The therapeutic use of psychedelic drugs has attracted no shortage of media and scientific interest over recent years - and this is only likely to grow.
A growing number of studies suggest psychedelics such as MDMA, better known as ecstasy, and psilocybin, the active in ingredient in magic mushrooms, can help treat some mental health conditions. Regulators in Australia and New Zealand have also begun allowing limited medical use of these medicines.
Now, researchers are exploring whether psychedelic therapy - typically combining measured doses with psychological treatment in a controlled setting - might help patients as they approach end of life.
Even when receiving the best available treatments, some palliative care patients report severe psychological and existential distress.
Up to one third of cancer patients, for instance, report experiencing anxiety and depression. While antidepressants are commonly used, their benefits can be inconsistent and delayed, and often accompanied by unwelcome side effects.
It's here where psychedelic therapies offer a potentially promising alternative. Research into their use is advancing , with more high-quality studies being published each year.
But important questions remain about their safety, effectiveness and appropriate place in clinical practice.
Moreover, we need to know how palliative care doctors themselves feel about psychedelics. One US study found surveyed clinicians to be cautious but still interested in their potential - particularly in relieving existential distress.
To canvas views closer to home, we surveyed nearly 100 working members of the Australian and New Zealand Society of Palliative Medicine.
We found widespread support for further research in the space, but also a healthy degree of caution about how and when these therapies should be used.
What doctors told us
Among those we surveyed, around three quarters disagreed with the notion that psychedelics are unsafe and should not be used clinically.
Nearly nine in ten agreed their use in palliative care warrants further investigation. Younger doctors and those based in New Zealand were somewhat more likely to believe psychedelics could improve patient outcomes.
Unlike some previous studies, we found no meaningful difference in attitudes between genders. Interestingly, many doctors drew a distinction between medical and recreational use.
Half agreed psychedelics should remain illegal for recreational purposes, while a slight majority believed they show promise in the care of palliative patients. Notably, two thirds of respondents agreed they might improve outcomes when combined with psychotherapy .
Medically assisted dying is another option potentially available to palliative care patients in Australia and New Zealand. A total of 84% of doctors we asked were either neutral or agreed that psychedelic therapies could offer an alternative for some patients who might otherwise consider this pathway.
Delving deeper into doctors' views, we carried out 12 interviews that turned up several key takeaways.
In all, the doctors appeared open to new innovations and recognised the therapeutic potential of psychedelics. But they also emphasised the importance of safety, patient-centred care and equity of access to treatments.
The case for more research
Just as with those US findings, our research suggests Australasian palliative care specialists are cautiously optimistic about the potential of psychedelic therapies.
While existing evidence suggests these treatments may help relieve existential distress and other psychiatric symptoms at the end of life, doctors generally agreed more research is needed to establish their safety, effectiveness and place in palliative care.
The view that emerged was not one of uncritical enthusiasm. Rather, many saw psychedelic therapies as a potentially valuable new tool for managing suffering at the end of life.
Its future role will depend on stronger evidence and, ultimately, regulatory change. This is now happening in Australia and New Zealand, albeit gradually. Both countries recently enacted laws that enable authorised doctors to prescribe psilocybin and MDMA.
And researchers are no longer just speculating, with clinical trials now directly testing psychedelic therapies. In New Zealand, an ongoing trial of MDMA-assisted therapy is already showing promising results among cancer patients experiencing existential distress.
Whether these treatments ultimately enter mainstream palliative care remains an open question. But we now have a much better understanding of what doctors themselves think about that possibility.
David Menkes does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
