Oregon Psilocybin Services: is it working so far?

Looking at the data we have, four years after the vote

If you’re a keen psychonaut in the States, you’ll be very aware that, back in 2020, Oregon voted to legalise the use of psilocybin via Measure 109, becoming the first state in the US to do so—though only for use in supervised settings, such as licensed therapy centres. While the state also decriminalised the possession of small amounts of drugs, it only voted to legalise the use of psilocybin-containing mushrooms in licensed premises. These are small but important distinctions.

It’s now been four years since voters approved Measure 109, but Oregon Psilocybin Services (OPS), formed to implement the regulatory structure around legal psilocybin in the state, has been in operation for a little under a year and a half. How have things been going? We figured it was time to take a look.

The licensing and rollout of services

One of the key parts of the Oregon project is that it differs from the medicalisation model being pursued elsewhere; you do not need a medical referral, or even a medical diagnosis, to be able to access psilocybin-assisted therapy in the state.

The first step of setting up these sorts of services is licensing. OPS publishes weekly reports on the amount of applications it has received for licenses of all types, as well as how many have been approved. As of the last of these reports, filed August 19th 2024, we can see it has approved licenses for:

• 31 service centres (from 32 applications)

• 356 session facilitators (from 371 applications)

• 13 manufacturers (from 14 applications)

• 1 testing lab (from 1 application)

• 24 training programs (from 24 applications)

• 667 workers (from 696 applications)

95-100% of applications approved, per category, suggests both that applicants are taking the application process seriously, and the OPS is positively engaged with the project of expanding access to psilocybin in the state. This isn’t always a given; when it comes to more contentious issues like psychedelics, the very bodies put in place to regulate them are sometimes covertly used to limit access against voters’ wishes. It’s heartening to see that this does not appear to be the case here.

However, while the OPS may be fully on board, not everyone in Oregon feels positively towards the OPS and the legalisation of access to psilocybin. The Oregon Psychiatric Physicians Association opposed legalisation, and continues to, citing a perceived lack of supporting research and data for the services offered. In addition, a number of counties in the state have voted in in ballot measures that would effectively exempt their counties from the statewide legalisation legislation; these include Coos, Curry, Douglas, Klamath and Josephine counties.

According to Measure 109, both cities and counties are automatically “opted into” regulated psilocybin but notably they are allowed to “opt out” if it is the wish of its voters. Rural areas in particular have been voting against psilocybin regulation, citing a number of concerns, some of which are rooted in real problems (medical response in less-accessible areas) and some of which are not. To learn more about the ins and outs of these legal issues, read more at this psilocybin legalities blog. It is certainly not the case that access to psilocybin will remain equal across the state; the voters of its counties are not all in agreement on that point.

The takeup and patient experience

While the current measures around reporting and data privacy mean it’s challenging to get real data on the number of patients using these centres, it was reported in June this year that somewhere in the region of 3,500 Oregonians had sought psychedelic therapy from the state’s legal treatment centres, with estimations of double that number by the end of the year.

It seems from various accounts that the patient takeup of these services has not been as extensive as expected, something that many advocates put down to the high cost of sessions and the lack of coverage by healthcare insurers; prices for one trip and two therapeutic sessions are said to run from $800 to $3,000, a cost that will exclude many from seeking out these services (especially if they are long-term users of psychedelics, who can and do buy illegal psilocybin for much, much cheaper, and feel, correctly or incorrectly, that they can get something like therapy from a friend or trusted trip-sitter). Already, at least one service centre has closed down due to lack of customers, and providers are not seeing enough traffic to pay themselves salaries in some instances.

This has resulted in the necessity of tax income funding these services in part, despite the plan for them to be fully self-funding. Whether or not you believe that medical services of all types should be taxpayer-funded, it’s easy to see that this situation will likely turn fence-sitting voters against regulated psilocybin, especially if the demand for the psychedelic therapy does not seem to be high (even if this is largely due to cost). Add this to the fact that, last year, most of the users of the service came from out of state, and it’s easy to imagine that Oregonian voters might start to wonder if this is the best use of their already-stretched tax money.

Concerns have also been raised about the cost of facilitator training, which can run to around $6,500, and the regulation of these training providers. Without a clear path to a confirmed income, many potential practitioners will balk at spending thousands of dollars to be trained by people who may not be accredited teachers.

The future of Oregon Psilocybin Services

Aside from the takeup and economics of psychedelic service centres in the state, Oregon’s regulated psilocybin project is at the mercy of legislative changes and also federal laws too; after all, psilocybin remains illegal at a nationwide level, with “no accepted medical use”. This creates a legal grey area into which some potential consumers are not willing to step.

On the state level, as this is such a young project, and the first of its kind in many ways, it’s only to be expected that certain course-corrections, alterations and regulatory switches are made in the first number of years. One of the changes coming into force next year is SB 303, which will require service centres to provide more data on the operations of their centre and the effects patients have experienced—including average doses given to patients, any adverse reactions and the reasons people have been turned away or refused.

On the 30th of September 2024, the state filed a proposed further rulemaking changes, which you can read in full here. Interestingly, for those mushroom nerds reading, the rules only consider Psilocybe cubensis as the mushroom of choice for service providers, and prevent the cultivation of dung-lovers (like Panaeolus cyanescens) or wood-lovers (like Psilocybe cyanescens) through specifically prohibiting the use of growing materials like uncomposted manure or woodchips. The rules sensibly imply a focus on proper sanitation, by demanding mushroom compost providers strictly control their compost temperatures and test for pathogenic bacteria. The choice to prohibit growing materials containing wood may be driven in part by concerns around potential misidentification or cross-contamination of grows with the ”funeral bell” (Galerina marginata), a deadly poisonous mushroom, which might find its way into psilocybin products if not properly controlled for. Another concern which may be driving the preference for Psilocybe cubensis (which doesn’t grow on wood) is wood-lover’s paralysis, a condition (rarely) experienced by those consuming psilocybin containing mushrooms grown on wood—something that the Oregon Psilocybin Advisory Board collected research on earlier this year.

Wood-loving Psilocybes

Other proposed changes include greatly restricting license limits; previously, businesses became licensed for five years. Going forward, licenses will only be one year long, and four hours of training will have to be completed in order to renew a license. On the face of it, this is a loss; it places a greater burden on providers which could act as a slight deterrent to those wishing to offer these services. We are supposed to be making them more accessible, not less.

However, four hours is a relatively small time investment for those who have already gone through the expensive rigmarole of becoming licensed, and when it comes to services that target people’s mental health, the standard is (and always should be) rigorous regulation. This, of course, is necessary; no matter how much we value psychedelics and support their broad legalisation, we must also accept that those who are operating professionally in this space need to be held to best practices and high standards. Therapy even without the psychedelic element has an enormous effect on a person’s health and wellbeing; when you add in mind-altering substances, the benefits increase but the potential pitfalls from bad therapy or substandard practitioners increase also. It’s important that patients are protected from poor practitioners, and these regulations go some way towards that.

Is the future looking bright for regulated psilocybin in Oregon?

When it comes to legislation, the devil is always in the details. When it comes to enacting things like regulated psilocybin access in a state, the variables are great: public perception, the shifting economics of the region, the integrity and efficacy of those first licensed to practice, county politics, ability to travel and much, much more. The first few years of a major social or legislative change will always be the most difficult, as it is required to not only change “hearts and minds” but also practices, laws, spending and deeply-ingrained moral judgements. When we evaluate the success of OPS so far, we should keep all this in mind.

At the very least, we have to recognise that there are a number of practical barriers to patient access to these services in the state, the most pressing being the high relative cost and the lack of insurance coverage. Is the latter likely to change? Probably not; medical insurers are famous for excluding any and all coverage possible, especially if the efficacy of the treatment in question is (rightly or wrongly) not broadly accepted. For now, at least, it seems the cost of these services will remain the burden of the user.

Reading about OPS, there is one glaring omission from much of the reporting: the experience of service users and whether or not they felt it was worth the cost. There are a number of reasons for this, including privacy—but this remains a key point, especially given the fact that users are unlikely to have a long-term engagement with this type of therapy the way that they might have a long-term relationship with another therapist; the point of psilocybin therapy is that is promises big changes quickly, and the cost makes it unattractive as a long-term prospect. Service user satisfaction, and the word-of-mouth reviews of it, will go a huge way to either diminishing or increasing the demand for services in the state. Perhaps the best we can do for now is say we will watch this space.

One thing, however, is clear: there are challenges ahead for those who support and provide access to regulated psilocybin in the state. Are those challenges insurmountable? We will see.