Kiwi scientists are preparing to microdose advanced-stage cancer patients with LSD to see if it can help with feelings of anxiety, loneliness, depression and existential distress.
It's part of the psychedelic renaissance at New Zealand's universities as researchers turn their attention back to these powerful tools and investigate their potential medical uses.
If this ground-breaking study is successful, it could have life-changing results for thousands of terminally ill Kiwis.
Newshub spoke to study leader Dr Lisa Reynolds about her research - and her hopes for the future.
University of Auckland health psychologist Dr Lisa Reynolds has devoted years to supporting patients and their whanau as they come to terms with their cancer diagnosis and prognosis.
"It's common to be fearful of some things - so fear of death, fear of dying, fear of treatment, fear of what lies ahead, concerns about loved ones being left behind," she tells Newshub.
"There can be feelings of isolation and hopelessness and demoralization. It can also be thinking about the life that you've lived and concerns about unfinished business."
Now she's leading a key study funded by a three-year $250,000 Health Research Council emerging researcher grant that could unlock a new way to help them face the end of their lives.
"It's been awarded for a particular project that I've designed in collaboration with some other experts and psychologists and pharmacists and various people," she says.
"We've designed a trial where we're going to test the feasibility, the acceptability and the safety of LSD microdosing alongside talk therapy."
Dr Reynolds became interested after reading Michael Pollan's book How To Change Your Mind, which details how people with cancer were given a single high dose of psilocybin and had dramatic reductions in anxiety and depression.
"I've been interested for a number of years in supporting cancer patients or people with cancer as they adjust to illness and sometimes adjust to end of life. But I guess quite recently - maybe in the last three or four years - I heard about psychedelics," she tells Newshub.
"I looked into some of the studies that were happening and it seemed like a really promising area that was really different to what's currently being offered.
"So that's why I got interested in the possibility of psychedelics as another option for people who have cancer."
Treating cancer patients with LSD isn't new, of course. In the 1960s and early 1970s psychedelic pioneers like Stan Grof gave them a high dose full-on psychedelic experience and found they had reductions in fear of dying and feelings of isolation.
But this psychedelic research got shut down in the 70s and has only just started to reemerge.
Dr Reynold's study is different in that it uses microdoses of LSD, which is still novel, and will work with terminally-ill people, instead of healthy people.
"There's been nothing to my knowledge where LSD microdoses have been used with cancer patients," she tells Newshub.
Microdosing involves tiny sub-perceptual amounts of LSD - too small to trip, but potentially large enough to have mental benefits. This will be combined with talk therapy - meaning-centred psychotherapy that aims to help people connect with what's most meaningful and purposeful in their lives.
It's still unknown just how LSD might ease the fear of death. Dr Reynolds says the current thinking is that it works on the serotonergic pathways in the brain and opens us up to being able to think more clearly.
"Certainly at a high dose the experiential effect of LSD or another psychedelic can be that people have an experience of connection - so a connection with each other, connection with the land, connection with the universe and that seems to be really helpful in a person who is facing death because it seems to make some sense of mortality," she says.
"That, of course, is a high dose. Whether a microdose works the same way we don't know.
"Our thinking around this trial is that the relief of fear of dying, that the heavy lifting of change, that is going to come from the psychotherapy and that the microdose will enhance that effect - so maybe make it work more quickly, more effectively."
How the study works
The phase one early-stage trial is expected to take around three years in total - including 12 months just to tick off all the approvals.
After these are completed, Dr Reynolds is aiming to start recruiting 30 people from about July next year.
"Most will have stage 4 cancer, sometimes they might have stage 3 cancer but they're certainly people that have a shortened life expectancy," she says.
"They will also be people who have symptoms of anxiety or depression or have some existential distress."
They'll then be randomized to either receive an LSD microdose or placebo microdose, which they'll take every three days over the course of seven weeks.
"They will come in once a week and have their psychotherapy and they'll have that in conjunction with a microdose. Then they'll take home a couple of microdoses to have themselves in their home over the course of the week," Dr Reynolds says.
"They'll come back in the following week, have another psychotherapy session, microdose and they'll continue that for seven weeks."
What does success look like?
Dr Reynolds says if this trial is successful it will show medical microdosing is both logistically possible and has benefits for patients.
"We'll be assessing whether this is a safe thing to do and looking for indication that it's helpful in terms of those key things that we are measuring - helpful in terms of anxiety, fear of death, reductions in depression... that it helps their quality of life, maybe improves spiritual wellbeing," she says.
The next step after that would be a larger second-stage trial with more participants, and if this is also successful would hopefully lead to offering microdoses of LSD as an authorised treatment.
"Research is a means to an end," Dr Reynolds tells Newshub.
"I am interested in doing this because I think it has the potential to help people and provide another option for people at the end of life.
"So ideally, you know where I'd like to see this research go, is translated into viable psychological interventions or help for people who are facing death."
New Zealand researchers leading the world - and hope for the future for patients who currently don't have much hope.