No one can imagine what’s it like to die with cancer. Some lucky few have a fairly smooth departure, and many others approach the end of life facing a daily struggle with one, or several, discomforting physical symptoms (chronic pain, fatigue, lost appetite, cachexia, nausea, vomiting, constipation, shortness of breath, serious drug complications) and emotional challenges (anxiety, depression, existential dread, practical financial and family concerns).
There are already a number of available ways to ease the final path for the terminally ill. Many patients receive psychiatric drugs, opioids or other painkillers, and, increasingly, medicinal pot; often enough, it is a combination of these drugs. All are often helpful, but all also have dangerous risks and marked limitations. Any new, safe and effective addition to the palliative toolkit would be most welcome.
That brings us to the possible medicinal use of Psilocybin, a hallucinogenic drug derived from mushrooms.
Magic mushrooms grow wild and are easy to cultivate. They have a 5,000-year history, all around the world, of use in religious and spiritual rituals (including the ancient Greeks, the Vikings, and especially, for many centuries, among indigenous peoples of the Americas).
In the 1960’s, “shrooms” hit the U.S. market with a bang, becoming a popular, natural hallucinogen used, mostly by young people, for recreational and spiritual purposes. Psilocybin was soon made completely illegal in the U.S., even for research purposes – it was identified as a Schedule I drug with a high potential for abuse and no recognized medical uses. This was an example of Nixon-era drug puritanism – a knee-jerk and broad brush reaction to fears about drug use by hippies, on college campuses, and by returning Vietnam vets.
Hallucinogenic mushrooms can certainly cause serious problems in some people, but they also have a long history of medicinal and religious uses in many different cultures and are much less likely to cause addiction, abuse, or complications than other Schedule I drugs. In 2007, the Supreme Court backed off a bit and protected the freedom to use hallucinogenic mushrooms as part of religious practice. They opened question whether Psilocybin should be legalized for research and medical use. This is largely unanswered because, until recently, it has been extremely difficult to get approval or funding for research on hallucinogens. Very few research groups have done studies.
New Studies Report Magical Results
Fortunately, two Psilocybin studies (conducted at Johns Hopkins and NYU) were published in the Journal of Psychopharmacology. The surprising, exciting, and converging result of both studies was that just one Psilocybin trip, lasting a mere eight hours, can reduce anxiety and depression in about 80% of cancer patients. Many of the patients reported having deep spiritual and emotional experiences that gave them a new and enriched perspective on life, death, and their place in the overall scheme of things. And the effects stick, with improved quality of life for periods lasting up to 6 months.
Researchers conducting the two studies are brimming with enthusiasm, calling their results remarkable. The Journal of Psychopharmacology devoted its entire issue to Psilocybin and did a great job of stirring up media interest by widely distributing pre-publication, contraband copies. Their efforts were richly rewarded. The Psilocybin studies are an instant media hit, being reported with unmodulated enthusiasm by all the major outlets. The message for anyone suffering from cancer would seem to be “get yourself into a research study that will give you access to Psilocybin or go out and pick mushrooms”.
Cause For Concern And Caution
This is all wildly premature. The benefits of new treatments are always exaggerated at the start, only to fade gradually with greater familiarity. In the past, researchers have developed and studied new approaches to drug use and psychotherapy. Most are true believers, making claims that never replicate. Magic results almost always turn out to be too good to be true.
In stark contrast, the risks of new treatments are initially neglected, until they gradually accumulate as more patients take part. Psilocybin isn’t addictive or toxic, but it can have seriously negative psychological and behavioral effects, especially when used widely and haphazardly. The last thing we want to do is give “bad trips” to people who are already suffering enough.
Terrific results achieved with a small group of highly selected patients treated in a highly controlled and well-monitored environment can translate into terrible results with large groups of unselected patients treated in every day, less expert settings. Psilocybin may be very useful in helping some cancer patients deal with their psychological and spiritual challenges, but it may be very harmful to others.
Two small studies can’t possibly answer all the questions that need to be asked about indications, patient selection, safety, and applicability in real world practice. More research is highly desirable but widespread, premature introduction into general clinical practice would be unwise and potentially disastrous.