Oregon will soon be hitting the six-month mark since its first-in-the-nation psilocybin centers first started offering legal, if strictly regulated, access to the drug. One consequence that Oregon voters may not have anticipated when they approved this model in 2020 is an influx of people seeking psilocybin from out of state, as a number of new media reports highlight.
This is not legalization in the way 24 states, including Oregon, have legalized cannabis. There are no mushroom dispensaries to buy for use at home, and growing your own remains prohibited. Instead, this limited form of legal access—not quite medical, not quite recreational, with no diagnosis needed but many people seeking to address mental health conditions—requires people to visit a psilocybin “service center” to purchase and use the drug, on site and under supervision. A trained “facilitator” talks with each client before and during their trip, and remains with them in a private room to make sure things go smoothly.
“People are pursuing psilocybin services to get relief from mental health problems. That’s why they’re coming out to Oregon.”
Per state law and Oregon Health Authority regulations, all clients must sign an informed consent form, aknowledging that it is “not a medical or clinical treatment.” Rules apply to what facilitators and businesses can say about the drug. Clients with certain sensitive health conditions are not allowed to use it, and other vulnerable people are encouraged to speak to a doctor first. According to one 2022 review, psilocybin may pose risks to people with certain conditions and on certain medications.
Oregon’s model provides safeguards, but drives up costs and effectively leaves psilocybin out of reach for many. Health insurers won’t cover services that aren’t legally medical. And even if you can afford it, many centers have huge waitlists.
To learn more about how this looks on the ground and how things might be improved, Filter spoke with a business owner who operates a service center and is also a licensed psilocybin manufacturer. Andreas Met is CEO of Satya Inc, a service center among the first wave to open in Oregon. Many of its clients are from other states, and many are experiencing serious mental or physical health challenges. Our interview has been edited for length and clarity.
Alexander Lekhtman: When did you start and how many people are you seeing?
Andreas Met: We started on July 17. I think we’ve done about 180 clients.
Are a large proportion of your clients from out of state? Why do they come?
Absolutely; 90 percent are out of state. The reason people are pursuing psilocybin services is to get relief from mental health problems, such as complex trauma, treatment resistant depression, anxiety, OCD, end-of-life anxiety. That’s why they’re coming out to Oregon.
“It’s a challenge to know how much to administer to people who are taking significant amounts of drugs because it will blunt the effect of psilocybin—but not always.”
Is anyone doing repeat sessions?
Yes, about five out of 180 have; it’s not very frequent. Most people who will book two sessions for the same week don’t do the second session because they get what they need from the first one. I have had several clients come back for second sessions because they’re more vocal.
What’s the benefit in that?
It’s typically people who have had treatment-resistant depression for a long time and they’re usually on different drugs like SSRIs or antidepressants, so we don’t know how effective the [psilocybin] treatment or dosing level will be.
So oftentimes, the first session is like an intro to guage where we’re at, the dosing level and experience. It’s a challenge to know how much to administer to people who are taking significant amounts of drugs because it will blunt the effect of psilocybin—but not always.
The second session, if they didn’t have a full experience or there’s things they still want to address, is when a greater amount of psilocybin is given.
Do you employ a nurse or medic who does intake specifically for people with severe mental illness?
We have a facilitator, who is an independent contractor. This person is an anasthesiologist—but is not acting in their capacity as a doctor here. We frequently use them as a resource to ask about potential drug interactions. So we get advice, but that person is not acting as a doctor because it’s not legal. They use their skills to let us know if there are any interactions present.
We’re not concerned about negative interactions, ever. There’s not many drugs that have a problem interacting with psilocybin. The reason we look into this is to know whether those interactions are a blunting effect on psilocybin, which means you need to administer more. Generally, if you find someone with high levels of SSRIs, antidepressants or antipsychotics, you have to provide more—you don’t want to give too much or too little.
Do you have any liability if someone took your psilocybin and had a very adverse side effect?
Yes, of course. There is a shared responsibility for the dosing between the facilitator and service center. That’s why we take this so seriously. Dosing conversations happen more than once with clients.
There is a potential [that] if there was an adverse side effect, we would have liability. However, we’re not concerned about that because we believe psilocybin is an exceptionally safe molecule.
What makes your services different from other providers?
The most important difference is, many service centers put a 30 miligram cap on their psilocybin dose to clients. The state allows a maximum of 50 mg. We administer up to 50, because 40-50 percent of our clients require that much because of the medications they’re on.
The rooms are basically the same throughout the state. The music is up to the client, we don’t direct that.
What also differentiates us is our cost structure. We believe in having everyone access psilocybin, so I’ve personally hosted journeys where it’s $750-$1,000 all-inclusive, with the psilocybin. And not just me, we have several facilitators who are continuously offering good value for their services. I think we have the lowest cost in the state.
“Costs are too high in general, even our service center.”
How are you able to offer these lower costs?
It’s just a matter of committing to that. We could charge more and make more money, but we have a strategy to make this socially equitable, and accessible to people of color, people from challenging backgrounds. We have rooms available that are $300. Because we manufacture psilocybin we pass on the cost savings to the customer.
We have facilitators that deal with many clients, and we sometimes will charge $500-700 instead of the $1,300-1,500 some providers charge. Our average cost for all-inclusive services is around $1,100.
Does everyone have to pay in full?
We accept payment up-front the day of service. For clients who can’t afford it, we discount the rate. We have a modest GoFundMe page; when [other] clients wish to pay more, I just say, “Go to the GoFundMe and go put money in there so we can have someone be paid for out of that.”
It hasn’t been super-successful but that’s how we handle it. There have been some clients where we have done service for free.
How do you think Oregon’s model stands right now, and what is the most important problem to fix going forward?
The biggest challenge is lack of awareness about the services that could benefit people. There is a growing momentum to increase that; not enough people understand the benefits and the possibility it can dramatically change people’s lives.
The second challenge is cost. Costs are too high in general, even our service center. Until we get to an “all in” cost of an average $750-$1,000 statewide, it’s going to be a challenge. It’s not accessible to people. They have to take off work, book airfare if coming from the East Coast. A lot of people are paying $2,000 just to get out here, with hotels then another $2,000-4,000.
The excuse I’m hearing from other service centers is, “We have to charge these prices because of the $10,000 state licensing fee.” Come on—if you’re charging $3,000 a service, you pay that off in four or five clients in less than a month, even if you’re a small center. The cost of licensing is not as bad as people make it out to be.
Seventy percent of people look for value. It’s the most important thing people calling us talk about: How much does it cost, and how can you make it affordable for us?
Photograph by Mushroom Observer via Wikimedia Commons/Creative Commons 3.0
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