Facing Death Without Fear: Psychedelics for End-of-Life Care

Medically Reviewed by Jennifer Casarella, MD on December 16, 2022
7 min read

For Christine “Cat” Parlee, who has stage IV metastatic melanoma, the Roots to Thrive program was a godsend. Not that she expects it to save her life: The probability of surviving advanced melanoma for 5 years is about 15%-20%, according to the American Cancer Society, and Parlee was diagnosed in 2017. But an innovative approach to group therapy at Roots to Thrive, based in Nanaimo, British Columbia, has helped her deal with this life-threatening disease.

Parlee’s health issues are complex. As if malignant skin cancer wasn’t enough, the 50-something resident of Vancouver Island also has a condition called trigeminal neuralgia with anesthesia dolorosa. With that rare disorder, she says, “emotional outbursts can literally cause me severe pain. So I got very good at suppressing my emotions.” 

“But you don’t grow, or grieve, or eventually accept the end if you don’t process your fears,” she continues. Roots to Life has “allowed me to experience my own anger, fear – the feeling that this is SO unfair – without pain or panic attacks. … It’s one of the hardest yet most beautiful experiences I have ever had to put in words.”

A key ingredient of that experience is psilocybin, aka magic mushrooms. Founded in 2019, the nonprofit Roots to Thrive is the first Canadian medical practice to legally use psychedelic drugs, specifically psilocybin and ketamine, in group therapy for patients facing the end of life. Combined with two other ingredients – a psychotherapist and a supportive patient community – the drugs have proved highly effective in easing the distress that comes with a terminal diagnosis, according to Pamela Kryskow, MD, the medical lead at Roots to Thrive.

“Once that safe community is built, a psilocybin mushroom session with that same group of people creates a healing container, where patients can deeply explore their challenges while under the influence of the medicine,” says Kryskow, who is also a clinical instructor at the University of British Columbia and adjunct professor at Vancouver Island University.

Research confirms the promise of psychedelics – from plant-based psilocybin and DMT to synthetic MDMA (ecstasy) and LSD – for palliative and end-of-life patients. In 2016, a landmark study at NYU Grossman School of Medicine found that a single dose of psilocybin relieved depression, anxiety, and hopelessness in cancer patients. More recently, in a follow-up study, 80% of the same patients reported that the positive effects were sustained 4½ years later. And more testing is in progress.

“There are 113 clinical trials currently registered at clinicaltrials.gov,” says Paul Stamets, a mycologist whose 2020 book Fantastic Fungi is a companion to a popular Netflix documentary. “This is unprecedented, and a reflection of the scientific justification for exploring the benefits of psilocybin over a wide range of mental health issues.”

That exploration dates back to the 1950s, when psychiatrists like Humphry Osmond, who coined the word “psychedelic,” first experimented with LSD-assisted psychotherapy. Studies during that period were less than rigorous by today’s standards, however, and in the United States they virtually came to a halt with the 1970 signing of the Controlled Substances Act. But decades later, in 2014, Scientific American called for an end to the ban on clinical trials involving psychedelics. By then, the country was in the middle of what psychiatrist Ben Sessa dubbed a “psychedelic renaissance.”

Right-to-try laws, which give gravely ill patients access to experimental drugs without having to wait for FDA approval, have helped jump-start the surge in psychedelic research. Currently, 41 states have their own versions of these statutes, which stand alongside the federal Right to Try Act, signed into law in 2018. Two states have focused on psilocybin in particular. In 2020, Oregon became the first to legalize the therapeutic use of psychedelic mushrooms. Colorado voters recently followed suit, decriminalizing magic mushrooms on Election Day 2022. This is expected to pave the way for similar changes in Colorado laws that prohibit other plant-based psychedelics, such as DMT, ibogaine, and certain forms of mescaline, in June 2026.

As defined by the National Institutes of Health, psychedelics are potent psychoactive substances that alter cognition, changing the user’s mood and perceptions by acting on neutral circuits in the brain that involve the chemical serotonin. Much of this happens in the prefrontal cortex, the part of the brain that regulates how you feel and how you see the world. “Psychedelic drugs, including psilocybin, are believed to all act on what are called serotonin 2A receptors,” explains Charles Nemeroff, MD, PhD, chair of the Department of Psychiatry and Behavioral Sciences and co-director of the Center for Psychedelic Research and Therapy at the University of Texas’s Dell Medical School in Austin.

Matthew W. Johnson, PhD, a professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine in Baltimore, describes the activation of the subtype of serotonin receptor as “the first step in the chain,” one that leads to “changes in brain communication” during the psychedelic experience. “It’s likely that the brain looks different in the long term in a way that corresponds to psychological and behavioral improvements,” he says, noting that psilocybin “works more like psychotherapy than other psychiatric meds.”

However psychedelics work, they have been shown under certain circumstances to be an effective complement to psychological support for end-of-life patients. In a recent study of more than 3,000 adults, the Johns Hopkins Center for Psychedelic and Consciousness Research found that taking these drugs under the right conditions made people less afraid of death, much the way a near-death experience unrelated to drugs may reduce the fear of mortality. The result, of course, can be a dramatic improvement in quality of life for the terminally ill. 

This isn’t to suggest that psychedelics are a panacea. Johnson notes, for example, that the therapy is especially risky for patients with schizophrenia or severe heart disease. Gauging the risks calls for further research, says Gregory A. Fonzo, PhD, an assistant professor and co-director of the Center for Psychedelic Research and Therapy in the Department of Psychiatry and Behavioral Sciences at Dell Medical School. “Current studies have focused primarily on establishing efficacy,” he points out. “But future studies with larger numbers of participants are necessary in order to identify individuals who are likely­ – and not likely – to respond well to this treatment.”

For those who respond well to psychedelic therapy, it isn’t just an individual experience. “Many patients report breakthroughs in family dynamics,” says Johnson. In some cases, this happens as “they start having more open conversations about potential or pending death.”

There have been other kinds of breakthroughs as well. “We’ve heard many reports of profound insights, transpersonal experiences, and rapid shifts in patients’ moods and their sense of self occurring during psychedelic experiences,” Fonzo says. “It’s possible that these patients’ subsequent changes in their belief systems, their perceptions of self and others, and their overall mood state are key factors that promote benefits for conditions such as depression. But additional research is needed to validate that.”

Clinical trials have even dipped into the realm of spirituality. In 2021, a Johns Hopkins review of psychedelic research focusing on end-of-life and palliative care noted that some psilocybin studies used a mystical experience questionnaire designed to measure things like “a sense of unity, reverence, and authoritative truth … transcendence of time/space, and ineffability.”

But for many end-of-life patients, one of the most important benefits of the therapy is more concrete: They come to see themselves as separate from their diagnosis. “These sessions typically lead to changed narratives that a person carries about the cancer and themselves,” Johnson says. “I think these patients are actually learning things about themselves and about life, and that's what separates psilocybin from other psychiatric medications.” 

In helping terminal patients overcome the fear of death, psychedelic therapy often frees them, paradoxically, to live more fully. “[Patients] say that they have healed old traumas they’ve carried, so they are able to be more present with their family and friends,” Kryskow says. “They are able to focus on having more fun and more connection.” 

Still, results vary, and Cat Parlee maintains that each psychedelic experience is unique. “Mine changed me to the very core of my DNA,” she says. Before she signed up for Roots to Thrive, she says, “the very thought of death caused me to have massive panic attacks.” But those days are gone. Her advice to prospective patients considering a similar program: “Be open. Be vulnerable. And no matter what you’ve heard, leave your expectations at the door.”