🫠 Psychonaut POV

Welcome to Tricycle Day. We’re the psychedelics newsletter that knows someday we’re all gonna die. Maybe in the next life, we’ll come back as a YouTube channel about gardening. Wouldn’t that be nice? 🌼

For years, Christine Caldwell watched how the medical establishment treated death as something to be swept under the rug. Now, as founder of End of Life Psychedelic Care, she's helping people change their relationship with mortality from terror (or outright denial) to curiosity and acceptance.

We asked Christine how psychedelic therapy changes people’s outlook on dying, which medicines work best for specific end-of-life challenges, and how she's helping folks access psychedelics before they take the ultimate journey.

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What gaps did you notice in end-of-life care during your time running a home health agency? What led you to psychedelics as a possible solution?

If I had it to do over again with my 250-client home healthcare agency, I would offer ketamine, end-of-life doula services, and train my aides in mindfulness and somatic techniques. There's so much we know now that I didn't know then. What came across clearly was how the medical establishment treated death and dying—like something to be prevented, something to not even talk about. When you own a home healthcare agency, your clients die on a routine basis. It's normal.

I felt helping them in their home was one good way to help them live a better life. I think about my own mother who died at 92. Her social network became the two home healthcare aides who took care of her. Isolation can be a killer, so those interactions with aides didn’t just improve her quality of life; I believe they prolonged it, too.

There clearly is a need to shift our narrative around death and dying and the medical establishment's belief around it. Now I live in a psychedelic bubble. The people I meet—physicians, nurses, chaplains, doulas—they all believe like we do. But that's not the norm in healthcare. I’m also big on helping people stay in the home, and I don't mean just at end of life. If they feel their psychedelic journey should happen in the comfort of their own home, then we should do our best to help them do that.

How do patients who've experienced psychedelic therapy approach their final days differently from those receiving conventional care?

With the majority of clients or patients, we see almost a reversal about death and dying. Instead of being afraid of it, some of them are even welcoming it. I think that's one of the biggest benefits.

Of course, people demonstrate reductions in anxiety and depression. All the research has shown that. But once they get their anxiety under control, it becomes a matter of understanding what death and dying are really about. Let me get a glimpse of the other side. They can live comfortably in the present moment, understanding that death is coming and that that’s okay. It is a part of life.

In our western society, we are scared shitless of death. As we get older, it begins to weigh on us a lot more. If we can reverse that relationship 180 degrees, how beautiful. People describe the shift differently. They could mean "I'm at peace with dying," "I welcome it," "I'm looking forward to the other side," or "I know there's more than this physical body." Not everybody should be using psychedelics, but for many, it transforms their relationship with mortality.

Have you found certain psychedelic medicines work better for specific end-of-life challenges than others?

As the physical body becomes more frail, the veil thins and we become more ethereal. We are already becoming more in touch with the other side, though we don't always acknowledge it. Different medicines have different advantages along this continuum.

Ketamine can be used through this whole continuum, from diagnosis to really close to the end of life. Because it's dissociative, you get that split between mind and body. You become that neutral observer to look at issues like guilt or emotional wounds. You also experience what it feels like to not be in my body anymore. Many people lose their fear of death because of that. In a retrospective study of some 15,000 reports, ketamine was found to be the most like a near-death experience.

Psilocybin is gentle and creates an embodied, felt sense in the body. People with cancer often confront their cancer. They talk to it, have dinner with it, feel it in their body. Thomas Hartle, the first Canadian to receive psilocybin therapy through Health Canada, talks about realizing his cancer "was as much a consciousness as me." People use psilocybin along the entire continuum, but digesting it closer to the end of life can become physically more difficult.

MDMA is a heart opener. What better medicine when you can't forgive yourself or somebody else? However, it can be tougher on the heart, so it's something people might want to use upfront, less so when the person's body becomes more frail.

5-MeO-DMT, at very low doses around five milligrams, can take a person through the journey arc and let them experience unity consciousness very close to the end of life. As someone becomes more frail, they may not need the full breakthrough dose to experience non-dual states.

Pragmatically, some people might prefer a legal medicine like ketamine, while others may be comfortable working underground with a broader choice of medicines, or using state-regulated options in places like Oregon or Colorado.

Given the current legal landscape, how are you working to make these medicines truly accessible for people with life-threatening illnesses?

My organization, End of Life Psychedelic Care (EOLPC), has three pillars: education, advocacy, and connection. Education includes educating the public, people working in end-of-life care, and aspiring psychedelic facilitators. In Oregon where psilocybin is legal, we can help train licensed facilitators to understand how to work with somebody toward the end of life. Similarly in Colorado, we're preparing for their natural medicine program.

On the advocacy front, I'm involved in legislative reform efforts like amending Oregon's law to allow for psilocybin services in the home. I'm working with others to develop protocols that ensure safety while expanding access.

For connection, I have the first practitioner's directory where professionals must have both end-of-life and psychedelic care experience. I also did work with a palliative care physician in Northern California, pairing an end-of-life doula with him to administer ketamine in homes. The doula did the initial intake, the doctor handled medical screening, and the doula managed preparation, integration, and supported the client throughout. This model reduces costs and brings care to where people are most comfortable.

Most of all, I want to light a fire under efforts to deliver psilocybin and ketamine services now, not later. Canada’s Roots to Thrive program has demonstrated how effective group therapy with psilocybin can be and at a fraction of the cost of many US models. I want to bring those group protocols into Oregon, Colorado, New Mexico, and Utah, adapting them to fit local regulations. We also need to collaborate with palliative care and oncology teams to deliver ketamine, especially since those medical models already exist. The groundwork is there. Now we just need to put it into practice.

What might the journey look like for someone with a terminal diagnosis who reaches out to EOLPC about trying psychedelic therapy?

I direct them first to my website where I've got recorded videos on the basics. I have them listen to Thomas Hartle's video, which is so beautiful it’ll make you cry. I've also got other resources there, like Kayse Gehret’s workshop on microdosing for end of life.

I invite them to join our Journey Circle, where they can talk with others, lose their fear of psychedelics, and connect with a group that understands their pain. Thomas tells the same story that the group therapy inordinately made the whole experience better.

There's also the connector directory where they can find practitioners either locally, regionally, or who work remotely. I'm always here to answer questions, and we offer classes diving into particular topics related to end-of-life care that are normally not covered—like meditative practices, visualizations about where you want to go when you die, somatic techniques, and supportive touch.

It's important to understand that psychedelics may not be right for everyone or at every stage. As you get closer to the end of life and the veil thins, there are other “death medicines,” such as reiki, meditation, and guided visualization, that can help. Our goal is to bring about the best death and dying journey possible, and bring death back to being a sacred journey. Psychedelics are just one tool for that.

Want more from Christine?

Join a free online gathering for people living with life-threatening illnesses, or become a member of EOLPC if you’re an end-of-life care practitioner.

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DISCLAIMER: This newsletter is for educational and informational purposes only and is not intended as a substitute for professional medical advice. The use, possession, and distribution of psychedelic drugs are illegal in most countries and may result in criminal prosecution.