Dying is a Trip

My fathers’ last six months were greatly eased by marijuana – a mild psychedelic. It enabled him to get off OxyContin (a narcotic) and refocused his pain into curiosity about his current life. When he died several years ago I was beginning my postgraduate year of study on psychedelics at CIIS (California Institute of Integral Studies). My focus was “Can Psychedelics help with a better approach to dying?” Can they soften the anxiety? Ease the fear and help us see “death” less as an enemy?

I know the battle cry of fighting death. My 35 years as a Family Physician gave me an inside look. In the hospital “don’t let them die on your watch“ was a recurrent theme. For doctors, death is often “a failure,”talked about in meetings as “what did you do wrong?”  And certainly don’t mention hospice or dying, you might hasten it, or be perceived as giving up.

Indeed, fighting dying has become a battle cry of the “medical industrial complex” – fueled by Pharma, Hospitals and our collective denial. Physicians are the appointed warriors. New expensive drugs, fancy surgeries, and more to offer you – the consumer. All at considerable, but hidden cost. Half of our medical budget is consumed in the last six months of people’s lives. Sadly, our bodies often become the battlefield, and it doesn’t go well.

Death in Person

The average American sees thousands of deaths on television, yet, rarely one in person. To challenge that, a wonderful movie, “The Last Ecstatic Days“ chronicles the last two weeks of a man’s life. Ethan, 36, aka  E3, (where one of the E’s is “ecstatic”), brings his family and community together as he “live streams” his death. After fighting brain cancer for several years, he’s been told there’s nothing left to do. He signs out of hospice – goes to a friend’s home, stops eating and drinking, and films it all. It’s an honest, moving and beautiful story – of dying well.

Ethan experimented with psychedelic medicines. How exactly those plants and fungi helped him isn’t made clear in the movie. And maybe he just had that open accepting loving attitude all on his own? Or maybe he was onto something? Studies from Tony Bossis PhD, at New York University’s Langone Medical Center, and Bill Richards PhD at Johns Hopkins, demonstrated significant reductions in end-of-life anxiety through the use of psilocybin assisted therapy. Dozens of clients found meaning, and came to be more accepting of their impending death.  

What came up might be uncomfortable. Tony says, “about a third of the time tough things do come up.” Those repressed fears and anxieties fuel existential dread. Bill suggests, “Help them go into the fear (aka the Monster). Dive into the monster’s mouth, and look out through its eyes.”  Shake, cry and purge. Sob. And sob some more. Then realize you still have today, and maybe tomorrow. People love you, and you have time to forgive yourself and others. Maybe now is a good time to start.

Set, Setting and a Guide

I spoke to a woman once, who told me of her recurring nightmare. Her whole family was lined up on a beach. A huge wave looms over them. She’d  awake in a panic, just before the wave hit. Then, on a mushroom-assisted journey, she was able to change the story. This time she called out to her family “run and dive into the wave,“ and they all did, emerging swimming and safe on the other side. The nightmares disappeared. Running from trauma can keep you in fear and anxiety. A good guide and good “INtention” can facilitate going “INward” and a good “INtegration” process afterward is key. Trust, safety and support (aka the Set and Setting) matter, So does the Settor (guide).

Often psychedelic journeys lead us to connection – to loved ones, to nature, to spirit, to Holy Ghost and to the Universe. In Judaism, representations of G-d include “the unknowable,” “the everything,” and “the breath giver.” So too, in our final breath, (which the movie chronicles for Ethan), we return to the universe and  the great beyond. One fable asks, Why should I care about the afterworld? If I die, and it’s amazing, well that’s great. And if I die, and there’s nothing there, well, then I won’t be there to worry about it. Psychedelics help us face these quandaries rather than repress and bury them.

Remember the “war on cancer?”  New chemotherapy agents can exceed $30,000 a month. Miracles? Poisons? Both? Too often we’re buying little quantity and questionable quality.  Most of these costs are borne by insurance or Medicare, (or cause bankruptcy –  but that’s another story). The system makes money keeping people alive – even if they don’t want to be. 

While 3/4 of people want to die at home, only 1/4 do. Most people want family around them. Palliative Care services are helping with goal setting, but they are late in the game. Much like hospice – it’s “giving up.” We’re fighters, remember?  

Well-Supported Psychedelic Assisted Therapy

What isn’t offered, and in my humble opinion should be, are options for a well-supported Psychedelic Assisted Therapy (PAT). Maybe at the time of a serious diagnosis? Or as was done in Greece, upon turning 60? Cannabis and psilocybin have been studied. Ketamine also shows promise. It is a synthetic (aka not naturally occurring) which decouples your head (thoughts) from your body, allowing somatic fear to be taken off-line as you look at the situation. 

Two other hopeful substances I’d add are LSD and MDMA. LSD  comes from a mold, clavicep purpera, which grows on rye. It has been used for 4,000 years, in various Greek rituals. Many studies in the 1960s found great promise for LSD and psilocybin around the end of life – before the war on drugs banned them.

Another promising chemical, recently in the news, is MDMA, (see Lucid News Phil Wolfson July 17, 2024). It isn’t a psychedelic, instead, it helps open the heart as an empathogen. It’s a way to bring in the lost, scared, isolated parts of all of us and connect them. Some therapeutic approaches are exploring how different psychedelics might work effectively together.  Coupling MDMA with therapy and psilocybin….well things could get very interesting.  And what’s the worst that could happen? You’re dying, right?

If what we really want is to connect and to be understood, what better way to do it then through psychedelics? For thousands of years psilocybin was used in Mexico, ayahuasca in South America, cannabis in the Middle East, and claviceps purpera in the Greek empire. We don’t know exactly what transpired, but I’m sure dying, death and meaning were certainly in the conversation.

Psychedelics may offer us a glimmer of what lies beyond. Descriptions of trips include, “oceanic boundlessness,” “loss of ego” and “merging with the infinite.” If people were offered a week of psychedelic psychotherapy after a brain cancer diagnosis, would that be an ok option? I recently had a physician colleague diagnosed with a glioblastoma – upon hearing the diagnosis he responded, “take me home.” He knew the industry offerings all too well. He died comfortably at home several months later.

I do believe in options for people when they’re facing difficult choices. And I don’t mean only Chemo, Radiation or Surgery. Times are changing, minds are opening. Opportunities to use psychedelics therapeutically are becoming more common. Michael Pollan, in his book and Netflix series, “How to Change your Mind,” addresses this wonderfully. Mushrooms are decriminalized in Oregon, Colorado, and Oakland. Cannabis is legal in 36 states. Ketamine is an ordinary part of the medical armamentarium in all 50 states.

My father only did THC (cannabis) during his final year. He’d use his vape pen, once in the morning, one puff at lunch, and a last one after dinner. I offered him other substances, but he said, “I’m so happy now, why would I want anything else?” He died at midday, his granddaughter noted, “at high noon,” and he died happy.

We are gratefully having more discussions around death. It doesn’t have to be so frightening.  It can happen at home, surrounded by loved ones. Embracing the unknown, going into the monster’s mouth and looking out through its eyes is never easy. Psychedelics are not for everyone. I, for one, am ecstatic that psychedelics are an option as we face our mortality.