Oregon’s psilocybin program starts to take shape
In November, Oregon voters approved Measure 109, which allows the use of the psychedelic drug psilocybin in supervised facilities. The program won’t be up and running until 2023, and there’s a lot of work to be done before then. Oregon’s Psilocybin Advisory Board convened earlier this year and is currently learning about the safety and efficacy of psilocybin in treating a variety of mental health conditions. The Oregon Health Authority recently named Angie Allbee as the manager for the agency’s Psilocybin Services Section. We hear from Allbee and André Ourso, administrator of the Center for Health Protection at OHA and the agency’s representative on the Psilocybin Advisory Board.
This transcript was created by a computer and edited by a volunteer.
Geoff Norcross: This is Think Out Loud on OPB, I’m Geoff Norcross.
Last November, Oregon voters approved a ballot measure that brought psilocybin therapy above ground. The compound found in hallucinogenic mushrooms is believed to help people suffering from a range of afflictions, from depression to addiction. Measure 109 directed the state to come up with a framework for legal, controlled psilocybin therapy in the state by the year 2023. We wanted to see how that’s going. Angie Allbee was appointed manager for the Psilocybin Services Section at the Oregon Health Authority just this month; that agency will oversee the new program. André Ourso represents OHA on the Oregon Psilocybin Advisory Board.
Welcome both of you to Think Out Loud. It’s good to have you.
Angie Allbee: Thank you so much, we’re happy to be here
André Ourso: Hi Geoff, thanks for having us.
Norcross: Angie, it seems like so long ago, but when you heard that Measure 109 passed back in November, what was your reaction?
Allbee: Yeah, that’s a great question. First and foremost, I was excited to see that there will be a new opportunity for anyone that these services will be appropriate for. There’s a lot of people with anxiety, depression, addiction, trauma, that could actually be helped by psilocybin. So it’s an exciting time and there’s a lot of work to be done, there’s a lot of clarification that we need to make. I just remember thinking about how we’re really moving forward to help provide opportunities for those that are struggling with mental health issues.
Norcross: Yeah, a lot of clarification needed. And we’ll get into some of the nuts and bolts in a minute, but what was it like just to start trying to create a legal framework around a substance that isn’t legal anywhere in the country right now?
Allbee: Well, first and foremost, there’s been a great amount of work done already before I joined in this specific role. André, who’s with us, is the Center Administrator for the Center for Health Protection, and had been doing some work pulling together the advisory board. They’ve been meeting since March, I think March 31st was their first meeting, so there has been a tremendous amount of work.
But yes, there’s so much to be done as far as really beginning to draft rules, and to work with the advisory board on recommendations, and then to better understand how this will continue to evolve and fit within the federal landscape. I don’t know if André has anything else you’d like to add?
Ourso: No, that sounded great. The board has been meeting since March, and they’ve already started dividing the kind of subject areas of expertise amongst themselves and talking about what type of advice they want to provide the agency.
Norcross: And the advisory board, André, is really focused on reviewing the existing scientific literature on psilocybin right now, whatever literature exists at the moment. Can you give us an idea of what questions you’re trying to answer?
Ourso: Yeah, Geoff, so the board’s goal for June 30th is to come up with some findings and recommendations on the available medical, psychological, and scientific research on psilocybin. And then the agency’s gonna publish that and make that available to the public by the end of July.
Some of the questions that we’re looking at is what is psilocybin good for, basically? What are the safety issues around the use of psilocybin? What is it effective for? We know that we’ve seen some research recently that shows that it has some real promise in treating Major Depressive Disorder, that it can treat addiction, and can treat anxiety associated with terminal illness. So, the research is really going to uncover what the science tells us about the effectiveness and safety of this type of therapy.
Norcross: You mentioned safety concerns. Like what?
Ourso: I think we need to look at who would be a suitable client or patient for this type of therapy. It’s not gonna be for everybody. We have some indication that people that have experienced psychosis, that it might not be an appropriate form of therapy for that sort of individual. And we’re also looking at the safety of the product itself, looking at potency. How much of the psychoactive chemicals [are] present in particular species of mushrooms, what species are appropriate for this type of therapy, and what forms of products would be suitable for this type of therapy. So are we looking at a synthetic form? Are we looking at whole mushrooms?
Those are some of the questions that we’re gonna be diving into and providing some advice and recommendations to the agency as they develop standards and rules around those topics,
Norcross: Do you have, at this point, what you would consider a rock solid conclusion that you can work from when putting this program together? One that you would recommend, that “This is what we know, this is what we’re comfortable with. You can work with this”?
Ourso: I wouldn’t characterize it as rock solid. I think we have this two year development period that started back in January and extends into January 1st 2023, when the agency has to start accepting applications for licensure. So that development period is really going to provide the time that we gather this information and then we can translate it into implementing the measure, and setting up a comprehensive regulatory framework for allowing people to access this type of therapy
Norcross: Angie, there are so so many questions to tackle when it comes to setting up a brand new program like this, especially one that includes a controlled substance. Can you give us a sense of where you are and what you’re focusing on right now in this process?
Albee: Absolutely. So, again, I started in this role about 3-½ weeks ago, and as the manager of this section, it’ll be up to me to ensure that we continue to create policies and procedures as we build out our team. Currently, we’ve got a lot of work to do to build out our team, and work closely with the Psilocybin Advisory Board on recommendations. We need to adopt rules and regulations for a comprehensive regulatory framework that André mentioned. I have to work within our budget to create a sustainable program, ensure we meet our deadlines, and ensure that information is available to the public on our website.
And I think at the very base of it all we need to ensure the safety, effectiveness, and equitable access of these services in Oregon.
Norcross: André mentioned the question about whether or not you would use natural psilocybin in mushroom form or you would use a synthetic. What are you weighing as you consider that question?
Albee: The advisory board has really had a really impressive list of guest speakers to come and speak with us, and I think that right now we’re in the information gathering stage where we’re receiving information. Again, the research subcommittee is looking at all of the research that’s out there. I think that, again, to Andrés point, we don’t have a rock solid framework at this point in time. There’s a lot to consider.
You started off talking about what is psilocybin? Psilocybin is a compound that’s produced by more than 200 species of fungi. So there’s a lot of work to be done to figure that out, the product safety and the manufacturing piece. So we’ll continue hearing from those guest speakers and continue looking at the research that comes out when we complete that scientific literature review that will be made available to the public on July 31.
Norcross: And André, you’re reviewing that scientific literature. How would you characterize it? Is there a lot of research on psilocybin you can draw on?
Ourso: Well Geoff, coming into this, I really didn’t know too much about psilocybin. But from what I understand, there is quite a bit of research literature that’s been going on for the past 14 or 15 years since we’ve had a renaissance in psychedelic research back in the mid 2000s. So there’s quite a bit. I was a bit surprised by the robustness of the amount of research out there. And there are some pretty impressive institutions that are engaged in psychedelic research and psilocybin therapy research, institutions like Johns Hopkins University, the Imperial College of London, NYU and UCLA all have research programs looking into this type of therapy.
Norcross: If you’re just tuning in, we’re talking about how Oregon’s effort to create safe and legal psilocybin assisted therapy is going. Angie Allbee is the manager for the Psilocybin Services Section at the Oregon Health Authority which will oversee the new program. André Ourso represents OHA on the Oregon Psilocybin Advisory Board.
Angie, of course, there are people in Oregon who know the territory. They have been facilitators for this type of underground therapy for decades. Are you reaching out to them and talking to them as you put together this legal program?
Albee: Yes, absolutely. First I’d like to back up and say that we need to acknowledge as we build out this program, but there’s a history of psilocybin. There’s centuries of use by Indigenous and tribal communities. There are decades of research by medical, psychological, and academic institutions and, as you say, there are many practitioners and facilitators of this work. We are asking for presentations and information from guest speakers who might come and talk to our sub-committees or advisory board, and there’s a lot to be learned. There are frameworks set up already for training and facilitation that practitioners are using around the world in places where they actually can provide psilocybin services. So we’re listening, and it’s incredibly important that we understand what has worked, what hasn’t worked, and then how we fit that in Oregon, and with the way that we want to build out this program
Norcross: Back in November, we talked to Mara McGraw, who went through psilocybin therapy to help her cope with her terminal cancer diagnosis, and when she was on the show, she described how the process went. And this is what she said:
Mara McGraw: After the initial phone call about some assessment around my condition, my medical needs, and my experience, which at the time I did not have experience with anything that would be categorized as a psychedelic medication, then you meet to have a planning session, answering any questions around safety and comfort. I had a lot of questions around how this might affect my body and what the experience could potentially be like for me.
And then you take a significant amount of time to set an intention, to really have a focus. Set and setting are key to this type of experience. So, mindset, having an intention, a focus, a goal, and then the setting, I chose to do my psilocybin therapy session where I could have access to the outdoors, into nature, because I find that comforting. So that process was about two weeks prior to my psilocybin session, and then the session itself is about 6, 6-1/2 hours where the facilitator is present there. It’s a fairly inwardly focused process, there’s not a lot of communication, but there can be if you need support in a particular area or if I felt like I was getting stuck, I could check in.
And then post-psilocybin experience, about two weeks after, I met with the facilitator to have what they call an “integration session,” where I got to discuss my insights and how I was going to put those into practice in my life.
Norcross: Angie, Mara laid that out pretty clearly about how the session went for her. Can you imagine the session will be substantially different from that once Measure 109 is in effect in 2023?
Albee: What I can say is that the advisory board is currently looking at the different ways that a psilocybin session experience would happen, and we’ve heard accounts of something similar. I think right now it’s important to just note that we have an enormous responsibility to make sure that we have a successful regulatory framework, and that we continue learning, adjusting, and evolving in a way that centers on the client receiving the services.
I think as we hear the recommendations from the advisory board, and as we consider safety and equity, and effectiveness, we’ll be able to develop the minimum requirement and a standard of practice that can be used in order to shape what a psilocybin experience would look like. So while I can’t completely confirm that that’s exactly what will happen or be required, I think it’s definitely a possibility as we continue to build out the program based on recommendations and the information that we’re receiving
Norcross: And Measure 109 specifically states that the state may not require a psilocybin service facilitator to have a degree from a university or a college or a postsecondary institution or other institution of higher education. So can you give us a sense of what requirements will be in place?
Albee: Yeah, so that’s correct there. Our role is to implement this program based on the language of Measure 109, and there’s a lot of benefit to being able to have requirements for training and facilitation, to make sure that there’s enough education, that there’s a standard of practice established, that safety is considered. We don’t have those recommendations or those requirements set up yet. We are in that development period, as we’ve talked about with you previously, and that development period started in January as André said, and goes until December 31st of 2022, so we are currently working on pulling that information together, and really defining what those recommendations and requirements will end up looking like.
Again, safety is incredibly important, and we want this program to be effective, we want it to provide really important experiences for those it’s appropriate for. So we have a lot to continue learning as we pull information together, and [we’re] excited to come back and share that information with you at a later time.
Norcross: We’re in early days here, but do you have a sense of how you measure success?
Albee: Well, first and foremost, I think it’s incredibly important to remember that this particular section is housed within the Oregon Health Authority, in the Center for Health Protection, so safety is something we’re very committed to.
Also, OHA has been very transparent about our commitment to health equity, and our strategic planned goal of eliminating health inequities by 2030. We are working towards that goal and what is within our purview is definitely part of that work. So part of this is completely making sure that we’re applying a health equity lens as we roll out our programs, to make sure that we have safe experiences and requirements, that we’re evaluating, that we’re working through any challenges that we’ve encountered and that we continue the lines of communication and keeping those open, and setting up some kind of evaluation tool and mechanism to be able to actually lay out what is a success to this program?
At the end of the day, the success is that we are providing an opportunity for those that are struggling with mental health issues to heal, and to have an opportunity to get past that and live a life full of joy, and to be healthy.
Norcross: André Ourso, you have some experience as the former director of Oregon’s medical marijuana program that could be helpful here. How are you bringing that experience to this current role?
Ourso: Geoff, I think there’s a lot of similarities between legalizing cannabis and there’s a lot of huge differences with psilocybin therapy. We did learn a lot of lessons from legalizing cannabis four or five years ago, and I want to bring those lessons learned to the implementation of this program. So there are things that we’re going to look at as far as product types, what product is most effective? What are the safety levels of the product that we should be concerned about? Supply issues are something else that we’re also concerned about.
And then the difference between the two is that with medical cannabis, you go see your physician, physician says, “Here’s my recommendation for the use of cannabis to treat X condition”, and then you go out to a retail shop or to a medical marijuana dispensary, and you purchase a product that you think would be best for your particular condition.
With psilocybin therapy, it’s a lot more restricted. The psilocybin is being administered within a therapeutic setting, as Mara described in the clip earlier, and then the client or patient isn’t actually going out and purchasing the psilocybin firsthand themselves, or possessing it themselves, all that is done through the facilitator at the service center.
So yes, there’s there’s some lessons that we learned from cannabis, but not necessarily all of them are going to apply directly to how we implement the psilocybin therapy program.
Norcross: We did get a boost with recreational cannabis in that we had Colorado and Washington who went there first, and we could look to them for guidance. But we’re on our own here. How does that make this process more challenging?
Ourso: Well, it is more challenging since we don’t have our peer states to kind of help us bounce ideas off how we best regulate the substance and the administration of the substance. We had that luxury of being third or fourth with cannabis. So we could reach out to Colorado, we could reach out to our neighbor in Washington and say, “Hey, how are you testing cannabis? What limitations are you putting on potency?”
None of that exists here for psilocybin. Oregon is truly the pioneer state when it comes to psilocybin therapy. So we are kind of going it alone, but we do have an amazing board with a diversity of experience that we’ll be relying on and gathering information and taking their advice and recommendations.
Norcross: André I assume you’re in this role because you believe in psilocybin as a therapeutic agent. But can you help someone who may be concerned understand why it’s a good thing? Why is this compound useful for these conditions like addiction and depression and anxiety?
Ourso: Well, working for the Oregon Health Authority and the Public Health Division, we are an evidence based organization. We rely heavily on the science to tell us what’s useful and what’s helpful. From my novice understanding of the research of psilocybin, I do believe it’s helpful. I really think it can help people. Oregon is a state where there’s a lot of people out there suffering from mental health crises. And if we have avenues that can help alleviate that suffering to help people heal, to make people better themselves, then why not try it?
Norcross: André, Angie, I’m afraid we’re gonna have to leave it there, we’re running out of time. But thank you so much for the time. I appreciate it.
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