SCIENCE OF PAIN

Could LSD Be the Right Prescription for the Terminally Ill?

Opiates are the drugs of choice in battling pain in the terminally ill, but opiates render such patients dull and unresponsive. Hallucinogens could well offer a better path.

The ’60s was the golden age of LSD research. The U.S. government subsidized at least 116 experiments (that we know of) over this interval to unlock its secrets. Dr. Stanislav Grof, one of the early experimenters, described LSD as a “non-specific amplifier of the unconscious,” for both good and bad. The suggestion was that LSD might be a primary modulator of the unconscious mind, and unlocking its mysteries would answer the questions of who we are, why we are here, and what’s to become of us. Big questions indeed. Maybe too big to be left to scientists?

As hard as you may try, you can’t keep something this big locked up in the lab. These molecules escaped from the ivory tower and started a (relatively) bloodless revolution within America, especially among young people, who were disillusioned with the U.S. government, and the handling of the Vietnam War and the civil rights movement. Psychedelics were all the rage in the late ’60s throughout the country. College campuses were the testing ground for this social experiment, and some still are.

Who on this earth is in greatest need of happiness, or at least the alleviation of the severest form of dysphoria or distress? Terminal cancer patients, that’s who. Standard hospice care provides such patients with opiates like hydromorphone (Dilaudid), which, while alleviating pain, dope them up to the point where they can’t and don’t care, and can’t even respond: they can’t tell their doctors that they are scared, or their loved ones that they love them. And of course these opiates are highly addictive. You could argue: Who cares about addiction if you’re already dying? Both of my parents died in hospice care, both doped up on opiates at the end. I couldn’t tell them I loved them, and they couldn’t communicate back. Prescribing opiates is more humane than letting patients suffer but nonetheless not an optimal way to depart this world. We all deserve a better exit than that, at peace with our own imminent mortality.

Using LSD as the hallucinogen, Peter Gasser in Switzerland showed that 12 cancer patients also showed short- and long-term benefit.

In a study that took a full decade to complete, and with the approval of the FDA, NIH, DEA, and a host of institutional review boards, Charles Grob at Harbor-UCLA Medical Center assessed the use of psilocybin (the compound in “magic mushrooms”) as a stand-alone treatment for the reactive anxiety and depression that attends death due to terminal cancer. In an initial study, 12 individuals with a life-threatening cancer diagnosis participated in a double-blind randomized crossover fashion (neither the subject nor the physician knew which treatment was being administered) with either psilocybin or niacin (Vitamin B3), which results in a tingling sensation and acted as the placebo control. Furthermore, every subject was prepared by a licensed psychologist beforehand to minimize the possibility of any side effects or a bad trip. Each had their own personalized metaphysical tour guide, who remained with them through the session. They optimized the set and the setting by providing a pleasing and comfortable environment. These clinical research studies were carefully performed and documented, and above reproach. The results were quite remarkable. Feelings of “oceanic boundlessness” and “visionary restructuralization” were followed by positive mood and reduction in depressive scores, which persisted up to six months after the psilocybin treatment ended.

Several follow-up studies are now being conducted. Stephen Ross at NYU School of Medicine randomized 29 participants with cancer in a double-blind fashion to receive either psilocybin or niacin. Again, reductions in long-term anxiety and depression were observed, and with long-lasting effects still measurable six months after hallucinogen exposure; and again the benefit correlated with the extent of the “mystical experience.” Using LSD as the hallucinogen, Peter Gasser in Switzerland showed that 12 cancer patients also showed short- and long-term benefit, and with no persistent side effects beyond the day of the study itself. Further studies have corroborated these beneficial effects up to 14 months out.

These studies provide yet another line of reasoning to support the assertion that our brains are being hacked—that our emotions are just the inward expression of biochemical processes in the brain. In the case of hallucinogens, signaling of the serotonin-1a receptor drives contentment, whereas signaling of the serotonin-2a receptor drives the mystical experience. In our modern society, the role of mind-altering drugs to achieve heightened consciousness and/or contentment has yet to be determined, and will require careful scientific investigation in controlled settings along with philosophical and ethical debate before the public can be trusted with the key to nirvana.

We are our biochemistry, whether we like it or not. And our biochemistry can be manipulated. Sometimes naturally and sometimes artificially. Sometimes by ourselves but sometimes by others. Sometimes for good and sometimes for ill.

Reprinted from The Hacking of the American Mind by arrangement with Avery Books, a member of Penguin Group (USA) LLC, A Penguin Random House Company. Copyright © 2017, Dr. Robert Lustig.