All the Buzz, Limited Access: Practical Considerations for Practicing Psychosocial Oncology in the World of Cannabis, Ketamine, and Psychedelic-assisted Therapies

With growing interest in novel therapeutics for psychospiritual distress in patients with serious illness, more patients are requesting information and guidance about how to access psychedelic-assisted therapies (PAT). While not a classical psychedelic, ketamine has demonstrated safety and potential efficacy for treating depression and anxiety in patients with serious illness, and is increasingly accessible in community settings. Classical psychedelics, primarily psilocybin, a Schedule I substance, are still being actively studied and show promising results attenuating psychospiritual and existential distress in patients with cancer. Neither ketamine nor psilocybin is currently readily available for clinical use in seriously ill patients, which presents a unique challenge when medically and psychiatrically complex patients seek these treatments in the community. This workshop will highlight the role of the consultation-liaison psychiatrist in treating patients with serious illness who request access to ketamine and PAT, including how best to inform ourselves and speak to our patients about these novel treatments.

Based on our experience working in a major cancer center with an active PAT research program, we will review the challenges and ethical considerations that are raised in responding to requests for consultation and advice on the consumption of ketamine and PATs, and discuss the potential risks and benefits of offering guidance on its use in therapeutic settings outside the institution. We will also review the challenges and ethical considerations encountered in liaising with both licensed and non-licensed community providers. In addition, we will consider the appropriation of psychedelic medicines from indigenous peoples, and limitations in participation in research and access to ketamine and PAT for patients of color. We will illustrate these points with three cases. 1) A young Asian man with metastatic rectal cancer who grows his own psilocybin seeking consultation on "how to best use psilocybin safely." 2) A white woman status post hematopoietic stem cell transplant for relapsed ALL expressing interest in ketamine therapy in the community without disclosing the severity of her medical illness. 3) A white woman with stage IV ovarian cancer who has identified a shaman in the community and asks her psychiatrists advice and recommendations around psychedelics.

We will end by considering what lessons we can apply to ketamine and PAT from cannabis and the ways it has and has not been successfully integrated into serious illness care. We will discuss the gap that exists between medical providers’ knowledge and confidence in discussing cannabis use with their patients and the level at which patients are accessing and using cannabis for a variety of symptoms.