Mathieu has struggled with anxiety and depression all his life. In 2017, he was first diagnosed with cancer, then survived the gaping hole left in his face by the total amputation of his nose. Head held high, he agreed to face the world with a synthetic nose, and tried a number of experimental treatments to cling on to life.
But after five years of mourning and fighting illness, the enemy sawed off his legs and signaled the end of the match for this fighter of incredible resilience.
“When I was diagnosed with incurable lung cancer, it was quite a shock. I only saw the end. We increased my antidepressants, but it was still difficult. So when the Dr Farzin told me about a new approach to dealing with depression, I said to myself: why not, if it can help me and help people not to go through what I have been going through all my life? »
On Friday, Mathieu Kirouac will abandon himself to the care of Doctor Houman Farzin and psychiatrist Nicolas Garel during the first psilocybin treatment administered in Quebec as part of the special access program (PAS) to hallucinogenic drugs set up last January by the federal government. The SAP authorizes doctors on a case-by-case basis to use these substances — including synthetic psilocybin (magic mushrooms) and MDMA (ectasy) — to help their patients when they are supplied by producers licensed by Health Canada.
This is a small revolution in the Quebec medical world, since he is a palliative care doctor from the Jewish General Hospital and a resident doctor in psychiatry from McGill University who will pilot this experimental treatment based on the psychoactive potential of magic mushrooms. PAS is currently reserved for patients with depression, anxiety, obsessive-compulsive disorder (OCD) or drug addiction whose illness is resistant to traditional treatments.
“Me, I suffer from all that. I have never taken any drugs, except a little cannabis. I do it to manage my anxiety, but especially for my loved ones, so that my last moments with them are moments of quality, ”says Mathieu, whom suffering makes at times irritable and distant from his family.
A turning point
Rare patients in Quebec have already received psilocybin in the past as part of research protocols, thanks to a rare exemption granted by Health Canada. However, they had to source the substance at their own expense from non-legal suppliers.
This time, says psychiatrist Nicolas Garel, this treatment will be given legally in a clinical setting and will be fully covered by the public health insurance system. At Mathieu’s request, the treatment will take place in the cozy cocoon of his chalet, where he wishes to end his days. He will be accompanied by the two doctors during the six hours that the hallucinogenic effect of the psilocybin will last. “He knows he is paving the way for others and wants to leave some sort of legacy,” adds the Dr Garell.
“The pharmacological tools that we have do not always work, especially in the terminal phase. To date, I have seen tremendous benefits in some patients,” adds Dr.r Farzin.
According to the Dr Nicolas Garel, psilocybin plunges patients into an altered state of consciousness, particularly on the auditory and visual levels. “It leads to heightened sensitivity and can help patients come to terms with their impending death, or even expose them to an experience that can change their outlook on life. The goal is not to treat physical pain, but psychological pain,” explains the psychiatrist.
For his part, the Dr Farzin emphasizes the global aspect of this approach, which requires prior preparation. “Six hours will be spent under the influence of medication, with headphones and a mask to cover the eyelids. But we will be there for nine hours to train the patient and accompany him all day. »
Trials conducted under research protocols have reported long-term positive effects in about 70% of depressive patients resistant to traditional treatments, says Dr.r Garell. And those effects can linger for months, if not years, he claims.
“At the end of life, patients don’t have time to wait for the effect of an antidepressant. In palliative care, there is an urgency to intervene,” confirms Dr.r Farzin.
another paradigm
More associated with soaring trips than with medicine, this type of treatment is not without creating a stir in the medical world. “Not all oncologists are open to this, there is still work to do [de sensibilisation] to do,” says the Dr Houman Farzin.
“It goes against the modern psychiatric approach based on a drug taken daily. We are aiming for an experience that alters the functioning of the brain and increases its neuroplasticity,” explains Dr.r Garell.
Asked about the risks of this experimental approach, the two doctors insist on the importance of supervision to provide such treatment. “It’s not a magic bullet. That doesn’t fix everything. This opens up avenues for continuing work in psychotherapy. The patients are handpicked, and it takes well-trained therapists to accompany them. It can also cause harm, ”says the Dr Houman Farzin.
Among the risks associated with this procedure is the increased risk of psychosis, he says.
The Dr Garel, who has previously used ketamine — another psychoactive but medically legal substance — to treat patients with intractable depression, says this field of psychiatry is expanding. “There are still few studies, but interest in the use of these substances for medical purposes is growing, both in psychiatry and in palliative care,” he says.
The Dr Farzin, on the other hand, believes that psilocybin could benefit more patients, especially those with life-threatening illnesses.
Since January, Canada has been a pioneer in the use of psychedelic drugs for therapeutic purposes. But patient groups are already pushing for greater access to these substances and they want to challenge the law that makes their use and possession illegal.
Currently, only one other patient in Quebec has reportedly obtained access to psilocybin through PAS, through the Mindspace Clinic, a private clinic offering psychedelic-assisted psychotherapy.
A peaceful end
More than death, it is the repeated bereavements since 2017 that have finished undermining the morale of Mathieu Kirouac. “First, it was the loss of my nose, then suffering the gaze of others, then the loss of my quality of life and of all life projects, which fell. »
For him, it is now midnight minus one. “I don’t feel distress in the face of death. It’s the front that scares me, the decline. When you know you’re going to die, all your priorities change. And now, my priority is to live intensely and harmoniously with those around me. »