HEALTH: Mar 05, Au Edition

DON’T WORRY, DIE HAPPY
Are party drugs really the best way to make a cancer patient’s last days more livable?
Aside from those who die suddenly in accidents, quietly in their sleep, or simply sitting at the dinner table, a good proportion of the population gets not only a fair bit of advance warning that their time is almost up, but also a rough estimate of when that will be. That diva of death, Elisabeth Kübler-Ross, counseled coming to terms with and embracing death as a part of life, seeing it as a “transition” to a better place. She was quite a morbid little lady though – and perhaps a little impatient for death to come as well, having spent so much time preparing for it.
On the other side of the coin, there are those of us who would prefer to achieve immortality through not dying. Being firmly in this camp, I plan a last-minute panic, followed by months of denial – but having spent several years working in aged care, my experience is that very few people actually spit the dummy completely when given notice. Still, there is psychological work to do to wrap up a life, and it is painful to watch a patient who is trying to achieve some measure of acceptance and reconciliation but is exhausted by the effort.
Which brings up the question: how much intervention is appropriate to help this process along? Some people these days are answering, “a lot”. Pending a license from the US Drug Enforcement Administration (DEA), Harvard will this year commence an FDA-approved trial of MDMA, better known as the party drug ecstasy, in end-stage cancer patients suffering from severe anxiety. Meanwhile in Los Angeles, the Harbor-UCLA Medical Centre is trialing the use of psilocybin (the active in ingredient magic mushrooms) in terminally ill cancer patients. But these are all very small studies, and are of the “qualitative”, or anecdotal, kind: see what happens, and then know what to look at if it progresses to the level of a drug trial. Essentially, they are pre-trial trials.

(This is not the first time since the heady days of Timothy Leary that U.S. researchers have toyed with illegal drugs to treat various mental conditions: the University of Arizona has lately reported success using psilocybin to treat obsessive compulsive disorder, while in Charleston, South Carolina, MDMA is being studied in victims of violence who are suffering post traumatic stress disorder.)
What some medical researchers have discovered is that ecstasy can make people happy. And expansive. And positive about themselves and at one with the world and like, man, there’s like love, just like, everything is love, you know? Feeling like this, they reckon, is better than being fearful and anxious, as most cancer patients are to some degree. What if we could make them happy? Give them tools to make the work of wrapping up a life and preparing for death a little easier? Or just generally unbridle the unconscious, facilitate communication with family, and defy the poet to go gently into that good night?
In the Harvard and UCLA studies, the patients will be evaluated, given low-to-moderate doses of drugs in the company of a psychiatrist, and then spend a fair few number of consecutive hours talking it all out. And then do it again a few weeks later. The studies aim to see if this helps people to deal with end of life issues. Certainly, most of the unpleasant side effects could be controlled in this very controlled setting. The idea seems to be that these are patients who may not have the time and energy for an in-depth rigorous sorting through of the subconscious issues in guided psychotherapy: if they are uninhibited and happy, it can all get done a lot quicker.
Myself, I’d like anything in my subconscious to stay put, and thus avoid both psychotherapy and hallucinogenic drugs for this reason. But putting aside the issue of how the process could be patented to make money, and determined to be safe, and then approved ten years hence, would anyone really want to find a psychiatrist to sit and talk with them for six hours at a stretch? Furthermore, how much damage might a “bad trip” do to someone in their last days? And if dad has always been a cranky old bugger, will it really help the family to hear him waxing lyrical under the influence? My own feeling is that there wouldn’t be a lot of takers for this kind of treatment, and that they would be a fairly self-selecting group. But what if it took off?
Personally, I don’t like the idea. It rings wrong to me, and I have been trying to find a way to come at it reasonably. Debating the idea of using hallucinogens like this often leads to overwrought fears about a dystopian, mood-managed future á la Huxley’s Brave New World, and brings up a lot of the same issues that came up when it was discovered that Prozac could not just cure depression, but smooth out challenging personality traits. There are, if you tilt your head and squint, some interesting ethical dilemmas here, but the reality is — as for the overwhelming majority of drugs that are tested for any medical use — that cost, profitability, patentability and practicality, as well as safety and the broader concerns of the community may well be immovable obstacles standing in the way of Nana ever getting high.
This small wave of tests involving medical mushrooms and prescription party drugs will probably die out with the patients in the studies, and people will continue to wrap up their lives in much the same ways they always have.