Oregon officials signed off on nearly every detail of training for the first class of "magic" mushroom facilitators seeking state certification.
As the four-day session began inside a hotel conference room in early December, an important tool was missing: the mushrooms themselves.
The regulatory framework for the production and sale of the hallucinogenic fungi was still being hammered out two years after Oregon voters narrowly approved the use of the drug.
The students, most of them seasoned mental health professionals, would have to role play with one another using meditation or intensive breathing practices that could lead to altered states of consciousness.
Everyone was happy.
Like many of the two dozen students who paid nearly $10,000 for the course,Jason Wright, 48, a hospital psychiatric nurse in Portland, said he was thrilled to be part of a bold experiment with national ramifications. He said it was amazing to be on the front lines of something that has the potential to change our relationship with drugs.
On New Year's Day, Oregon became the first state in the nation to allow adults to use the drug, which has shown promise for treating depression, post-traumatic stress disorder, and end-of-life anxiety.
Although scientists are still working to understand their therapeutic dynamics, scientists believe that the benefits of the drugs include a rewiring of the brain that gives patients fresh perspectives on longstanding mental health problems.
A recent study on alcohol-use disorder found that two doses of psilocybin coupled with talk therapy led to an 83 percent decline in heavy drinking among participants, and that nearly half of them had stopped drinking by the end of the trial.
The long-term benefits aren't clear.
The measure authorized the creation of service centers where people over the age of 21 can consume mushrooms. A key requirement is that a state-certified facilitator is present during the drug journey.
Unlike cannabis, which can be purchased at a dispensary, Oregon will not allow the retail sale of the drug.
Drug reform supporters hope that Oregon's approval of Measure 109 will inspire other states and cities and convince federal authorities to ease longstanding prohibitions.
In 2020 Oregon voters voted to decriminalize possession of small amounts of hard drugs like heroin, cocaine and meth.
Although the federal government still considers the drugs to be illegal, Oregon has decided to change its approach to mind- altering compounds.
Colorado voters approved a ballot measure that removes criminal penalties for possession of certain drugs, and similar ballot measures have been introduced in New York, Washington and a dozen other states. Washington D.C., Seattle and a number of other American cities have decriminalized the drug.
The highest levels of government have become more interested in the scientific aspects of the drug. The FDA granted breakthrough therapy status for major depressive disorder, paving the way for trials. The researchers think they will get full F.D.A. approval in the next couple of years. MDMA, also known as ecstasy, is likely to get F.D.A. approval sooner for treating post-traumatic stress disorder.
Sam Chapman is the executive director of the Healing Advocacy Fund, a nonprofit organization that supported Measure109 and has been working to guide its implementation. We need to create a golden standard that is worthy of wider implementation.
Oregon has had its share of problems. The passage of the ballot measure caused a backlash in rural areas. In November, 25 of the state's 36 counties voted to opt out of the program.
Entrepreneurs took advantage of the regulatory vacuum. In early December, police raided Shroom House, a store in Portland that the authorities said was selling illegal mushrooms.
Even though they acknowledge the gantlet of novel regulatory and logistical challenges, state officials are undaunted. Brazil, Nepal and the Bahamas are some of the countries that have legalized the use of the drug.
The process was slow and bumpy because officials sought to maximize public participation through advisory panels, public hearings and meetings with law enforcement officials.
As long as the drug is listed as a Schedule 1 substance by the federal government, it won't be covered by insurance.
A single session is going to cost a lot of money.
There was a debate about whether to embrace a therapeutic model that would require more intensive, and costly, oversight by a therapist, or a less rigorous approach that would allow anyone over 21 to access the drug, with or without a mental health diagnosis. The non- directed approach was chosen by health officials.
Being the first in the nation requires us to learn on the fly.
The first group of students gathered at the Dossier Hotel in downtown Portland for a 160-hour course run by Fluence, an education and training consultant that offers certification in the field of psychedelic-assisted therapy.
One of the instructors said it felt like he was dreaming. I didn't think this would happen in my life.
A trauma specialist who sheepishly described herself as a Christian fundamentalist shaped by a lifetime of antidrug sentiment was one of the new doctors.
The trauma therapist, Sherry Beckmann, 52, said her recent experience with deeply troubled war veterans convinced her to rethink her antipathy after some of her patients had breakthrough after a hallucinogenic experience. Ms. Beckmann sees the drugs as spiritual gifts from God. It is part of my own journey as well. I don't know why I'm here, but I trust agut feeling.
Anyone with a high school degree can take part in the certification programs. Only residents of Oregon can get licensure. The Fluence program mostly chose applicants with experience in the field of mental health
Indigenous traditions involving hallucinogens, the negative social effects of U.S. drug policy and the impacts of systemic racism were some of the topics covered in the curriculum.
The practical aspects of the course sought to prepare the participants for potentially difficult moments, such as sexual arousal or intense emotional eruptions, especially among those with repressed trauma.
According to Nathan Howard, the director of operations at InnerTrek, the company was especially interested in applicants with a quality known as equanimity, or the ability to maintain calm. He said that people are going to be undergoing one of the most intimate and intense experiences of their lives. You don't want to direct the experience, but you may need to hold their hand at certain times.
The first day of the Fluence course was mostly self-reflection, with many students frustrated with the limitations of the drugs used to treat mental illness, not the underlying causes. They talked about their own experiences with the drug.
At one point in the class, the instructor asked the students to close their eyes and think about what happened. They broke into small groups to talk about times in their lives when they felt marginalized. The lack of diversity within their ranks prompted a round of soul searching about their role in promoting a therapy that will likely only be available to the privileged few.
There was a lot of joy that the long-awaited moment had arrived. The hospital's psychiatric nurse, Mr. Wright, said he wanted his patients to experience the healing power of the drug and that he had personally experienced it.
He said the model of care focused on calming patients who show up at the emergency room in the throes of a psychotic or manic episode. The drugs were effective at stabilizing patients, but many of them returned because the underlying trauma or depression remained unaddressed He said he wanted to stop pushing drugs to his patients.
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