The Hallucinogenic Way of Dying

Almost as soon as Dr. Charles Grob secured approval to study the effects of psilocybin on Stage IV cancer patients, he faced another challenge, one nearly as formidable: recruiting 12 participants. Unlike so many other experiments in radical cancer treatment, Grob's does not offer a cure; he merely hopes to find that psilocybin, the most potent of the many compounds in psychedelic mushrooms, ameliorates a dying person's fear of death. The study targets patients relegated to "palliative" treatment, people with metastatic cancer for whom there is no reasonable hope for remission. It is a segment of the population, says the National Cancer Policy Board of the Institute of Medicine -- which put out a call in 2001 for "novel" approaches to palliative treatment -- largely ignored by medical science.

In this case, however, it has not been ignored by the Food and Drug Administration (FDA), which holds Grob's study to the same stringent requirements it applies to any study of any new drug. Participants in the study must have cancer of sufficient severity, but they must also be free of most other medical problems: high blood pressure, anemia, heart disease or liver dysfunction, brain tumors or metastases to the brain, kidney disease. In other words, says Grob's research nurse, Marycie Hagerty, "We're basically looking for healthy dying people."

Psilocybin is relatively safe -- significantly safer, in fact, than the drug Grob had initially sought to use for the study, MDMA (otherwise known as Ecstasy); according to most research, you'd have to ingest your own body weight in "magic mushrooms" to poison yourself. But it's still a Schedule I drug, regarded by the federal authorities as having a high potential for abuse and no medical application. "I had to get the FDA, the DEA, the IRB, the California Research Advisory Panel and our research committee here [at Harbor-UCLA] onboard," says Grob, who heads up the child-psychiatry division at Harbor-UCLA Medical Center. "Along the way, the criteria we had written initially got modified and tightened." For instance, where Grob and Hagerty had specified a systolic blood-pressure reading of 160 or lower, "after a great deal of discussion with the research committee here, we lowered it to 140. We're going to lose people with that."

According to Dr. Charles Schuster, a former director of the National Institute of Drug Abuse, now head of Wayne State University's Substance Abuse Clinical Research Division, the federal government sometimes objects to such studies out of concern not only for the patients but for the overall mood of the country. "If psilocybin is shown to have some medical value," he says, "that might weaken the government's argument against it as a drug of abuse. I understand their concerns and share them, but if psilocybin or MDMA or any of these agents were to prove to have a unique therapeutic value for something we can't treat well currently, ethically we have a responsibility to pursue them." (Cocaine, he notes, is used in hundreds of thousands of nasal surgeries every year.)

Grob hopes to find that, in addition to reducing psychological distress associated with impending death, psilocybin is the rare substance that can safely reduce a cancer sufferer's need for pain medication -- not because it blunts pain, as morphine does, but because it "changes one's perception of pain." He abandoned MDMA for mostly political reasons, after now-debunked research by George Ricaurte of Johns Hopkins University claimed one-time use of the drug could cause permanent brain damage. But he thinks psilocybin is better, anyway: "I was concerned about the possibility of cardiac arrhythmia associated with MDMA," he says. "And psilocybin might open up a deeper spiritual dimension for some people."