Barry Blechman, 81, an international relations analyst with metastatic bladder cancer, traveled last winter from his home in Washington, D.C., to a clinic in Bend, Ore., where he drank a tea containing psilocybin, the psychoactive component of magic mushrooms. He then stretched out on the floor and closed his eyes.
When he phoned his wife, Kitty, 10 hours later, she was startled by the levity in his voice. “He sounded 20 years younger, like a weight had been lifted off him,” she said.
In the months since, the angst and depression triggered by his cancer diagnosis no longer hound him, Mr. Blechman said, and he has gained profound insights into aspects of his personality he believes negatively affected his relationships.
“Psilocybin therapy has been a life-changing experience,” he said.
Mr. Blechman is among the thousands of Americans with serious medical conditions who have turned to psychedelic medicine to address the anxiety and existential distress that often accompany a potentially terminal diagnosis.
Those who can afford the $2,000 treatments have been flocking to psilocybin clinics in Oregon, the only state besides Colorado where they can legally operate. (Colorado’s psilocybin program begins in 2025.) Many more have been trying ketamine in their therapist’s office or at home.
Although not a classic psychedelic like LSD and psilocybin, ketamine, a powerful anesthetic, is widely considered a psychedelic therapy because of its effects. It can be legally prescribed “off label” for psychiatric conditions, and it is far less expensive than psilocybin therapy.
Though still in its infancy, the field of psychedelic-assisted palliative care has been exploding in recent years, its rise mirroring the overall growth in psychedelic medicine that has been offering new approaches to the treatment of some psychiatric conditions.
Dr. Michael Fratkin, a palliative care specialist in California, said many of the patients he treated with ketamine experienced a marked relief from fear, anxiety and even physical pain.
“I’ve been blown away,” said Dr. Fratkin, a board member of the Institute for Rural Psychedelic Care. “It provides an alternative perspective of the end-of-life experience they are having.”
There are not many ways to quantify the field’s rise, but when Dr. Fratkin recently created an online group focused on psychedelics in palliative care, it drew more than 800 providers.
For the first time since the 1970s, when the war on drugs effectively shut down the nascent field of psychedelic research, federal research agencies have begun funding studies that examine the use of psilocybin for alcoholism, smoking cessation and end-of-life emotional distress. Earlier this month the U.S. Department of Veterans Affairs announced it would begin funding research into MDMA-assisted therapy for post-traumatic stress disorder, and the Food and Drug Administration is evaluating nearly two dozen applications for psilocybin with early promise in treating depression, anorexia and alcohol-use disorder.
Many in the field remain undaunted by the agency’s rejection last summer of MDMA-assisted therapy for PTSD, the first psychedelic compound to reach regulators. In declining to approve the application, the F.D.A. cited inadequate data and requested an additional round of clinical trials.
Most studies on psychedelics in palliative care have been small, but the results suggest that the treatments can have lasting benefits. A study last year in the journal Cancer found that 80 percent of patients who took a single dose of psilocybin had a sustained, positive response, and that 50 percent reported full remission in depressive symptoms two months later. A 2020 study in the journal Psychopharmacology found similar results for patients more than four years after their initial treatment.
Although experts in the field are generally bullish on the efficacy of psychedelic therapy for palliative care, they acknowledge the need for larger and more rigorous studies. Some note a challenge inherent to research on psychoactive compounds: how to conduct randomized, double-blind studies, the gold standard for clinical trials, when most patients can accurately guess whether they were given the drug or a placebo.
Much of the recent boom in palliative psychedelic care has been fueled by anecdotal accounts shared among care providers. Diane Hendel, a family nurse practitioner in Virginia with a geriatric medical practice, said her interest had been born of frustration. Antidepressants and anti-anxiety medications, the go-to interventions for end-of-life distress, tend to leave patients dazed and disconnected, she said. “I don’t want to sedate people so they’re like zombies.”
When she began administering ketamine to patients two years ago, she was startled by the results. Those on the precipice of death reported relief from sadness and fear.
Her palliative care work is now almost entirely focused on ketamine.
She cited the case of Elvia Gordon, an 88-year-old retired municipal worker from New York grappling with several health issues: lung cancer, diabetes, arthritis and crushing bouts of depression.
In interviews last spring, Ms. Gordon said the oral ketamine treatments had given her the energy to get out of bed, and had altered her outlook on living with a terminal illness. After each session, she asked Ms. Hendel to play “Gracias a la Vida,” the Mercedes Sosa classic that seemed to encapsulate her newfound appreciation for life.
“I know I’m going to die but now I’m not afraid,” she said.
Her projects last summer included mastering mail-kit recipes so she could maintain the culinary affections of her 15-year-old granddaughter, Caroline.
Sometimes she and family were taken aback by the moments of lightheartedness.
Ms. Gordon had savored a recent kitchen interaction with Caroline, who had erupted with joy upon hearing her grandmother break into song. “Grandma, I never heard you sing,” Ms. Gordon recalled her saying.
She died at home in early August surrounded by family.
Researchers are still trying to understand how psychedelics help alleviate existential distress, but the mode of action is likely similar to their effects on psychiatric conditions characterized by circular, pessimistic thinking.
The neuroplasticity, or rewiring of the brain psychedelics induce, allows patients to see their lives and struggles from a fresh perspective.
Unlike psilocybin, which appears to have lasting benefits after a single dosing session, ketamine has less durable effects, leading some patients to undergo repeated sessions.
Because the therapies are still so new and largely unregulated, practitioners are sometimes unsure about the ideal dose for, say, a patient weakened by chemotherapy. “The lack of standardization can be challenging,” Ms. Hendel said.
Most psychedelics are well tolerated by the body and have a low potential for abuse, but ketamine can be addictive, especially among those with a history of substance use disorder. Even if such risks are less of a concern among those with a terminal diagnosis, they gained prominence after the death last year of the actor Matthew Perry, who was found face down in his hot tub after taking anesthesia-levels of ketamine.
Because the doctor treating him for depression and anxiety had refused to increase his dosage, Mr. Perry had obtained ketamine from unscrupulous providers, according to law enforcement officials, who said that the amount of ketamine in the actor’s system suggested a dose nearly 20 times greater than is ordinarily used to treat depression.
The science on psychedelic medicine is still in its infancy, but researchers have been building on a large body of work from the mid-20th century, long before the drugs were banned and stigmatized. Those studies included thousands of participants who received LSD for alcohol addiction or end-of-life anxiety. Although the studies were non-blinded, meaning participants and practitioners knew they were receiving the drug, the results caught the eye of Dr. Stephen Ross, an addiction psychiatrist at NYU Langone Health, when he was doing his residency.
“I was shocked because it was a huge part of psychiatry hidden in plain sight,” he said. “It taught me something I had not learned in my medical training, which was to help people have a good death. In medicine, we’re trained to fight disease and never give up.”
Dr. Ross went on to start a psychedelic research group at N.Y.U. and he has been largely focused on replicating and refining those earlier studies with larger numbers of patients, including a study with 40 patients funded by the National Cancer Institute — a first.
Dr. Yvan Beaussant, a palliative care specialist at Dana-Farber Cancer Institute, has been examining the drugs’ ability to reduce physical pain, and he has been collaborating with the company Sunstone Therapies on ways to make psychedelic treatments more accessible, given the high costs and the challenges of treating patients who may be too frail to travel to a clinic. Another study he is working on with Sunstone explores whether MDMA-assisted therapy for patients and their loved ones can reduce the stress that a cancer diagnosis often has on a patient’s family.
Psychedelic-assisted therapy, he warned, is not for everyone. The treatments require hard work and a willingness to confront potentially uncomfortable emotions and trauma.
“These are not miracle drugs that will take away our suffering but they can change the way we relate to it,” Dr. Beaussant said, emphasizing the importance of the talk-therapy component. “These sessions often delve into deeper aspects of patients’ lives, beyond their cancer. It’s an opportunity to slow down, engage in self-reflection, and sometimes begin the journey toward self-compassion and healing.”
After a lifetime as a self-described overachiever and impatient taskmaster, Mr. Blechman, a founder of the Stimson Center, a foreign affairs research institute, has been surprised by the insights gained from his psilocybin session. The biggest reveal? Seeing with unmistakable clarity the relationship between his unrelenting drive and his working-class parents, who seldom expressed satisfaction with his accomplishments.
“They taught me you can’t celebrate good things because, kinahora, it will bring bad luck,” he said, using the Yiddish expression of superstitious belief aimed at warding off the evil eye. “I never enjoyed my accomplishments.”
He also came to understand his simmering anger — a botched cancer procedure in the 1980s that left him physically impaired.
After 40 years in remission, the cancer returned during the pandemic.
To prepare for his psilocybin session, Mr. Blechman attended four video appointments with Betty Warden, a clinical social worker in Bend, Ore., and a state-certified psilocybin facilitator. She explained how the session would unfold, and the two discussed Mr. Blechman’s intentions and expectations.
The vivid and fantastical visions that came after he drank the psilocybin brew included ominous clouds, an angry confrontation with the surgeon he blames for his disfigurement and a convulsive moment of grief for the sister whose death two years earlier he had never truly mourned.
Ms. Warden was at his side the entire time, squeezing his hand when the terror felt overwhelming and reminding him he was safe. “She encouraged me to look at the things that scared me,” Mr. Blechman said.
After two decades as a therapist but just two years as a psilocybin facilitator, Ms. Warden has been awed by the benefits that psychedelic therapy has brought to her patients. At the same time, she is left wondering how the treatment works. “It’s hard for me to wrap my head around how a person who is agoraphobic and hasn’t left their home for weeks can do a single psilocybin session and the following day go to the grocery store without problem and feel an intense sense of relief,” she said.
Mr. Blechman, too, feels wonder-struck. He no longer loses his temper over trivial matters, and he revels in a newfound ability to find joy in small moments of beauty.
His daughter Jenny Blechman, a palliative care doctor in Oregon who encouraged her father to try psilocybin therapy, has also been thrilled. “He has a sense of peace about him now,” she said.
Over the summer, with his cancer in remission and his mood buoyed, he embarked on a whirlwind of travel — London, the Paris Olympics and Alaska.
By August, as the appointment for a key imaging scan approached, the anxiety returned. “I’m no longer walking on water,” he said.
A few days later, Mr. Blechman was back in Oregon for another psilocybin session. This time, the experience wasn’t as positive. At the onset, he found himself trapped in a dark cavern menaced by IV tubes and other medical equipment. Then he grasped Ms. Warden’s hand and clambered toward the light. “It was really unpleasant,” he recalled afterward. “If I had this experience the first time, I don’t think I would have done psilocybin again.”
Then he got the results of the scans: His cancer was still in remission.
Since then, the elation he felt after his first session has returned. He has been making plans for trips to Chile and South Africa; occasionally he indulges in snatches of optimism, imagining himself living into his 90s.
But mostly he feels a sense of calm, something that eluded him for so long.
“I understand death in a more positive way,” he said. “I’m less fearful of it. Yeah, it’s going to happen, but until then, I’m going to have a heck of a good time.”
