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Happy Thursday. Today I'm going to talk about psilocybin in a therapeutic context.
Oregon is the first U.S. state to allow therapeutic psilocybin (as of last week's election passing their ballot initiative with 56% popular support)
Oregon is the first U.S. state to allow therapeutic psilocybin (as of last week's election passing their ballot initiative with 56% popular support)
this is approximately how it appeared on the ballot https://ballotpedia.org/Oregon_Measure_109,_Psilocybin_Mushroom_Services_Program_Initiative_(2020)
first I want to discuss the legal status a little bit, then I'll talk about psilocybin therapy from both a first person (my own personal experiences doing underground psilocybin therapy) and a more detached perspective.
"create a program to permit licensed service providers to administer psilocybin-producing mushroom and fungi products to individuals 21 years of age or older"
is what was approved by the voters. let's dig in a little.
is what was approved by the voters. let's dig in a little.
this is not a decriminalization resolution, nor is it a legalization for general (aka recreational) use. it's a mandate to create a regulated program. the state of Oregon shall now create a program to figure out the details of they would like to do this.
two interesting parts of this:
1. licensed service providers
2. psilocybin-producing mushroom and fungi products
1. licensed service providers
2. psilocybin-producing mushroom and fungi products
there has never been a program anywhere to officially license and credential a therapist or doctor or any other kind of service provider to work with psilocybin. that hasn't stopped underground use of it, but it's never been done in the light before (in Modern Western culture).
what will the requirements be for this licensing program?
the originators of the ballot initiative petition are Tom and Sheri Eckert. They are both licensed therapists. https://psychedelicstoday.com/2020/05/05/tom-and-sheri-eckert-oregon-psilocybin-therapy-initiative/
the originators of the ballot initiative petition are Tom and Sheri Eckert. They are both licensed therapists. https://psychedelicstoday.com/2020/05/05/tom-and-sheri-eckert-oregon-psilocybin-therapy-initiative/
they emphasize that the treatment model they advocate is for a full-dose psychedelic experience, with a guide and talk therapy sessions both before and after the experience.
their position is that a breakthrough experience is what opens up the potential for healing.
their position is that a breakthrough experience is what opens up the potential for healing.
the other noteworthy thing specified in the initiative that it legalizes the use of psilocybin-containing mushrooms, rather than legalizing the psilocybin molecule specifically (or other psychedelics more broadly).
this is significant for a couple of reasons. the first of which is that it safeguards (somewhat) against a pharmaceutical company, like say Compass Pathways, becoming the sole supplier of synthetic psilocybin tablets for medical use. mushrooms are from the Earth itself.
the price per dose of cultivated mushrooms is much higher than the price per dose of synthetic psilocybin. HOWEVER, it's basically immaterial here because the therapy program is not chronic daily use, it's a handful of guided sessions.
Mushrooms can't be patented. Mushrooms can be grown in small batches by just about anyone, doesn't require special equipment. Psilocybin mushrooms are common enough as wild species in Oregon that you can just forage for them if you know a good spot (and when to go look).
So even though the price per dose is higher, the accessibility and democratization of production when using fungi rather than synthetic sources is really important.
it will be interesting to see what the economics of this will end up being. the therapists' time is much more expensive than the price per dose of mushrooms in any case. it will probably not be insurance covered at all. there's still an economic obstacle here.
Psilocybin remains a schedule 1 controlled substance under Federal law. this is the category for "no recognized medical use" as well as "high potential for harm". All psychedelics were placed under schedule 1 by the DEA, for political and cultural reasons.
Psilocybin is being studied by a few research labs (Johns Hopkins has been prominent here) for treatment of things like end-of-life anxiety in the terminally ill. that is, it's already being studied by FedGov for medical use. It's considered a "breakthrough therapy" right now.
This means it's being fast tracked and the FDA will be legally obligated to recommend that Psilocybin be rescheduled (probably to schedule 2) if/when the studies prove out medical safety and efficacy, which they almost certainly will.
Oregon voters decided not to wait for the FDA and go ahead with a program in their state to develop a therapeutic program on their own terms. I broadly support this.
politically speaking, there's a ton of momentum behind this movement and I expect the next 5 years to dramatically overturn the status quo on psychedelics in terms of law enforcement and medical use.
ok, that's background. I want to talk about the therapy itself. That's probably the more interesting discussion anyway. let's not bury the lede, it will get it's own thread and I'll link it here.
thread discussing psilocybin therapy more directly https://twitter.com/danlistensto/status/1326893585724141569?s=20
