Here are some highlights of Darracott-Cankovic\u2019s conversation with Herald national desk editor Hannah Brown.<\/p>\n
What fears and questions are your patients typically grappling with?<\/p>\n
They\u2019re fearful of the dying process and what it might entail in terms of suffering, pain and distress.<\/p>\n
Others have a fear of what comes after dying \u2013 which can range from judgment day and guilt and whether they led a life that was good enough \u2013 or it can be a fear of no afterlife.<\/p>\n
“One of the most common fears is how those left behind will cope. People don\u2019t want their families to suffer,” Dr Fi Darracott-Cankovic told the Herald. Photo \/ Sylvie Whinray <\/p>\n
One of the most common fears is how those left behind will cope. People don\u2019t want their families to suffer.<\/p>\n
Can you talk me through the new therapy from start to finish?<\/p>\n
My permit from Medsafe is for a very specific protocol: two therapists pair up for an individual patient, the patient is assessed, we do preparatory sessions, and then we have an all-day psilocybin session with an integration afterwards \u2013 bringing meaning to the experience.<\/p>\n
Each patient can have up to three cycles of it within the permit. One to three treatments.<\/p>\n
First there\u2019ll be a detailed informed consent sheet the patient will read to find out more about what the therapy entails, then we\u2019ll move into a screening process including a medical assessment, and we\u2019ll look at psychiatric history.<\/p>\n
There\u2019ll also be a psychological screening process to make sure people have adequate support around them to embark on something like this.<\/p>\n
At this point I\u2019ll be joined by a second therapist who will stay with us through the rest of the arc of treatment. We\u2019ll have two preparation sessions, where we build a sense of trust. It\u2019s really important for the patient to feel a sense of safety and connection to us.<\/p>\n
In those early sessions we\u2019ll also explore their expectations for treatment, and any fears and concerns that they might have.<\/p>\n
A big emphasis on preparation then?<\/p>\n
Yes, and we also talk about what the medicine day will look like and encourage them to think about an intention for that day. It might be directly around their fear of dying, or something looser \u2013 like \u201chow do I access love?\u201d<\/p>\n
We also emphasise that something will probably come up from their subconscious on the day.<\/p>\n
There\u2019s often a fair amount of trepidation, but they have commented it\u2019s also an opportunity for hope.<\/p>\n
Dr Fi Darracott-Cankovic has prepared a space at Dove Hospice in Auckland to be conducive to psychedelic therapy, with patient access to a Japanese contemplative garden outside. Photo \/ Sylvie Whinray <\/p>\n
We also really look at consent. That\u2019s because it\u2019s hard to consent to something when you don\u2019t know quite what it will be, and in an altered state of consciousness you\u2019re not used to.<\/p>\n
We especially talk about consent for touch. It\u2019s really important for the patient to make their decisions about consent while they\u2019re in an ordinary frame of mind.<\/p>\n
It\u2019s known that touch can be incredibly supportive during a psychedelic experience \u2013 typically that means holding a patient\u2019s hand \u2013 but consent needs to be given in advance.<\/p>\n
Talk us through what happens when they take the drug \u2013 on dosing day.<\/p>\n
It only happens once we\u2019re all in agreement that the patient feels suitably prepared.<\/p>\n
It\u2019ll be an all-day session, done in Dove Hospice<\/a> \u2013 in a room set up to be conducive to the psilocybin setting, so it\u2019s more like a comfortable home with beautiful artwork and subdued lighting, flowers, and the participant will be invited to bring in personal meaningful items: photos, taonga, anything that will bring them comfort.<\/p>\n We explore people\u2019s musical preferences and tastes and that helps us curate music for the day. I have a music therapist on the team \u2013 it\u2019s like two therapists plus music.<\/p>\n Patients have told us it\u2019s often a very meaningful, often sacred experience and we\u2019ve worked with M\u0101ori and other indigenous perspectives. We may open with a karakia or poem and we will offer aromatherapy and a guided meditation to start.<\/p>\n People can wear headphones and eye shades, to encourage them to go deeper within so they\u2019re really immersed in a world, rather than being distracted by the room \u2013 but all these things are optional and never mandatory.<\/p>\n When everyone\u2019s in a nice calm, centred, connected state, the patient will be offered the psilocybin capsule and it\u2019ll be a matter of them lying back with the music, the two therapists will sit alongside, and our role is to be supportive and be there for the patient \u2013 but in an unobtrusive way.<\/p>\n We\u2019re not going to be asking questions or directing the process, but they\u2019ll know we\u2019re right there with them, just holding the space, offering support at any point.<\/p>\n Then after six to eight hours approximately, as the medicine is wearing off, we\u2019ll offer them some food and drink, and we\u2019ll have art materials on hand if the words aren\u2019t flowing easily.<\/p>\n Once they\u2019ve returned to a baseline state of being and there are no ill effects felt and they feel ready to go home, we\u2019ll send them home with their companion, and we\u2019ll provide aftercare advice and contacts in case anything emerges.<\/p>\n A week later there will be a follow-up therapeutic session with both therapists, and the aim of those is to explore the content of the session, the visions, the emotions, we look at meaning-making and how they can really bring that meaning into everyday life: perhaps through time in nature, mindfulness meditation, movement and dance, through art, there are a number of different ways people can integrate what happened.<\/p>\n What are they typically seeing and experiencing?<\/p>\n The music often is very, very rich and that itself can be very evocative for them, so there\u2019s that sense of deep immersion into the music, they can feel merged with the music.<\/p>\n People may well have visions \u2013 they may be immersed in the forest, ocean, having rich experiences in nature.<\/p>\n They can feel a sense of support and contact with ancestors, loved ones.<\/p>\n Can they bring their partner to the medicine day?<\/p>\n At the moment they will have a nominated support person who knows all about the therapy, and will transport them. Towards the tail end of the session it would be okay for them to come in.<\/p>\n Some say psilocybin is most effective in nature \u2013 can they access nature?<\/p>\n One day we\u2019d love to offer this therapy in nature. At the moment there\u2019s a beautiful Japanese contemplative garden and patients have access to that.<\/p>\n What does the room feel like during a psilocybin therapy session?<\/p>\n I find as a person, a human sitting alongside, it\u2019s very moving. It can be a huge cathartic emotional experience with themes of love, peace, connectedness, a mystical beautiful experience.<\/p>\n But there often is also contact with some really difficult emotions \u2013 so there can be expressions of grief, fear, anger. We welcome everything in this type of therapy. We\u2019re not trying to suppress; we\u2019re allowing things to come up for release.<\/p>\n Why do you have two therapists there at all times?<\/p>\n It\u2019s partly pragmatic because you just can\u2019t leave someone. How would you go to the bathroom?<\/p>\n But more than that, one of the tenets is to never leave the patient on their own. It\u2019s been the model for many of the trials.<\/p>\n It\u2019s also for safety. With two, you\u2019re accountable and transparent.<\/p>\n These are relationships \u2013 and a lot of the healing comes from the relationships. This way, you have different ones at play, and what we all hold as humans is differently useful for people at different times. It also means deeper and wider expertise.<\/p>\n We\u2019re a really new cohort of therapists doing this in this country. We don\u2019t have extensive elders and practitioners in the field.<\/p>\n What do you mean by that? Which countries have elders and what do they offer?<\/p>\n Before psychedelics became illegal there were a number of researchers who gained a lot of experience working with psychedelics in the US and Europe. That\u2019s partly how we know how effective they are \u2013 the work they did from the 50s to the 70s.<\/p>\n And it\u2019s important to acknowledge that psychedelics have been used for a long time by indigenous populations for healing and ceremonial purposes, and there are countries where those traditions are still alive. I\u2019ve had the incredible opportunity to train with indigenous Peruvian medicine people of the Andes.<\/p>\n They use these medicines with deep reverence and understanding and experience.<\/p>\n Where do you get your psilocybin?<\/p>\n There\u2019s no one producing pharmaceutical-grade psilocybin here.<\/p>\n I\u2019m using a company in Australia called Natural Med Tech \u2013 I really like their ethos. They use a more natural, eco-friendly process than some others who favour a pharmacological synthetic production. And they\u2019re very well-priced.<\/p>\n How will people access this therapy?<\/p>\n Patients will come through Dove Hospice \u2013 people can refer themselves to Dove.<\/p>\n The cost is high. We\u2019re budgeting $9000 for a round of treatment \u2013 that\u2019s about half the cost you\u2019re looking at in Australia. And that\u2019s not including the cost of travel and how daunting that could be. The main cost is the hours of therapy from two therapists.<\/p>\n My vision is that we won\u2019t have to charge patients for it at all \u2013 and the handbrake to that at the moment is we don\u2019t have funding. I\u2019m hoping we\u2019ll attract some philanthropic donors.<\/p>\n I do have a first patient \u2013 next month. I know her well and it feels like a good case to start with.<\/p>\n Could people just go out and get psilocybin and do it themselves?<\/a> With their partner or a good friend?<\/p>\n Because the cost of this therapy is high, and access is very limited, I can understand why people could be drawn to do it themselves with trusted loved ones.<\/p>\n But people at end of life can be physically or psychologically vulnerable, and we\u2019re confident that we are providing safe psilocybin and a robust process.<\/p>\n Why psilocybin? Why do you like working with that specific drug?<\/p>\n What Medsafe looks at is the level of evidence that the therapy works. And there\u2019s good evidence that psilocybin is an effective drug for end-of-life care.<\/p>\n There\u2019s less evidence for MDMA \u2013 there is a trial going on in Auckland at the moment for MDMA for advanced cancer, but it\u2019s not finished.<\/p>\n What research is out there, for those who are interested?<\/p>\n One of my dear colleagues is a clinical psychologist called Margaret Ross in Australia. There was a really amazing documentary made about her work called The Edge of Life \u2013 it\u2019s beautiful.<\/p>\n She released a paper recently on exactly what we\u2019re going to be doing: end-of-life psilocybin work.<\/p>\n The research paper is called Psilocybin-assisted psychotherapy for depression and anxiety associated with life threatening illness.<\/p>\n Roland Griffiths did another very influential randomised, double-blind trial in 2016 which showed how effective and sustained psilocybin therapy can be at reducing depression and anxiety for people with life-threatening cancer.<\/p>\n Once our psilocybin therapy is underway, we\u2019ll be working with the University of Auckland to gather data on outcomes.<\/p>\n Where does New Zealand sit globally in this area?<\/p>\n It\u2019s new here. I have a lot of support and mentorship from people in the States.<\/p>\n And there\u2019s a lot of research. It\u2019s actually one of the fields within palliative medicine that has been studied a lot: facing mortality. It\u2019s an area where people have suffered hugely, and this therapy really offers a new hope, and beautiful scope to bring meaning, peace and help people.<\/p>\n Canada has been delivering a compassionate programme for terminal patients for four or five years \u2013 they\u2019re a leading country in this area.<\/p>\n Medsafe starting to approve it here puts us at the cutting edge of legal psilocybin therapy globally.<\/p>\n You\u2019ve worked with other drugs for end of life too, haven\u2019t you?<\/p>\n I\u2019ve been leading a ketamine-assisted therapy programme at Dove Hospice for the last three years. It\u2019s a two-hour experience rather than the longer experience you get with psilocybin.<\/p>\n It\u2019s been transformative for some of my patients, and allowed them to access peace, love, loss of their fears, and helped them to be more present in life and really appreciate their living, rather than being so stuck on the dying.<\/p>\n It\u2019s been beautiful work, but psilocybin offers a longer session, and it\u2019s a natural medicine.<\/p>\nResearchers around the world will be taking interest in Medsafe’s decision to grant a single New Zealand doctor permission to use mind-altering psilocybin \u2013 derived from magic mushrooms \u2013 in her care of the dying. Photo \/ 123rf<\/p>\n
Dr Fi Darracott-Cankovic has been leading a ketamine-assisted therapy programme at Dove Hospice for three years. She says many of her patients have found it transformative, but research shows the effects of psilocybin therapy could be even more enduring. Photo \/ Sylvie Whinray <\/p>\n
Dr Fi Darracott-Cankovic (inset) is the first person in the country licensed to prescribe the psychedelic drug psilocybin \u2013 derived from magic mushrooms \u2013 specifically for end-of-life care. NZ Herald composite photo<\/p>\n
Psychiatrist Cameron Lacey received the first Medsafe licence in New Zealand to work with psilocybin. His work is in treatment-resistant depression. The move came two years after a similar decision in Australia. Photo \/ Elimbias Health<\/p>\n