Psilocybin Therapy and Mental Health Care in Oregon: What Is Happening and Where Do We Need to Go From Here?

On May 28th, 2021, Portland Psychotherapy hosted a moderated panel discussion with leading advocates, psychedelic therapy researchers, and psychedelic therapist training providers on creating legal, equitable access to psilocybin therapy in Oregon after the passing of Measure-109. Presenters gave an update on the status of the Oregon Psilocybin initiative, particularly as it relates to the training of facilitators, and discussed ways that local therapists can get training in the practice of psilocybin-assisted therapy. Watch the recording below.

What Do Licensing Boards Think of Psychedelic Integration Therapy?

Psychedelics are growing more popular for treating mental health problems and public demand for integration services is growing in sync with this demand. Many therapists have begun offering psychedelic integration therapy for clients who are already using or experimenting with psychedelics, but also have questions about legal and ethical risks involved in doing this kind of work. Psychedelic integration work is a relatively new practice and guidelines are still developing. Practicing in any new areas entail risk, so it’s important to think about how to manage it. A common question is, “What will my licensing board think?”

These two activities are particularly risky when it comes to licensing boards: 

  1. Helping clients access psychedelics, for example by referring them to an underground guide 
  2. Doing therapy with clients while they are under the influence of psychedelic substances that they obtained themselves.  

Both of these are likely to lead to licensing board sanctions if your licensing board finds out. They could even put you at criminal risk as an accessory to a crime or due to drug house laws that forbid hosting a place for people to use illicit drugs. 

It would be ideal if we could just ask our licensing boards what they thought, but licensing boards typically do not make generalized statements about ambiguous situations, especially in cases where there may be a legal or ethical gray zone.  

So, we are left thinking this through on our own. First off, we might consider What is the role of a licensing board? Licensing boards have a primary duty to protect the public and take disciplinary action against providers in situations such as: 

Becoming familiar with common types of licensing board violations can provide a better sense of how to practice within ethical boundaries. In evaluating your own practice, take some time to imagine how a licensing board might perceive what you are doing. To help mitigate risk around psychedelic integration therapy, here are some things to think through. Taking each of these steps is likely to reduce your risk of licensing board sanctions should a complaint be filed against you. 

  • Ethical violations 
  • Sexual misconduct 
  • Illegal activities 
  • Provider impairment 
  • Billing or insurance fraud 
  • Practicing outside areas of expertise 
  • Malpractice 

Stay within the law: With some exception, most psychedelics remain illegal. Therefore, do not help clients obtain access to drugs, or even access to other people who can supply drugs such as underground guides. Do not allow clients to attend therapy sessions while under the influence of drugs. 

Obtain education and trainingThe more training and education in the area of psychedelics that you have, the more you can argue that you are practicing within an area of competency. Be able to demonstrate that this is an area of expertise. 

Consult with others: If you choose to incorporate client usage of psychedelics into your therapy practice, consult with other therapists who are doing the same thing. This is especially important when you are confronted with situations or dilemmas that you aren’t sure how to respond to. 

Be clear with clients: Aiming for clarity in communicating with clients is key in reducing the risk that a client may misunderstand what you are offering. Make sure that clients understand what it is you can offer, and what it is you can’t offer.  

In the end, there is no guarantee of protection against disciplinary action by a licensing board. However, taking steps to lessen risk can allow you to provide psychedelic integration therapy to clients who have an increasing need for this service.  

Written by Brian Pilecki Ph.D. & Jason Luoma, Ph.D. 

Measure 109 & 110: Psilocybin-Assisted Therapy Is Here! (But Not Until 2023)

Measure 109 in Oregon was recently approved by voters, making Oregon the very first state in the U.S.A. to legalize psilocybin-assisted therapy. While many are eager to begin providing or receiving this breakthrough service, psilocybin-assisted therapy will not be officially available until sometime in 2023. This is because the Oregon Health Authority (OHA) will be in charge of creating a program that establishes training requirements for facilitators and suppliers which will begin in January of 2021. It will take two full years to implement before psilocybin-assisted therapy is available. When it is available, it will be restricted to people 21 years of age and older.

Although many want to access these services immediately, there are steps that must be taken to ensure that health and safety factors are not overlooked. For example, the OHA will determine what eligibility requirements need to be met for individuals to obtain a license to provide this service. This includes establishing guidelines for what qualifications, education, training, exams, and professional codes of conduct will be necessary. Therefore, for now, this service is still unavailable and illegal until these rules and regulations have been established.

Measure 110 was also recently passed in Oregon, making personal non-commercial possession of controlled substances, such as psilocybin, MDMA, cocaine, and heroin, no more than a Class E violation, with a max fine of $100. This measure also includes the establishment of a drug addiction treatment and recovery program, wherein individuals who are charged a fine up to $100 for a Class E violation have the option to complete a health assessment instead of paying the fine. This new approach establishes that personal use of controlled substances will be decriminalized, shifting the approach from criminalization to one of health and safety. Like Measure 110, the implementation period has yet to be completed. The amendments voted in through Measure 109 do not become law until February 1st of 2021.

Although we are all eager for these measures to be officially implemented, we must be patient for a little longer. At the moment, Portland Psychotherapy therapists are not able to provide psilocybin-assisted therapy because it is still illegal. For people who are wanting to use psychedelics for personal growth or healing, we are able to meet with you before or after your use of psychedelics in order to help you understand the risks and benefits, maximize safety, and integrate experiences into your life.

If you would like to learn more about our harm reduction and integration services, please click here. And If you’d like to learn more about Measure 109 and Measure 110, please check out voteyeson109.org and voteyeson110.org.

By Sarah Smith

First Randomized Trial of Psilocybin Assisted Therapy for Depression!

In recent years, psychedelics have reemerged as a popular topic in cultural, political, and scientific discourse. From Michael Pollen’s best-selling book How To Change Your Mind to legalizing psilocybin-assisted therapy through Measure 109 in Oregon, people are curious about how and why these substances may be powerful tools in psychological healing. Additional data, especially on common problems like depression, is particularly important as psilocybin therapy starts to become more widely used.  Until now, psilocybin therapy for depression has never been studied in randomized clinical trials. But now, the first data have been published, with excellent results.

In this trial, Alan K. Davis and other investigators at the Center for Psychedelic and Consciousness Research at Johns Hopkins conducted the first randomized, clinical trial exploring psilocybin-assisted therapy for treating Major Depressive Disorder (MDD). Traditional treatment methods typically include psychotherapy or pharmacotherapy, or a combination of the two. Current pharmacotherapies, such as SSRI’s, often have limited efficacy and can result in negative side effects such as suicidal ideation, decrease in sexual drive, and weight gain. Additionally, people must be on antidepressants for several weeks before experiencing any benefit, with many only partially responding. Lastly, many people do not respond to treatment, whether that’s pharmacological or psychological. Clearly more treatments are needed.

The team at Johns Hopkins treated 24 people with depression with two administrations of psilocybin combined with therapeutic support. This intervention produced strong antidepressant effects that persisted for 12 months, with 71% of their participants showing a clinically significant response 4 weeks after treatment. Unlike traditional antidepressants, psilocybin was not associated with serious adverse effects and does not have to be taken daily. The only frequent nonserious adverse effects found by Davis et al. were mild-to-moderate headaches and challenging emotions during the session itself. In sum, while this study is small, it provides excellent data to support the idea that psilocybin-assisted therapy is effective for the treatment of depression, while we await results from larger studies that are ongoing.

Although we have come far in psychological healing, there is still more work to do in order to provide services that are effective and accessible to all who need it. Antidepressants do not work for everyone, making promising treatments like psilocybin-assisted therapy worthy of further exploration. If you would like to learn more about psilocybin-assisted therapy for depression, Portland Psychotherapy is hosting a seminar series, Therapy and Research in Psychedelic Science (TRIPS), that includes a presentation from Alan K. Davis, the lead investigator in this trial. He will be discussing what this therapy looks like from the point of view of the patient along with a description of the therapeutic process involved in preparing for and integrating psilocybin experiences as a part of therapy. Click here to register for this event and check out the other events in our seminar series!

TRIPS Seminar Series

By Sarah Smith

Understanding Risks in Practicing Psychedelic Harm Reduction and Integration Therapy: Advice for Clinicians

You may have noticed that the buzz around psychedelic assisted therapy has grown by leaps and bounds within the last several years. Many therapists are eager to become involved in this newer form of mental health treatment, though psychedelics remain largely illegal. Using a harm reduction approach, some therapists have begun to incorporate client’s personal use of psychedelics into therapy by offering a safe space to prepare for or integrate psychedelic experiences. However, many therapists may be cautious to practice in this area due lack of clarity about potential risks for themselves. Here are some tips that might be helpful when considering practice in psychedelic harm reduction and integration (HRIT).

Know the law. First, most psychedelics are illegal. Therefore, clients who discuss plans to use psychedelics will likely be discussing plans to engage in an illegal activity. While therapists are unable to encourage illegal behavior, a harm reduction approach can be used to help clients identify potential risks and benefits and make their own informed choices. Even if you are in one of the increasing number of cities where psychedelics have been decriminalized, they remain federally illegal. The legal risks for working with psychedelics will vary by your local jurisdiction. If you want to do integration work around psychedelics, it’s a good idea to consult with a local attorney who knows criminal defense so you can understand how risky it is in your area to do this work.

Consider your licensing board. It is helpful to consider how practicing HRIT may be perceived by your licensing board. Will they consider this outside your scope of professional expertise? What happens if a client has an adverse event involving psychedelics after one of your harm reduction sessions? Licensing boards are unlikely to give direct approval or permission to practice HRIT.  Nonetheless, it still is helpful to anticipate how your own board may view such therapy.

Consider your norms. When deciding whether to practice HRIT, it is helpful to consider the norms of the area you live in. Geographic locations that are more politically conservative or mental health settings that are more traditional may confer greater risk.

Decide for yourself. Practicing HRIT involves some degree of legal and regulatory risk. We suggest that therapists reflect on the level of risk they are willing to take on given their own circumstances. For example, therapists who are not trained in harm reduction or who do not feel comfortable engaging in helping clients plan how to stay safe when using psychedelics could consider limiting services to psychedelic integration, or therapy that is focused on helping clients after they have already used psychedelics.

Get prepared. If practicing HRIT is of interest to you, there are several things that you can do to prepare. First, identify gaps in education or knowledge and seek out training opportunities to address such gaps. Second, consult with therapists who are practicing HRIT to learn more about how to incorporate this newer clinical area into your practice. Third, stay up to date. This is a rapidly evolving clinical area that is likely to develop more fully over the next several years. One option for learning more is our TRIPS Seminar Series, which can help you get up to speed.

As more people are using psychedelics for personal growth and therapeutic purposes, there is a greater need for therapists to provide support and information. Taking the time to learn about potential risks as a therapist can be helpful in deciding whether this is right for you.

Written by Brian Pilecki, PhD

Dr. Brian Pilecki is a licensed clinical psychologist who earned his Ph.D. from Fordham University and completed his postdoctoral training at the Warren Alpert Medical School of Brown University. He specializes in the treatment of anxiety disorders, trauma and PTSD, and matters related to the use of psychedelics. Additionally, Dr. Pilecki has experience in mindfulness and meditation and practices primarily from an orientation based on Acceptance and Commitment Therapy (ACT). He is also engaged in scientific research on psychedelics.

UPCOMING TRAINING EVENTS


Using Acceptance and Commitment Therapy to Guide Exposure Therapy: The Basics

Brian Thompson, PhD, Brian Pilecki, PhD, and Joanne Chan, PsyD
September 17th, 2021 from 12-3pm

This is a beginner workshop intended to provide the foundations of exposure therapy including types of exposure interventions and design effective exposure exercises for various anxiety disorders and OCRDs. Participants will learn how to use ACT processes to guide the implementation of exposure techniques and how ACT processes may be enhanced by traditional exposure methods. This workshop will provide some background in theory and will emphasize applying exposure to clinical contexts using case studies, exposure demonstrations, and the practice of new skills by participants. Read More.


Overcoming Barriers to Effective ACT-Informed Exposure Therapy

Brian Thompson, PhD and Brian Pilecki, PhD
October 15th, 2021 from 12-3pm

This workshop will offer a brief introduction to Acceptance and Commitment Therapy-informed exposure and focus on practical ways to address common problems in implementation. Case examples will be provided to illustrate common client barriers such as lack of buy-in and difficulty grasping core ACT concepts. Strategies for overcoming these barriers will be offered and participants will have the opportunity to practice newly acquired skills through role-plays and break-out rooms.Read More.


Therapy and Research in Psychedelic Science (TRIPS) Seminar Series

Second Friday of each month from 12:00 PM – 1:00 PM (PT)

TRIPS is an online seminar series that hosts speakers discussing science-informed presentations and discussions about psychedelics to educate healthcare professionals. This series was created to guide healthcare providers and students preparing to be professionals towards the most relevant, pragmatic, and essential information about psychedelic-assisted therapy, changing legal statuses, and harm reduction approaches in order to better serve clients and communities. This seminar series is a fundraiser for our clinical trial of MDMA-assisted psychotherapy for social anxiety disorder that Portland Psychotherapy investigators are preparing for and starting in the Fall of 2021. All proceeds after presenter remuneration will go to fund this clinical trial. Read more.

September 10th, 2021 – Cultural Considerations in Outreach to and Assessment of Minoritized/Marginalized Individuals in Psychedelic-Assisted Psychotherapy with Terence Ching, Ph.D.

October 8th, 2021Presentation Title TBA – Dr. Elizabeth Nielson

November 12th, 2021Presentation Title TBA – Anthony Bossis, Ph.D.

December 10th, 2021Presentation Title TBA – Jamilah R. George

January 14th, 2022Presentation Title TBA – Jordan Sloshower, MD, MSc