In a recently published study, the team surveyed more than 120 people involved in palliative care (doctors, other healthcare professionals, caregivers and administrators) in Canada’s four most populous provinces: Quebec, Ontario, Alberta and British Columbia.
Respondents were asked about their knowledge of psilocybin-assisted therapy, their attitudes toward it, and their perceptions of the benefits and barriers to effectively integrating it into palliative care settings.
Fewer than half felt well-informed about the drug’s risks and benefits, but the majority were in favour of its use in Canadian healthcare. Doctors were the most open to the possibility.
According to Garel, their receptiveness speaks to the limitations of current treatments. “Despite advances in medicine and psychotherapy, some people do not respond well to conventional approaches,” he said. “Psychedelic therapies seem to hold promise for addressing needs that are not currently being met.”
The public seems to agree. A previous study by the research group found that more than 60 per cent of Canadians are favourable to this type of therapy.
Alleviating existential distress at the end of life
Psilocybin-assisted therapy combines the administration of the psychedelic drug with structured psychotherapeutic support before, during and after the experience. The therapeutic benefits are believed to stem from the interplay between the drug’s neurobiological effects and the psychological work done by the care team.
“Psilocybin induces altered states of consciousness that can temporarily transform a person’s perception of self, others and the world,” Garel explained.
In the context of palliative care, research shows a reduction in symptoms of depression and anxiety among people facing incurable illness or imminent death. Researchers have been particularly interested in its impact on existential distress, the feeling of loss of meaning, despair or inability to make the most of the time one has left.
“Qualitative studies suggest these therapies may promote greater acceptance of the illness and the end of life,” Garel continued. “A number of participants have said they were able to reconcile the idea of death with the fact of being alive in the present. Others have described a heightened sense of connection—to loved ones, to themselves or to something greater.”
For some, the experience restores a sense of purpose and allows them to make better use of their remaining days. However, it can be difficult for others, stirring up feelings of fear and anxiety or resurfacing traumatic memories.
A more flexible brain
What drives these effects? At the neurological level, psilocybin temporarily alters the way regions of the brain communicate with each other, Garel explained. It is also believed to boost neural plasticity—the brain’s ability to create or reorganize its connections.
This transient flexibility may help patients break free from mental ruts—chronic rumination, rigid thinking or fixed narratives about their situation—and increase the effectiveness of psychotherapeutic interventions by making the patient more open to new perspectives.
“Research suggests that these brain changes could last several days, or even weeks, after psilocybin is administered, long after it has cleared from the body,” Garel added.
The importance of training
For all the promise, the path to clinical adoption is challenging. The main obstacle, according to Garel, is not access to psilocybin but the shortage of adequately trained professionals.
Psilocybin-assisted therapy requires specific skills in psychotherapy, clinical support and managing the psychological reactions that may arise during the experience. However, there is currently no standardized training program or recognized certification in Canada.
Developing specialized university training programs is the next critical step. Some U.S. universities have already begun to incorporate this content into their psychiatry programs.
Garel believes the scientific and public momentum is unlikely to reverse. The data collected so far suggest that psilocybin-assisted therapies will eventually earn a place in the therapeutic arsenal, particularly for people whose suffering is resistant to current treatments.
“This doesn’t mean they’ll be a miracle cure or suitable for everyone,” Garel cautioned. “However, the question is no longer whether we should consider using them but rather how to do it safely, rigorously and equitably.”
