Yvan Beaussant, MD, is a hematologist, palliative care physician, Instructor of Medicine and researcher at the Dana-Farber Cancer Institute in Boston. Dr. Beaussant’s research investigates interventions addressing severe existential and psychological distress in the context of serious illness, in particular in patients with cancer, with a specific focus on developing and assessing psychedelic-assisted therapies in this population. With Dr. Justin Sanders, he will be co-leading a symposium entitled, “Promoting Equity in Psychedelic-assisted Therapy in Serious Illness Care” at the McGill International Palliative Care Congress this October.
Devon Phillips (DP): I understand you are co-leading a session at the McGill International Palliative Care Congress in October entitled “Promoting Equity in Psychedelic-assisted Therapy in Serious Illness Care”. What key issues inspired the planning of this session?
Yvan Beaussant (YB): I would like to talk about why this session has been framed around the issues of equity and access in psychedelic therapies. It is a very exciting time for medicine, and palliative care in particular, that we are able to resume investigating the therapeutic potential of psychedelic-assisted therapies to address psycho-existential distress. Psycho-existential distress is a huge issue in serious illness care, and existing treatments are limited. And there are promising results that have made many people enthusiastic about the potential of these new interventions to address this suffering.
And yet these interventions are not new to many indigenous people around the world, who have used psychedelics for healing and traditional ceremonies for ages. There is a wisdom here that our culture might benefit from if we approach it with humility and reciprocity. Additionally, through the war on drugs and psychedelics’ prohibition, these medicines are also linked with systemic racism in our culture. There is a risk to perpetuate an oppressive system if our model continues to develop by extracting cultural or medical knowledge from indigenous people, or by not addressing discrimination or access issues. The result could be that only wealthy white people can access them as opposed to more underserved populations who might actually benefit the most from these interventions.
So there is awareness especially in the community of researchers and people who are advocating for the reinvestigation of psychedelic-assisted therapies, that we need to make space for the voice of people who have indigenous knowledge on psychedelic use and integration, as well as those who have been traditionally underserved or discriminated against.
DP: In the context of end of life and the use of psychedelic-assisted therapy, is there a promising future for these treatments? Is there good research taking place?
YB: There is some progress but not as fast as in more general fields of psychiatry. I think it’s a little ironic because the most recent research that has really triggered the renaissance of psychedelic research in medicine and in our society is drawn on research from 2000 and up to 2016 by Johns Hopkins, UCLA and NYU. It draws on work being done on patients with cancer, with a portion of these patients being at the end of life. Regulators and industry sponsors want to leverage these results to go to the next step. Initially they wanted to stay focused on the seriously ill population but then decisions were made to first study the general population with major depressive disorders and post-traumatic stress disorder (PTSD). So the most advanced research currently is with MDMA-assisted therapy for PTSD, and psilocybin-assisted therapy in major depressive disorders.
In palliative care there has been a lot of interest and people getting together thinking about how to advance the field. Justin Sanders and I organized a two-day seminar at Harvard in 2020 to bring together researchers in the field of serious illness care as well as those in different fields relevant to psychedelic research in serious illness care. The goal was to define priorities and set an agenda in order for the research to move forward.
There have been efforts like that and then there have also been a number of small investigator-initiated trials that are ongoing and that are very important to investigate specific populations or to investigate specific treatment modalities. These teams are advancing single-site research studies that are going to bring preliminary answers to some of the feasibility questions that are in the field, such as: Can we treat a certain population? What are possible treatment modalities?
What we also need are larger multi-site clinical trials that will confirm efficacy in the end-of-life patient population and provide the evidence we need to really define standards of care and get regulatory approvals to be able to treat patients. There is some work being done to get there but it’s of course much more expensive and harder to put together.
DP: This is the first time we have had a dedicated seminar on psychedelic-assisted at the McGill International Palliative Care Congress. What outcome are you aiming for?
YB: One thing that is really important is to set directions on the kind of psychedelic-assisted therapy we will develop, to ensure that it is informed by representatives from all the cultures that compose our society. We need to make sure that the evidence we build in psychedelic-assisted therapy reflects the needs of our multicultural population. And what does that entail? How do we need to think about protocols design, about therapeutic process, who is providing the therapy, where, what are the degrees, training and competencies required? My hope is that we can raise these important questions and inspire researchers and teams to have these issues in mind when engaging in research.
DP: We are thrilled that you will be a part of this year’s Congress. Are you looking forward to bringing these important issues to an international audience?
YB: I feel very excited to come. And I feel very excited especially for the palliative care community to have this opportunity, particularly after COVID. Getting together in person as the palliative care community, internationally, is going to feel really good. I am also excited and grateful that the congress is making space for the symposium on psychedelic- assisted therapies with this specific focus on equitability and access.