There has been a number of articles, videos, and books on the role of psychedelic medications and the role they might play in helping people deal with their existential fears near the end-of-life.  Now Michael Pollan, the food writer, has a new book out called “How to Change Your Mind.”

In this book, he reports on the history of these medications, new evidence of benefit and their current use.  There are a few experimental protocols and studies that a select few patients might be eligible for.  However, an increasing number of people are seeking this kind of treatment outside of traditional care.  This is certainly a unique CAT (Complementary and Alternative Treatment).  Mr. Pollan tries psilocybin mushrooms with one of these underground alternative providers to report on his experience.

I would encourage you to listen to one of his interviews which can be found on Fresh Air with Terry Gross.  Or watch a video, presentation or if you have the time, check his book out at the library.  It is currently on a wait list at my library, which demonstrates the public interest.  As Palliative Care providers we need to be prepared for patients to not only ask about cannabis but also LSD and psilocybin.  It is much too early to recommend this as an evidence-based treatment.  Yet I have already had patients take this into their own hands and seek out an underground provider.

While evidence is still limited, the reports from both the scientific and lay press are intriguing.  Some dismissed this as taking a pill instead of doing the “work” of dealing with existential distress. I disagree.  Some people will need help opening themselves up to these scary topics. It is not just about having a “trip”.  It is about being carefully supported as one opens oneself up to face your greatest fears. I hope this proves a safe and helpful adjunct to the important spiritual and psychological support we can provide.

Know that you have probably already had patients who have sought this out as an option and that you need to be prepared to talk about it.

Fresh Air. Gross, T. (2018). Reluctant Psychonaut Michael Pollan Embraces “New Science” of Psychedelics. v



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