In 2012, two years after her first cancer treatment and tormented with anxiety over her cancer resurfacing, Bazer participated in a clinical trial at NYU Langone. She reclined on a couch in a room that looked more like a living room than a lab — a space complete with flowers, art, and coffee table books. She put on a sleep mask and headphones and pressed play on a preselected playlist of classical music. Then she swallowed a dose of psilocybin.
Psilocybin is the naturally occurring psychedelic compound found in so-called “magic mushrooms.” It is also an illegal Schedule 1 drug in the United States.
But scientists say it could one day be reclassified as medicine, able to transform the lives, and deaths, of hundreds of thousands of cancer patients. Studies suggest the compound, paired with psychotherapy, can be a fast-acting, long-lasting treatment for crushing mental health effects and existential dread.
The renewed interest in psilocybin is in part thanks to a renaissance in psychedelic research over the past two decades. That future has already begun in Canada, where, in August 2020, four terminally ill cancer patients won the “right to try” psilocybin-assisted therapy after pushing back against the country’s legal restrictions. The group’s victory offers a playbook for others to follow suit in the United States.
Stephen Ross is a psychiatrist and researcher at NYU Langone. He led one of the three randomized double-blind clinical trials — the gold standard of medical research — which found a single dose of psilocybin can help people with cancer-related psychological distress, leading to immediate and sustained improvements in anxiety and depression.
“It was very surprising and very moving to see somebody terminally ill with cancer feeling like their life is over, scared out of their mind, disconnected from family and friends and their spirituality, to suddenly just be out of that terrible place and feeling so much better,” Ross tells Inverse.
“To this day, it’s some of the most rewarding work I’ve been able to do.”
But it comes with limits. For now, psilocybin-assisted therapy is not something that people in the US can easily — or legally — access outside of a clinical trial. This hasn’t stopped individuals from requesting it, often hoping that a lab like Ross’s can help.
“I’ve had thousands of terminally ill cancer patients contact me since our publication in 2016 and it’s heartbreaking,” Ross says.
“It’s horrible to say ‘there’s nothing I can offer you right now.’ That is very disturbing to me.”
AN EXISTENTIAL CRISIS
Cancer, an insidious disease where abnormal cells divide uncontrollably and spread into surrounding tissue, is the world’ssecond leading cause of death. It kills almost 10 million people every year.
Cancer also jeopardizes mental health. About40 percent of people with cancer will experience anxiety or depression. Another 25 percent have existential distress — feeling like their life is meaningless, that they have no hope, or wish they could be dead already. These symptoms can lower their chances of survival and heighten the risk ofsuicide.
Matthew Johnson, a psychiatrist at Johns Hopkins University who co-authored a 2016 landmark psilocybin trial, says that while cancer-related psychological distress is devastating and common, it’s also poorly understood. Cancer-related distress is not in the DSM, the so-called “psychiatric Bible.” There’s a huge unmet clinical need, Johnson explains.
“The problem is it’s an existential crisis. It’s an issue of meaning; it’s an issue of the story of their life,” Johnson tells Inverse.
“It’s oftentimes a sense of betrayal from the universe, from God, or whatever their particular metaphysical orientation is.”
Few approved treatments help provide relief. Antidepressants and anti-anxiety medications often don’t work any better than placebo treatments for people with cancer in the throes of anxiety, depression, or existential dread, Johnson explains.
Michael Verbora is a physician who advocates for the Canadian group of patients who received access to psilocybin-assisted therapy. This group waited over 90 days for a response from Canada’s federal health minister who ultimately granted their request after public outcry. (None of these patients were available for an interview due to treatment schedules.)
That’s where psilocybin comes in.
To date, three randomized controlled trials and a longitudinal follow-up show that, contrary to its dangerous street reputation, psilocybin is extremely safe in clinical settings. And unlike conventional therapies, it appears to radically and immediately shift people’s orientation to cancer. It helps them overcome the fear of death and give some of “their life back,” researchers say.
In 2011, UCLA led the charge in reviving psilocybin as a potential mental health treatment for cancer patients with anxiety, depression, and existential dread. Twelve people with advanced cancer experienced long-term reductions in anxiety and depression after taking psilocybin. Still, the findings were limited due to the small sample size.
Five years later, Johns Hopkins researchers found that a high dose of psilocybin produced major decreases in depression and anxiety, along with increases in quality of life, life meaning, and optimism. Overall, study participants were less frightened of death.
That same year, in the 2016 NYU Langone study, 80 percent of participants no longer met criteria for depression related to cancer just one day after receiving a dose of psilocybin alongside psychotherapy. These effects lasted for close to five years after the initial dose.
“If you had to design a disorder that is going to be most optimally treated by psychedelic therapy, dealing with life-threatening cancer is right up there,” Johnson says.
“The thing that our patients often came to was that they weren’t engaging with life — but they still could. So much of the suffering was through their own creation.”
WHAT IT’S LIKE TO RECEIVE PSILOCYBIN-ASSISTED THERAPY?
In the 2016 NYU Langone trial, three out of four participants said psilocybin-assisted therapy was the singular or top five most spiritual and most meaningful experiences of their lives. One of these patients was Estalyn Walcoff. She had been diagnosed with a rare form of incurable lymphoma.
“The whole experience opened me in a way — I wish I could put it into words,” Walcoff tells Inverse.
“It was life-changing and one of the most beautiful experiences of my life.”
During her psychedelic experience, she was neither cognizant of her cancer, her fear, or, really, herself. She was connected to broad dimensions of suffering across humanity like slavery and environmental destruction. Since her treatment, Walcoff has carried this feeling of connectedness forward by embracing meditation and a deep spiritual practice.
“Even had I not survived the cancer diagnosis, the psilocybin dosing would’ve given me the courage and faith to know that, in some way, I would have ‘gone on,’” Walcoff says. “I didn’t know this before the dosing.”
Bazer’s experience, although the same to Walcoff’s in dose and setting, was quite different; initially rooted in what brought her there — her anxiety and fear.
“The psilocybin dose took effect very suddenly, and it was terrifying for me,” Bazer recalls.”I was really, really scared and I was thrown into an incomprehensible space.”
Bazer reached out to her therapists who took her hand and encouraged her to “just go with it.” So she did.
“I saw my fear as a big black lump in my abdomen under my rib cage. It was not the cancer — that’s not where the cancer was, to begin with. But it was the fear itself. And it infuriated me to see it. I was so angry, and I screamed, ‘Who do you think you are? Get the fuck out.'”
“Once I did that, it was gone,” Bazer says. “It just disappeared. And it has never come back.”
It’s been eight years and Bazer’s cancer-related anxiety never returned.