Wired on “Psilocybin Therapy”
This is a great explanation of why we use the term Psilocybin Facilitator instead of “Psilocybin Therapy”
FROM THE breathless media coverage, it would appear that Oregon is on the brink of becoming a haven for shroom-fueled mental wellness.
Oregon’s Measure 109, which was approved by the public in November 2020 and took effect at the beginning of this year, allows adults over 21 to access and use psilocybin, the active ingredient in magic mushrooms, in a supervised setting. All eyes are on Oregon as it becomes the first US state to roll out a program through which people can legally trip. It’s been held up as a real-world experiment in psychedelic medicine—a field that has sparked hope as a treatment for a range of mental conditions, including post-traumatic stress disorder and depression.
One small hiccup: Oregon hasn’t legalized psychedelic medicine. According to the bill that permits use of psilocybin, the law only allows what’s being called “supported adult use.” Basically, people can legally trip under the watchful eye of a facilitator. But psychedelic-assisted therapy it is not. “It’s literally against the regulations to treat people in any way,” says Mason Marks, a legal scholar at Harvard Law School’s Petrie-Flom Center and former chair of the Licensing Subcommittee of the Oregon Psilocybin Advisory Board.
Before their legal trip, a client must sign a consent document stating that they “understand that psilocybin services do not require medical diagnosis or referral and that psilocybin services are not a medical or clinical treatment.” Note the word “client”—not “patient.” To keep even a hint of medicalization from creeping in, the rules are stringent; service centers cannot even be located in the same building as a health care facility. And facilitators cannot direct or guide clients, only support them.
Marks suspects Oregon pursued the nonmedicalized route because it wanted to “create something new that falls totally outside the health care system.” His impression from his time on the licensing subcommittee “was that they were creating a new type of professional, the psilocybin facilitator, who was not a health care provider and provided a service that might complement one’s health care regimen, but not be a part of it,” he says. Think yoga instructors, massage therapists, workout instructors: they’re not health care specialists, but the services they provide do offer health or psychological benefits.
Facilitators here and throughout Oregon are not required to have any clinical education, only a high school diploma and 160 hours of training. In fact, if a guide already has a degree in counseling or mental health, they are not permitted to exercise any skills from that training. EPIC Healing Eugene’s owner, Cathy Rosewell Jonas, has a 35-year background as a clinical social worker and is a licensed clinical therapist but will not be allowed to draw on that experience in her practice.
Yet with the hype swirling around psychedelic-assisted therapy, it’s likely that many will be seeking the drug for its reported therapeutic qualities. Jonas saidthat most of the people on her waiting list have cited a mental condition, including PTSD, depression, and trauma, as the reason they signed up. “Probably a good third are very depressed,” she said.
Marks says confusion about whether the bill follows a medical model goes all the way back to its inception and included people on the psilocybin advisory board. In March 2022, a psychologist and member of the advisory board, Kimberley Golletz, told Stat News, “We’re saying both things. This is not medical … But this is psilocybin-assisted therapy,” she said. “Psilocybin facilitation … I mean, nobody knows what that is.” The ballot for Measure 109 itself makes reference to the mental health crisis in Oregon and the preliminary clinical evidence that psilocybin could be a potential treatment.
In June 2021, Angela Allbee, manager of the body that oversees the psilocybin program, said in an interview that they would deem the success of the program to be “providing an opportunity for those that are struggling with mental health issues to heal.”
Marks also points to confusion spread by the Healing Advocacy Fund, a nonprofit that supported implementation of the program and whose head, Sam Chapman, was formerly the campaign manager for Measure 109. The homepage of its website today says: “In 2023, Oregonians suffering from depression, anxiety, or addiction or approaching the end of their life will gain access to this ‘breakthrough therapy’ demonstrated to provide healing and hope.” Chapman has said publicly that psilocybin therapy “can help address our state’s mental health crisis.”
Perhaps people will be unaware of the distinction—or ignore it—and just treat Oregon’s psilocybin program as psychedelic-assisted therapy anyway. Does that matter?
Aryan Sarparast, a psychiatrist and assistant professor of psychiatry at the Oregon Health and Science University (OHSU), believes it does. When we think about psychedelics, we think about “the outcomes that we’ve seen in clinical trials, which are really promising, really favorable and exciting,” he says. “However, those environments are dramatically different.” The screening, the preparation, the dosing sessions, and the amount of integration are all different. “Everything is, frankly, different,” he says.
The risk, says Sarparast, is the effect on vulnerable patients; expectancy bias could inflate their hopes for how effective the experience will be. “I worry about somebody with mental health conditions looking for a mystical, transcendental experience to treat their mental health issue and having some challenging things come up,” he says. Researchers have speculated that when an individual with a mental health disorder tries psychedelic-assisted therapy and it isn’t as effective as expected, it can make their condition worse, such as triggering suicidal behavior.
And clients may not receive the aftercare they need. The integration component—when individuals take the lessons and insights from a hallucinogenic experience and learn to fold them into everyday life—is optional in Oregon’s program, and some may skip it, perhaps because of cost. In studies on psychedelic therapy, an integration element is typically employed.
Licensed service centers have already been peppering their marketing materials with therapeutic language. On the EPIC Healing Eugene’s YouTube channel, Jonas refers to psilocybin as “medicine.” Another of the service centers, Bendable Therapy, calls the service a “psilocybin treatment program” that helps candidates “explore adding a new treatment option to their existing mental health path.” And in the planning permission application of another approved service center, called Shrooms Help Center, the owner, Mike Kirkwood, referred to the services that would take place in the center as “therapy.”