As conversations about the decriminalization and legalization of psychedelics continue to grab news headlines, an increasing number of mental health professionals are tuning in to conversations about psychedelic-assisted therapy. They are specifically wondering how – and when – those conversations could impact their own career trajectories.
The pathway to legalizing this therapy for mental health conditions like PTSD, treatment-resistant depression, end-of-life anxiety, and addiction has begun to attract bipartisan support across the United States. Two recently passed pieces of legislation – Oregon’s Ballot Measure 109, and Colorado’s Proposition 122, or the Natural Medicine Health Act – have begun the process of making this kind of therapy available.
Psychedelic-assisted therapy has the potential to shift how professionals treat mental health disorders. This shift could have far-ranging implications for the way care providers see patients, craft treatment plans, and consider long-term care. Increasingly, healthcare professionals are considering how the legalization of psychedelic-assisted therapy in their state – and eventually at the federal level – might impact their next career moves.
What will a future that includes psychedelic-assisted therapy look like? Elizabeth Nielson, PhD, Co-Founder at Fluence, stresses that healthcare professionals first need to understand that “services provided in Oregon under Measure 109, and in the future in Colorado under the NMHA, are not part of the existing healthcare system. Although there are some similarities in terms of professional licensure and responsibility, these laws establish a new license type with its own regulations.”
She believes more and more opportunities will arise for caregivers to provide psychedelic therapy and related services “within their existing scope of practice, including psychedelic harm reduction and integration, ketamine-assisted therapy, and eventually will likely include FDA-approved psychedelic therapies.”
Fluence offers continuing education and certificate programs to prescribing clinicians, psychotherapists, and wellness practitioners, about this emergent training space. Certifications in psychedelic harm reduction and integration and ketamine-assisted therapy are available for residents of all 50 states. A certification in psychedelic-assisted therapy is currently only available to Oregon residents, with plans to expand to Colorado. All of it is new territory for these states and for the healthcare professionals that practice there.
Oregon’s Ballot Measure 109 passed in 2020, legalizing the use of psilocybin mushrooms with facilitation at service centers (projected to open this year) with licensed facilitators. The NMHA, which passed in November of 2022, includes both decriminalization of several psychedelics and the legalization of adult-supported services at licensed facilities complying with the state’s regulatory structure, which is currently in development.
“Colorado was a big win for psychedelic therapy, and is in a position to improve on Oregon’s implementation,” says Victor Cabral, LSW, Director of Policy and Regulatory Affairs at Fluence. “The legislation is much more expansive, and provides additional protections for residents of Colorado looking to engage with these medicines outside of a regulated system.”
Cabral predicts that other states will follow these two in passing legislation to decriminalize or legalize psychedelics, especially after the FDA approves MDMA-assisted therapy (projected to happen as early as next year). The details of the training programs that will become available in each state will depend on what local legislation looks like in order to build state-specific certification programs.
Each state might handle the subject very differently. “My prediction is that we will continue to see an increase in legislation introduced that will range from decrim to the establishment of task forces focused on policy analysis,” Cabral says, “with more progressive states [like Colorado] moving toward less regulated approaches and conservative states leaning more toward limited and regulated access, research, or analysis.” Eventually, he says, infrastructure and regulations may be developed at the federal level that will support these state-level efforts.
The bottom line, however, is that institutions – whether they’re already offering some training or plan to – are ready to tailor materials for new states as legislation passes. Faculty also keep former, current, and prospective students looped in with evolving regulations. “We’re very up front with folks about how things are developing. Everyone is watching and adjusting as things happen,” says Cabral.
While people in states where psychedelic-assisted therapy is not yet legal wait, they can complete other certifications and coursework, like certificates in harm reduction and integration or ketamine-assisted therapy.
Nielson points out that people who want to become licensed need to keep in mind that their licenses “do not negate the federal government’s classification of psilocybin and other psychedelics as Schedule 1 drugs,” even in Colorado and Oregon. She encourages healthcare professionals who do not want to put their licenses at risk “to pursue options for practice that fall within their scope of practice as licensed healthcare providers,” like research with FDA and DEA approval, certification in psychedelic harm reduction and integration, or certification in ketamine-assisted therapy.
“Ketamine-assisted therapy is currently legal, and therapists can begin to practice and learn skills that will likely be transferable to supporting other psychedelic-assisted therapy,” says Cabral. “And, as more legislation is passed and the use of these medicines continues to increase, there will be increased need for support around harm reduction and integration, which is an essential framework for psychedelic-assisted therapy and one that therapists can apply to their practice even in states where these medicines remain illegal.”
Becoming certified in ketamine-assisted therapy would give students transferable skills for MDMA or psilocybin-assisted therapy, and Cabral and others are working towards a future where accreditation in additional therapies won’t be an endless process. “We are figuring out what these standards of care and training look like, and whether there will be reciprocity among these programs,” he explains. His hope is that people will be able to apply credit for training they have done to additional programs.
Cabral anticipates a professional, psychedelic-assisted therapy field “where folks are able to move around with that education they’re receiving and not have to do five different training programs to be trained with each medicine,” he says.
Regardless of how discussions play out, he says, “our trainings will be designed to equip folks to be ready when these medicines are legal.”