Journal of Palliative Medicine
January 22, 2018
Ira Byock
164 citations
Despite growing evidence that psychedelics are safe and beneficial, political, regulatory, and industry hurdles block their legitimate medical use. Federal expanded access programs and state right-to-try laws already allow terminally ill patients to receive unapproved medications. Because many such patients endure persistent suffering and physician-hastened death is increasingly accepted, the authors argue it is time to reconsider the legitimate therapeutic use of psychedelics.
Journal of Palliative Medicine
April 1, 2020
Yvan Beaussant, Justin J. Sanders, Zachary Sager et al.
39 citations
Experts in serious illness care and psychedelic research hold polarized views on psychedelic-assisted therapies for patients with serious illness, ranging from strong support for medical utility to reluctance due to risks such as delirium or worsening psychological distress. Research priorities focus on patients with clinically diagnosed psychosocial distress like depression, anxiety, or demoralization, though some roles extend beyond traditional medical diagnosis. Essential safety and efficacy guidelines are needed for integrating these therapies into existing care models. The study proposes a conceptual framework for such integration based on interviews with 17 experts from the United States and Canada.
Journal of Palliative Medicine
August 17, 2023
Robert Gramling, Emily Bennett, Keith Curtis et al.
6 citations
Directly observing therapeutic connection during psilocybin-assisted therapy is feasible. In a clinical trial, three coders independently reviewed audio and video from four 8-hour psilocybin administration sessions, identifying 372 moments of therapeutic connection. Eighty-three percent of these moments were detected by at least two coders, and 41% by all three. Coders used both audible cues (speech prosody, words) and visible cues (body movements, eye gaze, touch) in 51% of observed events. The expressions of connection varied as the drug's effects on consciousness changed over time. The findings suggest that evaluating both sound and video is necessary to capture the full range of therapeutic connection.
Journal of Palliative Medicine
September 12, 2024
Jean-François Stephan, Sani Karam
2 citations
A patient with end-of-life distress from stage 4 astrocytoma received psilocybin-assisted therapy through a special access program and had a positive response without adverse events. Standard treatments for existential distress are often ineffective, and psilocybin-assisted therapy is rarely available, especially for patients with brain cancer. The authors argue that access to this therapy needs to be expanded urgently, as many patients with unresolved existential distress resort to medical assistance in dying without knowing about psilocybin-assisted therapy.
Journal of Palliative Medicine
June 25, 2024
Mary P. Clark
1 citation
No Summary
Journal of Palliative Medicine
July 15, 2020
Anthony L. Back
1 citation
No Summary
Journal of Palliative Medicine
November 9, 2018
Anthony L. Back
1 citation
No Summary
Journal of Palliative Medicine
April 30, 2024
Min Ji Kim, H. Walker, Matthew D Clark et al.
A postoperative cancer patient who was taking buprenorphine–naloxone for chronic noncancer pain and then switched to methadone for uncontrolled cancer-related pain successfully transitioned back to buprenorphine–naloxone using a microdosing strategy over one week in an inpatient setting. This approach avoided the need to reduce total opioid intake before starting buprenorphine, which is typically required to prevent precipitated withdrawal. The case suggests that microdosing may be a feasible method for transitioning from methadone to buprenorphine in patients who require higher opioid doses, such as those with cancer pain, though more research on its tolerability is needed.
Journal of Palliative Medicine
December 20, 2021
Kyle Quirk, Maximillian H. Stevenson
Microdosing induction of buprenorphine, in which the drug is gradually titrated while full agonist opioids are continued, offers a viable alternative to traditional inductions that require an opioid-free interval or withdrawal. This review of 34 publications found that the most common strategy involved administering divided doses of sublingual products marketed for opioid use disorder, with 73.5% of articles using partial tablets or films ranging from 1/8 to 1/2 of a 2 mg product. Transdermal patches, low-dose sublingual buprenorphine available in Europe, intravenous buprenorphine, and buccal buprenorphine have also been used. The speed of induction, setting, final dosing, and management of concomitant full agonists varied widely.