Psychedelics for end of life care

"I wasn’t gone. I was part of the earth."

I recently presented at the Death, Grief, and Belief conference on psychedelics in the death process. Last Monday, I recapped some of the history of psychedelics leading up to the current renaissance in clinical studies. Today I write about current research on psychedelics in the death setting.

Timothy Leary was a controversial figure in the psychedelics space. Many complained that the invented political fervor over psychedelics stems in part from his spiritual advocacy and public shenanigans. Yet he also had a profound impact on the cultural understanding of psychedelics.

Leary popularized the term “set and setting” to describe the psychedelic experience. (The term was coined by another cosmonaut, Al Hubbard.) Set is your mindset when consuming a psychedelic: what’s going on in your life, what you’ve emotionally suppressed, your intention for the trip. Setting is your physical environment, your culture, and the people you’re with. I’ve taken the same batch of psychedelics with different people in different environments and have had wildly different experiences. It’s never just the drug.

Culture matters quite a bit. In terms of end of life care, dying in America is an expensive process. Health care is excessively pricey during the last few months of life—approximately 10% of healthcare costs are at the end stage of life, totalling $430 billion—while funerary services average roughly $8,000. These factors place a burden on the dying and bereaved, and can affect the entire death process.

The current rollout of legal (or decriminalized) psychedelics is following this trend. I live in Oregon, the first state to offer psychedelics services. On the decriminalized market I pay $20 for an effective dose of psilocybin; going the medical route costs up to $3,400. Of course, the latter comes with multiple rounds of therapy, which is appropriate for some people. The problem is that appropriate doesn’t necessary equal accessible.

Ingesting psychedelics in a ritualistic jungle setting is going to be markedly different than doing so in a hospital room. All of the researchers I’ve read and talked to express difficulty in describing the psychedelic experience from a clinical perspective. Not only is it challenging to double-blind for psychedelics, but finding the right language to describe the experience is often impossible. Ironically, this is sometimes to the benefit of the dying person, who experiences such awe that language loses meaning.

Aldous Huxley wrote that the human mind is like a reducing valve: it limits information surfacing to conscious awareness to ensure that you, first and foremost, survive. The neuroscientist Dan Levitin writes that our brains can only handle 120 bits of information per second, equivalent to talking to two people at once and retaining the narrative. I’ve heard autistic people describe their experiences as taking in way more information at once, which makes responding challenging: it’s not that they don’t understand what’s going on, it’s that they understand too much, and it forms a type of paralysis. (This is limited to a few people I’ve watched describe it; I’m not describing the entire spectrum.)

What Huxley wrote about over 60 years ago is similar: psychedelics open the doors of perception so that you take in much more information all at once. Modern researchers acknowledge the possibility while cautioning that the human brain is known to create illusions. Yet, from a therapeutic perspective, some researchers think this could be a key to the potential success of psychedelics: if you disrupt the mental patterns associated with addiction or OCD, for example, then you show the sufferer that there are other ways to think and be in the world. The “realness” of the thought is secondary. This might be a key to understanding psychedelic efficacy in hospice care: patients receive new information that changes their perspective on life, and on death.