One year into the two-year process of legalizing psilocybin services in Oregon under Measure 109, therapists, lawyers, doctors and activists are thrashing out their ideas in huge Zoom calls, preparing to submit recommendations to the state in March.
Measure 109 passed in November 2020 with 56% of the vote after Oregonians elected to make guided psilocybin mushroom trips legal under a system overseen by the state’s health authority. Now the hard work of deciding which practitioners get what legal protections and who calls the shots, is in progress.
The state has had down-home psychedelic cred since Oregonian Ken Kesey and his Merry Pranksters drove the Furthur bus from La Honda, Calif, to New York. It also has a strong culture of underground healers who use psychedelics.
While Measure 109 allows for psilocybin to be manufactured, delivered, and administered at supervised, licensed facilities, the two-year development period stipulated in the measure has specific requirements.
The Oregon Health Authority (OHA) must oversee the program and appoint a community Board of Advisors from a variety of disciplines to help shape the program and make recommendations. This process marks the first mainstreaming of psilocybin under state law, with Oregon as the nation’s test case.
Psilocybin has shown promise in treating anxiety, PTSD, addiction and other mental health conditions. The FDA has designated it as a breakthrough therapy for treating depression. While research is ongoing, and companies such as Compass Pathways are waiting for FDA-approval to monetize psilocybin-assisted therapies, Oregon is pioneering how to take a grey market and turn it into at least a cottage industry, maybe even into something you’d find at a strip mall.
“What Oregon represents that’s different is the notion of an integrated platform, where we can address concerns ranging from preventative and wellness, to therapy, and medicine,” says therapist Tom Eckert, chief petitioner and architect of Measure 109. “All of those have different kinds of requirements. What we’re doing in Oregon is saying that all that’s possible. And there’s a lot to sort out.”
Developing a Regulatory Structure
A common misunderstanding is that because Oregon legalized magic mushrooms you should book your 2023 Airbnb now and prepare to party on down.
Another misinterpretation is that Oregon legalized psilocybin therapy. No again. It’s more accurate to say it allows adults to use psilocybin while being watched over by someone responsible.
In March 2021, Oregon Governor Kate Brown set up the Oregon Psilocybin Advisory Board (PAB), which tries to balance people with medical or pharmacological expertise with members of psychedelic communities. This being Oregon, there is some overlap. There are doctors and lawyers who trip, and underground psychedelic therapists who know everyone, including politicians.
The advisory board, or PAB, meets monthly and receives input from five subcommittees which address research, products, licensing, equity and the training of facilitators to support the adult use of psilocybin.
The subcommittees will submit their recommendations in March. The PAB will continue to meet through 2022 to create a regulatory framework for delivering psilocybin therapies, products and services. Development of psilocybin products and the training of facilitators have been prioritized so these sectors can hit the ground running in January 2023 when the measure takes effect.
Much of the plan to implement Measure 109 hinges on who can facilitate psilocybin therapy. The measure was broad enough that this “facilitator” could be a doctor, nurse practitioner, psychologist, shaman or just someone from your local drum circle. Some of these facilitators may have been underground psychedelic guides for years, and some may be just dipping their toe in, attracted by the research or the hype.
The PAB is chaired by Eckert, who said he takes a particular interest in training and chairs the training programs subcommittee. Six weeks after Measure 109 passed, Tom’s partner and the bill’s co-creator Sheri Eckert, died of a heart attack. Tom Eckert kept up his committee work, moved across town and established the Sheri Eckert Foundation which will provide scholarships to encourage the training of diverse psilocybin facilitators.
“Even back to the campaign, we foresaw that the training piece would be the first piece to get in line,” said Eckert at his home in Portland. “The beating heart of the whole initiative is having competent, trained facilitators that are well-networked and have a community orientation.”
One question is who will train the first wave of facilitators this year, when the risks of working with a Schedule 1 substance is still high? Who will take on the liability? Under Measure 109, new facilitators need to be trained by those who are already working with psilocybin. One recommendation is that those receiving training from these practitioners be required to receive 120 hours of instruction, plus 40 hours of practicums.
“The program rolls out in 2023. We want to see approved training programs open up and start moving students through, hopefully in the summer (of 2022),” said Eckert.”
“We’re not trying to pack them into a short amount of time, because you want to sit with that knowledge for a while, and mature into that role. There will also be a licensing exam and a mentoring program afterwards, and the expectation to stay in continuing education, like many professions.”
In the training subcommittee, there has been talk of providing online training. Zooming has taken over much of office life and some medical consulting. So why should someone from rural Oregon have to spend two weeks in overpriced Portland to train?
During regulatory discussions, there is also tension between arguments to open training up to anyone – facilitators are only required to have a high school diploma – and keeping standards up by requiring more formal education. Matching the right facilitator with the right client is considered crucial.
“Oregon is very much about supported adult use. It’s equivalent to recreational or adult use cannabis, in that you can take psilocybin for any reason,” says Mason Marks, a Senior Fellow at the Project on Psychedelics Law and Regulation at Harvard Law School and one of Governor Brown’s appointees to the Oregon Psilocybin Advisory Board.
“It could be just to see what it’s like. It could be for fun. It could be for spiritual reasons, or for wellness reasons. Measure 109 in Oregon is not a medical program at all. It may be helpful to people with mental health conditions or health conditions. But it’s not a medical therapy, it doesn’t constitute medical diagnosis or treatment. We’ve even put that into our informed consent forms.”
Eckert notes that facilitators who are not trained as therapists and come from other healing traditions will play a role offering psilocybin services. Systems for including these communities in the Oregon model may point the way for integrating this knowledge in other states that pass similar measures.
“There’s probably good and bad underground things happening. But I think there’s a lot of quality underground practitioners that are waiting to come above ground,” says Eckert. “And they tend to be really serious, because you have to be super careful, you have to be really dedicated to take those risks.”
Balancing Safety and Accessibility
Clinical psychologist Alissa Bazinet is a psychedelic therapist, researcher, and co-founder of Sequoia Collective nonprofit clinic in Portland. She serves on the PAB training subcommittee and plans to operate a service site for psilocybin-assisted therapy. She says she wants to bridge conversations about screening and assessing people who are seeking a psilocybin facilitator license required by Measure 109.
“A false dichotomy between safety and accessibility has emerged in these meetings, where folks tend to be on the side of not having any screening or assessment measures, allowing anyone and everyone to access psilocybin services,” Bazinet said. “And then there’s another side that is concerned about potential negative side effects or inaccurate information on the safety side.”
According to Bazinet, there is also an inaccurate public perception that people on the safety side are licensed professionals, and those on the access side are more from the underground or support the decriminalization perspective. But she notes that the psilocybin facilitator license is just a baseline licensure for folks who are not required to have prior licensure.
“In my ideal world would be an array of providers, medical doctors, psychologists, therapists, sound healers, clergy, all of these different people who also have a psilocybin facilitation license,” says Bazinet. “Then they can operate and provide the type of service that best matches their prior skills and experience.”
There’s a strong sense that Oregon must not mess this up. Some supporters of Measure 109 are concerned that allegations of sexual abuse, such as those leveled at Californian psychedelic therapist couple Aharon Grossbard and Francoise Bourzat could scare away clients and attract predators. Oregon will follow MAPS guidelines, where sexual touch with clients is banned.
Marks says that the already-licensed healthcare providers have been talking about ways to screen clients so those with, say treatment resistant depression, are steered toward the higher-educated facilitators. For her part, Bazinet believes that a key piece of matching clients with practitioners is providing good education for consumers and setting up good screening systems.
“I can’t tell you how many emails I get from people in the public who are confused, and do not understand what will be available, who are scared to seek services because they don’t actually know what they’ll be getting,” says Bazinet.
Bazinet believes that a formalized screening assessment and matching system of some kind needs to be created so that consumers can see the array of possibilities that they have and seek out a facilitator who matches their needs.
“My fear is that if we don’t do that, we will waste a lot of time and money and create unnecessary stress for consumers, who will show up to a psilocybin facilitator who won’t have the appropriate skills,” says Bazinet.
As an example, Bazinet cites cluster headaches, which psilocybin has been shown to ease. She observes that as a psychologist, she doesn’t know much about cluster headaches, so she is not the right person to provide care for that client. She also notes that if someone wants to have psilocybin given to them by someone who supports their specific faith or spiritual orientation, she might not be the right facilitator because she doesn’t necessarily have the same training, background and approach.
Who Provides Integration?
In addition to matching with the right facilitator, the question of integrating encounters with psilocybin. For five years, Bazinet says she has worked with people who have had psilocybin experiences with “challenging or complex results,”some to the point of feeling suicidal. She notes that integration therapy is delicate work and that it is talk therapy – not focused on substances.
“They can’t make sense of the things that came up for them. They didn’t have anyone to talk to about it,” says Bazinet. “People can come into contact with their childhood trauma, with trauma they didn’t even know existed. If they’re not given proper education about that before undergoing a trip, it can be very surprising.”
Bazinet remembers one client had been in a group session and talked about wanting to die. The facilitator brushed him off, saying ‘The mushroom won’t show you anything that you can’t heal from. Why don’t you look at the positive?’
“That made it worse, as he felt like he was the only one in the group that wasn’t having a blissful, transformational experience. From that point on, he experienced two years of intermittent suicidal ideation before he sought out further support.”
Bazinet is concerned that integration is not mandatory under the Oregon system. If facilitators using psilocybin are not providing these services in a careful way, it might put more pressure on an already burdened healthcare system.
“Not every client needs integration, but we need to be able to offer it when it’s needed,” says Bazinet. “And right now, mental health therapists are completely full. This could be sending people out into a market that’s not even available anymore.”
Eckert stresses that Oregon didn’t vote for psilocybin therapy. He argues that a psilocybin session is not talk therapy and very non-directive. “It’s not active interpretation and counseling, it’s allowing the medicine, psilocybin, to do what it does, and to create a safe container for that to happen,” says Eckert. “Now, the integration piece afterwards, therapists could do that and be more active in their role and in helping folks make sense of the experience.”