Pushing Back on the Term “Therapy” in Oregon’s Measure 109

After years of anticipation, Oregon’s Measure 109 is finally coming to fruition. The legislation made history in November 2020 by establishing the Oregon Psilocybin Services Division, which created a regulated network for adults over 21 to access and use psilocybin. 

However, the transition from conceptualization to implementation reveals a far more complex and contentious landscape than initially anticipated. The intricacies of the rollout are generating conversation on the costs of services, accessibility, and the significance of using precise language to describe the nature of the psilocybin experiences offered within Oregon’s regulated framework.

As a pharmacist and advocate for broader applications of psychedelics, I’ve observed firsthand the debates that have sprung up during advisory board calls and discussions among stakeholders.

Debating Terminology

While the high cost of services (possibly unavoidable under current rules) is a constant focus, particularly among advocates and the broader psychedelic community, I often find myself debating the terminology for psilocybin services under Measure 109, particularly the use of the term “therapy.”

Using “therapy” to describe services under Measure 109 is, arguably, a misnomer. In traditional healthcare settings, therapy implies a medical or clinical intervention to treat or manage a particular condition. However, psilocybin services under Measure 109 are distinct from medical services. Measure 109 was intended to foster non-medical pathways for accessing psilocybin, creating opportunities for personal growth, healing, and wellness for a diverse range of individuals and reasons.

Licensed psilocybin facilitators, even those with healthcare backgrounds, can’t diagnose or treat health conditions while providing these services. Administrative rules explicitly state facilitators cannot exercise other professional license privileges during these sessions. Licensees who violate these rules, including “Making representations or claims that the psilocybin product has curative or therapeutic effects” stand to have their licenses revoked or suspended, or face civil penalties as outlined under ORS 333-333-6200.

Yet, the term “therapy” persists, causing confusion and potential misunderstandings about what psilocybin services entail. As the original text of the Measure 109 addresses psilocybin’s Breakthrough Therapy designation and refers to psilocybin as a “therapeutic option” on multiple occasions, confusion on the part of voters about what services they can receive is no surprise.

Over the course of the two year rule making period, there was ultimately an attempt by the majority of the Psilocybin Advisory Board to avoid the creation of a “two tier” licensing system or a recreational system and a clinical system. The final rules established by the Oregon Health Authority reflect this, firmly clarifying that all facilitators have an equal scope of practice, despite not addressing the ongoing use of the non-protected term of therapy.

Perceptions and Expectations 

To add to the confusion, the first licensed psilocybin service center, EPIC Healing, is staffed mainly by individuals with healthcare backgrounds who seem to advertise psilocybin services alongside their clinical practice. News outlets compound the problem. For example, OPB highlighted Cathy Jonas, owner of EPIC Healing, in a recent article as a “licensed therapist” who owns the first licensed psilocybin service center in Oregon, saying she had “60 people on a waitlist for the therapy and said she plans to work with about 30 patients a month.” While it is true that she is a licensed clinical social worker, the title, coupled with the words therapy and patients, is highly problematic.

The use of language plays a pivotal role in shaping perceptions and expectations. Using terms like “therapy,” service centers, and facilitators may inflate expectations, potentially leading clients to believe they are receiving a higher level of care or a medical service. 

Clients who believe they are receiving therapy may be more willing to pay $3,500 or more for a 6-hour session. However, when it becomes clear that a healthcare professional-turned-facilitator can’t provide more than other facilitators, the high cost becomes harder to justify. All facilitators, whether they have healthcare backgrounds or not, are acting effectively as “trip sitters” who need only a high school education and a four-week (160 hours) training course. Bureaucracy and regulations may force high costs to be reality. But without highlighting the details of why costs are high, and that costs are largely a function of intense regulation, how can we expect the public to call for the accessibility and affordability they were promised? For comparison, an esthetician in Oregon requires 500 hours of training, 195 of those hours in live “practical instruction.” A facilitator requires only 30 hours of “direct practice” in their training program.

At the heart of this debate is the question of what value these providers bring to the psilocybin experience outside the medical system. Are high or additional costs justified? Under a non-directive model, which is also reinforced in psychedelic clinical trials, the substance itself is arguably the therapy, and support personnel help to maintain calm and reinforce safety. Are clients truly receiving a different, more valuable service, or is this a case of rhetoric being used as a marketing tool? 

The required informed consent documents reinforce that this is not a medical program on line item 2 “I understand that psilocybin services do not require medical diagnosis or referral and that psilocybin services are not a medical or clinical treatment.” However, clients may be too invested in the process to back out by the time they receive informed consent. 

Rising Costs and Accessibility 

While healthcare professionals undoubtedly bring layers of professional skills and experiences to the table, these benefits must be weighed against the potential for increased costs and decreased accessibility. Indeed, someone who has worked for decades with people in crisis as a clinical social worker will have skills to pull from when acting as a facilitator. Though, the same might be said of a teacher. If psilocybin services are seen as a high-priced, specialized treatment accessible only to those who can afford it, then we risk further undermining the spirit of Measure 109. 

Many community advocates, including myself, see Oregon’s current state of affairs as a failure. However, I still see it as a disappointment in the right direction. Hopefully, this failure will be a rallying cry for models like Jon Dennis’s Community Practitioner Framework and more true decriminalization as additional states grapple with demands for psychedelic access.

Measure 109 aimed to create non-medical pathways for psilocybin experiences. To achieve this, we need an equitable, inclusive system prioritizing accessibility and affordability. Achieving those aims requires pushing back against the term “therapy,” questioning inflated costs, and ensuring transparent, accurate regulations and language.

We need to challenge our notions of what psilocybin services should look like. We must acknowledge that the term “therapy” carries assumptions and expectations that may not align with the reality of provided services. Also, using inclusive vocabulary for psilocybin services and pushing back on the term “therapy” allows for meaningful conversations around “non-therapeutic” uses.

Moreover, we must critically evaluate the potential effects of a future bifurcated system, where costs vary drastically based on the purveyor’s professional background. As progress continues nationwide on the legalization and decriminalization front and the medical front, this bifurcated system is looming. Psychedelics like prescription MDMA and psilocybin are nearing FDA approval.

When we highlight that facilitators can receive training around basic ethics, history and harm reduction and it need not be a lengthy or burdensome exercise, we can broaden the potential for accessible and affordable community access points.

Confusion Among Professionals 

The ongoing confusion around these issues is evident in recent conversations on LinkedIn and Twitter. Facilitators, experts, and healthcare providers have differing views about what can and cannot be offered under Measure 109. For instance, Selisha Abbas, an educator with the Clinical Cognitive facilitator training program, stated on LinkedIn, “…we are NOT offering psilocybin-assisted therapy. This is a regulated, adult use model. Not medical or retail. There is no medical oversight.” Meanwhile, Jeeshan Chowdhury, founder and CEO of Journey Colab, questioned, “If you’re a clinician, how does your professional background and training disappear when you enter a service center for adult use?”

This confusion is not just frustrating; it’s potentially harmful. It can lead to misinformed decisions, inflated costs, and a system that benefits some at the expense of others. I find potential psilocybin clients looking to rationalize the expense by comparing ketamine infusion centers and still coming up short in making sense of things but feeling pressured to fund legal access by any means necessary.

Challenging the Dominance of the Medical Paradigm

If the goal is to reinforce the dominance of the medical paradigm and continue to limit services, one might continue to refer to the Oregon experiment as psilocybin therapy. But if, like me, your goal is to work towards actual access and affordability, recognizing the breadth of potential applications and uses for adults to engage with psychedelics, I urge you to challenge the pervasive and commonly accepted term of therapy when describing services in Oregon. Though psilocybin assisted therapy certainly has its place in the developing psychedelic ecosystem, it’s not only misleading to potential clients to present Oregon’s program as such, but it’s also shortchanging the wider movement towards psychedelic and cognitive liberty.