Early Research Suggests Hallucinogenic Drug Psilocybin May Ease Patient Distress

Anthony Bossis, PhD

Anthony Bossis, PhD

Findings of research published in a special issue of the Journal of Psychopharmacology suggest that the hallucinogenic drug psilocybin, a compound found in psychedelic mushrooms, may help to lessen anxiety and depression in patients with cancer, with this early-phase study showing that the agent was able to relieve cancer-related distress for up to 6 months in approximately 80% of participants when combined with psychological counseling.¹

Twenty-nine patients, aged 22 to75 years and receiving treatment at NYU Langone’s Perlmutter Cancer Center, were randomly assigned to a single dose of either 0.3 mg/kg psilocybin or 250 mg niacin, a vitamin placebo. Halfway through the trial, each arm’s participants were switched to the other protocol.

The study was double-blinded with the intention that neither clinicians nor patients knew which agent was being used. All patients were also provided with counseling from a psychiatrist, psychologist, nurse, or social worker and were monitored for side effects and improvements in their mental state.

Patients who received psilocybin first experienced immediate and enduring anxiolytic and antidepressant response rates, the investigators reported. Those in the niacin-first group had no significant within-group reductions prior to crossover to the experimental arm.

Anthony Bossis, PhD, a clinical assistant professor of psychiatry at NYU Langone, said in a statement that patients in the experimental arm also reported post-psilocybin improvements in their quality of life, such as going out more, greater energy, getting along better with family members, and doing well at work.

He cautioned, however, that patients should not consume psilocybin on their own or without supervision by a physician and a trained counselor. Additionally, “psilocybin therapy may not work for everyone, and some groups, such as people with schizophrenia, as well as adolescents, should not be treated with it.”

For a perspective on the study, Oncology Nursing News spoke with Mark Lazenby, PhD, APRN, FAPOS. Lazenby, an associate professor at Yale School of Nursing and expert on psychosocial and end-of-life care for patients with cancer. Lazenby raised some concern about the methodology of the trial, which he was not involved with, and the selection bias of the patients who participated.

Tumor types were variable, and included breast, gynecologic, digestive, and blood cancers. While 18 of the 29 patients were Stage III or Stage IV, there isn’t enough information for Lazenby to feel comfortable with this patient population. Different cancer types at different stages can result in different prognoses. “I don’t know the possibility of cure of their patients and the treatment history,” Lazenby said. “Without knowing prognosis, it’s pretty tough.”

Lazenby also suggested that scores on the Hospital Anxiety and Depression Scale (HADS) of the acutely depressed and anxious patients with cancer would be “a lot higher than the baseline HADS that they had in this study,” for example, a patient with stage IV ovarian cancer or stage IV prostate cancer. “Stage IV ovarian patients are really anxious that they’re dying soon,” he said. “Stage IV prostate, they’re in misery.”

Another question is how long it had been for these patients since their cancer diagnosis. “The longer a person has been living with cancer, the more they integrate living with cancer into their lives,” Lazenby pointed out. At the time of diagnosis, anxiety is at its highest.

Lazenby also noted that 55% of the patients in this trial had prior experience with hallucinogenic drugs. Since so many patients knew the agent, “these weren’t double-blinded. The people knew they were taking a hallucinogen … The patients knew, at some point, they were going to get mushrooms, and I’m assuming, after you took the niacin, you’d know pretty well it was niacin.”

Another issue he raised relates to the choice of placebo. “I wondered why they went to niacin,” Lazenby said. “Why didn’t they do an anxiolytic, why didn’t they do a benzodiazepine?” The researchers’ reasoning for niacin is that the vitamin mimics the rush of hallucinogenic drugs. Lazenby was not convinced, explaining that niacin is a vasodilator and the opening of capillaries often results in hot flashes, but not an experience that would resemble a hallucinogenic drug.

The conclusion that psilocybin itself relieved distress was also a concern. “They’re not testing just an agent,” Lazenby pointed out. “They’re testing an agent plus some sort of psychotherapy. So, what’s working? Can we really say it’s the agent?”

For patients who have a higher burden of disease and poor prognosis who are not benefiting from standard depression treatment, Lazenby suggested: “We’ve been using ketamine. And it’s working … We have non-hallucinogenic treatments that have shown to have as good an effect as this.”

The NYU Langone—led study was published along with a similar study from Johns Hopkins.²

• Ross S, Bossis A, Guss J, et al. Rapid and sustained symptom reduction following psilocybin treatment for anxiety and depression in patients with life-threatening cancer: a randomized controlled trial. J Psychopharmacol. 2016;30(12):1165-1180.
• Griffiths RR, Johnson MW, Carducci MA, et al. Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: a randomized, double-blind trial. J Psychopharmacol. 2016;30(12):1181-1197.