Psychedelics & the death experience

On living and dying better

On Saturday, I presented at the Death, Grief, and Belief conference on psychedelics in the death process. This week, I’ll recap some of the history of psychedelics leading up to the current renaissance in clinical studies. Next Monday, I’ll look more in-depth at what the current research on psychedelics in the death setting is revealing.

While psychedelics have likely been in use far longer than recorded history (and in laboratory-manufactured form for roughly a century), Michael Pollan’s 2015 New Yorker article, The Trip Treatment, is responsible for the current mainstreaming of these peculiar molecules.

The current focus is on a range of medical applications, such as treating anxiety, depression, PTSD, OCD, and suicidal ideation. Yet the Pollan article focused on psychedelics easing existential distress in terminally-ill patients.

Such research into psychedelics isn’t new. Between 1953-1973, the US government funded 116 LSD studies for a variety of conditions, including alcoholism, obsessive-compulsive disorder, depression, autism, schizophrenia, even terminal illness. They also funded studies on creativity and spirituality. $4 million was spent on over 1,700 participants during this time.

There was an acute interest in LSD, as Sandoz, the lab where Swiss chemist Albert Hoffman synthesized LSD-25, sent it to anyone willing to do clinical studies on possible applications anywhere in the world. Hoffman and his bosses knew they were onto something. They just had no clue what it was.

Many of these early studies yielded positive results—and these only account for government-funded research. There were thousands of other studies happening, some in therapeutic settings, some for anecdotal experimentation. Yet the quality of these clinical studies wasn’t great. Double blinding for a psychedelic is nearly impossible. Attempts were made, with niacin, which gives you a tingly feeling, or Ritalin, which causes a slightly anxious effect In general, you’re going to know who was dosed with an actual psychedelic.

When it comes to alleviating existential distress, however, anecdotes are all we really have, so this might not be a net loss in terms of scientific progress. As David Nichols, emeritus professor of pharmacology at Purdue, told Science magazine: 

If it gives them peace, if it helps people to die peacefully with their friends and their family at their side, I don’t care if it’s real or an illusion.

Researchers are still trying to study psychedelics from every angle. A 2021 study at Imperial College London with 191 volunteers found the placebo to be as powerful as LSD. There were problems, however: since LSD is illegal, participants had to supply their own dose. No quality control whatsoever.

Another issue: it was a microdose. Microdosing is a feasible therapeutic for people suffering from anxiety or depression; early studies are positive but limited. At the end of this particular study, the control group self-reported the same improvements in life satisfaction and mindfulness, along with a reduction in paranoia, as the microdosers. 

In another study, Imperial College London found that psilocybin was as effective at treating depression as Lexapro at the six-week mark. A pilot study, with 59 volunteers, participants either took a daily dose of Lexapro alongside two 1mg daily psilocybin, or two 25mg doses of psilocybin three weeks apart (while taking a placebo all other days).

An odd construction given that the SSRI group was also taking a tiny amount of psilocybin. Yet both groups performed similarly in terms of depression alleviation. Of note: the larger doses of psilocybin were only administered two times in six weeks compared to daily use of Lexapro.

Which leads to one of the bigger debates about psychedelics-as-medicine: hero’s dose or microdose? An ongoing debate. From my perspective, if something works, use it. There’s a belief that macrodoses “permanently rewire the brain,” and while what that entails remains uncertain, larger doses have been shown to be important, especially at the end of life. And we have one man to thank for that.