The Oregon Psilocybin Advisory Board convened for the first time Wednesday to begin the long process of integrating legal psilocybin therapy into the state’s mental health care system.
Wednesday’s meeting marked the first major milestone since Oregonians voted to pass the Oregon Psilocybin Services Act in November. The act, also known as Ballot Measure 109, directs the Oregon Health Authority to begin regulating the manufacture, delivery and sale of medicinal psilocybin products after a two-year development period.
The Oregon Psilocybin Advisory Board operates within the OHA and consists of 16 members elected by Gov. Kate Brown who work with the OHA during the development period to establish rules and regulations regarding the use of psilocybin services. Some of the board’s responsibilities include making recommendations to the OHA on the available scientific studies relating to the safety and efficacy of psilocybin therapy, the necessary training for psilocybin service providers, the requirements for a provider to receive a psilocybin license and the specifics for how and where psilocybin should be administered to qualifying patients.
Psilocybin is the hallucinogenic compound found in psychedelic mushrooms. It was given a “breakthrough therapy designation” by the Food and Drug Administration in 2018 after it was shown to demonstrate “substantial improvement over available therapy” for treatment-resistant depression during clinical trials run by a company called COMPASS Pathways. In a 2016 study, researchers at Johns Hopkins University found that a single dose of psilocybin provided significant relief to symptoms of depression and anxiety in a majority of terminally ill cancer patients.
Each of the board’s 16 members volunteered for their positions and were appointed by the governor’s office. The board primarily consists of health care and law professionals from around Oregon and includes epidemiologists, hospice nurses, clinical psychologists, a mycologist, lawyers, psychopharmacologists and physicians. The board’s three OHA representatives are non-voting members, meaning the board maintains full decision-making autonomy from the OHA.
Psilocybin services will not be available to the public until at least January 2023, according to the text of the act, after which the OHA will issue psilocybin licenses to healthcare providers and drug manufacturers. According to Sam Chapman, the executive director of the Healing Advocacy Fund — a nonprofit that supported the implementation of measure 109 – psilocybin products will remain illegal for retail sale, as well as for unauthorized consumption, possession and cultivation. He also said that there will be no branding or advertising for psilocybin products.
“You’re not going to be driving down I-5 and see an advertisement for mushrooms,” he said.
Board member Tom Eckert said the specifics surrounding the implementation of the Oregon Psilocybin Services Act will differ from those of other newly approved pharmaceutical drugs. He is a Portland psychotherapist who, along with his late wife Sheri, spearheaded the initiative to legalize therapeutic psilocybin as the chief petitioners and principal architects of Measure 109. Eckert said that the board must acknowledge the cultural history of therapeutic psilocybin as it establishes a regulatory framework and ensure that all qualifying community members have equal access to psilocybin therapy.
“Psilocybin is not exactly a pharmaceutical drug,” he said. “It shouldn’t necessarily be regulated like it’s some new pill that’s created in a lab with unknown side effects. We must respect the deep history and knowledge of psychedelic use, plant medicine and ceremony dating back thousands of years.”
The members spent a specific portion of the meeting discussing the internal structure of the board itself. They debated whether to elect a chair and vice chair or two co-chairs to preside over future meetings, before Dr. Andre Ourso — an administrator from the OHA’s Public Health Division who led the discussion — decided to push their decision to the next meeting. They also discussed how to divide the board’s work and proposed several subcommittees, including ones for equity, research, training and education for psilocybin facilitators and manufacturers. The board voted to approve the formation of the research and training subcommittees.
Dr. Jessie Uehling, a mycologist and botany professor at Oregon State University, called attention to the specific types of psilocybin products that the state would allow to be administered to the public, which she said will affect the kinds of research she conducts for the board.
“Are we talking about providing whole mushrooms, psilocybin extracts, synthetic psilocybin, or a combination of these products? That would really guide a lot of the research I would do,” she said, “and would also shape the thinking about safety and concerns in the clinic as these therapies are being administered.”
As the board discussed the different types of research that should be included in its recommendations to the OHA, Dr. Angela Carter — a primary care physician serving the Portland transgender community — asked the board to consider evidence that may not fit the standards of traditional western medicine.
“There are a lot of Indigenous, non-western ways of knowing around psilocybin therapy and psychedelic use in general,” they said. “Just because it’s not a double-blind randomized clinical trial that is western-modeled doesn’t mean that that evidence is not useful pertaining to the use of psilocybin.”
Dr. Rachel Knox is a cannabinoid medicine specialist and health equity specialist who served as the past chair of the Oregon Cannabis Commission. Drawing on her experience from her work in regulating the recreational cannabis industry, she emphasized the far-reaching effects that a medicinal psilocybin industry could have on Oregon.
“Eventually we’ll want to tackle things like business, and law, and how the supply chain operates — how it flows,” she said. “We have to be honest with ourselves about this: It does create an industry. So how are we going to steward this industry with integrity?”
UO clinical psychology professor Nicholas Allen, who does not sit on the board, said that while he fully supports the implementation of therapeutic psilocybin programs in Oregon, the board’s recommendations must align with the latest scientific research. He said that for the Oregon Psilocybin Services Act to affect positive change, the board must recognize that psilocybin is an emerging mental health treatment rather than an established one, and that its implementation must be based on the same evidence standards as other new forms of mental healthcare.
“Whatever regulations are put around psilocybin treatment needs to recognize that in reality, there is an ongoing scientific process,” he said. “We don't have the level of evidence on this treatment that we have on other mainstream treatments for depression and anxiety.”
The OHA has directed the board to submit its findings and recommendations on the available scientific research regarding the efficacy of psilocybin in treating mental health conditions by June 30, 2021, and to begin distributing its findings to the public no later than July 31, 2021.