Module 8: Psilocybin and Ketamine

Some people never learned organized surrender before the fall. For them, there is psilocybin. It is not a guarantee. The research is strong enough that your person deserves to know about it. The decision is your person's, made with their medical team.

What the Research Shows

In 2016, trials at Johns Hopkins and New York University studied people with life-threatening cancer and clinically significant anxiety or depression. Each participant had preparation, a psilocybin session with trained support, and follow-up. Anxiety and depression dropped substantially and stayed down at six months. NYU's long-term follow-up found the reductions held in most surviving participants at about three and four and a half years. Many rated the experience among the most meaningful of their lives. These were small studies, and the long-term follow-up had no comparison group. Research continues at universities and medical centers across the country.

Roland Griffiths, who led the Hopkins trial, went in cautious about what the experience would do to someone facing their own death. The results were the reverse of what he feared.

What It Is and What It Is Not

A psilocybin session is not a shortcut around presence. Preparation, a trained guide during the session, and help making sense of it afterward are the mat. Fear, confusion, and distress can happen even with that mat. Without it, a person can collapse there too. This is not something to do at home.

Legal Routes for Psilocybin (as of November 2026)

Psilocybin remains a Schedule I substance under federal law. Legal access exists through specific routes, and the rules change quickly. Check with the regulator before you act. Local decriminalization is not a licensed program.

Oregon: licensed psilocybin service centers with trained facilitators. Clients must be 21 or older. No diagnosis is required.

Colorado: licensed healing centers under the Natural Medicine Health Act (Proposition 122). Clients must be 21 or older. No diagnosis is required.

New Mexico: a medical psilocybin program created in 2025. End-of-life care is a qualifying condition. As of November 2026, the Department of Health reports that patient enrollment has not started; its goal is to enroll the first patients by the end of December 2026. The law requires the program to be running by December 31, 2027.

Clinical trials: search ClinicalTrials.gov for psilocybin studies in cancer, palliative care, and end-of-life distress. Check recruitment status, eligibility, and location, then contact the study team.

Federal review: on November 9, 2026, Compass Pathways completed its FDA application for COMP360, its psilocybin formulation, for treatment-resistant depression. It is not yet approved, and the application is not for end-of-life care.

Ketamine

Ketamine is the psychedelic-assisted option available now, legally, in every state. It is an FDA-approved anesthetic, and physicians can prescribe it off-label for depression. A related nasal spray, esketamine (Spravato), is FDA-approved for treatment-resistant depression. Ketamine also has a long history in palliative care for pain.

Intravenous ketamine can work faster than standard antidepressants ~ often within hours to days rather than weeks ~ and that matters when time is short. The evidence in hospice is small: in a 2013 open-label trial, 14 hospice patients started daily oral ketamine; the eight who completed the month showed improvement in depression and anxiety. In those eight, anxiety improved significantly by day 3 and depression by day 14. There was no comparison group. Ask your person's hospice or palliative team about it. If they don't offer it, ask who does.

Medical Screening

Neither medicine is right for everyone. Every legitimate program or prescriber screens medically and psychiatrically. A personal or family history of psychosis or bipolar disorder needs careful review. So do heart and blood pressure problems, delirium or significant cognitive impairment, and every medication and supplement. Being eligible for a legal program is not the same as being medically safe to take part. Your person's hospice or palliative team should be part of the decision. Don't stop or change medications to qualify without the prescribing clinician. Travel to another state is a real burden for someone who is seriously ill; factor that in.

How You Can Help

Ask your person if they want you to gather information, and which question they want answered first. If they say no, close the folder.

Help find and evaluate a program, study, or prescriber. Ask how facilitators are trained, how screening works, and what preparation and follow-up look like.

Help with logistics: travel, scheduling, medications, the hospice team in the loop.

On the day, follow the program's rules about who may be present.

Afterward, listen. Your person may want to talk about what happened, or may need time. Don't interpret it for them. Ask what it meant to them.

Companion Workbook

Module 8: Psilocybin and Ketamine

Worksheet: Program Questions

For one program, study, or prescriber, with your person's permission to ask. This is a question list, not an eligibility check.

Completed Example: Program Questions

Fictional example. Evan's sister Ruth wants questions answered, not bookings made.

Worksheet: Your Person's Choice for Now

After a conversation your person wants. Include a decision to decline or leave it alone.

Completed Example: Your Person's Choice for Now

Fictional example. Mae's partner Daniel chooses not to pursue this.