In November 2020, Oregon voters passed Measure 109, which allows psilocybin, a psychedelic compound derived from certain types of mushrooms, to be administered to adults in special licensed service centers. Psilocybin-assisted therapy, as it’s called, must take place under the supervision of “facilitators” who have undergone at least 120 hours of instruction in approved programs. The state’s first cohort of trained psilocybin-assisted therapy facilitators are completing their programs this spring, and the first service centers are expected to be licensed later this year.
Psilocybin-assisted therapy offers great promise as a tool for helping people cope with a range of mental health conditions: substance abuse; PTSD; a terminal diagnosis. Psilocybin can also simply help people feel better and more engaged in their lives, advocates say. They point to a growing body of research that supports the safety and efficacy of the therapy, and to the Oregon Health Authority’s strict protocols for facilitators, training centers, and the substance itself.
There are challenges and concerns. Psilocybin is still a federally classified Schedule 1 substance, and many Oregonians are nervous about the consequences of Measure 109. Last November, 27 counties and over 100 municipalities voted to opt out of allowing psilocybin-assisted therapy. Even where they are allowed, the fees and requirements for service centers—annual fees, liability insurance, security cameras, storage—are steep, and many are concerned that the cost of sessions, not to mention lingering stigma, will prevent those who might benefit the most from the therapy from accessing it.
Although many aspiring facilitators are already practicing in a health-related field—there are many therapists and psychologists; nurses and doctors—any Oregonian over 21 who has completed high school may apply. JPR talked with four Oregonians who are currently enrolled or just completed their programs to learn more about what is motivating people from all walks of life to assist others seeking psilocybin therapy.Chelsea Phegley - Talent, OR
Chelsea Phegley, 39, is a critical care rapid response nurse at Asante Rogue Regional Medical Center in Medford. She lives in Talent, Oregon. She experimented with psychedelics as a teenager and learned about the country’s early research on psychedelic therapy, primarily with LSD, while studying anthropology. The shut-down of that research felt like a missed opportunity, she recalls, but she really didn’t think about it again until COVID hit.
Phegley: "The straight trauma of working through that experience and the witnessing of the suffering of my co-workers and the patients and the docs and myself and just everybody was this slow drain of complete self-annihilation. I was like, gosh, I don't know what to do. I don’t know where to go from here. And my boyfriend got me a book, one of Michael Pollan's books, for Christmas. I was on a travel assignment and I read that book, and bam, I was like, we're doing this, this is happening again, and I am going to be a part of this."
Phegley started Googling schools and learned about the InnerTrek program, which was founded by Tom Eckert, who helped write the original Proposition 109. She applied and was accepted to the program within a few weeks, and even received a grant from the Asante Foundation to attend. Phegley graduated on March 10—one of the very first cohort of facilitators in the state.
"When I got into nursing, I thought that I was getting into a healing profession. And I think that anybody who spent a significant amount of time in critical care, intensive care sort of realizes that that's not that world—it’s not a healing space. And so being able to go to school for this program, and to really learn about healing and what it takes to heal, and then be able to look forward to using those tools in a way to be able to do what I always thought I was going to do before. Now it’s the barriers to actually being able to practice."
Legal facilitated psilocybin experiences won’t be possible in Oregon until licensed service centers are up and running, so for her practicum, Phegley traveled to Mexico and worked with a Mazatec woman and her assistant. She and a colleague from her program also facilitated experiences for each other. During one of these, Phegley, who has suffered from insomnia all of her life, experienced what she describes as a “deeply sedated” state.
"Basically, it would put me in this state of such extreme security, and showed me how to get there. And so, after that—and this is where integration so important; I could have walked away from that experience and been like, Wow, what a beautiful gift. I got this couple hours of the deepest, most satiating rest I've ever experienced in my life—but with integration, I was like, Okay, I'm gonna keep calling that feeling up. I'm gonna keep doing that. And so in continuing that work, I've basically been able to eliminate my insomnia. And I've slept every single night since that experience, which to me is a miracle. It's incredible."
Phegley believes that psilocybin-assisted therapy is a much-needed tool that can help address the mental health crisis that is overwhelming support systems not just in Oregon, but all over the country.
"We have this gaping hole in human care that boils down to this mental health crisis that we're in that's overwhelming our hospital, that's overwhelming our law enforcement, that bleeds into addiction. There's 100% correlation between childhood trauma and addiction. People are hurting so bad. And for a lot of people, what psilocybin gives them is a recognition and a sense of connectedness, a sense of support, a sense of recognizing a community."
Phegley would like to work with other health care workers and first responders and those in law enforcement—one-on-one at first, and then, in small pods of up to six people. People in these professions experience a particular type of stress and isolation, she says, which has been compounded by Covid. Phegley believes psilocybin therapy can help people help each other.
"Psilocybin is just a piece of that. The rest of it is building a community that they can then use to support each other and create something that's longer lasting, too. The integration piece is arguably the most important part; what you do after the experience is so vital to what you take away from it in the long term."
Dr. Jarrod Franklin - Portland, OR
Dr. Jarrod Franklin, 34, moved to Portland from Chicago to pursue graduate studies nine years ago. He is a naturopathic physician, holistic nutritionist, and Ayurvedic practitioner. He's currently enrolled in Synaptic Institute's Entheogenic Medicine Training Program, where he also teaches. Franklin says he was drawn to psilocybin-assisted therapy because of its potential to bridge the gap between mental and physical health.
Franklin: "What really drove me to be a facilitator comes down to a few key sort of points: Wanting to help the underserved, primarily people of color that have been impacted by generational trauma; also wanting to shed light on the mental health disparities that we experience in this country, and especially what has been sort of ruminating over the past couple of years with the COVID pandemic, and really championing that mental health goes along side by side as part of a holistic medicine approach, which is primarily my expertise and my career focus."
The Oregon Health Authority clearly lays out the sections that are required in a facilitator training program. Synaptic’s curriculum covers everything from neuroscience and the science of psilocybin to practical considerations such as selecting music for a session and how to handle challenging experiences. Franklin is teaching the social equity component.
"It addresses everything from historical trauma, to systemic oppression, to what is it to [make] responsible referrals and building networks and the importance of that, as well as understanding where we're coming from in the history in the United States, such as the history of the war on drugs. So, it's really addressing the social components of being able to deliver this medicine in an effective manner and examining the history of the pitfalls as well the benefits over time of utilizing psilocybin in a therapeutic fashion."
As outlined in OHA’s new guidelines, facilitators can’t diagnose or treat physical or mental health conditions while providing psilocybin services to clients. This means Franklin cannot incorporate psilocybin-assisted therapy into his medical practice, but he can offer it as a separate service.
"I plan to do that by concentrating on the communities and groups that I think I would like to work with, primarily people of color, at-risk women, and veterans, and again, anyone that is seeking a better way to go about approaching their mental health. Again, there is a mental health crisis in this country, including access to affordable mental health care, as well as finding mental health care that is culturally aware and informed."
One of Franklin’s chief concerns is broadening the scope and access of psilocybin-assisted therapy. Part of that will require changing perceptions about what this medicine is about, and who it is for.
"Right now, I think people hear psilocybin, and don't necessarily hear the therapy part. And their mind goes to other programs in the state that utilize other substances. But I believe as time goes on, people will be more informed; people will get the information correct and really understand what this program does and does not provide for people."
Mandy Miller - Portland, OR
Mandy Miller, 54, initially moved to Oregon from California to be closer to family. Last November, she enrolled in the facilitator program offered by Fluence. Although the Oregon Health Authority only requires participants to be 21 and hold a high school degree to enroll in a facilitator program, Fluence requires students to have an advanced degree or to be a credentialed or licensed in a health-related field. Miller has a private practice as a marriage and family therapist and is licensed in both California and Oregon. She plans to stay in Portland once she has completed the program.
Miller: "Part of the reason that I wanted to stay and settle in Portland is that the connections that I've made with the people in my program, some of the mentors and trainers, I think that this is a really exciting place to be to have this pioneer type of therapy, but also that it's widely accepted here. So there's several counties in Oregon that did not adopt the Measure 109. So it's not like I could be anywhere in the state and look to practice. Portland is where I feel supported socially."
Miller takes a somatic, or body-centered approach to therapy and has been interested in non-ordinary states of consciousness for many years. She has seen how psilocybin can help a person reconnect to themselves and others.
"Somatically, if we're feeling really disconnected from ourselves and our bodies, and we're really uncomfortable with ourselves, then we're going to do everything we can to not be in our bodies, if that makes sense. I think that leads to a lot of dis-ease.
I know of a person who was struggling with dependence on alcohol, and tobacco, and didn't want to use those substances any longer, and started to take small doses of psilocybin. And he was able to stop drinking, and increase his connection to himself and other people in the community where he was getting the support, and also stopped smoking tobacco. And basically, when his relationship to those things that he was dependent on changed, a whole new world opened up for him, and he was able to have more sustaining and lasting relationships with people."
Facilitators aren’t guides, says Miller. Though she and her clients will have conversations before the session to prepare and afterwards to help make meaning of the experience, she will take a hands-off approach during the actual psilocybin sessions.
"What my role is, in my way of thinking, is to be a person who reminds the person who's in this non-ordinary state of consciousness that they're safe, that there's someone there with them, you know, after four to five milligrams of mushrooms. But in that dose, people normally aren't able to talk; there's not a lot of interaction. So it's not like I'm inviting them or directing them to go anywhere, or think about anything in particular, in fact, it's quite the opposite. I'm witnessing; I'm sitting with; I'm meditating, you know, in more of a meditative space, of just really observing and holding the space really."
Psilocybin-assisted therapy is different from traditional psychotherapy, and Miller cannot provide psychotherapy while in a psilocybin session with a client. She feels her personal and professional experience has prepared her well for her new role as facilitator.
"I've written all over my house on little notes, like, “do less,” and “get out of the way.” And there's a non-directive approach in this kind of therapy. At this stage in my life I have had a lot of experience, and so supporting people, suggesting ways of feeling better and getting better is kind of in my toolbox. But in this particular kind of therapy, it's really about being right here right now, and exploring and discovering and staying curious about what arises for the participant or the client. And just me getting out of the way so that they can emerge and they can see themselves more than me being a mirror or giving them reflection."
Steve Elfrink - Grants Pass, OR
Steve Elfrink, 60, founded OmTerra and co-founded the Psychedelic Somatic Institute; he is enrolled in Synaptic’s Entheogenic Medicine Training Program. Elfrink has a long relationship with psychedelics, starting with recreational use as a teenager. He has struggled with anxiety, depression, and thoughts of suicide, and claims a profound experience with LSD in his late 20s saved his life.
Elfrink: "I had the full-on experience of unity consciousness: I saw myself in the mirror, and I saw myself as the most beautiful person in the world. But then I saw the faces of humanity unfold in front of me. Every face that ever existed just folded out in this infinite Rolodex of images, of faces. But all of us were part of this; we are all one—it was that classic, “we're all one.” I also had the experience of laying on the floor and love streaming in and streaming out reciprocal love with the universe. For a lot of folks that sounds kind of wacky or crazy, but that's one of the most beautiful things about this work in these medicines; it takes us to a place that resides in all of us."
After that experience, Elfrink started meeting other “alternative” practitioners. He began exploring psychedelics more intentionally for himself and facilitating experiences for others who were suffering. In 2015, he took part in a psilocybin study hosted by the FDA. Today, he works as a psychedelic somatic therapist, primarily with clients suffering with complex PTSD, early childhood trauma, and pre-verbal trauma. He describes his work as focusing on helping the body process and release trauma.
"For me, what's so important is to take someone into symptom resolution, versus symptom management, where we're constantly just trying to cover up these feelings. There's a joke about a client of a psychiatrist or therapist saying, “I think you need to up my meds; I'm having feelings.” We're trying to just suppress everything. And with these medicines, it allows people to go deeper into these feeling states; they can go deeper into an understanding of their life, or what has gotten them to where they are."
Elfrink is planning to open a service center in Grants Pass. His protocol will include three preparation sessions before the actual psilocybin experience and three integration sessions afterwards. In addition to facilitating the kinds of experiences that are possible with higher dosages of psilocybin, he is interested in exploring how lower doses might aid his body-centered trauma work.
"What's really important is preparation. And part of that is really just building relationship with the facilitator. So creating a rapport, creating trust. Anyone I work with, I'm sharing some about myself. And just to give them the sense, or build the confidence in me, as far as I've been to these places; I've been in some of these difficult places, and whatever shows up, I can get you through."
All eyes are on Oregon as the first groups of facilitators earn their certifications and the first service centers open later this year. Elfrink wants the roll-out be as successful as possible; this includes setting realistic expectations for people who choose to take part in psilocybin-assisted therapy.
"Is it a magic pill? No, I it's not a magic pill. And also, there's variability in humans. The kind of wild card here is the level of complex trauma. That's where I always go to because that's me. And so, what happened in that early childhood? Is everyone going to have one dose and, have unity consciousness? No, probably not. It doesn't work that way. Sometimes it takes a little bit of work. Sometimes there’s the level of complexity within someone or maybe that first dose wasn't high enough for them. So there's going to be variables. I do have my own concern around that. Because for me, it's all about expectations. And right now, there's a very high expectation fed by the media, and this perpetuation of a single dose and Bob's depression was gone forever. And that's not always the case."
Elfrink has some advice for anyone who is considering pursuing psilocybin-assisted therapy for themselves.
"I think I said this earlier about setting expectations that this can be profound work, this can be life changing work. Again, I wouldn't be here without this work. And there's also, it's not a one-shot deal sometimes. Sometimes it's going to take personal work. And sometimes there's deeper work you have to do. It's not going to be necessarily one and done."
Before clients can access psilocybin therapy, the state must issue licenses to the manufacturers that cultivate psilocybin and the laboratories that test it, as well as to facilitators and service centers.
Correction: a previous version of this story misidentified Asante Rogue Regional Medical Center as Rogue Regional Hospital.
This story was co-reported and produced by JPR News Director Erik Neumann.
