How psychedelics are aiding in end-of-life care in Oregon

In 2020, Oregonians voted to legalize the use of psilocybin mushrooms in therapeutic settings. This came as fresh research showed promising results of psychedelic therapy for depression, PTSD and substance use disorder. Now a new kind of patient is seeking out this care. As reported in the New York Times, some people are seeking psychedelics, such as ketamine and psychedelic mushrooms, for palliative care. Andrew Jacobs is a health and science reporter for the Times. He joins us to share more.

Note: The following transcript was transcribed digitally and validated for accuracy, readability and formatting by an OPB volunteer.

Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. In 2020, Oregonians voted to legalize the use of psilocybin in therapeutic sessions. This came as fresh research showed promising results of psychedelic therapy for depression, PTSD and substance use disorder. Other clients are seeking out this care as well. As reported in The New York Times recently, people in palliative care, people with late stage cancer or other terminal illnesses, are turning to psychedelics for solace and perspective as they approach the end of their lives. Andrew Jacobs is a health and science reporter for The Times. He joins us now. It’s great to have you on Think Out Loud.

Andrew Jacobs: Great to be here. Thanks for having me.

Miller: Can you tell us about a man named Barry Blechman? He traveled to Bend from his home in Washington, D.C. last winter. Why?

Jacobs: Barry, who’s 81, is a fairly buttoned-up Washington foreign affairs guy who has metastatic bladder cancer. He was looking for some relief from the negative emotions he was experiencing. As it happens, his daughter is a palliative care doctor in Oregon, and she was the one who encouraged him to do it.

Miller: How did he describe the impact of his session?

Jacobs: Well, he called this a life-changing experience. His wife said it sounded like he was 20 years younger. I think we can all have some idea of what this is like, but the anxiety, fear, depression and horror that you feel when you get a serious medical diagnosis, it’s very, very hard to live with. I think people like Barry are finding there is some relief in these psychedelic compounds like psilocybin.

Miller: How does his story fit into others that you’ve heard?

Jacobs: They are remarkably similar in terms of their descriptions of benefits, of relief, of having an entirely new perspective on dying. The fear associated with this dissipates – not totally evaporates – but I think it is a way of seeing the end with less fear, and also choosing to embrace the light while you’re still alive and enjoy what’s left of it.

Miller: Is it possible to quantify this? Or is this in the realm of trends, and anecdotes, and individual stories of truly transformational experiences?

Jacobs: There is some strong science backing up … Oddly enough, a lot of the science from the middle of the last century, before these drugs were banned. But there have been a bunch of recent studies that are very promising. They are small and there are some limitations, but the science does bear out very pronounced benefits for people who’ve gone through both psilocybin and other kinds of psychedelic therapies, including ketamine.

Miller: Your article actually mentioned a challenge that seems to be inherent in this kind of research – that it can be hard to do the gold standard of double-blind experiments, where neither the person setting this up nor the person taking the substance knows if they got it or not. It can be hard to do that if, pretty quickly, subjects know if they’re on a psychedelic trip or if they’ve just had a placebo. How do you get around that?

Jacobs: Scientists are experimenting with lower doses of some of these compounds or other compounds that trigger sensation. But it’s really hard and no one has found something that satisfies everyone, all the criticisms of this, because it is very hard to measure in that way.

But I think, even with the problem placebo, the results are so high and really pronounced, that I think a lot of people are willing to overlook that. Especially, like you say, anecdotal accounts. This is largely how this has been spreading, through practitioners who report great results with their patients, and also through the media. But at this point, it’s a lot of anecdotal positive reports.

Miller: What are the prevailing theories for why these therapies seem to work?

Jacobs: Well, it all has to do with neuroplasticity, which is the wiring in your brain. And the thinking is that these drugs basically help you rewire some of your ways of thinking. A lot of the emotions you experience with a lot of psychiatric illnesses, including a terminal illness, is this pessimistic looped thinking. So it’s thought that by rewiring the brain in a way, it helps you get out of that loop, and see your life and your challenges from a new, fresh perspective.

Miller: How durable are the effects that have been described or experienced?

Jacobs: Some studies show it lasts for years. The most recent studies are limited to six months or a year, but older studies show much longer time periods. So they are quite durable.

Miller: That actually, to me, is the most surprising piece of this – not that an incredibly powerful experience that alters one’s sense of self or ego could change the way that they’re thinking about mortality, but that that shift could be long lasting. Have you heard anything from researchers about how it is that, in some cases, a one-time trip can lead to changes that last for years?

Jacobs: It’s not really that well understood. There is thought to be some association between the length of a trip and the length of its durability. Some of these compounds, like ibogaine, which has a very, very long journey, a day-long journey has the most durable effects. So there’s something to do with perhaps the quality and length of the psychedelic experience, but I don’t have an answer for that.

Miller: We talked earlier about Barry Blechman’s first trip last winter, but you write in your article that he actually had a second one that was pretty different and not as positive. What did he tell you about that second experience?

Jacobs: Well, he had a very harrowing visual sensation of being surrounded by medical tubes, and there was some very unpleasant imagery. At that point, he was facing a very critical scan to see if his cancer had returned. He admits his anxiety level was very high. So it may have been that. It may have been also maybe the dose of the psilocybin [or] the type he got was different.

I think what it does illustrate is that every psilocybin experience is slightly different. And I think that speaks to an individual level and perhaps with the compounds themselves. I think it’s important for people to be aware that it’s not some silver bullet and not every experience will be pleasant. It requires hard work and there can be some unpleasant moments.

Miller: Where does FDA approval of psychedelic therapy for this stand right now, whether we’re talking about psilocybin – obviously, the supervised use of which is now legal in Oregon – MDMA or other compounds?

Jacobs: At the moment, there is no federal approval. I should say ketamine, which is not a classical psychedelic but also has been used in palliative care – that is legal. But MDMA therapy, for example, was rejected by the FDA over the summer. That was an application for MDMA-plus therapy for PTSD. That’s not dead. The drug company has to go back and do some more testing on that. But at the moment, nothing is happening.

There are others. Psilocybin is in the pipeline. It has received breakthrough therapy status and other psilocybin-like compounds. So I would say we may see regulation in the next two to three years. That’s probably the most optimistic … unless the FDA is led by RFK Jr. We don’t know where that’s gonna go. He’s voiced a lot of support for psychedelic medicine, so who knows?

Miller: I also want to turn to cost. It’s something that you mentioned in your article. It’s something we’ve talked about on this show a fair amount. Barry Blechman traveled 3,000 miles from D.C. So there’s the travel cost. Then, despite the state’s efforts over the years – since the system was started – to make this kind of experience broadly accessible, in general, it costs thousands of dollars for everybody who wants to do it this safe, legal way. What would it take for Medicare, Medicaid or, say, the VA to cover this?

Jacobs: I don’t think it’s impossible because if you look at the costs associated with any kind of mental illness, it’s huge amounts of money – tens of thousands of dollars. And if you talk about the other impacts, health impacts of some of these conditions, PTSD for example, huge. So a $2,000 treatment like this is actually saving money from our healthcare system.

So I would say that that logic alone, I think it is likely, once these drugs come under FDA regulation. And the VA, as you mentioned, is actually far ahead of the FDA at this point and they are doing some testing with psychedelic medicine.

Miller: Andrew Jacobs, thanks very much.

Jacobs: Thanks for having me.

Miller: Andrew Jacobs is a health and science reporter for The New York Times. You can read his article there about psilocybin therapy as a part of end-of-life care.

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