr]; 21
(4
): 417-421
PMID29356590
show ga
BACKGROUND: Psychiatric research in the 1950s and 1960s showed potential for
psychedelic medications to markedly alleviate depression and suffering associated
with terminal illness. More recent published studies have demonstrated the safety
and efficacy of psilocybin, MDMA, and ketamine when administered in a medically
supervised and monitored approach. A single or brief series of sessions often
results in substantial and sustained improvement among people with
treatment-resistant depression and anxiety, including those with serious medical
conditions. Need and Clinical Considerations: Palliative care clinicians
occasionally encounter patients with emotional, existential, or spiritual
suffering, which persists despite optimal existing treatments. Such suffering may
rob people of a sense that life is worth living. Data from Oregon show that most
terminally people who obtain prescriptions to intentionally end their lives are
motivated by non-physical suffering. This paper overviews the history of this
class of drugs and their therapeutic potential. Clinical cautions, adverse
reactions, and important steps related to safe administration of psychedelics are
presented, emphasizing careful patient screening, preparation, setting and
supervision. CONCLUSION: Even with an expanding evidence base confirming safety
and benefits, political, regulatory, and industry issues impose challenges to the
legitimate use of psychedelics. The federal expanded access program and
right-to-try laws in multiple states provide precendents for giving terminally
ill patients access to medications that have not yet earned FDA approval. Given
the prevalence of persistent suffering and growing acceptance of
physician-hastened death as a medical response, it is time to revisit the
legitimate therapeutic use of psychedelics.
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