A few months ago, drug policy reform proposals from the Scottish government, including the decriminalisation of possession for personal use, were rejected by No. 10 within an hour of their publication. This encompassed all drugs including the ‘psychedelic’ compounds lysergic acid diethylamide (LSD) and psilocybin, the psychoactive agent present following ingestion of magic mushrooms.
Under current UK legislation, these compounds are Class A substances, which means that possession can result in an unlimited fine, and up to 7 years in prison. Considering the heavy penalties surrounding these substances, it would seem bizarre to discuss them in the same breath as palliative medicine.
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The majority of people surveyed believe patients receiving end-of-life care in the NHS should be given equal priority to other patients. Despite this, psychiatric comorbidities are typically overlooked in those receiving palliative care, with many having clinically relevant depression and anxiety. The outcomes of these patients are usually much worse, with increased suicide rates, and decreased adherence to treatment regimens.
In the UK, anxiety and depression are not treated differently in patients receiving end-of-life care to otherwise, healthy individuals, if there are no contraindications. These treatments lack an evidence base of efficacy in those with a life-threatening disease and instigate an array of side effects that accumulate with the symptoms these patients are already experiencing.
During my time as a healthcare support worker and medical student in various healthcare settings in South Wales, it became apparent that many people in our communities are dying in hospitals, whilst in a great deal of distress. There is an obligation for healthcare providers to explore novel therapies to alleviate this anguish in the final moments of their patients’ lives.
LSD and psilocybin, termed ‘psychedelics’, were investigated as therapeutics in studies involving thousands of patients in the 1950s and 1960s, prior to their bans. Incidentally, they were examined as interventions to alleviate the distress associated with a diagnosis of a life-threatening disease. Results were promising at the time, but scheduling and classification effectively criminalising the scientific or medical application of these compounds halted research almost entirely for a period of decades.
More recently, a renaissance in this area of research has bloomed, with further bodies of evidence now existing, advocating the value these compounds may have in the future of psychiatric care, particularly in end-of-life psychiatry. Participants in the more recent studies have seen significant reductions in anxiety and depression, as well as improved quality of life, and less fear of death. Nevertheless, difficulties would emerge regarding the practicality of applying such an intervention to fit the budget of an entity like the NHS.
Reportedly, over half of people on cognitive behavioural therapy lists have been waiting for at least three months, if not more. Given a cohort of terminally ill patients, three months can be too long to wait. It’s important to note that these drugs aren’t solo wonder cures for anxiety and depression – the treatment regimens involve several sessions of specific talking therapy, with the psychedelics acting as adjuncts.
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So, what’s the use of discussing this if we’re never going to see it materialise?
Currently, there aren’t any specific drugs we use to treat existential distress experienced by dying people, but sparking conversations like this one could potentially allow us to re-evaluate how we look after our dying patients, by promoting a psychosocial approach to their care.
It is of utmost importance to note that these clinical benefits in this group of patients have only been observed in a tightly controlled medical setting, albeit in more relaxing hospital rooms specifically designed for this purpose. There is no definitive scientific evidence that self-medicating with psychedelic drugs has any clinical benefit.
However, in the UK today, should a terminally ill person choose to do so, they could face up to 7 years in prison.
Whilst we may not see these treatments employed on a large-scale in the NHS, it’s possible to hypothesise that a significant increase in public interest and support into psychedelic therapies would shift public perception away from stigmatisation of drug use, and allow for more support of science-backed policy reform, in the interest of harm reduction.
In Canada in 2021, exemptions to bans were granted to allow for the use of psilocybin as a medicine for mental health conditions, which has led to the decriminalisation of all drugs in the province of British Columbia.
If the public are made of aware of the medical applications of psychedelic drugs, much like we have seen recently with cannabis prescriptions in the UK, perhaps we will move away from outdated attitudes toward users of all drugs and allow for some sort of positive reform.
We need more conversations to establish further public understanding of science-backed information around drugs, to enact desperately needed policy modernisation.
Sam Moore is a graduate entry medical student at Swansea University, having completed his undergraduate in applied medical sciences. His final year project investigated the efficacy of serotonergic hallucinogens on anxiety and depression associated with the diagnosis of a life threatening disease. Sam has a special interest in psychopharmacology, and is a member of the Swansea University Psychedelics in medicine society.