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Cited by 161Psychedelics and Drug StudiesPalliative and Oncologic CareReligion, Spirituality, and Psychology

Taking Psychedelics Seriously

Open access
Byock, Ira·2018·Journal of Palliative Medicine
DOI 10.1089/jpm.2017.0684PMC PMC5867510
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Abstract

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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Crossref · 10.1089/jpm.2017.0684

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  • Research with hallucinogens is not easily performed due to the legal context in many countries, especially developing countries.

    “As for the use of psychedelics, due to the legal context in many countries (Byock, 2018), specially developing countries, research with hallucinogens is not easily performed”

    From Virtual reality and psychedelics for the treatment of psychiatric disease: A systematic literature review (2020) · cites this paper as Byock, 2018

    The Background says Schedule I classification abruptly halted clinical research and that US researchers later needed governmental permission to conduct trials. Political and Regulatory Considerations calls the renewal of research long and painstaking. These passages support legal barriers to research, but do not establish that they apply in many countries or especially in developing countries. (LLM, conf=0.85)

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  • Information about research with psychedelics is scarcer and often repetitive, expected because of the great taboo and potential of misuse surrounding these substances, as well as the lack of legal availability of most of them.

    “Information about research with psychedelics is scarcer and often repetitive, but that is expected because of the great taboo and potential of misuse surrounding these substances, as well as the lack of legal availability of most of them (Byock, 2018).”

    From Virtual reality and psychedelics for the treatment of psychiatric disease: A systematic literature review (2020) · cites this paper as Byock, 2018

    The Background (page not provided) says Schedule I classification abruptly halted clinical research and that only a few small studies followed; Political and Regulatory Considerations describes a long, painstaking effort to restart research. This supports limited research linked to legal and political barriers, but the paper does not say that research information is often repetitive or specifically attribute its scarcity to a taboo. (LLM, conf=0.84)

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Research works printed but not linked: 15

  1. [3]Johnson MW, Griffiths RR: Potential therapeutic effects of psilocybin. Neurotherapeutics 2017; 14: 734– 740 28585222 PMC5509636
  2. [6]Bone E: Can Mushrooms Treat Depression? The New York Times 11 29, 2014; Sunday Review
  3. [11]Griffths RR, Grob CS: Hallucinogens as medicine. Sci Am 2010; 303: 76– 79 21141361
  4. [12]Kast E: LSD and the dying patient. Chic Med Sch Q 1966; 26: 80– 87 4163076
  5. [16]Swiatek KM, Jordan K, Coffman J: New use for an old drug: Oral ketamine for treatment-resistant depression. BMJ Case Rep 2016; 2016: pii: PMC4986200 27489070
  6. [17]Mithoefer MC, Grob CS, Brewerton TD: Novel psychopharmacological therapies for psychiatric disorders: Psilocybin and MDMA. Lancet Psychiatry 2016; 3: 481– 488 27067625
  7. [18]Sessa B: MDMA and PTSD treatment: “PTSD: From novel pathophysiology to innovative therapeutics”. Neurosci Lett 2017; 649: 176– 180 27394687
  8. [19]Quill TE, Byock IR: Responding to intractable terminal suffering: The role of terminal sedation and voluntary refusal of food and fluids. ACP-ASIM End-of-Life Care Consensus Panel. American College of Physicians-American Society of Internal Medicine. Ann Intern Med 2000; 132: 408– 414 10691593
  9. [25]Carhart-Harris RL, Erritzoe D, Haijen E, et al.: Psychedelics and connectedness. Psychopharmacology (Berl) 2017 [Epub ahead of print]; DOI: 10.1007/s00213-017-4701-y 28795211 · DOI
  10. [26]Ruck CA, Bigwood J, Staples D, et al.: Entheogens. J Psychedelic Drugs 1979; 11: 145– 146 522165
  11. [31]Jones DA, Paton D: How does legalization of physician-assisted suicide affect rates of suicide? South Med J 2015; 108: 599– 604 26437189
  12. [32]Kheriaty A: Social contagion effects of physician-assisted suicide: Commentary on “How Does Legalization of Physician-Assisted Suicide Affect Rates of Suicide?”. South Med J 2015; 108: 605– 606 26437190
  13. [34]Simmons Z Right-to-try investigational therapies for incurable disorders. Continuum (Minneap Minn) 2017; 23(5, Peripheral Nerve and Motor Neuron Disorders): 1451– 1457 28968371
  14. [36]Miller JE, Ross JS, Moch KI, Caplan AL: Characterizing expanded access and compassionate use programs for experimental drugs. BMC Res Notes 2017; 10: 350 28754150 PMC5534121
  15. [37]Cohen-Kurzrock BA, Cohen PR, Kurzrock R: Health policy: The right to try is embodied in the right to die. Nat Rev Clin Oncol 2016; 13: 399– 400 27217273

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Authors
Byock, I.
Affiliations
Dartmouth College (US)
Corresponding author
Byock, Ira
ORCID
Byock, Ira
Venue
Journal of Palliative Medicine
Publisher
SAGE Publications
Published
2018-04
Volume
21
Issue
4
Pages
417-421
ISSN
  • 1096-6218 (ISSN-L)
  • 1557-7740
DOI
10.1089/jpm.2017.0684
PMC
PMC5867510
OpenAlex
W2784340661
Cited by
161
References
9
Citations by year
2026: 3 · 2025: 11 · 2024: 48 · 2023: 29 · 2022: 15 · 2021: 16 · 2020: 30 · 2019: 6 · 2018: 2
FWCI
15.86
Type
journal article
Language
en
Open access
Licence
www.liebertpub.com/nv/resources-tools/text-and-data-mining-policy/121/ (tdm)
Locations
  • Journal of Palliative Medicine (publishedVersion)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Psychedelics and Drug Studies
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
  • Social Sciences › Health › Religion, Spirituality, and Psychology
Keywords
psychedelics, psilocybin, MDMA, ketamine, treatment-resistant depression, anxiety, terminal illness, palliative care, existential suffering, spiritual distress, physician-assisted death, expanded access program, adverse effects
MeSH terms
Mental Disorders, Hallucinogens, Humans, Palliative Care

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