Will California follow Oregon’s ‘strategic’ approach to psychedelics?

Jim Carroccio was desperate. After decades of cognitive therapy, his struggles with PTSD and Obsessive-Compulsive Disorder were as acute and debilitating as ever. So it was time to take a trip.

Literally and figuratively.

The literal trip came when Carroccio and his wife drove from their Arizona home to Bend, Oregon so Jim could undergo psilocybin therapy. It is hard to gauge such things, but it is believed that he is the first person to legally undergo this treatment since Oregon voters approved Measure 109 in November of 2020, making it the first state to legalize the use of psychedelics in the treatment of certain mental health disorders in those 21 and older.

He says the figurative trip he experienced at a facility called Bendable Therapy “was life changing, and it still is to this day.”

Carroccio traces his struggles to a pair of tragic events from his youth: first a traumatic brain injury (TBI) he sustained from a fall down some stairs when he was about 12, followed two years later by finding his father dead from a heart attack. As disturbing as his father’s death was for him, he says the brain injury was actually worse.

“The cerebral spinal fluid that your brain floats in came from the inside of my skull and embedded itself on the exterior of my scalp,” he says. “I couldn’t even attend school because they knew it was dangerous. There was nothing protecting my brain. Nobody knew that it would develop into a lifetime of struggles.”

Jim Carroccio. Photo courtesy of Jim Carroccio.

He says he’s not sure why, but the brain injury was something he felt he had to hide, and for years he couldn’t even talk about it with others. Now, at age 71 he says the new Oregon law has given him the ability to deal with that fear.

“It’s only now through the psilocybin journey and integration am I able to even talk about that,” he says. “It has allowed me the ability to not look at myself as a victim but as a survivor and how I’ve gone through life and what kind of adjustments can I make now.”

A growing acceptance
There is a growing acceptance in mental health circles that some psychedelics – particularly psilocybin, MDMA, Dimethyltryptamine (DMT) and mescaline – have great promise for treating certain mental health disorders, including post-Traumatic Stress Disorder (PTSD), anxiety, and depression.

Those disorders have for years been treated primarily with talk therapy and anti-depressant medications. But Dr. Walter Dunn, co-director of the UCLA Psychiatry Residency Neuromodulation Program, says it can be very difficult for a PTSD patient to access the memories that produced their trauma. What drugs like MDMA do, he says, is ramp down the activation of the brain’s amygdala, the center of our natural “fight or flight” reflex.

“In what we call trauma therapy, if you’re under the influence of MDMA, for example, your amygdala will not fire as hot as it otherwise would,” he says. “The patient is able to recall, talk about, discuss and think about their traumas without that level of anxiety, fear, or overall distress that they otherwise would experience in a normal type of situation.”

Not only that, he says, MDMA also “promotes the pro social part of your brain, and patients actually feel more connected to the other people in the room.”

Dunn also emphasizes that MDMA is not a traditional psychedelic in the way that psilocybin is.

“With MDMA, you feel very connected to other people around you. It’s a stimulant, so you feel good, your mood is generally improved, and you tend to trust people more. You tend to be less fearful,” he says. “Psilocybin, on the other hand, is what we call a traditional psychedelic. I wouldn’t say patients are necessarily hallucinating, but they’re having what we call altered consciousness type of experiences. They do feel connected, but not to people. They feel more connected to the world around them. They feel more connected to nature.”

And our brains function differently then as well.

“I wouldn’t say patients are necessarily hallucinating, but they’re having what we call altered consciousness type of experiences. They do feel connected, but not to people. They feel more connected to the world around them. They feel more connected to nature.”

“Certain parts your brain naturally ‘talk’ to each other in everyday life,” he says. “When they’ve done imaging studies for people under the influence of psilocybin, you have a lot of parts of your brain talking to each other that normally do not talk to each other. And that’s one of the explanations as to why you have that very kind of different kind of subjective experience.”

Carroccio says that describes his own experiences quite well.

“It gave me a different perspective. It really did. It was five hours of under the influence of a psychedelic journey that was very medicinal in its purpose. It wasn’t cavalier,” he says. “The receptors in your brain are communicating with one another, unlike anything else that anybody can offer you, especially pharmaceutical.”

Dunn says the real key to the efficacy of psilocybin therapy is often in the aftercare, when a patient and therapist discuss what happened during the psychedelics experience.

“One of the hypotheses as to why this is so effective is that the patients are able to see things from a different perspective,” Dunn says. “For example, if your narrative is that your mother is a bad person who treated me poorly, under psilocybin you might come to believe she was only doing the best she could and didn’t mean to do you any harm. The drug allows you to see things in a different light.”

Perhaps with that in mind, Colorado voters followed Oregon’s lead in November of 2022 by endorsing Proposition 122, a measure that legalizes psilocybin therapy and also allows residents to grow and possess a small amount of their own psilocybin mushrooms. Now a number of states – including California – are looking to do the same. The federal Food and Drug administration is also inching closer to endorsing psilocybin, the psychoactive component that puts the “magic” into magic mushrooms, for therapeutic use.

California seems most likely to next join the club – and the first to do so via legislation rather than a ballot measure – given that Golden State lawmakers approved a legalization bill last year.

Gov. Gavin Newsom vetoed that bill, but did so with a message stating his support for the use of psychedelic medications in treating mental health disorders and urging bill author Sen. Scott Wiener (D-San Francisco) to “send me legislation next year that includes therapeutic guidelines.”

The federal Food and Drug administration is also inching closer to endorsing psilocybin, the psychoactive component that puts the “magic” into magic mushrooms, for therapeutic use.

Wiener and principal co-authors Assemblymember Marie Waldron (R-San Diego) and Josh Lowenthal (D-Long Beach) have now done just that. Under SB 1012, California would create a licensing and regulatory framework for the use of therapeutic psychedelic treatments, including a new state board under the umbrella of the Department of Consumer Affairs to oversee the entire system.

“We know psychedelic therapy saves lives, and safe and controlled access to these innovative treatments will be transformative for so many Californians seeking relief from mental health and addiction challenges,” Wiener said in a press release announcing the bill.

Newsom has called that possibility “an exciting frontier” in which California “will be on the front end leading it.”

It is a classic Newsom declaration, though factually not quite the case given that Wiener’s bill would set up a system that looks lot like the same one Oregon has already had up and working since last summer. Colorado is also likely to have a similar structure in place long before California can get into the game.

Sen. Scott Wiener, image by Sheila Fitzgerald

And what of Oregon’s system?

Establishing the framework
With all the attention on how the newly approved law would be implemented, Angela Allbee, psilocybin services section manager at the Oregon Health Authority, says her agency took a very “strategic” approach to setting up the state’s psylocibin regulatory framework.

That framework has four distinct elements, each requiring its own license:

1. Cultivators who grow and transport the products to the labs for purity testing
2. The labs doing the testing
3. Therapy centers which connect clients with licensed facilitators that guide them through the therapy
4. Facilitators who are required to be with the clients in a non-directive role during that person’s entire therapy session (meaning they cannot guide the patient or try to implement any other kind of traditional therapy during the session)

It took almost the full two years Measure 109 allowed to put it all together. Allbee says a big part of that time was spent creating a cloud-based portal where people could sign up for training, apply for licenses and pay their fees, and by which the state could track all of the above. The resulting system – the Training, Licensing and Compliance portal, or TLC – is now essentially one stop shopping for everyone involved, from growers to patients to clinicians to regulators.

The TLC portal ultimately proved immensely valuable in another way as well.

“By statute, we knew we needed to either develop a product tracking system or contract with a vendor used by the Oregon Liquor and Cannabis Commission,” she told Capitol Weekly. “We ended up developing it ourselves in our TLC system, which was really important because the other system would have been based off cannabis.”

That, Albee says, would have been problematic for a number of reasons.

Mushrooms and cannabis have vastly different growth environments and growth cycles. And unlike cannabis, Oregon’s psilocybin program does not include dispensaries. Patients cannot legally buy psilocybin products to take home with them – all such products must be consumed on the facility premises under the close watch of a licensed facilitator.

“With those very different challenges, it was a very important part of our process for psilocybin to have created it inside of our TLC system,” Allbee says.

The in-house only use requirement also has its specifics. While facilitators might already be a clinician in another practice area, they are not required to be or to even have any experience at all in providing mental health therapy. Anyone undergoing the minimum of 120 hours training from an authorized training center and passing the licensing requirements can become a facilitator.

Even if that person is licensed in another form of therapy, psilocybin facilitators are prohibited from directing a patient’s experience in any way. There are also strict rules about physical contact with a patient. Facilitators can only touch a client’s hands, feet or shoulder, the only exception being in the case of a need to secure a patient’s immediate physical safety.

Facilitators also cannot physically handle the psylocibin, be it be in mushrooms or tea.

There are many more details associated with each license, ranging from age requirements, training mandates and, at least until January of 2025, Oregon residency. There are also restrictions on therapy centers in regard to their proximity to schools, and every therapy center must also have an accepted social equity plan. Perhaps most important for non-Oregonians to understand, treatment is not available statewide.

That is because Measure 109 also gave cities and counties the right to hold their own vote later to determine if they wanted to opt out of the new law. In November 2022, 27 of Oregon’s 36 counties put that question to their voters. The result: 25 counties and 114 cities voted to ban psychedelic therapies.

Most of those opting out are in the state’s rural areas. In contrast, 17 of Oregon’s most populous cities and counties are sticking with the program, ensuring around 3 million Oregonians across 11 counties will have access to the services.

And as Jim Carroccio’s story illustrates, a significant number of people from other states will continue to travel to Oregon to seek therapy. Confidentiality laws preclude the public from knowing just how many psychedelic patients are from outside the state, but anecdotal estimates are extremely high. And more lawmakers from around the country are showing interest as well.

“We’ve had numerous states reach out to us for information, just trying to clarify or get clear on what this model is and how it’s going with implementation,” Allbee says.

For those interested in psychedelics therapy in Oregon, the possibility of needing to travel is just one of the challenges to expect.

“Psilocybin services are obviously not covered by health insurance, and it can be quite costly, about $3,000 per session.”

By statute, patients don’t need a prescription or referral or even to have an officially diagnosed condition in order to obtain treatment. But there is a fairly intensive screening process every potential client must go through. Carroccio says he had several online meetings with the staff at Bendable Therapy, the non-profit facility he was working with in Bend, before he was cleared to start treatment there. The law allows a facilitator to reject anyone who is suffering from an active psychosis like schizophrenia, or who might be a danger to themselves or others.

The treatment is also not cheap, and because it uses a drug still listed as a Schedule 1 narcotic under federal law, insurance won’t be an option.

“Psilocybin services are obviously not covered by health insurance, and it can be quite costly, about $3,000 per session,” says Bendable Therapy co-founder Amanda Gow, who concedes that price tag “is unaffordable to many Oregonians.”

Gow says her facility doesn’t bill their patients in the traditional way, but instead asks them to make a donation of at least $2,300 and, wherever possible, to donate on a monthly basis. Bendable then offers scholarships to those otherwise unable to come up with that kind of money.

None of which has deterred Carroccio at all. He has already returned for a second session, and says he plans to go back for a third and fourth time in the future. He has also become a monthly donor.

California’s path forward
Much of what Oregon is doing is replicated in SB 1012. But Wiener’s proposal adds a wrinkle of its own: a strong emphasis on – and funding for – public education surrounding the use of psychedelics in a therapeutic environment.

“The California bill goes beyond what they did in Oregon, in part because it establishes a fund specifically just to support public education,” says Dr. Brian Anderson, an assistant professor of psychiatry at the University of California San Francisco (UCSF) who has done significant research into the use of psychedelics in treating some mental health disorders.

“In Oregon, it’s not licensed as a therapy and a treatment. It’s called psilocybin services,” he says. “And I actually think that’s good and fair because it’s not necessarily treating anything. But here in California you can reach out and hopefully get lots of good education as part of the informed consent before you ever set foot in the room to access state authorized psychedelic care.”

“I have never seen as many non-mental health clinicians interested in psychedelics. I’ve got emergency room docs, I’ve got primary care docs, I’ve got ENTs, surgeons, who want to get involved in this.”

While a facilitator could always screen someone away from getting the therapy, he says, in theory SB 1012 will ensure someone has already been fully educated on all the pros and cons of the process before they even seek it out.

Assemblymember Waldron believes the education component of SB 1012 will help psychedelic therapy become more mainstream, which could ultimately prove to be very important in addressing the cost factor.

“Once it’s being used – and the more people that get into using it – I could see it becoming more mainstream, and at that point it would be part of the mental health or behavioral health treatment options that should be covered by Medicaid,” she says.

The next Gold Rush?
The mainstreaming possibilities, however, concern clinicians like UCLA’s Dunn, who notes the recent proliferation of ketamine clinics across the United States, and particularly in Los Angeles.

Ketamine is a drug most commonly used by medical doctors and veterinarians as an anesthetic. But it also has mildly hallucinogenic effects, making it a popular party drug for decades. In more recent times it has been offered by some doctors for use as an anti-depressant. Possibly adding MDMA, psilocybin and other psychedelics to the mix has Dunn concerned.

“If this becomes legalized in California, the floodgates are going to open up like you would not believe,” he says. “Part of it is the profit motive. There’s money to be made, number one. And number two, there is unprecedented media coverage around psychedelics. We call it the Michael Pollan effect because of his book [and ensuing Netflix series] that came out in 2018 where he talked about his experience with psychedelics.”

Ah yes, Michael Pollan’s book. It is hard – nay, impossible – to talk to anyone associated with psychedelics without How to Change Your Mind coming up. Dunn credits that tome – and the plethora of other media coverage on psychedelics – in creating an “unprecedented” level of awareness of psychedelics treatment. That’s certainly not all bad, but he is deeply concerned about the profit motive.

“I have never seen as many non-mental health clinicians interested in psychedelics. I’ve got emergency room docs, I’ve got primary care docs, I’ve got ENTs, surgeons, who want to get involved in this,” he says. “This is not going to be a niche thing. And the ketamine clinics that are everywhere in Los Angeles, they are already gearing themselves up to do this type of treatment, for better or for worse.”

UCSF’s Anderson is not quite as alarmed at that possibility, noting it would likely depend on how many licenses the state issues once the rules are finalized, which Waldron says would likely by 18-24 months. In that regard, it will be important for everyone to remember that California will be crafting a new form of state-licensed care, and that it will be different from conventional Western medicine.

“It will be an interesting challenge, and hopefully the public understands that this is not just your same old type of talk therapy,” he says.

As of this writing, SB 1012 is in the Senate Committee on Business, Professions and Economic Development. No hearing date has yet been scheduled.