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Canada is now allowing access to psilocybin for the terminally ill

You are likely aware that during this year, 2020, four terminally ill patients were granted a legal exemption by Canada’s Ministry Of Health to access psilocybin-assisted therapy, and, in august, the first-ever non-research legal dose of psilocybin for a dying patient was administered here in Canada.

This was the result of the very hard work of the team at TheraPsil, a coalition of healthcare professionals, patients, and advocates dedicated to fighting for the rights of Canadians facing end-of-life or illness-related distress to have legal access to therapeutic psychedelics.

psilocybin-assisted therapy for terminally-ill
Thomas Hartle was treated with psilocybin-assisted therapy guided by Dr. Bruce Tobin. Courtesy of @TheraPsil on Instragram

Since that first therapy session in august, Therapsil has even managed to achieve legal exemption and provide therapy for a non-palliative patient. Someone suffering from trauma. This is another incredibly significant event for psychedelic medicine and further precedent for the integration of psilocybin into Canadian medicine.

The man who administered those therapy sessions, Dr. Bruce Tobin, is on Adventures Through The Mind today along with two other members of the TheraPsil team, medical director Dr. Sean O’Sullivan and Therapsil CEO, Spencer Hawkwell. (Their bios are below)

This interview was recorded several months ago and so we don’t talk about their trauma patient or trauma treatment but are more focused on psilocybin as a treatment option for terminal anxiety.

The discussion leans heavily into the legal argument for access to psilocybin-assisted therapy for the terminally ill here in Canada, and especially the role of psilocybin in helping alleviate the existential suffering that comes during a person’s dying time, and thus into talk about life’s meaning and its presence or absence in that dying time.

This discussion about psilocybin is heavily nested in the context of psilocybin as a western clinical medicine for North American people, which, of course, has a rich value for its integration into that cultural context, but also paradigmatic limitations for understanding psilocybin role in a meaningful life and death. There are some added thoughts I have about this, which you can read below.

Enjoy!


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Our Guests

Dr. Bruce Tobin - Founder & Chair of Therapsil

Bruce Tobin TherapsilDr. Tobin received his doctorate from the University of Washington in 1983, specializing in the philosophy of psychology. He has been in private practice psychotherapy for 35 years, specializing in the treatment of anxiety, depression and emotional trauma. He taught clinical skills for 25 years at the University of Victoria, where he was an Adjunct Assistant Professor and a member of the Graduate Faculty. He worked under contract with Health Canada for 20 years providing psychological services to First Nations communities in the Victoria area. He is interested in the interface between psychology and spirituality, and the role that altered states of consciousness play in enhancing clinical processes

Sean O'Sullivan, MD - Medical Director for Therapsil

sean o'sullivan therapsilSean practices emergency medicine and psychotherapy. His psychotherapy practice includes Mindfulness-Based Stress Reduction and ketamine-assisted psychotherapy. Dr. O’Sullivan certified in Holotropic BreathworkTM in 1990, and practiced that modality for several decades.

Sean, together with his wife Donna Rosenthal, was involved in the efforts to legalize the Santo Daime religion in Canada. Dr. O’Sullivan is presently working with Bruce Tobin, PhD, and his team to move psilocybin towards legal status for appropriate patients, focusing initially on patients with existential end of life distress.

Spencer Hawkswell - Chief Executive Officer for Therapsil

Spencer Hawkwell TherapsilSpencer was first introduced to healing psychological trauma with altered states of consciousness and therapeutic psychedelics from reading the work of Terrence McKenna, Rick Strassman, and Carl Jung and believes that these methods need to be treated seriously by governments and institutions. Spencer believes that responsible drug policy requires effective organization and leadership and is dedicated to bringing together the experts and advocates, to facilitate change that results in increased access to compassionate care, harm reduction, and treatment options for those in need. Psilocybin-assisted psychotherapy is a reasonable treatment option for palliative patients in end-of-life distress and is where we need to begin.


Episode Breakdown

  • What access to psilocybin-assisted therapy for terminally ill patients matters
  • Our constitutional right to psilocybin
  • How psilocybin has helped me with the anxiety of knowing I will die
              • (some of my further personal thoughts on this can be found here and here)
  • The ignorance of the modern medical paradigm around mental health issues
  • The modern medical paradigm’s focus on suppression rather than healing
  • The cultural limitations to undoing bad laws
  • Why society more receptive to psychedelics now then they were in the 60s
  • Psilocybin revealing the meaning of life through the dissolution of cultural ideologies
  • The psychological context of a dying person and why psilocybin-assisted therapy for the terminally ill is helpful in that context
  • The negative cultural paradigm we have around death worsens end of life distress and how psilocybin helps
  • Dying people are generally on a lot of drugs, how to assess the pharmacological safety of psilocybin in that context
  • The complexities of pain management during psilocybin-assisted therapy for the terminally ill
  • Advice to palliative nurses based on lessons learned in psilocybin assisted therapy for terminal anxiety
  • Pain management reduction of total pain after a psilocybin experience
  • The increase of spiritual care in palliative medicine
  • What it took for therapsil to succeed in getting access to dying patients in Canada
  • Will decriminalization hinder medical access?
  • The impact increased access to psilocybin might have for society
  • The successful progression of medical science; achieving patient access to psilocybin-assisted therapy for the terminally ill

therapsil logoPlease go follow up with this podcast by checking out therapsil.ca 


Their work in the Canadian medicalization of psychedelics is only just blossoming and there is a lot of exciting information and growing news around their work that you can find on their website.


My added thoughts to this episode

[This is a wondering more than a set of conclusions and is also heavily influenced by my study of Stephen Jenkison]

Much of this conversation in this interview with the therapsil team was justly and appropriately focused on psilocybin as a clinical medicine within the cultural context of North America, for North American people. As such, the exploration of psilocybin’s role in a meaningful life and meaningful death in this discussion were defined and confined by the paradigms of that particular cultural context: Western medicine for North American people. This is an incredibly important angle for the discussion insofar as the integration of psilocybin into the Canadian health care systems, but is far from a total representation of psilocybin place in living and dying in general.

The limitations that this specific viewpoint offers to our scope of psilocybin’s place in our lives and in our dying time does not negate the relevance of those viewpoints. But I do think it’s important to couch our discussion of them in an awareness of their paradigmatic limitations. Essentially, the meaning of all this psilocybin stuff extends far beyond what western medical science has to say about it, despite how valuable what it is saying might be.

Additionally, when it comes to the sense of annihilation at one’s dying time, discussed during the episode. This, too, deserves to be couched in the acknowledgment that this situation itself is a culturally specific one and does not necessarily extend to all dying people everywhere. For many peoples and cultures around the world, their desperation of existential uncertainty is not as palpable as it is here in North America, as their cultural identities serve to support their dying time, which is in direct contrast to how the North American cultural relationships to dying.

In his book Come Of Age, author Stephen Jenkinson–who has been on the show for episode 59 What Dying Means, and again for episode 105 –discusses the history of how we in the west have all had our original cultures damaged or decimated by the dislocation of our peoples, willing or otherwise, over the course our present civilization’s historical arc. And that the result of this is that most of us born into the modern western world are cultural orphans, with only the “dominant culture of North America” to feed us, a culture that extracts deep meaning for our lives and replaces it with a toxic mimic that holds little to no solace for us in our lived life, let alone our dying time.

Additionally, explored in his book Die Wise, Jenkinson discusses how the dominant culture of North American is deathphobic. It rails against death as if dying were an insult and an enemy, and the event of death is a defeat of the now-dead person’s well to live, and a failure on behalf of medicine in general.

Take this cultural orphanhood and deathphobia and add into it a profound uncertainty around ancestry and resulting desperation for legacy in this same Western culture, and that sense of death being annihilation, oblivion, seems like a logical outcome.

That is the psychological and cultural context of dying people in the west, and the one that in many ways demands something like psilocybin to help bring meaning and trust back into the final event of one’s life. (Although, Jenkinson doesn’t agree about that view on psilocybin.)  But, it is not how all dying people everywhere understand and engage their dying time. This latter point is something unexplored in the interview but is something that I believe serves us to hold onto in our wondering about meaning in life and in our dying time.


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