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What’s Next for Legal Psilocybin in Oregon

What’s Next for Legal Psilocybin in Oregon

It’s been almost two years since voters in Oregon passed the first ballot initiative in the country to legalize the use of psilocybin, the psychoactive agent in magic mushrooms. The passage of Measure 109 put in motion a deliberative process to put rules in place for the use of psilocybin in therapy, in ceremony, and in pursuit of personal wellness. These services become available in 2023. 

Next week in Portland, many of the leading figures involved in this pioneering experiment will come together to discuss it at Horizons Northwest, a conference organized by Horizons in partnership with the Sheri Eckert Foundation. The event offers a deep dive into the current state of psychedelic science. It also will explore the Oregon model in detail.

Looking ahead to Horizons Northwest, Lucid News convened a roundtable discussion of conference organizers and participants to give a 30,000 foot overview of the Oregon initiative and discuss why it’s so central to the future of psychedelic legalization. 

The participants: 

  • Tom Eckert is the co-chief petitioner of Measure 109, and the founder of Innertrek, a training company for psilocybin service center facilitators, and the Sheri Eckert Foundation, an organization established to ensure diversity in Oregon’s evolving psychedelic ecosystem.
  • Rebecca Martinez (she/her) is a queer Chicana writer and community organizer born and raised on Chinook homelands known as Portland, Oregon, and founder of the Alma Institute, an Oregon-based non-profit psychedelic training and mentorship program.
  • Kevin Balktick, founder and director of the Horizons Public Benefit Corporation, is a New York-based producer, creative director, and cultural entrepreneur focused on live experiences and hospitality.

Horizons is a Lucid News content partner. Ann Harrison, managing editor of Lucid News, took part in the conversation. The transcript was edited for clarity and concision. 

Yesterday San Francisco decriminalized plant based psychedelics, joining Denver, DC, Seattle, and another dozen or so cities around the country. The psychedelic decrim movement keeps picking up steam. What makes Oregon Measure 109 different and how is it pioneering an alternative model?

Eckert: The Oregon model legalizes access to psilocybin-assisted therapy and wellness services in a licensing framework. That means prospective clients can access these services and move through a sequence of supervised sessions with licensed personnel at licensed facilities. It looks a bit like the medical model, although it sits outside of that system. It’s based on its own licensing framework and has its own foundation, which opens it up to folks who don’t have a diagnosis or a prescription. But it is based on practice standards, safety standards, ethical standards. It’s a program in which clients work with newly licensed personnel who are licensed specifically to do this work. They’ll oversee preparation sessions, safety planning, psilocybin administration in a licensed facility, and then integration services afterwards – which could be a pass off into a broader integration network. 

So it’s a regulated system that opens up access to anyone who can safely benefit, whether or not they’re working on mental health issues. That’s new in this country. Measure 109 was actually the first campaign in all of the states, all the way back to 2015. The measure passed in 2020. Since then the program has been developing, as was prescribed in the measure, over a two year period. We’re getting close to rollout, which happens probably somewhere in the middle of 2023. That’s when services will actually be hitting the ground. 

Balktick: As someone who works on the education and media side of this field, explaining the difference between decriminalization and the varieties of regulation is something that we continue to struggle with. There is much public confusion about it. One of the things I often tell people is that decriminalization is not really about drugs, but about jail cells. Regulation is entirely different from decriminalization, in that it does allow people to offer products and services to start, fund and operate businesses, and to really build an ecosystem. Decriminalization largely just takes away handcuffs, but doesn’t allow any formal building of institutions or infrastructure on top of it.

Martinez: I’m part of the Plant Medicine Healing Alliance, which is a Portland-based initiative that’s seeking to decriminalize entheogens in the city. A lot of what we came up against are people saying, didn’t that already happen through Measure 110? That’s a separate groundbreaking measure to decriminalize the personal possession of all substances in Oregon. [110 also passed as a ballot initiative in 2020.] They serve completely different purposes. 

It’s important that we come at drug policy transformation collaboratively, and that we’re not pitting a therapeutic legalization model against a community-based access decriminalization model. And that we’re not pitting the “psychedelic movement” – I’m doing air quotes, because it’s many movements within a larger phenomenon – against broader drug policy reform. Many of us in the field feel strongly that this is part of a goal towards a complete end of criminalization of substances. I think it’s important to rally people who are excited about psychedelics to think about the deeper values that make them excited about community access, and inquire how far they’re willing to take that to keep people out of jail, and keep people from being punished for the substances that that they choose to use and possess. 

It’s been about 18 months since the first meeting of the Oregon Psilocybin Advisory Board. What’s the remit of that board? And what has actually been accomplished by it so far?

Eckert: It was written into the initiative that an advisory board would be formed once the measure passed and be active for a two year window of development. It’s a governor appointed board, a group of experts, that can provide advice and recommendations regarding the details of the program. Measure 109 was pretty hefty, it laid out a lot. But even so, there’s a lot in between the lines that needs to be figured out – what we call “rules.” The advisory board does not create the rules. It gives advice and recommendations to the Oregon Health Authority, which houses the entire program. So ultimately the OHA writes the rules, which have been coming out gradually. It was smart to bring in experts that are working in the field to share what they know. That was absolutely instrumental to the process.

What’s the timeline for the advisory board to complete its work? 

Eckert: The way we wrote it in Measure 109 was that rules for the entire program would be in effect by January 1 of 2023. Applications for licensure would open up at that time. Now that doesn’t mean services will hit the ground in January 2023, because then there’s processing. The Oregon Health Authority has to work through the applications and do all the due diligence. So it’s unclear exactly when services will hit the ground, but things actually start opening up in 2023. 

Tom, initially you were the chair of the advisory board, then you stepped down. What happened? 

Eckert: Well, I’d done a full year at the advisory board voluntarily, after volunteering on the campaign for five years. There was a lot of talking out there, but in my mind it wasn’t such a story. 

Some questions were raised about whether you should serve on a regulatory board that made rules impacting your business, or companies run by people close to you. Do you think any additional measures should be taken to help promote fairness and transparency for the rulemaking process?

Eckert: Well, as I said, the advisory board are not rule makers. They’re providing recommendations and advice. The board was set up by the Oregon Health Authority, which intentionally appointed folks from the community who are involved in psychedelics. That’s what made them experts. They’re commenting, providing advice based on their expertise on a system that will contain forthcoming projects. So that was sticky, but I think the advisory board handled it well. I’m not sure the media handled it very well, because they got a kind of distorted narrative going. But within the advisory board there were periodic disclosures of interest. And there was no issue on the Oregon Health Authority side whatsoever.

Balktick: There’s been a lot of confusion about the role of the advisory board. Many people did not fully understand that the Oregon Health Authority and its civil servants are the people who create these rules. The advisory board is just that: advisory. It was intentional that the products committee has people who will manufacture products on it. The training committee had people who will conduct trainings on it. But they’re not actually rule makers. So that’s the kind of thing we hope to give people a broader understanding of at the conference on Saturday morning. What does the Oregon Health Authority do? And what does the advisory board do?

Has the state government been supportive during this process?

Balktick: I come from a state, New York, that is not so well regarded in terms of public administration. And it was interesting for me as an outsider, when I started to meet people involved in Oregon, to hear everyone say how supportive and professional the OHA was. That doesn’t mean there aren’t disagreements over specific rules, or specific aspects of the bill. But I kept hearing that the OHA saw the law as being the law, and wanted to implement it faithfully for the benefit of the people of Oregon. And that many of the people they appointed to do so, as civil servants, we’re doing so pretty faithfully.

Martinez: I serve on the equity subcommittee for the advisory board. From the outset, we were actually very pleasantly surprised. Some of the people who would be writing the policy, including the manager of the program herself, Angie Allbee, were sitting in on those meetings. It helped to avoid some of the “telephone” phenomena that could happen, because they were sitting and listening to active discussions, listening to public comments, and really trying to get a well rounded understanding of all of the ideas, questions, concerns that we were putting forth. 

Working in policy is complicated. A lot of hoops have to be jumped through. There’s a lot of restrictions that are not ideal. You know, we’re dealing with mushrooms here. The whole nature of mushrooms is unwieldy and sort of magical. We’re trying to fit something ineffable into a structured governmental system. There’s a natural tension, it’s awkward. 

I think some of the frustration that people have felt is wanting a program that feels like this ineffable thing. And we’re trying to fit it into a structure that can scale, that can meet standards of safety and access. I’ve sensed, from the outset, OHA has been interested in helping us be a successful program, and they expressed that the simpler we make it at the beginning, the less variables there will be and the more chances for success. So I think we’re all making sacrifices compared to what our ideal would be. But there are areas where we have some really big wins, like asking that license holders include a social equity plan to make this successful in their community, or the option to have services outside as long as the circle leader is licensed and there are safety parameters in place. 

Recently a number of Oregon counties and localities have moved to block psilocybin therapy centers in their areas. Do you see that as a sign that the state isn’t ready for this? 

Eckert: Well, in Jackson County there’s a lot of big cannabis farms and there’s some issues with farms and black market stuff. All of that has the county commissioners antsy about psilocybin, which is too bad, because it is absolutely incomparable. The circumscribed need for products for the therapeutic and wellness system that measure 109 sets up can probably be housed in a single room. It’s not like these sprawling cannabis farms that need to be regulated. And who in their right mind would try to do black market activity through a licensed center when you could just do it in your bedroom? The concerns are not terribly rational. But it comes from the cannabis hangover. 

That’s one particular county. Other counties have other stories where unfortunately, it falls into the hands of the city commissioners, whether they choose to go for an opt out. That was part of measure 109. But it was meant to be a way to work with counties that are very much against it. Instead of those counties grouping together and organizing opposition to measure 109, we could put that to bed by saying, there is a way for your county not to move forward. Unfortunately, some counties where measure 109 actually carried the vote are opting out. That was not the spirit of the measure.

What is the licensing process for those who want to offer therapy or group experiences? 

Martinez: I’m part of a training program for a nonprofit, we’re called Alma Institute. As long as we’re approved by the Oregon Health Authority, and the state’s Higher Education Coordinating Commission, we can convey the educational pieces. If students successfully go through an entire program, they receive certification from a training program, and they can take that to the state and say: I’ve gone through the training, now can I take the licensure exam? It’s actually the state that provides the licensure to facilitators. But they won’t give that licensure exam to anyone who hasn’t already completed a training program. So our role is to certify the state licenses. 

In terms of other types of license holders, it seems like a pretty straightforward process. There’s a detailed application. Each type will be different. Alma Institute is planning to have a service center, and the draft rules for service centers were just released. They are very detailed, very lengthy, about what you need to have in place. 

Then, of course, there are fees involved with each of these types of licenses. There are four categories. There’s the facilitator license, the service site, the grower, and a separate license for labs. 

What’s the difference between a facilitator and a therapist?

Eckert: Another point of confusion for those who aren’t deeply into this, but it’s super important because it gets to the inspiration behind the initiative. You know, this program sits uniquely, because of some of the philosophy behind it. One of those pieces is that we wanted to create a therapy and wellness framework where anyone could access these services who could safely benefit. And by safely benefit, I mean, moving through a safety planning and preparation process and into an administration session. We did not want to medicalize this model.

We thought that the FDA process, as important as it is, and as much as we support all the efforts, can’t be the only container for psilocybin and psychedelic services down the road. That was an inspiration to do the initiative. We were trying to fill out the picture and develop the wellness aspect, the ability to create an integrated framework that can address a full spectrum of concerns, from preventative to wellness, therapy to medical. Now that’s a lot to sort out. That’s why the advisory board conversations are so interesting, and why there’s so many different opinions and angles, because it’s tricky to sort all that out. But we took that on quite intentionally, because we think it’s possible.

Balktick: One thing that is clear is that, altogether, 109 is a less expensive model than what we’re going to see in a few years under the FDA model. You’re going to see a lot of service centers doing sliding scale, where they deliberately serve lower income populations. Alongside that, you’re going to have luxury resort centers that will operate more like high end retreats at very high price points. There’s a lot of room for variety within the model. 

Has there been any pushback from OHA around the idea of non-medical use? 

Eckert: I would say no. OHA, to Kevin’s point, has been super supportive of the measure as written. They understand that that’s their job. The people of Oregon voted to make this a reality. 

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Martinez: Within the therapists/facilitators conversation, there’s a lot of concern about: is this therapy, or medical, or is this just for personal wellness? A lot of that can be addressed with good training and systems within service centers. Specifically by helping the facilitators who are being trained to have solid baseline skills for holding space. And also training them how to assess if someone is beyond their scope of practice, and helping them to understand the necessary steps during the initial interviews and intakes, so they know when to refer someone. 

Part of what we’re doing in Oregon is forming a strong network of referral systems, so that people have a choice of a facilitator who they feel good about. We want to help them find someone organically that is a good fit for the types of things they’re looking to explore using psilocybin.

Recently much attention has been given to the potential for abuse in both psychedelic therapy and ceremonial contexts, including sexual abuse. What guardrails are being put in place in Oregon to ensure safety? 

Eckert: The whole notion of a regulated system – that’s one of the reasons it exists this way. Because with regulation comes licensing, comes accountability to your license, comes an ethical board, somewhere to go if there’s a breach or a violation of ethics. And a board or organization or governmental agency in place that is funded and prepared to follow up on those potential allegations. They wouldn’t just appear in the media. There are actually systems in place to address violations.

Martinez: There are many angles we need to address on the topic of preventing harm and abuse. A lot of those have been written in. One of the pieces is a client Bill of Rights as a part of the informed consent process. Before someone shows up for an administration session, they talk through a detailed plan that includes pre consent to a variety of things. That includes: I don’t want to be touched at all, or I only want to be touched on my shoulder. It gets very specific, so that there’s very little room for interpretation or changing things later and saying: Well, it was what was called for in the moment. 

The training programs have a big responsibility to be the initial filter for who’s going to lead these sessions. We need to be scrutinizing our participant lists in these training programs to make sure that we have confidence that each and every person is ready for the type of power and responsibility that comes with holding space for someone in an altered state. We also have to make hard decisions along the way, if we’re training someone and it starts to become clear that they’re not ready. There are going to be people who will not finish the program and graduate. Unfortunately, not everyone is a good fit for this kind of work. 

I would add that a couple of professional associations are forming – the American Psychedelic Practitioners Association and the National Psychedelics Association – that are adding another layer of accreditation. So folks can say, I’m accountable to several governing bodies, and the public can feel more confident. 

Lastly, we also need to create community-based repair models. Not everything is as black and white as something happens and you lose your license and you’re exiled from the community. There’s a lot in the middle where we have to intervene, whether it’s miscommunication, or harm, or conflict. We should use the existing systems of restorative and transformative justice, and make use of other consequence-based accountability systems. That’s so important. I’m in many conversations around that. We’ll see what we’re able to do. For a lot of it, we need resources to scale to the degree that Oregon’s going to need. 

Balktick: I want to say something, just to make it clear: the Oregon model does not provide retail access to psilocybin under any circumstances. The licensed manufacturers can only sell to the service centers, and the only psilocybin consumption happens at a licensed service center under the supervision of a licensed facilitator. There is no way in which individuals can purchase, store or possess mushrooms privately under this system. However, it is also worth saying that, because there is also decriminalization, there is no criminal penalty if you do so. But that still does not allow people to create points of retail. This is a huge point of confusion, and where the cannabis analogies are particularly unhelpful. Cannabis has primarily been a retail market, whereas the 109 psilocybin system is really the exact opposite.

Psychedelic retail may not be part of the system, but there will be a psychedelic economy focused around therapy and sessions. What is the vision for this? 

Eckert: Horizons has set up an interesting day at the conference about the forthcoming ecosystem in Oregon. One thing I’m kind of proud of is how we set up the Oregon system flexibly so it allows a lot of avenues into service, into working in the evolving ecosystem. In my opinion, I feel like there’s an over-emphasis on products in Oregon. I don’t see that as having big business potential. It’s a circumscribed program and it doesn’t need a lot of mushrooms. It’s not like cannabis, it’s not retail. So there’s not going to be some big gold rush to make mushrooms to fulfill this relatively small need to have therapeutic access and wellness access to mushrooms.

The service side is where things are really interesting. And that’s what we want: a vibrant marketplace of potential access, hitting lots of different categories. It’s really neat. And I don’t think people fully understand this. They think it sounds a bit like a clinical model, and that it’s probably going to be kind of sterile, etc. No, not really. Service centers can come in a lot of forms, and cater to a lot of different populations. When facilitators get licensed they can stay independent, or they can contract with service centers, or they can create their own service center. They can stack the licenses and create an organization that does it all in one place. There’s lots of flexibility. The common denominator is the adherence to practice standards, safety standards and ethical statements. But beyond that, we can have a vibrant marketplace. 

There’s a lot of talk about price points. There will be a lot of different access points. Nobody is dictating what’s being charged. So we can have urban centers, we can have retreat centers, we can have big organizations, we can have therapy offices. And as a community, we’ll come together and think through the issues around access to ensure that this is getting everywhere it needs to go, to all the different communities around the state. 

Martinez: Coming from the training side and having a service center in the works, a lot of the economic concern that my group has is around IRS tax code 280E, which forbids any organization that is handling psilocybin from writing off their expenses at the end of the year when they file their taxes. It’s a huge financial burden. Until we have federal legalization, this is going to keep a lot of folks from participating, from starting their own service center, from even operating as facilitators. Because they can’t get it to pencil out so they can make a decent living, or keep their sites open. I don’t think a lot of the small businesses are concerned with, you know, getting rich and buying yachts. These are folks who really want to do good things in their community, and make a living doing something they’re passionate about and feel is important. 

Have you been able to find liability insurance for providers, or has that been a challenge? Has the state taken any steps to help support providers to get the insurance they need to protect themselves and their practices?

Martinez: This was one of the first things I anticipated. And as I called around to my colleagues, they said that agents couldn’t even get them a quote. Dozens and dozens of different groups said we don’t cover that. So I raised this with the National Psychedelics Association, and they – thank goodness – have been willing to take on some of the hairier situations, whether it’s banking or liability insurance. Those are the two big ones that they’re tackling, and which are going to be so critical. Even as a nonprofit – and at Alma Institute we don’t actually handle the psilocybin, that will happen under the service center – even with that, Alma has had a really hard time getting directors and officers insurance for my board of directors. That’s general liability, not even assessing any risk involved with psilocybin. I do have a lead now. One group said they got access to a new market that will cover it. I anticipate it’s going to be expensive. 

Of course, one reason insurance and banking are so hard to get is that psilocybin is an illegal Schedule 1 substance at the federal level. How do you imagine this conflict with federal law will play out? 

Eckert: There’s some pretty smart folks working on it, with connections. They’re having conversations. The idea is that we would come into Measure 109 with relationships, in conversation, and hopefully in an environment of collaboration with national officials and the state attorney to ensure that this program is safe. The important thing is that we would see trouble coming before it arrived, and we would work through that. But I don’t foresee conflict at this point. This is the age old “states versus US law” that we went through with cannabis. Hopefully that’s an area where maybe we did learn from cannabis about how to get to a place where these two things can exist simultaneously. 

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