As California Seeks to Legalize Psychedelics for Therapy, Oregon Provides Key Lessons

California has an opportunity to massively expand places where people can use psychedelic drugs under supervision, according to a new bill proposing to legalize substances in approved service centers, including psilocybin, MDMA and mescaline for therapeutic use.

It’s a model similar to Oregon’s Psilocybin Services Act — the first law in the United States to establish a regulatory framework for receiving psilocybin, or psychedelic mushrooms — which went into effect in 2023.

Now, as California lawmakers look to legalize the therapeutic use of psychedelics, uneven outcomes of that legal experiment in Oregon are surfacing.

“It was billed by a lot of people as a solution to Oregon’s mental health problems, as a new option for mental health treatment,” said Mason Marks, a visiting professor of law at Harvard Law School who served on the advisory board for Oregon’s new psychedelics law. “Now, some years later, you have evidence to suggest the system is largely serving a psychedelic tourism of people flying in from out of state to pay very high prices.”

If passed in California, SB 1012 would create a professional licensing board to train facilitators, develop guidelines and regulate the therapeutic use of psychedelics. People could then use regulated psychedelic substances like magic mushrooms under the supervision of a facilitator.

The bill passed a critical and tense state committee hearing Monday afternoon. But only after lawmakers added an amendment that said facilitators must also hold at least one medical license, such as psychologists, psychiatrists, therapists, social workers and nurse practitioners.

In California, the program would be overseen by a new department called the Division of Regulated Psychedelic Substances Control that would adopt rules over the coming years for the approved substances.

“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,” San Francisco state Sen. Scott Wiener said upon announcing the bill. “When paired with therapeutic support, psychedelics show amazing promise for treating conditions that resist other forms of treatment.”

Last year, Wiener pursued a different bill that would have broadly decriminalized personal use and possession of psychedelic substances. But Gov. Gavin Newsom vetoed it and asked for a bill that focused on psychedelic therapy instead.

“Both peer-reviewed science and powerful personal anecdotes lead me to support new opportunities to address mental health through psychedelic medicines like those addressed in this bill,” Newsom said in his veto message last year. “I urge the legislature to send me legislation next year that includes therapeutic guidelines.”

Studies have shown that MDMA-assisted therapy can help mitigate symptoms of post-traumatic stress disorder and depression. Other studies have also linked psilocybin as a tool for treating depression and LSD as an option for generalized anxiety disorder. However, a small portion of people have negative experiences using psychedelics, including anxiety, aggression and suicidal thoughts, particularly with recreational use outside of controlled studies where dosage is tightly controlled.

The research literature points out the importance of a person’s mindset heading into a psychedelic experience, as well as their immediate environment, to preventing these negative outcomes, what Timothy Leary and his colleagues in the 1960s coined the “set and setting.”

Today, clinical trials are underway at the Food and Drug Administration to approve several treatment courses with psychedelics, and an MDMA treatment course could be approved as early as August.

A trip to the mushroom doctor

For ages, psychedelic substances have been used across cultures and societies for healing and medicinal purposes, as well as for recreational use. And unlike daily medications or weekly counseling, treatment with psychedelics usually takes a day or two, typically followed by counseling, according to Jennifer Mitchell, the chief of staff for research at the San Francisco Veterans Affairs and professor of psychiatry at UCSF.

That different approach to treatment attracted Tobias Shea, a veteran who participated in one of Oregon’s programs in 2023 who was struggling with post-traumatic stress symptoms after two tours in Afghanistan.

“I went through a big bout of depression in 2012 that I just couldn’t navigate,” he said. “I just suffered through it.”

Before he went through with the therapy session in Oregon last fall, he had phone calls with a facilitator who asked him about his background and mental health to see if he would be a good candidate for the program.

On the day of his appointment, he arrived at the service center, which he described as a relaxed environment, similar to a massage parlor or spa. In a small, enclosed room, someone was assigned to give him the appropriate dosage. A different facilitator then entered the room, and the two went over his intentions for the session, which lasted seven hours.

For his first session, Shea said he sought to reflect on some of his experiences in the military and the grief he had struggled with following his father’s death.

“I don’t want to sound cliche here when I say this, but it opened my mind again to the bigger picture of, like, not just being a soldier anymore and not being involved with the military,” he said. “It brought me back into what it means to be a human.”

Setbacks in Oregon, teachings for California

Shea’s success story comes alongside mixed perceptions about issues with Oregon’s program. It’s still in its infancy, so advocates say there’s still time for things to sort out. But already, the state had to bail out the program using tax dollars because it hadn’t made enough money from service fees and revenues.

Educating and training new facilitators — who work directly with individuals with mental challenges and who could need emergency help — has also been a hurdle. Organizations like the Synthesis Institute, which trained people to deliver psilocybin therapy, promised to revolutionize psychedelic-assisted therapy in Oregon. However, the school abruptly closed down in 2023 after going bankrupt.

“An issue there with Oregon that I think has come up is how well-trained the guides are and what they’re being used for,” said Mitchell of UCSF.

Marks, who served on the Oregon Psilocybin Advisory Board for a year, is also critical of how centers brand their services as “therapy” when, in fact, they are not yet FDA-approved. Instead of psychedelic-assisted therapy as it’s often branded, he said Oregon legalized “supported adult use of psilocybin” and points out that providers can’t diagnose medication conditions or make medical claims.

It’s also proven to be unaffordable for many people who can’t pay out of pocket, reserving the new treatment approach for people who can pay for and travel to it. Several service centers have reported that the majority of their clients are visitors from out of state.

“My estimation of the average cost of a psilocybin treatment course in Oregon is from about $1,500 to $3,500, and that’s for a single dose,” Marks said. “That obviously could get pretty expensive pretty quickly and is not affordable for a lot of people.”

Sen. Wiener’s bill incorporates some of the critiques from Oregon’s model. It also creates a new public-private fund that will promote education and safety around psychedelic substances, as well as guardrails against conflicts of interest among officials crafting psychedelic laws.

According to the legislation, board members cannot have any immediate family with ownership or economic interest in any institution that’s engaged in psychedelic-assisted therapy education.

As states roll out psilocybin decriminalization policies unevenly around the country, there’s increasingly room for inequitable opportunities and treatment outcomes, as well as drug enforcement challenges. But, believers say the inevitable kinks of the new policy will be worked out.

“Hindsight’s 2020, so we can use Oregon as the beta tester and say, ‘Oh, that didn’t work. Oh, that works really well,’” Mitchell said. “I want to laud them for trying it first.”