Longitudinal experiences of Canadians receiving compassionate access to psilocybin-assisted psychotherapy

Abstract

Recent clinical trials have found that the serotonergic psychedelic psilocybin effectively alleviates anxiodepressive symptoms in patients with life-threatening illnesses when given in a supportive environment. These outcomes prompted Canada to establish legal pathways for therapeutic access to psilocybin, coupled with psychological support. Despite over one-hundred Canadians receiving compassionate access since 2020, there has been little examination of these 'real-world' patients. We conducted a prospective longitudinal survey which focused on Canadians who were granted Section 56 exemptions for legal psilocybin-assisted psychotherapy. Surveys assessing various symptom dimensions were conducted at baseline, two weeks following the session (endpoint), and optionally one day post-session. Participant characteristics were examined using descriptive statistics, and paired sample t-tests were used to quantify changes from baseline to the two-week post-treatment endpoint. Eight participants with Section 56 exemptions (four females, M_age = 52.3 years), all with cancer diagnoses, fully completed baseline and endpoint surveys. Significant improvements in anxiety and depression symptoms, pain, fear of COVID-19, quality of life, and spiritual well-being were observed. Attitudes towards death, medical assistance in dying, and desire for hastened death remained unchanged. While most participants found the psilocybin sessions highly meaningful, if challenging, one reported a substantial decrease in well-being due to the experience. These preliminary data are amongst the first to suggest that psilocybin-assisted psychotherapy can produce psychiatric benefits in real-world patients akin to those observed in clinical trials. Limited enrollment and individual reports of negative experiences indicate the need for formal real-world evaluation programs to surveil the ongoing expansion of legal access to psychedelics.

Keywords: Distress; Palliative care; Psilocybin-assisted psychotherapy; Psychedelics.

Figure 1

Timeline of survey completion.

Figure 2

Raincloud plots displaying pre-post changes in the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder-7 (GAD-7), the McGill Quality of Life Questionnaire Revised (MQoL-R) Overall Score, the Functional Assessment of Chronic Illness Therapy—Spiritual Well-Being 12 Item Scale (FACIT-Sp-12) Total Score, the Fear of COVID19 scale, and the Medical Assistance in Dying (MAiD) questions. The dots depict individual data points, while the boxplots display the median, lower (25th percentile) and upper (75th percentile) quartile, and the one-sided violin plots display the overall distribution for both the baseline (green) and the endpoint (orange). * = p < 0.05.

Figure 3

Post-treatment evaluation of the psychological insight, meaningfulness, spiritual significance, and degree of psychological challenge of the experience.

Figure 4

Comparison of pre-treatment expected benefits to actual, post-treatment benefits.