Psilocybin Therapy in Palliative Care | An EOLWA Update 

In spite of psilocybin’s historical and cultural significance, it was classified as a Schedule 1 drug in the 1970’s under the Controlled Substances Act, making it illegal to possess, manufacture, or distribute. In recent years, interest in psilocybin has been rekindled, partly due to modern-era clinical trials, discussed in works like Michal Pollan’s How to Change Your Mind (2018), demonstrating psilocybin treatment reduced distress and suffering and enhanced the quality of life for terminal cancer patients[3].  While the research is promising, access remains illegal under federal law. 

Despite its controlled status, progress is being made in certain areas. For example, Oregon’s 2020 ballot measure legalized adult use of psilocybin and allows for supervised use. In Canada, there is a special access program for patients with serious or life-threatening illnesses. In Washington, some cities and counties have decriminalized psilocybin, but statewide decriminalization remains elusive.  The University of Washington School of Medicine is currently doing a research study on psilocybin for cancer patients; qualifying for a clinical trial can be onerous and unattainable for most patients. 

EOLWA has been a vocal supporter of psilocybin-assisted therapy for terminally ill patients. In 2020, EOLWA’s Board of Directors publicly supported it as a treatment option in a policy statement on Psilocybin. Dr. Sunil Aggarwal, a palliative care doctor and EOLWA board member, sees terminally ill patients who he believes might benefit from psilocybin treatment but cannot get access. Dr. Aggarwal turned to Kathryn Tucker, an experienced attorney with a long record of working with EOLWA; Tuckers served as campaign counsel to the first Washington Death with Dignity initiative in 1991. Her recent work has focused on opening access to psilocybin-assisted therapy for terminally ill patients. Her work with Dr. Aggarwal is pivotal in creating a federal safe harbor for access for this population. 

On behalf of Dr. Aggarwal and his patients, a challenge to the Drug Enforcement Agency (DEA)’s refusal to allow access was filed in the federal courts.  Known as AIMS et al v. DEA, the case argues that the DEA’s refusal to create a path to access violates state and federal Right to Try laws, which aim to provide patients with access to promising investigational drugs prior to FDA approval. The core issue is that the DEA’s role to prevent the diversion of controlled substances should not be allowed to intrude into the practice of medicine and limit palliative medicine or access to effective palliative therapies. The AIMS et al v DEA case demands that the DEA establish a pathway for terminally ill patients and palliative care providers to access psilocybin without threat of prosecution. EOLWA and many other stakeholders filed friend of the court briefs in support of Dr. Aggarwal in this case.  

Although the U.S. Ninth Circuit Court of Appeals initially denied AIMS’s request on procedural grounds, the case is now back before the court to reach the merits. Growing public interest is bringing more attention to the case. The Los Angeles Times, is covering the case, and Universities from Columbia to  Western Washington are holding events about psilocybin and its role in palliative care. the AIMS et al v DEA case hearing will be held in San Francisco on August 19th.  

This is a crucial step in this ongoing struggle for psilocybin access in palliative care. EOLWA continues to support psilocybin-assisted therapy despite legal and capacity challenges. EOLWA’s efforts have been focused on direct client support, limiting our capacity to support this initiative. The combined public and academic interest signify a promising shift toward broader acceptance and availability of psilocybin therapy in palliative care. As the landscape evolves, EOLWA remains committed to advocating for the rights of terminally ill patients to access effective treatments that can provide significant relief from end-of-life suffering.  

For more information on Tucker’s and Dr. Aggarwal’s effort: The Nowak Society, Colorado Psychedelic Community 

[1] Vargas AS, Luis A, Barroso M, Gallardo E, Pereira L. Psilocybin as a New Approach to Treat Depression and Anxiety in the Context of Life-Threatening Diseases-A Systematic Review and Meta-Analysis of Clinical Trials. Biomedicines. 2020;8(9):05. 

[2] George, D. R., Hanson, R., Wilkinson, D., & Garcia-Romeu, A. (2022). Ancient Roots of Today’s Emerging Renaissance in Psychedelic Medicine. Culture, Medicine and Psychiatry, 46(4), 890-903. https://doi.org/10.1007/s11013-021-09749-y 

[3] Tucker, Kathryn L., Oregon’s Pioneering Effort to Enact State Law to Allow Access to Psilocybin (August 14, 2020). Willamette Law Review, Vol. 57, No. 1, 2020, Available at SSRN: https://ssrn.com/abstract=3783484