During the November election, Oregon voters approved a measure allowing licensed centers to provide psilocybin, the substance found in “magic mushrooms,” to help treat people experiencing a range of mental health issues. Oregon is the first state to approve such a program—and with that, eyes will now be on the state to see how it fares moving a substance that remains federally illegal into the sphere of reputable treatment.
According to a study published in November 2020 in the Journal of the American Medical Association, major depressive disorder affects more than 300 million people worldwide. In the U.S., about 10% of the adult population has been diagnosed with major depressive disorder in the past 12 months.
Kuske served as a Navy SEAL for 18 years.
Chapman echoed sentiments from veterans Kuske and Wyly regarding an important first step for implementing the psilocybin services program: supporting equitable access.
“The most important part of the rulemaking process is ensuring that we can strike a very important balance between client safety and responsibility, while also ensuring that as many people that stand to benefit as possible have access,” Chapman said. “So, we're talking about equitable access, especially for populations that traditionally don't have access to regular health care.”
He currently sees two opportunities: one in educating health care providers and insurance companies on how people may benefit from psilocybin therapy.
“And the second,” Chapman said, “is working with the community and working with providers and psilocybin facilitators and manufacturers and the service centers to have sliding scales and to work with nonprofits to build equitable coalitions with community partners.”
The veteran community has shown that the strategy can work. For example, Heroic Hearts is a nonprofit that helps veterans already interested in psychedelic therapies. The organization researches providers and offers veterans financial assistance based on donations.
Founder and President Jesse Gould started the organization after being diagnosed with PTSD after three deployments in Afghanistan as an Army Ranger. The program has been growing every year, Gould said.
“I think the first year we probably helped around 10 [veterans], and then I think in the next couple of years we were able to do 20 to 25,” Gould told the Source. “This year we were set to do more than 100 or 150, but obviously COVID put a little bit of a wrench in that.” The organization was still able to assist 20 veterans last year and hopes to help a couple hundred this year.
Along with keeping costs down, Kuske, the Navy SEAL who sought psilocybin treatment, says he hopes to see indigenous wisdom regarding the use of plants and traditional treatments, like psilocybin mushrooms, considered as guidelines are finalized.
“Every time a new article comes out, they explain everything, like it's the first time that we discovered any of this,” Kuske said. “When in reality these safer medicines have been used going back millennia. And I think it's important that we adapt it to our own society, but at the same time that we incorporate it, acknowledge, respect and give honor to the ancestral ways of using these medicines.”
How can officials promote safety?
Dr. Nicole Cirino is president of the Oregon Psychiatric Physicians Association. Both the OPPA and the American Psychiatric Association opposed Measure 109. One reason: as written, the measure allows the use of psilocybin to treat conditions “including but not limited to” addiction, depression, anxiety disorders and end of-life psychological distress. It seems to neither require a specific condition nor a diagnosable mental illness at all, which Cirino suggested is misleading given the therapy focus of the campaign.
In a press release during the general election, the OPPA expressed concern that “neither the safety nor effectiveness has been established according to U.S. Food and Drug Administration guidelines or clinical trials,” which is required for all medications, including those that treat mental illnesses like those listed above. The statement said “the OPPA agrees with the FDA that early limited trials have shown promise” but that safety and efficacy just haven’t been proven yet.
“There are actually a lot of ongoing studies, but they need to be complete,” Cirino told the Source. “We need to analyze the data, and then we need to pull the data together to say what is the effective treatment, where the effective dose is and how we monitor it. It could very well be that in three to four years the FDA has approved psilocybin for a single or maybe two psychiatric conditions.”
Now that the measure has passed, Cirino says OPPA members hope they can help promote safety.
“We have had several of our members with expertise in this area apply to be part of the Psilocybin Advisory Board so that they could set some parameters around everything about the administration of psilocybin, including what sort of psychiatric evaluation and medical evaluation would be necessary prior to accepting a patient into a psilocybin clinic,” Cirino said. She says she’d like to see rules around training for psilocybin administrators as well.
“We're hoping that they have a mental health degree so that they can actually assess the mental health symptoms that are present,” she said. “And we're also hoping that there's going to be some monitoring of both medical and psychological sequelae after the psilocybin is administered to make sure that the adverse effects can be addressed adequately so this is a safe and effective treatment.” Sequelae is a medical term for conditions caused by disease or injury.
Cirino says medications usually come with FDA guidelines that say specifically what psychiatric conditions they treat, the appropriate dose and potential side effects.
“We're not going be able to do that,” she said. “But we might be able to become closer to make it safe and effective for patients.”
As psilocybin services become available in the next few years, Cirino recommends people interested in the option discuss it with their current mental health provider or medical doctor.
Unlike Oregon’s Measure 110, which decriminalized possession of small amounts of illegal substances, Measure 109 did not decriminalize psilocybin. Instead, it calls for a regulatory framework for adults 21 and older to receive psilocybin services at licensed centers for issues including mental illnesses like depression—but participants can take it for other reasons, too.
Dr. Peter Sparks, program coordinator and senior psychology instructor at Oregon State University-Cascades, says one reason there’s excitement around psilocybin therapy is that traditional antidepressants must be taken every day for long periods of time.
“And psilocybin therapy, at least in the research, often the way it works, is that you experience one or two episodes of psilocybin, and then the effects of the relief of depressive feelings and the relief of anxiety can last for months,” Sparks told the Source.
He said the therapeutic effect seems to correlate with “the experience of being small” in a large awe-inspiring world.
“There's something about that feeling of awe and the feeling of interconnectedness that causes, or is at least related to, diminishing the symptoms of depression,” he said. “And that seems to make sense because depression is an isolating condition where you feel like you're alone.”
The FDA granted breakthrough therapy designation to COMPASS Pathways’ research of psilocybin as a therapy for treatment-resistant major depressive disorder in October 2018, as discussed in Neuroscience & Biobehavioral Reviews in 2019. And in November 2020, the Journal of the American Medical Association published a randomized clinical trial of 24 adults diagnosed with major depressive disorder. The study found that after four weeks with two psilocybin sessions 71% of participants showed a “clinically significant response” and 54% met the definition for remission of depression.
Measure 109 passed with the support of 1.27 million Oregonians, or about 56% of voters statewide. Most people in Deschutes County supported the measure (53%), but only about 35% of Crook County voters and 41% of Jefferson County voters did. The measure stipulates that cities and counties can “impose reasonable regulations” on the operation of licensed psilocybin facilities and manufacturers—like the location of centers, hours of operation and public access to centers. As of press time, spokespeople for both Deschutes County and the City of Bend said there are no local agenda items related to Measure 109.
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