Yet with the hype swirling around psychedelic-assisted therapy, it’s likely that many will be seeking the drug for its reported therapeutic qualities. Jonas said that most of the people on her waiting list have cited a mental condition, including PTSD, depression, and trauma, as the reason they signed up. “Probably a good third are very depressed,” she said.
Marks says confusion about whether the bill follows a medical model goes all the way back to its inception and included people on the psilocybin advisory board. In March 2022, a psychologist and member of the advisory board, Kimberley Golletz, told Stat News, “We’re saying both things. This is not medical … But this is psilocybin-assisted therapy,” she said. “Psilocybin facilitation … I mean, nobody knows what that is.” The ballot for Measure 109 itself makes reference to the mental health crisis in Oregon and the preliminary clinical evidence that psilocybin could be a potential treatment.
In June 2021, Angela Allbee, manager of the body that oversees the psilocybin program, said in an interview that they would deem the success of the program to be “providing an opportunity for those that are struggling with mental health issues to heal.”
Marks also points to confusion spread by the Healing Advocacy Fund, a nonprofit that supported implementation of the program and whose head, Sam Chapman, was formerly the campaign manager for Measure 109. The homepage of its website today says: “In 2023, Oregonians suffering from depression, anxiety, or addiction or approaching the end of their life will gain access to this ‘breakthrough therapy’ demonstrated to provide healing and hope.” Chapman has said publicly that psilocybin therapy “can help address our state’s mental health crisis.”
Perhaps people will be unaware of the distinction—or ignore it—and just treat Oregon’s psilocybin program as psychedelic-assisted therapy anyway. Does that matter?
Aryan Sarparast, a psychiatrist and assistant professor of psychiatry at the Oregon Health and Science University (OHSU), believes it does. When we think about psychedelics, we think about “the outcomes that we’ve seen in clinical trials, which are really promising, really favorable and exciting,” he says. “However, those environments are dramatically different.” The screening, the preparation, the dosing sessions, and the amount of integration are all different. “Everything is, frankly, different,” he says.
The risk, says Sarparast, is the effect on vulnerable patients; expectancy bias could inflate their hopes for how effective the experience will be. “I worry about somebody with mental health conditions looking for a mystical, transcendental experience to treat their mental health issue and having some challenging things come up,” he says. Researchers have speculated that when an individual with a mental health disorder tries psychedelic-assisted therapy and it isn’t as effective as expected, it can make their condition worse, such as triggering suicidal behavior.
And clients may not receive the aftercare they need. The integration component—when individuals take the lessons and insights from a hallucinogenic experience and learn to fold them into everyday life—is optional in Oregon’s program, and some may skip it, perhaps because of cost. In studies on psychedelic therapy, an integration element is typically employed.