DAMASCUS, Ore. — Among tall Douglas fir and oak trees, surrounded by a winding creek that feeds into the Clackamas River, a new kind of therapist is being minted in Oregon.
The aptly named Inner Trek is one of many companies that takes local mental health professionals, health care workers, and alternative healers through a six-month course that will allow them to seek certification from the Oregon Health Authority to become some of the first guides to administer psilocybin to people in the United States. Last Friday at a retreat center in Damascus, east of Portland, about 30 people gathered to learn how to counsel people through a psychedelic experience.
While psychedelic drugs remain federally illegal, Oregon's Measure 109 was passed by voters in 2020 and will allow for the authorized administration of psilocybin at approved service centers in the state by licensed guides starting next year.
The industry's launch in Oregon gives a glimpse at what a potential rollout could look like in other states, including Washington. While a legalization bill during Washington's past legislative session failed to gain traction, the efforts are likely to resurface.
Most recently, voters in Colorado followed in Oregon's steps, and already local municipalities across the country, including Seattle, are decriminalizing the use of psychedelics, while dozens of ketamine and MDMA-assisted therapy courses are enlisting mental health professionals to jump headfirst into a psychedelic renaissance.
But with certification courses costing thousands of dollars, and thousands of people seeking care among a national mental health crisis with shortage of workers, how will this first wave of treatment play out?
There are over 200 varieties of psychedelic fungi across the globe. If ingested, psilocybin — the active ingredient in "magic mushrooms" — creates a mind-altering experience, often described as intense, euphoric or mystical. It sometimes includes visual hallucinations or in rare cases synesthesia, a neurological condition where senses are experienced differently and a person can taste colors, for example.
Compared with drugs like alcohol, psychedelic mushrooms are generally considered safe with low potential for abuse and no known lethal dose. Though they're not advised for people with severe mental illnesses like bipolar disorder or schizophrenia, for people with depression, PTSD or trauma, there's a growing body of research that's found significant therapeutic benefits.
Researchers at the John Hopkins Center for Psychedelic & Consciousness Research, for example, found that two doses of psilocybin provided relief for people with major depressive disorder for up to a year in some cases. The study, though small, was published in the Journal of Psychopharmacology in early 2022. Other researchers are investigating the value of psychedelics in helping people quit smoking, those with chronic illness or anorexia, and even health care workers experiencing burnout.
In Oregon, psilocybe cubensis, a common variety that grows in the Northwest, will be the species used in treatment. Clients do not have to be Oregon residents or have a mental health diagnosis but must be at least 21. At an initial session, they will first be screened by a licensed guide or facilitator for their medical history, learn about the process, and sign an informed consent form (the drug can cause headaches, nausea and increased blood pressure, among other side effects).
Then they will undergo a six-to-eight hour session with the drug, where a guide should keep them physically safe and help if their journey becomes uncomfortable or stressful. While many people have a good experience with psychedelics, it's not uncommon for the trip to become overwhelming or scary at times.
In trainings for guides, "we are going over ... how to do a really thorough screening, how to help a client refine their intention for the journey that they're going into," explains Jason Foster, a former civil engineer turned therapist and psychedelic educator with Inner Trek. "And giving [clients] the tools and knowledge about what to expect as they go into the journey."
Lastly, a third, optional session called integration will help clients make sense of their trip with the help of their facilitator.
Ultimately, the cost for a session is still up in the air — state officials will not regulate the cost, but sessions will likely cost upward of $1,000 (most international experiences cost $3,000 to $10,000 for anywhere from a few days to a couple weeks).
Foster thinks the first wave of "psychonaut" tourism in Oregon will range, "from the curious to the spiritually hungry to the people that are suffering" and he expects they won't just come from Oregon and Washington but nationally and internationally as well.
Under Oregon's current rules, people wanting to be licensed as guides must at a minimum have a high school diploma (though training companies state they often screen potential students with higher standards, looking for people who have a background in mental or behavioral health). They must also be an Oregon resident for at least two years or wait until 2025 before they can start providing services.
Facilitators must complete at least 120 hours of training and an additional 40 hours of practicum or hands-on experience by an approved training program. Their training ranges from the ethics and responsibility of being a guide, to topics of consent when touching clients, how to deal with people undergoing a difficult trip, and general facilitation skills before, during and after a psychedelic experience, as well as self-care for the guide.
During the class at Inner Trek (owned by Tom Eckert, architect of Measure 109), future facilitators discussed how varied the psychedelic experience can be for each person. Educators likened it to a flight: After ingesting psilocybin, the drug can take up to 75 minutes before takeoff — that's where people can expect some "turbulence" with feelings of breathlessness or anxiety. The peak of the drug hits at around three to four hours, with the descent coming in at hour five or six, often coming in waves of clarity.
Traumatic or repressed memories can come up and cause clients to cry, yell or have responses where they struggle to talk, the educators told students in the course. The facilitators need to be able to help their client without contributing their own personal feelings or agendas, or overstimulating the client.
Students in the course practiced how to stay mindful during a client's trip, by role-playing scenes that other facilitators had witnessed. Students were also led through guided meditations, using eye masks and soft music to practice grounding techniques.
The training programs currently cost about $8,000 to $10,000; facilitators must then pass a state exam before being licensed.
Major hurdles still remain before the industry is up and running, said Victor Cabral, a social worker and the director of policy and regulatory affairs with Fluence, another company that offers training for mental health professionals interested in administering psychedelics.
"Some of the administrative rules are still in public comment right now so they're not finalized," he said. "They do require us to be paying attention and to be ready to make potential changes, depending on what those finalized administrative rules look like."
For example, current rules say clients can only take 5 grams of dried mushrooms (about 50 mg of pure psilocybin) during their session. Some providers worry that's too small a dose for some people to get the necessary treatment, and during the last public comment period they shared that with state regulators.
The requirement for a 40-hour practicum also poses an issue: Students currently can't legally lead people through a psychedelic trip anywhere in the U.S. to get vital firsthand experience, meaning this first wave of therapists may be less prepared.
"One of the greatest potential problems is that there are just guides that aren't ready to actually pull people in and usher people through these experiences," explained Foster.
Many students are opting to gain those hours in Jamaica or Mexico, where retreats have popped up allowing new guides to train.
While the Oregon Health Authority will start accepting applications for facilitators, service centers, labs and manufacturers on Jan. 2, it's unlikely many will be ready soon. Starting this new supply chain will take time — educators think things will be up and running fully by summer or fall 2023.
Psychedelic aficionados also bring up concerns that plague the mental health field in general — how the workforce is largely white, despite psilocybin's use among Native and Indigenous people, and barriers to accessing care. This form of treatment is not reimbursable by insurance and the high cost means some people that would most benefit from the care, are the least likely to be able to afford it.
In Washington, state Sen. Jesse Salomon, D-Shoreline, who proposed a bill to bring psychedelic assisted therapy to the Evergreen State, is taking notes on Oregon's efforts.
Salomon said he plans to try again during the upcoming legislative session. After becoming the face of state legalization, he hears from people who would like the opportunity to heal or have a unique experience.
"One thing we did — that I think was genius — is let Oregon go first, and then we'll just learn, either adopt what they did or learn from their mistakes," he said.
