Some of the most striking early psychedelic research was done not with people with depression, but with people facing death. Cancer patients often experience anxiety and depression that conventional treatments do not fully relieve. Psilocybin-assisted therapy was studied as a way to help them find peace.

The studies

In the mid-2010s, two influential trials, one at Johns Hopkins (led by Roland Griffiths) and one at New York University (led by Stephen Ross), tested psilocybin in patients with life-threatening cancer diagnoses and clinically significant anxiety or depression. Both used a controlled design. Participants received either psilocybin or a very low or active control dose, with a crossover so that everyone eventually received the active drug.

Reported results were large. In the Johns Hopkins trial, about 80% of participants showed clinically significant reductions in depression and anxiety at six-month follow-up, according to the published paper. The NYU trial found similar reductions after a single session, with benefit lasting months. Participants often described the experience as among the most meaningful of their lives, and some reported reduced fear of death.

Follow-up work suggested benefits could last years in some participants, though sample sizes are small and attrition is a concern.

What the therapy looked like

These were not recreational experiences. Patients met therapists beforehand, took the drug in a comfortable room with trained guides present, and returned for follow-up sessions to talk about what had happened. The preparation and integration were an essential part of the design.

The limits of the evidence

Small samples. Each trial enrolled fewer than 100 people, and the crossover design made comparing long-term effects difficult.

Unblinding. Participants usually knew whether they had received the active dose.

Selected participants. People who volunteer for psychedelic trials may be more open to the idea than the general population, which could inflate the effects.

Expectation. Positive expectations are likely to amplify the benefit, which is difficult to separate from the drug.

Few large Phase 3 trials. The large pivotal trials have focused on treatment-resistant depression rather than end-of-life distress.

Access in Canada

Canada has been one of the few places where patients with serious or life-threatening illness could, in principle, request access to restricted drugs. Health Canada amended its Special Access Program (SAP) in January 2022 to allow practitioners to request psilocybin and other restricted drugs for patients with serious or life-threatening conditions when other therapies have failed. The first approvals came in March 2022, when Health Canada authorized psilocybin for six patients experiencing end-of-life distress. Since then, approvals have been uneven, and experts say the process remains cumbersome. Health Canada has said that clinical trials are the best route for most people.

Questions to ask if you are considering this

• Is the provider operating under an authorized clinical trial or a Health Canada approval?
• What are the screening criteria, and who is excluded?
• How many sessions of preparation and follow-up are provided?
• What happens if the experience is distressing?
• Who is accountable if things go wrong?

Underground or unlicensed services vary widely in quality and safety, and the legal risk falls on the participant.

The emotional side

People facing death may be especially vulnerable to promises of transformation. Good palliative care, counselling, and spiritual support remain central to end-of-life care. Psilocybin-assisted therapy is an addition for some patients, not a replacement for those supports.

The takeaway

The end-of-life studies produced some of the most hopeful psychedelic data, and also some of the most difficult to generalize. The field is waiting for larger, better-blinded trials, while Canada’s special access pathway remains a narrow door.

Sources: Griffiths et al. (2016) and Ross et al. (2016) trials; Canadian Psychedelic Law News and Health Canada SAP information; Mugglehead reporting on SAP amendments. Verify percentages in the original papers.