A Primer on Psychedelic Drugs, Around America and in Oregon

When it comes to drug deregulation, Oregon has a habit of going first.

In 1973, the state was the first in America to decriminalize cannabis, setting off waves of marijuana deregulation across the country. Now, with the recent approval of Ballot Measure 109, Oregon will see therapy with psilocybin — one of the most popular psychedelic drugs — legalized in the state by 2023.

Psychedelic drugs, along with psilocybin, were prohibited with marijuana in 1970 by the Controlled Substances Act, and much of the promising research conducted with psychedelics — which were being tested to treat mental illnesses — came to a halt. During that time, psychedelic drugs also came to be stigmatized; their close association with counterculture prevented them from being reconsidered by the medical community.

But in the past 15 years, a new era of research with psychedelic drugs has begun. At the center of this renaissance is Oregon, which will spend the next two years deliberating the best way to implement legal, supervised, therapy with psilocybin.

This series will document that deliberation period, discuss novel perspectives on psychedelics, and investigate business models and policies that will shape Oregon’s psychedelic landscape.

What are psychedelics?

Psychedelics are a class of drugs with psychoactive properties. Psychedelic drugs affect a user’s mood and perception, causing users to imagine various psychological, visual, and auditory stimuli. While experiences vary, users often report changes in depth perception, hallucinations, a stronger appreciation for their surroundings, and feelings of euphoria.

Psychedelic drugs can be naturally occurring, semi-synthetic, or synthetic.

Psilocybin mushrooms (or “magic mushrooms”) are the best-known naturally occurring psychedelics. Psilocybin mushrooms contain two psychoactive compounds: psilocybin and psilocin. (Psilocybin can also be manufactured synthetically, which is often how it is consumed for clinical research.) Psilocybin mushrooms are consumed orally, and they can be grown easily in one’s own home. Other naturally occurring psychedelics include DMT and Mescaline.

LSD is the best-known semi-synthetic psychedelic. It is manufactured through a series of complicated chemical procedures which are applied to naturally occurring ergot fungus that grows on rye grain. LSD is most commonly consumed orally as a tablet, and it is one of the longest-acting psychedelic drugs.

MDMA (or “ecstasy” and “molly”) is the best-known synthetic psychedelic. Ecstasy is most commonly consumed orally in tablet form, and it contains MDMA diluted with other substances. Molly is a purer precipitate of MDMA, most commonly consumed orally as a powder or tablet; it can also be snorted. There is still debate around whether MDMA is truly a “psychedelic” drug; its differing therapeutic effects and mode of action suggest it may better fit in its own category of drugs called empathogens.

What is the legal status of psychedelics?

Almost every drug classified as a “psychedelic” is a Schedule 1 drug under the United States Controlled Substances Act. According to the Drug Enforcement Administration (DEA), this means there is a “high potential for abuse” and the drug “has no currently accepted medical use.” Advocates and researchers have disputed these claims. However, these laws mean possession, use, sale, and/or distribution of psychedelic drugs are illegal and may result in fines or prison time, depending on the amount of drug being handled.

There is not much data around enforcement of these laws. In 2019, USA Today reported that according to Denver District Attorney Beth McCann’s office, “only 11 of more than 9,000 drug cases referred for possible prosecution between 2016 and 2018 involved psilocybin,” and “prosecutors filed charges…in three of those cases.” The Drug Policy Alliance, an advocacy group pushing for revised drug laws in the United States, says on its website that every year, thousands of people are arrested, charged, and serve jail and prison sentences just for having psychedelic drugs in their possession.

Some people have found ways to work around federal regulations. David Wunderlich, chair of the hemp and cannabidiol (CBD) practice at Denver-based law firm McAllister Garfield, P.C., says his firm has advised therapists who provide guidance to patients before and after their psychedelic experiences, while never actually helping them in the act of acquisition or consumption of the drug. Wunderlich also noted that people can legally sell spores that grow into psilocybin mushrooms.

Another workaround has been the establishment of psychedelic churches under the Religious Freedom Restoration Act. In 2006, the Supreme Court ruled that the church of União do Vegetal (UDV) was permitted to import a Brazilian tea with hallucinogenic properties because one of its religious traditions involves consuming the psychoactive beverage. Similarly, the government has historically permitted American Indians to use peyote, a plant with psychedelic properties.

In recent years, certain cities and states have begun taking their own measures to peel back regulations on psychedelic drugs. In May 2019, Denver, decriminalized psilocybin mushrooms. In 2020, Oakland and Santa Cruz, Calif., and Ann Arbor, Mich., followed suit.

In November 2020, Washington D.C. voters approved a ballot measure stipulating “enforcement of laws against natural plant medicines to be among the lowest law enforcement priorities,” a measure that includes psilocybin mushrooms. And in the same election, Oregon approved two landmark ballot measures that legalized psilocybin therapy and decriminalized all drugs, including psychedelics, opioids, and cocaine.

What are the health effects of psychedelics?

While psychedelics are often consumed recreationally, some of these drugs are also being tested in clinical trials to treat a variety of mental illnesses, including depression, anxiety for end of life, post-traumatic stress disorder, and addictions.

Thus far, many psychedelic drugs — specifically psilocybin and MDMA — have shown remarkable efficacy when users are accompanied by “guides” who complement psychedelic experiences with some form of psychotherapy. A 2020 paper reviewing nine clinical trials with psychedelics found that many of these drugs far exceeded the threshold needed to have “large” treatment effect; in other words, the drugs had significant impact.

Dr. Brian Pilecki, a Portland-based psychologist who is involved in early psychedelics research in Oregon, said “there are new therapies that come out [for mental illnesses] all the time, but they’re only marginally better than traditional therapies.” In contrast, he said psychedelics have shown marked improvement in early studies, as compared to traditional psychopharmacology.

Not all patients are appropriate candidates for psychedelics. A 2018 paper in the Journal of Palliative Medicine found that patients with “cognitive and emotional conditions associated with disorganized or diminished ego strength” may not be suitable candidates for psychedelic therapy. Patients with schizophrenia and personality disorders were also advised not to consume psychedelics, owing to the risk of triggering psychotic episodes.

How did the 2020 election change psychedelics in Oregon?

Last November, Oregon approved Ballot Measure 109, the Psilocybin Services Act, legalizing supervised psilocybin therapy in the state for people over 21. More than 55% of Oregon voters were in favor of the measure.

In the same election, Oregon also approved Ballot Measure 110, the Drug Addiction and Treatment Recovery Act, declaring that possession of any drugs or substances — including psychedelics — would no longer be a criminal violation in the state. More than 58% of Oregon votes were cast in favor of the measure.

Notably, the Psilocybin Services Act does not legalize recreational use of psychedelic drugs. It also allows for supervised services only with psilocybin, and no other psychedelic drugs.

Kaitlyn Dent, an attorney with Portland-based Emerge Law Group who helped draft the Psilocybin Services Act, said the focus was intentionally kept narrow. While a broader measure might have offered more people the opportunity to use the drug, it may not have been as likely to pass. “The goal was to maximize the number of people in need who can access psilocybin in a safe, controlled way.”

Still, legalization is still at least two years away. The Oregon Health Authority (OHA) must appoint a Psilocybin Advisory Board. Then, the OHA will work with the Advisory Board for two years to determine the rules under which the therapy will operate. The OHA will not begin the process of reviewing applications for licenses and issuing them until January 2023.

Pilecki explained that the measure was a way for the state to sidestep the Food and Drug Administration’s approval process for psilocybin therapy. However, other psychedelic drugs, such as MDMA, which is further along in the FDA’s federal review process, may become legal in Oregon sooner than psilocybin.

Wunderlich noted that these new measures don’t necessarily protect potential psilocybin service license holders from being prosecuted under federal law. “There could be a scenario where you could be raided by the DEA even though you have a state license.” However, this disconnect has existed for many years in the cannabis industry, and Wunderlich said he is not aware of federal criminal prosecutions that have occurred in this context.

Wunderlich said he wouldn’t be surprised to see other states take similar measures to legalize — or at least decriminalize — naturally-occurring psychedelic drugs. “You have people that believe these plants were put here by higher powers for the purpose of allowing people to treat their own traumas.”