About the Author
Andrew Whitman, PharmD, BCOP, is a lead clinical pharmacist for oncology/hematology and residency program director for the PGY2 Oncology Pharmacy program at the University of Virginia Health in Charlottesville.
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Pharmacy Practice in Focus: Oncology
June 2025Volume7 Issue 4
Investigating the Pharmacist’s Role in Psychedelic-Assisted Psychotherapy for Patients With Cancer
Author(s):
Key Takeaways
- Psychedelic medicines show promise in managing mental health issues in cancer patients, including anxiety and depression, especially at end-of-life stages.
- Historical studies, like Grof et al.'s LSD-assisted psychotherapy, laid the groundwork for current research on psychedelics in oncology.
Psychedelic treatments may ease cancer distress at various stages of the care journey.
Over the past decade, there has been an ever-changing landscape surrounding psychedelic medicines in the United States. Much has been written on the topic, yet it remains difficult to personally establish a comprehensive, evidence-based opinion. What can be said with certainty is that we need more options to manage mental health in our patients with cancer; this includes patients’ end-of-life suffering, anxiety, depression, and their overall ability to connect with their world. In the 2017 book The Big Picture, author Sean Carroll seamlessly blends the scientific with the philosophical and comments that “life is not a substance, like water or rock; it’s a process, like fire or a wave crashing on the shore. It’s a process that begins, lasts for a while, and ultimately ends.”1 To me, what’s most important to the sentiment of these words is the process of living and dying.
Image credit: Microgen | stock.adobe.com
I recently had the opportunity to blend my own science and philosophy at the Hematology/Oncology Pharmacy Association (HOPA) 2025 Annual Conference in Portland, Oregon, presenting on psychedelic medicines in oncology and palliative care. The narrative I provided to the audience was one of personal impact, and included a discussion on the available supporting evidence. Around late 2023, a friend was diagnosed with metastatic colorectal cancer at 46 years old. He was another parent at my kid’s preschool, and at the time, I didn’t know much about him other than that he was a nice guy and easy to get along with. After learning of his diagnosis, our relationship shifted from small talk at school events to detailed discussions in an infusion center setting about chemotherapy, immunotherapy, clinical trials, alternative medicines, and anticipated adverse effects. Fortunately, he had a great oncology team with a pharmacist who specialized in gastrointestinal oncology. So, on the medical front, I was confident in his care. In a similar manner, his spouse was in the field of mental health, specializing in posttraumatic stress disorder (PTSD), and she found social support and counseling for their 2 children surrounding death and dying.
About 6 months into my friend’s diagnosis, he brought up the topic of psilocybin mushrooms. I had been keeping up with the psychedelic literature over the past 15 years, so I was happy to discuss the topic. At chair-side in the infusion center, we discussed his anxiety, his fear about leaving his family, and his conflicting internal dialogue about what was important to him in life. He shared that he planned to undergo a high-dose psilocybin experience to explore these areas further. At the time, I felt it was best to avoid questions such as, “Where on earth are you getting the psilocybin?” Instead, I just listened. I also started to think about outcome measures, like any data-loving pharmacist. This was interesting because in the studies described in the next section, relatively broad measures are assessed (ie, anxiety, depression) along with other more specific areas, including cancer-related existential distress that looked at self-reported hopelessness, loss of meaning/purpose in life, despair, and a sense of giving up. What I was hearing from my friend was more along the lines of the things he’ll miss in life, the experiences he won’t have, and sentiments such as “I fear that I won’t get to see my kids grow up,” and “My garden is really going to suffer.” The studies that we have to assess the benefits of psilocybin mushrooms are pretty great overall, but it’s certainly a different experience hearing about loss and fear from a friend. Viewing the 2 lenses as a pharmacist vs a friend was an important lesson for me. He had his high-dose psilocybin experience and said it was extremely impactful but ultimately really hard to describe (otherwise known as ineffable in psychedelic lingo). I asked him for more details, but he declined and said he wanted to keep the experience close to home.
What Do the Studies Support?
One of the earliest studies in patients with cancer was completed in 1973 by Grof et al.2 They looked specifically at lysergic acid diethylamide (LSD)-assisted psychotherapy in persons with terminal solid tumor malignancies. The study was nonrandomized, unblinded, and included 41 patients. A dose of 200 to 500 μg of LSD was given as an adjunct to psychotherapy, which included an emphasis on set and setting, preparatory sessions, support during the experience, and posttreatment integration sessions.3 The goal was to look at the impact on depression, anxiety, pain, and quality of life. The results indicated that approximately 70% of patients had reductions in death anxiety and depressive symptoms, up to 50% of patients reported reductions in subjective physical pain, and the majority of patients described the LSD session as “one of the most meaningful experiences of their lives.” It’s easy to poke holes in this study; nevertheless, it laid some foundation for future, well-designed studies.
Three decades later, the 2006 landmark trial by Griffiths et al, “Psilocybin Can Occasion Mystical-Type Experiences Having Substantial and Sustained Personal Meaning and Spiritual Significance,” was published in Psychopharmacology.4 Aside from a mouthful of a title, this paper was what really sparked my interest in psychedelic medicines. In brief, this was a double-blind, placebo-controlled study looking to assess whether moderate to high-dose psilocybin vs methylphenidate as the placebo could induce mystical-type experiences in healthy volunteers. As with the 1973 study by Grof et al, the researchers included meetings before and after the sessions, equating to approximately 12 hours of counseling and support. Measures of mystical experiences were collected 7 hours after administration of the psilocybin or placebo using the States of Consciousness Questionnaire (adopted from the Mysticism Scale originally developed in the 1960s). The assessed categories included unity, ineffability, sacredness, positive mood, transcendence of time and space, and noetic quality. After the session, 61% of participants met the criteria for a complete mystical experience under psilocybin vs none under the methylphenidate. At the 2-month follow-up, two-thirds of volunteers rated it as either the most meaningful or spiritually significant experience of their lives, and one-third rated it as the single most important experience of their lives.
The relevance of the 2006 study by Griffiths et al cannot be overstated. It triggered an outflow of new psychedelic research interest and added evidence to the relationship between mystical experience and the efficacy of psilocybin.
Other well-done psychedelic studies in patients with cancer have been completed in the 20 years since. Ross et al published a landmark study in 2016 evaluating psilocybin’s impact on anxiety and depression in 51 patients with life-threatening cancer.5 To me, the highlights of this study go beyond the results themselves. The commentary on the current state of cancer outcomes impacted by depression and anxiety is extremely important. Uncontrolled anxiety can result in medication nonadherence, increased health care utilization, and increased pain. Depression in this population has even been seen to be an independent risk factor for early death. Likewise, the authors comment on the mixed efficacy of currently offered pharmacotherapy and psychosocial interventions and poor availability of these therapies in resource-limited settings. In this study, moderate doses of psilocybin were compared with very low-dose psilocybin (as a placebo) in a double-blind, randomized, crossover study. Using standardized rating scales, such as the Hamilton Depression Rating Scale, it was found that 92% of the higher-dose group had a clinically significant response compared with 32% in the very low-dose group. A response rate of 80% was sustained after 6 months in the original study.
An ongoing study by Bhagavan et al is looking at single-dose 3,4-methylenedioxymethamphetamine (MDMA)-assisted therapy on mood and anxiety symptoms in advanced cancer.6 In this study, up to 32 patients with advanced cancer and a diagnosis of depression and anxiety will be randomly assigned to either the MDMA-assisted group (120-mg +/– 60-mg supplemental dose) or methylphenidate-assisted therapy as a psychoactive control (20-mg +/– 10-mg supplemental dose). Various measures (ie, mystical experience, mood, anxiety, quality of life, and attitudes toward death) will be assessed at baseline and until the study’s conclusion. This international study is ongoing despite the recent FDA decision to reject MDMA-assisted therapy for PTSD, and it has the potential to add another treatment paradigm for patients with cancer.
Potential Roles of the Oncology Pharmacist
My friend died of his metastatic cancer in early 2025. While joining his friends and family at a local brewery for a celebration of life, I was able to hear stories of his time in the Peace Corps, share some stories of my own, and hear about his positive attitude about life, even within weeks of his death. I started to think about his care team and everyone involved in making sure he had a comfortable death. When it came to his own psychedelic experience, I questioned whether additional preparation and integration sessions would have helped even more. There does not seem to be a standard “team” for psychedelic-assisted psychotherapy. Have we explored all the key team members: physicians, psychologists, therapists, researchers, nurses, social workers, advanced practice providers, music therapists, shamans, pharmacists, etc? A fair amount has already been written about potential pharmacists’ roles in the psychedelic space, but more exploration is needed.7 The Psychedelic Pharmacists Association also supports endeavors such as education and advocacy of psychedelics.8 Nonetheless, I believe that the role of the oncology pharmacist could be uniquely specific. This may include, but is not limited to, the following:
- Education to patients, caregivers, and clinicians surrounding options for psychedelics (ie, psilocybin, MDMA, LSD, mescaline, ayahuasca)
- Advocating for legality for vulnerable populations
- Compassionate conversations aimed toward understanding goals of care and how psychedelics could fit into the cancer care plan
- Tough decisions and processes regarding tapering off certain medications prior to psychedelic therapies
- Drug-drug interactions research between psychedelic medicines and the many types of medications used in oncology care
- Application of pharmacotherapy knowledge (anticancer, internal medicine, chronic disease state management, supportive care) in preparatory sessions, with an emphasis on person-centered care
Overall, I think oncology pharmacists should and will have a role in the rapidly changing landscape of psychedelic-assisted psychotherapy. As a group, we should continue to advocate for our patients, be familiar with the research, and continue asking the hard questions about what is right for our patients, despite any existing sociopolitical controversies.
REFERENCES
1. Carroll S. The Big Picture: On the Origins of Life, Meaning, and the Universe Itself. Dutton; 2017.
2. Grof S, Goodman LE, Richards WA, Kurland AA. LSD-assisted psychotherapy in patients with terminal cancer. Int Pharmacopsychiatry. 1973;8(3):129-144. doi:10.1159/000467984
3. White CM, Weisman N, Dalo J. Psychedelics for patients with cancer: a comprehensive literature review. Ann Pharmacother. 2023;57(9):1062-1075. doi:10.1177/10600280221144055
4. Griffiths RR, Richards WA, McCann U, Jesse R. Psilocybin can occasion mystical-type experiences having substantial and sustained personal meaning and spiritual significance. Psychopharmacology (Berl). 2006;187(3):268-292. doi:10.1007/s00213-006-0457-5
5. Ross S, Bossis A, Guss J, et al. Rapid and sustained symptom reduction following psilocybin treatment for anxiety and depression in patients with life-threatening cancer: a randomized controlled trial. J Psychopharmacol. 2016;30(12):1165-1180. doi:10.1177/0269881116675512
6. Bhagavan C, Glue P, Evans W, et al. Effect of MDMA-assisted therapy on mood and anxiety symptoms in advanced-stage cancer (EMMAC): study protocol for a double-blind, randomised controlled trial. Trials. 2024;25(1):336. doi:10.1186/s13063-024-08174-x
7. Psychedelic Pharmacists Association is working to promote, establish the role of the pharmacist in psychedelic-assisted therapy. Pharmacy Times. January 17, 2024. Accessed May 16, 2025. https://www.pharmacytimes.com/view/psychedelic-pharmacists-association-is-working-to-promote-establish-the-role-of-the-pharmacist-in-psychedelic-assisted-therapy
8. About the PPA. Psychedelic Pharmacists Association. Accessed May 16, 2025. https://psychedelicpharmacist.org/
Articles in this issue
New Frontline BTK Inhibitor Strategy Gains FDA Approval in Untreated Mantle Cell Lymphoma
Investigating the Pharmacist’s Role in Psychedelic-Assisted Psychotherapy for Patients With Cancer
Understanding Recent Changes to 505(b)(2) Drugs and Reimbursement
Unicorns Don’t Exist: Rethinking the Generalist Model in Oncology Pharmacy
CAR T and Beyond: The Expanding Pipeline and Promise of Cell Therapies
Operationalizing Precision Oncology: The Expanding Role of the Clinical Precision Medicine Oncology Pharmacist
Sequencing of Liposomal Daunorubicin/Cytarabine Versus Hypomethylating Agents Plus Venetoclax for Secondary Acute Myeloid Leukemia
Clinical Manifestations of Acute, Chronic Graft-vs-Host Disease With PTCy in Patients Receiving Allogeneic Hematopoietic Stem Cell Transplantation
The Value of a Medically Integrated Pharmacy to Maximize Cost Avoidance and Reduce Waste of Oral Oncolytic Medications
Prevalence of Dosage Modifications and Impact on Response Milestone Among Patients With CML Treated With Imatinib Using RWD
Assessing Prescriber Justification for Use of Outpatient Chemotherapy in the Acute Care Setting
Impact of Patient Access to Care on Rates of Febrile Neutropenia Post Inpatient Administration of a Colony-Stimulating Factor
Impact of a Community-Based Specialty Pharmacist in Identifying Drug Therapy Problems for New Adult Oncology Patients
The Term 'Bispecific Antibody' Is No Longer Enough
Keep Looking Up: A Reflection on Our Path Forward
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