All eyes are on Oregon as the state moves toward implementing Measure 109 on January 1, 2023. That’s when adult Oregonians will be able to legally access psilocybin under the guidance of a trained facilitator. Oregon Psilocybin Services, which is part of the Oregon Health Authority, will consider proposals this summer for how to manage these new products and services and issue rules in December.
Five subcommittees are debating how the Oregon shroomiverse will be regulated. The next big deadline is March 25, when the Products and Training subcommittees will post notice of their proposed rulemaking. These rules need to be adopted before others, around May or June 2022, so that training programs and product manufacturing can start ahead of full legalization.
Companies based in the local business community and from throughout the world have been making moves to enter the psilocybin market in Oregon. Canadian company Field Trip Health, which operates ketamine clinics in the U.S. and a psilocybin retreat in Amsterdam, has said it will open a psilocybin center in the Portland area.
Alissa Bazinet, a psychedelic therapist, researcher, has co-founded the Sequoia Center, a nonprofit clinic in central Portland that will be a service site for psilocybin-assisted therapy.
Netherlands-based Synthesis started an Oregon subsidiary and bought a $3.6 million, 124-acre property in Ashland, near the California border. It is expected to be used for multi-day psilocybin retreats.
Tom Eckert, who chaired Oregon’s Psilocybin Advisory Board (PAB) and together with his late wife Sheri Eckert was a driving force behind Measure 109, is also developing a business in this new market. Eckert has a company called InnerTrek which will train licensed psilocybin facilitators starting this summer. It promises a mix of online classes and in-person intensives in a “beautifully wooded expanse just outside Portland.”
In addition to Eckert, other Oregon business owners in the psilocybin space have contributed to the ongoing conversations about the regulation of products and services. Eckert encouraged the online PAB subcommittees to receive input from the Synthesis staff. A combination of potentially lucrative business deals and the relatively small number of people involved in Oregon’s psilocybin regulatory process has raised questions, however, about the need for disclosing potential conflicts of interest.
Eckert resigned as chair of the PAB on March 10 after pressure from board members related to the organization’s new conflict of interest disclosure rules. A Vice story alleged that Eckert has been in a romantic relationship with Rachel Aidan, the CEO of Synthesis Institute.
Eckert’s resignation letter did not address that claim. He wrote: “As my life continues to change, with more relationships taking shape, I am mindful of appearances. I do not want anything to distract from the earnest work of this advisory board.”
Portland-style psychedelic therapy
Some businesses are particularly well positioned to take advantage of mushroom mania when it hits Oregon. In Portland, a ketamine clinic that opened in October 2021 is priming to add psilocybin services. Cascade Psychedelic Medicine has three exterior murals of magic mushrooms, a soulful woman meditating, and psilocybin spore prints. Founder Seth Mehr is an emergency room physician who still puts in a shift at the ER when he can, but is busy at Cascade. He says ketamine slots are booked up months in advance.
Mehr says he doesn’t even need to add psilocybin-assisted therapy to help support his business, he just wants to. “If and when we’re fortunate enough to get a license to do that next year, this would be more set up for long journeys,” he told Lucid News.
A look at Mehr’s ketamine clinic offers an idea of the therapeutic environments those seeking psilocybin treatments in Oregon might encounter. In his lobby Mehr has a display of his grandfather’s anatomy notebooks filled with drawings from his medical school training in Scotland in the 1930s. Mehr marvels at how detailed they are.
The books lend a medical aesthetic to Mehr’s ketamine therapy practice – a service that has become profitable business in larger cities like Portland. The display includes vintage vials of mercury used for treating syphilis, a reminder of how medical treatments evolve as research and therapies are refined.
Mehr has two treatment rooms for therapy and integration, one of which will also be used for psilocybin journeys. The other is currently used for ketamine sessions. It has a reclining chair, an IV pole, blankets hanging on a rack tagged with patients’ initials, trippy projection lights that crawl across the ceiling, and musical instruments such as hand pans, chimes and singing bowls.
Mehr administers ketamine intravenously so he can regulate the dose quickly as patients respond. He uses patient weight-based dosing of ketamine, ranging from 0.4 to 1.2 milligrams per kilogram. During the journeys, he keeps his conversations with the patient minimal and related to their comfort. The sessions last an hour and a half, plus integration time which can include talking with a provider, art, and journaling.
Mehr sits down in the reclining chair and explains that while ketamine patients are now getting this therapy, he believes the music and integration opportunities will also be ideal for psilocybin journeys.
“What I’m trying to do over a course of infusions is to safely allow people to have a psychedelic experience, where I make some adjustments during the session, and then from one to the next, gradually getting there as people feel more comfortable in the medicine,” says Mehr.
While Mehr notes that people respond differently, he says that few have adverse reactions. “Feeling stuck in the chair, having a disorienting and uncomfortable experience or feeling too out of control, rarely happens” says Mehr.
As Mehr works to establish his medical bona fides and patient outcomes, he suggests that they will transfer nicely to facilitated psilocybin journeys.
“Experiences on psilocybin, ketamine and LSD have more in common than they have differences,” says Mehr. “If you heard people’s reports of what they are experiencing, especially in the deeper levels of ketamine, you’d have a hard time determining if they’re talking about a ketamine or psilocybin journey.”
Ketamine versus psilocybin
Mehr charges $425 for a ketamine session and says he keeps 20% of his slots available on a sliding scale. “It could be considered a luxury because medical insurance doesn’t cover it currently,” he says.
It’s not yet clear what the costs will be for psilocybin licenses and other regulatory requirements for psilocybin providers in Oregon. “If it becomes cost-prohibitive for most people, that would be a failure of the system,” says Mehr.
The current regulations around facilitated psilocybin use in Oregon stipulate the number of people who need to be present for sessions. Due to the nature of psilocybin, it’s understood that these sessions will be longer than those involving ketamine, which may increase the cost to clients.
“With Measure 109 there will be two facilitators for every client,” says Mehr. “I’m sure part of doing a six-hour session with two facilitators is to allow one to go to the bathroom and get something to eat. There may be group sessions where the ratios could be different. I don’t know right now.”
While there is not firm data yet for price comparisons between psilocybin and ketamine therapies, there are some critical differences between the two.
Mehr believe that for someone with no psychedelic experience, IV ketamine is an ideal approach. He notes that an infusion pump makes it easy to adjust the dosage in real time while patients can tell you how they are feeling.
“As opposed to psilocybin, where you take whatever dose you’re taking, and if that happens to be too much for you, there’s no off switch. That’s a big difference,” says Mehr.
Despite the differences in dosing strategies, Mehr says his process of providing effective support for ketamine therapy has helped him create an approach to care that helps prevent traumatic or dysphoric experiences – and create an optimized therapy that can translate to psilocybin.
“What I’m doing, and where I think the evolution of this field should go, is to acknowledge ketamine as a powerful psychedelic like psilocybin and LSD, and to foster a positive psychedelic experience with it, to get more benefit from the sessions,” says Meyer. “That’s going to include preparation, supervision, music, integration, flexibility, communication, and collaboration with every patient to make this a safe psychedelic experience.”
Mehr says other preparations made for ketamine treatments would transfer to psilocybin therapy. For example, he’s prepared if the psilocybin rules committee required facilitators to have a steel door and a locked safe, as has been suggested.
According to Mehr, he already has a steel door and a locked safe at his clinic which is ADA (Americans with Disabilities Act) compatible. He says he also has all the needed safety and monitoring equipment. “I am a medical doctor and feel comfortable with the most intense levels of screening and monitoring, safety, and protection,” says Mehr.
In regard to how psilocybin therapies will scale, Mehr notes that state regulators will decide how many licenses they will issue to meet demand.
“My prediction is that there are going to be more interested people seeking services than there are available centers, staff, and time to see them. That’s been my experience with this clinic with ketamine,” says Mehr. “I got much busier, much faster, than I ever anticipated.”
Business associations for psilocybin providers
As more psilocybin providers begin to enter the market, professional associations are beginning to form. The Psilocybin Assisted Therapy Association (PATA) was founded in 2021 by two Oregonians, with a mission “to promote the advancement of Psilocybin Assisted Therapy” and an emphasis on serving therapists and licensed mental health professionals.
Then there’s the National Psychedelics Association (NPA), which has a Washington, DC address, but was formed in Portland in 2021. The organization is also focused on supporting Oregon’s growing psilocybin business community. The NPA’s goal is to “provide training organizations, facilitators in training, and service centers with financial/business resources, standards, best practices, integration with wrap-around services, insurance, and industry networking.”
NPA co-founders Britt Rollins and Chris Olson started thinking about a professional association in early 2020, with Measure 109 on the horizon. Rollins is a marketing and communications strategist from the ad industry, with an interest in veterans, mental health, and psychedelic-based therapies.
“You haven’t heard of us because we have not officially launched,” Rollins told Lucid News. He says the umbrella organization is launching first in Oregon, then in whatever states legalize psilocybin next. They are targeting business issues that a service center might face, such as professional liability insurance, professional malpractice insurance, banking services and credit services.
Rollins wants the NPA to partner with the psilocybin training programs, and then offer them facilitator-provider memberships to the association.
When it comes to worries such as slip-and-fall liability coverage or dealing with large bundles of cash (psilocybin is still a scheduled substance), the NPA wants to provide access to relevant services. They will also offer business consulting to, say, ketamine providers who wish to offer facilitated psilocybin therapy, but need to learn how to keep the two businesses separate.
Another group of business support services are also emerging to support the unique data requirements of psilocybin providers. The NPA partnered with software company Maya in January 2022. It will begin offering Maya’s Real World Evidence Platform to NPA members in late 2022.
Maya is designed to handle the data patients input when they seek psilocybin treatment with a provider. This information system has been developed to collect longitudinal data that can, for example, track a patient’s mood. If psilocybin users keep reporting that they are sleeping better – or worse – that information could be collected by Maya’s software and provided to academic researchers.
According to Maya’s CEO David Champion, NPA is going to recommend Maya as the software platform for facilitators. “Many people believe that Oregon will need to gather data, in an intelligent and informed way, on how these different facilitators are operating, what the quality of their work is, how effective it is for their participants,” says Champion. “And bring that data as a single body of evidence back to other groups like Oregon Health and Science University.”
Champion says being first to the market is important for software companies like Maya. He expects Oregon to provide a template for this type of data collection in other states. “And then make a case for Oregon having been successful, say, one year in,” says Champion. “So that there can be further evolution of Oregon legislation, and also to inspire and inform legislation in other states like Colorado.”
Rollins, of the National Psychedelics Association, says it was also looking for software that could provide a broad UX (user experience) and could be used by both a clinician and a non-clinician, as Maya’s platform does.
Rollins says he’s on the side of the mom-and-pop psilocybin business. “You could see a really dystopian world where this gets so capitalized, that it’s no longer about the therapy or the benefit,” he said. “It’s about how much money we can eke out of it.”
Fears of a corporate takeover
Oregonians saw what happened with legal cannabis, says Rollins, and are concerned with how those policies were implemented. It’s a scenario many do not want to repeat.
“Especially from an equity standpoint, but also just from a giant corporate takeover standpoint, the idea of a mom-and-pop weed farm had been quashed up and down the West Coast, by big weed,” says Rollins. “That raises fears here when some of the same players are showing up in the psilocybin space.”
Rollins adds that while Oregon is on the forefront of psilocybin regulation, it’s a small state. He says some residents have deep concerns about outside investors and companies potentially reaping business opportunities that divert from the stated intentions of Measure 109.
“Knowing Oregon is four million or so people, not a huge population, big money coming in and taking over is a real fear,” says Rollins “People want transparency, they want organizations who are coming in to explain their intentions.”
According to Rollins, some Oregonians who fought for Measure 109 are less concerned about being funded by outside interests, but about the intentions of investors and companies coming into the newly developing market.
“There is a lot to be hopeful about,” says Rollins. “It’s going to require a lot of the heart-centered folks to show up and really ensure the intent here is true. To ensure that this doesn’t become co-opted by corporate interests who don’t really care about the substance, or its legality, or the end result, which are just looking to make a buck.”