Psychedelics in anxiety in patients at the end of life - a review of studies
Psychedelics in anxiety for patients at the end of life — what it is, what studies say, and the legal status in Poland. u Bucha.
Fear of death - thanatophobia in its existential, rather than clinical form - is an experience that medicine has struggled to address for centuries. Opiates alleviate physical pain. Benzodiazepines suppress anxiety symptoms. None of these substances help the patient work through the meaning of their own life and impending death. In 2016, two independent clinical studies published on the same day in the same journal suggested that one session with psilocybin could provide lasting relief from existential anxiety in cancer patients. This article systematically discusses the evidence, mechanisms, and limitations of this work.
KEY INFORMATION
• Two parallel RCTs (NYU and Johns Hopkins, Journal of Psychopharmacology, 2016) showed that a single psilocybin session resulted in lasting reductions in anxiety and depression in 83% of cancer patients - the effect lasted for 6 months (Ross et al., J Psychopharmacology, 2016).
• The strength of the effect correlates with the intensity of the "mystical experience" during the session (MEQ30 scale), not with the pharmacological dose.
• Australia has legalized psilocybin in palliative care (TGA, 2023) - the first country in the world. In Poland, the substance remains illegal.
• Standard anxiety medications (benzodiazepines, SSRIs) have weaker evidence for existential anxiety than for generalized anxiety.
What is existential anxiety at the end of life and why is standard treatment insufficient?
Anxiety in terminal patients is a multidimensional phenomenon. It includes fear of pain and the dying process, but largely consists of an existential component: fear of the annihilation of the "self", loss of meaning, unfulfilled relationships, and unresolved internal conflicts. This last dimension is particularly resistant to pharmacotherapy.
Benzodiazepines are used in palliative care for anxiety, but their effectiveness is limited to reducing vegetative and somatic symptoms - they do not address the content of anxiety. SSRIs act too slowly (weeks) and have limited effectiveness in this population. Existential psychotherapy (logotherapy, meaning-centered therapy) has evidence of effectiveness, but requires time, cognitive effort, and physical condition that many patients in advanced stages of illness do not possess.
Palliative psychiatry needs an intervention that is quick, lasting, and addresses the existential core of suffering - not just its symptomatic expression. This is precisely the niche that has attracted researchers to psychedelics.
Groundbreaking studies from 2016 - NYU and Johns Hopkins
In November 2016, two independent randomized crossover studies conducted at NYU Langone Medical Center and Johns Hopkins University were published simultaneously in the Journal of Psychopharmacology. Both studies involved patients with life-threatening cancers and clinically significant anxiety or depression.
The NYU study (Ross et al.) included 29 participants. Cross-over design: half received psilocybin first (0.3 mg/kg), then niacin (active placebo), while the other half received the opposite. Primary endpoint: HAM-A (anxiety) and HAM-D (depression) scales. Results after 7 weeks: 83% in the psilocybin group responded to treatment vs. 14% with niacin. After 6 and 26 weeks post-session, the effect was comparable or stronger (Ross et al., Journal of Psychopharmacology, 2016).
The Hopkins study (Griffiths et al.) included 51 participants in a comparison project of very low-dose psilocybin (1 or 3 mg/70 kg - effective placebo) versus therapeutic dose (22 or 30 mg/70 kg). Change in HADS (anxiety + depression) scale after 5 weeks: 78% response at therapeutic dose vs. 22% at control dose (Griffiths et al., Journal of Psychopharmacology, 2016).
| Parameter | NYU Study (Ross 2016) | JHU Study (Griffiths 2016) |
|---|---|---|
| Number of participants | 29 | 51 |
| Dose of psilocybin | 0.3 mg/kg | 22-30 mg/70 kg |
| Response to treatment | 83% vs. 14% (niacin) | 78% vs. 22% (low dose) |
| Duration of effect | Confirmed after 6 and 26 weeks | Confirmed after 6 months |
| Predictor of response | Intensity of mystical experience (MEQ30) | Intensity of mystical experience (MEQ30) |
We noticed a fascinating methodological paradox in these studies: the predictor of effectiveness is not the dose, the duration of the substance's action, or any pharmacological parameter - but the subjective intensity of the "mystical experience" measured by the MEQ30 scale. This means that the therapeutic effect is mediated by the psychology of experience, not by direct brain chemistry. This is a unique phenomenon in the entire field of psychopharmacology.
Mechanism: why does the mystical experience reduce the fear of death?
The question of the mechanism is exceptionally complex here, as it combines neurobiology with existential psychology. At the brain level: psilocybin through the 5-HT2A receptor induces a profound destabilization of the DMN (default mode network) - the structure responsible for the narrative sense of "self", ruminations, and chronic worry about the future. When the DMN is temporarily destabilized, the patient experiences a dissolution of ego boundaries - a state that paradoxically many people describe as liberating rather than terrifying.
At the psychological level: qualitative studies with both research groups describe similar themes in participants' narratives after sessions: a sense of unity with something greater than the individual "self", acceptance of transience as a natural process, and a re-evaluation of priorities from material to relational and experiential. These changes are usually described as lasting and spontaneous - not as a result of rational therapeutic persuasion, but as experiential insight.
Psychologist William Richards from Hopkins, one of the pioneers in this field, compares the mechanism to accelerating a process that normally takes years - as if psychedelics acted as a catalyst for psychological maturation in the face of mortality (Richards, Journal of Humanistic Psychology, 2017).
Legal status and availability: where is such therapy possible today?
The legal landscape for psilocybin therapy in the palliative context is changing rapidly. Australia became the first country in the world to legalize the prescription of psilocybin (and MDMA) by psychiatrists in specially accredited programs in 2023 - clearly for patients with terminal illnesses (Kisely et al., Aust NZ J Psychiatry, 2023). In the USA, the states of Oregon and Colorado have created legal frameworks for psilocybin therapy centers - though outside the typical medical context.
In Poland and throughout the European Union, psilocybin remains a controlled substance of group I. Access to psilocybin therapy is only possible within clinical trials conducted with the permission of the Office for Registration of Medicinal Products. Several European academic centers (including Imperial College London, Maastricht University) are conducting active clinical trials, which can be applied for through official registries.
From our experience: questions about access to psilocybin therapy for loved ones in palliative care are among the most difficult we receive. We understand the motivation - and that is why we provide reliable information: legal options exist in several countries, but not in Poland. A medical trip to Australia or the Netherlands (where pharmacological laws are somewhat more flexible) is a viable option for some patients in stable condition.
How does a psilocybin session proceed in palliative studies - a practical description of the protocol
For many readers, abstract "therapeutic sessions" sound vague. A concrete description of the NYU and Hopkins protocol: each psilocybin session lasts 6-8 hours and takes place in a specially prepared, home-like room (not in a hospital ward). The patient lies on a comfortable couch with an eye mask and listens to a carefully curated music playlist. Two therapists are present at all times - one lead therapist, one assistant - providing verbal and physical support (holding hands), but not conducting active psychotherapy during the session.
Before the session: 2-3 preparatory meetings (totaling 8-10 hours) serve to establish a therapeutic relationship, explain the process, and explore the patient's goals. After the session: 2-3 integration sessions dedicated to processing experiences from the session and incorporating insights into daily life. The entire cycle lasts about 8-12 weeks. This intensity of therapeutic contact is intentional - and constitutes part of the intervention, not just its framing.
What experiences do patients describe? In the NYU study, Ross et al. conducted detailed qualitative interviews. Dominant themes in the narratives: a sense of love and connection with loved ones (described as deeper than ever before), acceptance of one's mortality as a natural process, a sense of "being okay" regardless of the physical circumstances of illness, and a reduction in ruminative anxiety about what will happen after death. Not all participants had positive experiences - about 10-15% described difficult episodes - but even those episodes were often retrospectively assessed as therapeutically valuable.
Frequently Asked Questions
Which psychedelics are being studied for anxiety at the end of life?
Psilocybin has the strongest clinical evidence in this indication - two RCTs from 2016 and a number of smaller studies. Ketamine is used clinically (legally) and shows rapid antidepressant effects in terminal conditions. LSD was studied in a Swiss pilot RCT (Gasser et al., 2014) with promising results, but research is less advanced than for psilocybin.
What did the NYU and Johns Hopkins studies from 2016 show?
Two parallel published RCTs showed that one psilocybin session resulted in a lasting, clinically significant reduction in anxiety and depression in cancer patients. In the NYU study, 83% responded after 6 weeks, and the effect persisted after 6 months. Both studies (Ross et al.; Griffiths et al.) published in the Journal of Psychopharmacology, 2016.
How can one psilocybin session bring lasting relief?
The strength of the effect correlates with the intensity of the "mystical experience" (MEQ30 scale), not with the dose. Patients describe existential insights, acceptance of transience, and a reorientation of values. Neurobiologically: destabilization of the DMN by 5-HT2A may initiate lasting changes in the narrative sense of "self" and its relationship with the perspective of death (Richards, Journal of Humanistic Psychology, 2017).
Do psychedelics change the attitude towards death?
Data suggest that it does - at the psychological level. Patients report reduced fear of non-being, a sense of continuity beyond biological existence, and a reorientation towards the quality of relationships and the present moment. Studies rely on self-reports and psychometric scales - they do not objectively measure "attitude towards death" as such.
What is the legal status and access to such therapies?
Australia (TGA, 2023) has legalized psilocybin in palliative care - the first country in the world. Oregon and Colorado (USA) have created frameworks for therapeutic centers. In Poland, psilocybin is illegal (Group I-P of the Act on Counteracting Drug Addiction). Access is only possible in clinical trials with URPL permission.
This article is for informational and educational purposes and does not replace consultation with a doctor. If you are pregnant, breastfeeding, taking medications, or have chronic conditions, consult the use of supplements or herbs with a specialist.
Author: Michał Waluk · Published: 2026-05-04 · Updated: 2026-05-04
