In November 2020, Oregon voters approved a ballot initiative, Measure 109, to legalize psilocybin for therapeutic use. We’re now well into a two-year implementation phase. On February 8, the Oregon Health Authority (OHA) gave us the first look at a set of proposed rules for psilocybin therapy—including, as Filter previously reported, the kind of mushroom products that may be permitted. But the proposal also contains detailed requirements for how psilocybin healers—or “facilitators”—would be trained to work with patients.
Some rules were already set. You don’t need a doctor’s or psychologist’s license to be a facilitator, just a high school education. And clients don’t need any medical diagnosis to get the drug—they can seek therapy for any reason.
The OHA’s release describes the training process facilitators would need to pass. It includes 125 hours of instruction on several topics, a 40-hour “practicum” where they will practice techniques, and a mandatory final exam.
The instruction component includes a wide range of subjects like psilocybin history, science and safety. Notably, facilitators will also be required to study areas like longstanding Indigenous psilocybin use, prohibition and the War on Drugs, and racial injustice and inequity.
“This work isn’t something you can just learn in a book, do a couple of practice sessions then be good to go.”
Rebecca Martinez is the executive director of Alma Institute, which is working to create a training and certification program for facilitators under Measure 109 on a nonprofit basis. She told Filter that she is pleased, overall, with the draft rules. But she recommended increasing the instruction to 160 hours, and at least doubling the practicum to 80 hours. Her institute plans to focus especially on training people of color and people from disadvantaged backgrounds.
“The nature of this work isn’t something you can just learn in a book, do a couple of practice sessions then be good to go,” she said. “You need ongoing mentorship, you need really more of an apprenticeship model to practice in a lot of different scenarios and get those core skills down.”
Martinez also encouraged the health authorities to make the requirements more specific, and emphasize topics like safety and ethics.
This all makes sense to me. I well remember holding my best friend in my arms on the occasion of his first psilocybin mushroom trip some years ago, endlessly repeating, “I got you, bro. I got you, bro. I won’t let anyone hurt you.” He stared back at me, his eyes wide with fear. I was tripping too—and it took me several minutes to realize that I was probably making things worse.
Facilitators ought to be better equipped than I was to address negative side effects during a trip. And first of all, they should make sure that patients understand any possible risk factors—like pre-existing conditions or potential interactions with other medications, as well as the variability of trip experiences—before they take the drug.
The draft rules mention using “nondirective” facilitation, which means “[Avoid] giving the client direct advice or directly interpreting a client’s statements or behaviors.” That’s because on psychedelics, you’re in a highly vulnerable state. A good facilitator should exercise patience and gentleness.
Martinez praised the OHA for requiring instruction on social equity topics, specifically around racial and cultural traumas. But Oregon has yet to accompany that with further steps, she noted—like, for example, investing in the training and hiring of facilitators from diverse racial, gender, cultural or income backgrounds.
“We need to have folks represented.”
This is an important point, when clinical research of psilocybin as a treatment for depression or other conditions has been conducted primarily by and with white people. Plus, Oregon’s pursuit of this quasi-medical model—as opposed to outright legalization—significantly raises the costs of the treatment, which will exclude marginalized populations.
“We need to have folks represented and you need to be able to choose a facilitator you feel comfortable with, and oftentimes that means choosing someone who has some shared identifier,” Martinez said.
She explained that while the OHA has seemed open to and interested in addressing equity issues, it can only do so much.
“OHA doesn’t have a lot of authority in what they can require of training programs or license holders around social equity plans,” she said. “Right now a lot of that is falling to community organizations like Alma, which leaves us working the philanthropic angle to get resources to diversify the field.”
All of this training—plus product testing and other requirements—will be expensive for businesses to comply with, and those costs will be passed on to clients. If Oregon is serious about making sure everyone can easily and fairly access psilocybin treatment, it will have to pay to help lower-income clients receive it.
Photograph via Department of Justice/Drug Enforcement Administration