A mild mannered, bespectacled professor, Dr. Charles S. Grob has been quietly pushing the envelope of psychedelic psychiatry and scholarship for decades.
A Lundquist Institute investigator and Professor of Psychiatry and Bio-Behavioral Sciences at the UCLA School of Medicine, Grob is also the Director of the Division of Child and Adolescent Psychiatry at Harbor-UCLA Medical Center.
Risking his own reputation in the medical community to conduct research that was at one time considered taboo, Grob carried forward the promising studies of the 1960’s and 1970’s which suggested that psychedelic substances had the potential to reduce the pain and anxiety of people approaching death.
Working in a modest office on the grounds of a county hospital in Los Angeles where he runs a mental health clinic for children and adolescents, Grob stepped up to continue meticulous clinical investigations to study the safety and feasibility of psychedelic medications.
Grob and his colleagues at the Harbor-UCLA Medical Center conducted pioneering research into the use of psilocybin as a mental health treatment for terminally ill cancer patients. Published in 2011 in the Archives of General Psychiatry, their Pilot Study of Psilocybin Treatment for Anxiety in Patients With Advanced-Stage Cancer was the first to show that psilocybin had a dramatic effect on the existential distress of people nearing death, improving their quality of life and offering psychospiritual epiphanies.
This early pilot study pointed the way for two following groundbreaking clinical trials published in 2016 that showed the promise of psychedelics to relieve emotional suffering at the end of life.
One set of clinical trials was led by Anthony P. Bossis, PhD, Clinical Assistant Professor of Psychiatry at New York University School of Medicine, and his fellow researchers at New York University. The second was carried out by Dr. Roland Griffiths and a team of researchers at Johns Hopkins University. Both investigations showed that psilocybin reduced anxiety and depression for patients with terminal cancer.
Grob is now practicing telemedicine due to the Covid-19 pandemic, but he and his fellow investigators continue the quest for a deeper understanding of how psychedelics can support people at the end of life.
The Lundquist Institute for Biomedical Innovation announced last month that Grob and Bossis will lead a new multi-site clinical trial to study the effectiveness and safety of psilocybin to treat terminally ill people with psychological distress.
The new clinical trial will be funded by an anonymous $1.75 million donation to The Lundquist Institute. The funds will also be used to develop education and outreach programs on the use of psilocybin for palliative care, a medical specialty that focuses on relieving suffering and improving the quality of life for people with a serious illness.
The Lundquist Institute study will be the first to investigate a psychedelic substance for palliative care and the first to conduct new clinical trials to move the findings of the 2016 trials forward. This research comes at a critical time as a wave of emerging companies and organizations are investigating the use of psychedelics for mental health treatments.
“We don’t die well in America and have few approaches to relieve end-of-life emotional suffering,” says Bossis in a statement from The Lundquist Institute. “Clinical research has demonstrated that psychedelic-generated mystical experience dramatically reduces depression, anxiety, and demoralization in end-of-life existential distress and can improve quality of life and a sense of personal meaning.”
Founded in 1952, the Torrance-CA-based nonprofit Lundquist Institute, supports more than 120 principal investigators working on over 1,000 research studies. The Lundquist Institute created the training for and coined the term “paramedics,” developed human growth hormone, and was involved in the early development of the profession of Nurse Practitioner. It is academically affiliated with the David Geffen School of Medicine at UCLA and works in partnership with the Harbor-UCLA Medical Center.
The editor of two influential books on psychedelics, Hallucinogens: A Reader and Higher Wisdom: Eminent Elders Explore the Continuing Impact of Psychedelics, Grob and co-editor Jim Grigsby will release in February 2021 the Handbook of Medical Hallucinogens, the first formal academic textbook on the topic of hallucinogens and psychedelics.
Grob spoke with Lucid News to reflect on The Lundquist Institute study and the history of research into the use of psychedelic substances for treating the mental health needs of people with terminal illness.
A $1.75 anonymous donation is significant. Who donated the funds for this study?
Dr. Charles S. Grob: I am sworn to secrecy. My lips are sealed. I haven’t even told my wife or daughter.
What makes The Lundquist Institute research unique in the study of psychedelic substances?
What makes this study different from preceding studies is that it has broadened the patient population, it will take place in palliative care settings, and it will train practitioners. There has been a strong level of interest in investigating the palliative treatment model at national and international palliative care conferences. We will be training different palliative care practitioners including doctors, nurses, chaplins, social workers and psychologists.
What also makes this research different is that in the pioneering investigations with psychedelics in the 1960’s and in the modern era, we looked at individuals with advanced cancer. In this study, we are opening it up to people with many additional medical illnesses that might be fatal and who are already enrolled in palliative programs.
When will the study start and how will it be structured?
I think it will start early next spring. We need to still finalize our protocols and submit them to regulatory agencies and go through an Institutional Review Board (IRB) presentation next spring or next summer. It will be a double-bind placebo controlled study and we have budgeted for 60 subjects, but we have been advised to estimate about 80 subjects.
We are not advocating that people use psychedelics in the dying process. The study subjects must have an estimated life expectancy of six months and a palliative care diagnosis for an illness that could lead to a potentially fatal outcome. The study will take place at four to five different sites around the U.S. using the same methodology, the same entry criteria, and the same outcome measures. I would imagine five to six researchers at each site. I can’t confirm the sites at this time.
Another potential complication is this strange world we live in with Covid. How are we going to administer psychedelic treatment in the age of Covid-19? This is going to be challenging because we will be in relatively close proximity to study subjects for many hours. We could be in a small space. Society needs to be in a much healthier place to do this kind of study and go through all the hurdles. I’m sure we will work this out and other groups working with psychedelics will work this out.
Why is this study needed now?
The study of psychedelic substances has gone from a small field to expanding rapidly into something that at times feels over the top. I am concerned that proper attention to establishing safety parameters – and the importance of that in this context – may not be a priority for some investigators. It’s good to see enthusiasm for this research, but people implementing these studies need to prioritize the need for safety and established ethical standards. I have written a paper with other researchers on the need for strong ethical standards and safety parameters which we will publish this year.
Is this study historically significant?
Yes. This is the first study of this sort since the 1960s or early 1970s. In the 1960’s, this was one of the most promising areas for psychedelic-assisted treatment. In the early 1960’s, Dr. Eric Kast, a pain specialist at the Chicago Medical School, conducted research administering LSD to hospital patients in chronic pain and recorded positive effects in pain reduction, improved mood, outlook and quality of life with less fear of death. This research was followed up by Walter Pahnke, Stanislav Grof, and Bill Richards who did work in the late 1960’s and early 1970s finding dramatic effects with the improvement of anxiety and the reduction of pain.
They found that the strongest predictor of positive therapeutic outcome was, during the course of the session, the patient having a powerful psychospiritual epiphany. Humphry Osmond, in the late 1950’s, also found that this predicted the best outcomes while studying the use of psychedelics to treat people with alcohol dependency.
Why did this research stop moving forward after the initial studies in the 1960’s and 1970’s?
The psychedelic research in the 60s and 70s was not halted due lack of positive outcomes or the safety of the research. It was stopped for cultural and political reasons. It got conflated with the culture wars of the 60’s and was identified with a politically active counterculture. In the 60’s, the divisiveness became a cultural divide and psychedelics became a sacrament for the counterculture. You were on one side or the other side.
Some leaders like Timothy Leary, who was a brilliant researcher, also had a penchant for being very provocative and the compounds were eventually considered too hot to handle. There was no approved research in the U.S. from the early 1970s to the early 1990s, when our team conducted the first clinical study with MDMA. Our Phase 1 study of MDMA was also around the same time as Rick Strassman’s investigation of DMT and Deborah Mash’s study of ibogaine. These three studies were the first approved investigations of psychedelics since the late 1960s and early 1970s.
What has changed culturally that has allowed this research to continue now?
The Archives of General Psychiatry, which published our pilot study in 2011, accepts a miniscule number of papers. Why did they accept ours? They recognized that psychiatry needs new and novel and more effective treatment models and after decades of quiescence, the world we live in has changed and investigating psychedelics has once again become accepted and respected. Our values have changed and we have a more mature manner in which this research is recognized. In the 60’s it was brand new and it took the culture by surprise.
By the late 1990s and the early 2000’s, we had weathered the tempest and were in a more open and receptive phase. There was recognition that conventional treatments in psychiatry are sometimes helpful, but sometimes lacking in efficacy. As healers and scientists, it is important to objectively examine new and novel treatments for people who do not get substantial relief from conventional treatments.
What researchers most influenced your work with psychedelic substances?
We were the first to work with an advanced cancer population and we basically took Stanislav Grof’s work and investigations from that era and adapted it, modernizing the protocol and changing some of the criteria. But the inspiration came from the pioneering research of Grof and Walter Pahnke, Gary Fisher, Bill Richards and others.
Those who came before these investigators were the true experts and authorities on psychedelic plants. The indigenous people throughout the world knew the plant life in their geographic areas and used these plants for healing and divination and spiritual purposes. I would like to credit not only the prior generation of investigators, but the indigenous people who have been historically mistreated. They kept the tradition of plant hallucinogens alive and concealed them from the Spanish and Portugese invaders.
What has most influenced your thinking about the dying process?
My views began forming early. Before I pursued my training in psychiatry and internal medicine, I grew up in a household where my father was a prominent internist. I grew up in that medical world and observed with patients and family members that the dying process is often associated with very severe psychological pain, isolation, alienation and existential distress.
I encountered Grof’s work in the early 1970s and his case reports of working with individuals not just undergoing physical suffering, but also psychological and psychospiritual pain and anguish. I would look at patients on medical floors and say, “there has got to be a better way.”
Aldous Huxley also had a beautiful image in his novel Island of how these compounds might help the passage from life to death. Grof’s work was very encouraging. I took his message to heart as I got my credentials and training and waited for a time to again do feasible human research with compounds that had been taboo for a long time.
What role do you see psychedelics playing in the future of palliative care?
We can see how they could endow palliatieve practitioners with additional tools. We developed our study with Dr. Ira Byock, a former director of palliative medicine at Dartmouth-Hitchcock Medical Center. He is a palliative care practitioner who really made a significant contribution to the evolution of Tony’s [Bossis] and my thinking on that issue. He helped us to embark on this study.
What else should we know about this study?
I’ve worked for 27 years with The Lundquist Institute and the Harbor-UCLA Medical Center. They have always been very collegial and supported research ideas that in some quarters were considered taboo. I explained our rationale and safety parameters and they heard me out. They knew I could be trusted to conduct the early MDMA and psilocybin research and take the data back to UCLA and Lundquist.
Although we have received a very generous grant for this study, it’s only half of what we think we will need in the bank to get this research off the ground. If a research program already has funding, it is easier for other funders to make generous donations. That is what we hope will happen here.
Top Image: Dr. Charles Grob, Stephie Grob, and Stanley Krippner