Oregon’s push to legalize psychedelic-assisted therapy began, as bold ideas often do, in the woods.
It was 2015, and Portland-based therapists Tom and Sheri Eckert had taken a trip to Mount Rainier, about 50 miles southeast of Seattle, to ponder the idea of creating a program for adults to legally access the power of magic mushrooms. The couple had just read Michael Pollan’s seminal New Yorker article, “The Trip Treatment,” which highlighted “stories of transformation,” as Sheri puts it, of patients who used psychedelics to treat various mental health conditions. Specifically, Pollan highlighted the power of psilocybin, a psychoactive compound found in hallucinogenic mushrooms. After reading it, “we got really inspired,” Sheri tells me over email, “but also apprehensive”; the idea of a statewide ballot initiative brought with it “a heavy sense of responsibility.”
“We decided to get out in nature and think more about it,” Tom tells me, also over email. “That night, over a campfire, we really talked it through.” They decided to devote the next five years of their lives to crafting and campaigning for a ballot measure that would bring psilocybin to “anyone who can safely benefit,” Sheri says, “while retaining the kind of practice standards that make the research so successful.”
They saw this as filling a particularly critical demand in their home state, where about one in four adults experience mental illness, one of the worst rates in the country. “We saw the need,” Tom says. “Beyond a terrible human toll, Oregon loses billions of dollars in missed work, disability, and mental health care costs. The pharma-driven status quo isn’t working; we need new therapeutic options.”
This week, the result of their work will appear before Oregon voters as Measure 109, or the Oregon Psilocybin Services Act. If it passes, Oregon will become the first state to formally legalize access to magic mushroom products.
Although it is radical, Measure 109 isn’t totally unprecedented. Decriminalizing psychedelics, or legalizing them in certain settings, has become more of a mainstream idea since the release of Pollan’s article and his subsequent best-selling 2018 book, How to Change Your Mind, amid a recent surge in research on the possible benefits of psychedelic-assisted therapy. And, the movement follows a decades-long push to legalize marijuana, which activists say helped open the door for psychedelics. “I think cannabis really cleared the way in large part,” says David Bronner, the Cosmic Engagement Officer (aka CEO) of Dr. Bronner’s Magic Soaps, which has been a major supporter of Measure 109, as well as cannabis policy reform.
As a result, psilocybin has been at the center of a movement at the city and local level over the past few years. In 2019, Denver became the first city to decriminalize psilocybin, followed by Oakland, Santa Cruz, and Ann Arbor. And this week, voters in DC will weigh a ballot measure to decriminalize magic mushrooms and other psychedelic plants, while Oregon voters will also consider Measure 110, which would decriminalize psilocybin, as well as many other drugs like cocaine, heroin, methamphetamine, and ramp up drug addiction treatment options.
But what sets Measure 109 apart from those decriminalization efforts is that it offers a legal pathway, specifically to psilocybin therapy. That is, rather than blocking penalties for possessing psychedelic products, it would establish a state-regulated program for using and obtaining them. In essence, accessing psilocybin as an adult in Oregon would be about as easy as signing up for counseling.
“This is something that is long overdue,” says Rep. Earl Blumenauer (D-Ore.), who represents much of Portland, in reference to Measures 109 and 110. “The two of them together, getting rid of a law enforcement approach to controlled substances—it’s still not legal to traffic, we still want to protect our kids, all of that—but it is decidedly a more thoughtful, more effective, and more humane approach.”
But unlike Measure 110, which has at least some formal opposition, there are, somewhat surprisingly, no campaigns registered against Measure 109. Even without organized pushback, organizers say the vote is expected to be close, and their biggest challenge is almost certainly reaching voters during a global pandemic. If all goes as hoped, supporters see Measure 109 serving as a legal psilocybin model for the rest of the country. The model just has to be proven first.
After all, as Blumenauer points out, it was Oregon that was the first state to decriminalize cannabis nearly 50 years ago: “I just see this as a logical evolution of what we’ve tried to do here in Oregon, to be a little more thoughtful, have a broader and more inclusive conversation, that we’re committed to research and learning together. And I think this ballot measure does precisely that.”
When I asked Tom Eckert how he would describe the experience of taking psilocybin, he said, “Verbal descriptions are pretty futile. It’s a profound experience that disrupts your usual way of thinking, feeling, and perceiving, including those loops and patterns that get you feeling stuck. There is also a ground-shifting sense of connection, the intensity of which, according to the research, correlates highly with positive therapeutic outcomes.”
Psychedelic-assisted therapy is a budding but promising area of research. Psilocybin in particular was designated as a “breakthrough therapy” by the Food and Drug Administration for its potential to treat treatment-resistant depression in 2018 and major depressive disorder the year after. This designation is typically granted to drug companies to help expedite the development of a drug when early research indicates “that the drug may demonstrate substantial improvement over available therapies,” according to the FDA.
Among the most influential studies on psilocybin is from 2016. Led by researchers from NYU School of Medicine, it focused on 29 cancer patients with cancer-related anxiety and depression who were given a single dose of either psilocybin or a placebo. Both groups also received counseling. After seven weeks, the groups switched treatments. The results were stunning: After just one dose of psilocybin, researchers saw an immediate reduction in depression and anxiety, as well as “decreases in cancer-related demoralization and hopelessness, improved spiritual wellbeing, and increased quality of life.” When the researchers checked back in with the patients after about six months, most were still experiencing the positive effects. At the time, lead author Dr. Stephen Ross called the results, which were published alongside a similar study from Johns Hopkins University, “the strongest evidence to date of a clinical benefit from psilocybin therapy.”
“People who had been palpably scared of death—they lost their fear,” Ross told Pollan, who included details of the study in his New Yorker piece. “The fact that a drug given once can have such an effect for so long is an unprecedented finding. We have never had anything like it in the psychiatric field.”
Supporters of Measure 109 hope to bring those same possible benefits to Oregonians. Under the proposal, Oregon would have two years to develop a program to allow adults over 21 to receive the psychedelic drug at licensed “psilocybin service centers,” under the supervision of a “psilocybin service facilitator.” The state would also be tasked with determining how to license and regulate the program, including the manufacture of psilocybin.
“I’ve had experience with people very close to me contending with their end of life,” says Blumenauer, who first heard about psilocybin-assisted therapy a few years ago from Pollan, who he says is a friend of his. “And I truly believe having the tools available to help people manage it, keep their perspective, is important. And this looks to me like an additional potential tool that could have significant benefits.”
One of the biggest remaining questions, though, is just who Measure 109 would benefit, especially as the proposal stipulates the drug be used in a controlled setting. According to Sam Chapman, Yes on 109’s campaign manager, the measure was crafted specifically to exist in a “therapeutic context,” something of a middle ground that, from his perspective, maximizes the number of patients in need who can access psilocybin—in a safe way. Some of the people who may benefit from this drug, he argues, may not be able to get it in a system where it is only decriminalized. “I don’t ever envision a terminally ill cancer patient going out to some cow pasture and picking mushrooms and feeling like that is an adequate way to access psilocybin,” he says. “There needs to be regulations and controls and certifications and training and protection for people that would otherwise not ever consider psilocybin therapy.”
Still, this doesn’t explicitly address issues of access and racial equity. While psychedelics have a long history in Native American culture, many of the most vocal and visible supporters of psychedelic-based therapy have been white, leading to worries that Indigenous people have been left out of the legalization conversation. “One phrase that comes to mind is, ‘nothing about us without us,'” says Ifetayo Harvey, a marketing coordinator at Drug Policy Alliance and founder of the People of Color Psychedelic Collective, a New York-based group “working towards a collective healing and justice through knowledge and expertise of psychedelics.”
“Specifically around ballot measures,” she adds, “I do not think that they should be doing legislation around Indigenous medicine without Indigenous people leading that charge. Because to me, that is just the replication of colonialism in a lot of ways.”
To create a psilocybin program with equitable access for all people of color, Harvey says Oregon could consider who is facilitating these psychedelic experiences and “really vet” them. “A lot of harm can come from traumatic psychedelic experiences, so I think that’s one thing—having a diverse set of [facilitators],” Harvey says. “As a Black person who’s been going to therapy for 10 years, I’ve always had a POC therapist. And so I think that’s something that needs to be addressed in this situation.” It also has to be affordable, she says, perhaps even employing a sliding pay scale, and include education efforts specifically tailored to communities of color.
Chapman says the campaign has already been doing work on this front, though a lot more will have to come if Measure 109 passes. According to Chapman, the campaign assembled a Healthcare Equity Committee comprised of BIPOC leaders in Oregon and nationally that is tasked with determining “what equitable access to psilocybin therapy needs to look like.” The committee, he says, will remain intact after the election and will begin reaching out to regulators on “day zero.”
“I think we’ve learned a lot of lessons from other movements and industries,” says Chapman, who has a background in helping craft equitable cannabis policy. The campaign needs “to ensure that those who have been disproportionately affected by the racist, classist, sexist war on drugs have a real opportunity to participate in this program.”
The limited opposition Measure 109 does face is mainly from medical organizations, which worry the measure is getting ahead of the science. Psilocybin, opponents point out, remains a Schedule I drug and is not FDA-approved to treat any illness. As the Oregon Medical Association, which opposes Measure 109, told me in a statement, the FDA’s “breakthrough therapy” status simply means “the drug is in the early stages of development and that scientific studies do not yet indicate that it is a safe and effective medical treatment.” The American Psychiatric Association and the Oregon Psychiatric Physicians Association (a district branch of the APA) also oppose the measure. The state’s largest newspaper, the Oregonian, issued an op-ed earlier this month urging voters to “follow [OPPA’s] advice and vote ‘no'” on Measure 109. “As eager as Oregonians may be for a promising therapy for mental health ailments,” the editorial board wrote, “they should let the FDA process play out first.”
There’s also concern that Measure 109 operates in a medical gray space: It’s not a hands-off decriminalization approach, and it’s not like many medical marijuana laws in the US, which legalized cannabis for strictly medical purposes. As Dr. Jonathan Betlinski, one of the past presidents of the OPPA who now serves on its executive committee, points out, if Measure 109 passes, adults wouldn’t need a prescription to take psilocybin or need to be diagnosed with a mental health condition first. “So what are we treating?” he asks. “If we’re going to call this a medical treatment, then just like a vaccine, or a treatment for cancer, or high blood pressure, or diabetes, or any of these other medical conditions, we must stick with the tradition of using rigorous and validated [research] to help be able to form a treatment.” (OPPA has no official stance on Measure 110, Oregon’s drug decriminalization bill.)
The Yes on 109 campaign has tried to push back on this criticism by fighting doctors with, well, doctors. After the OPPA issued its statement opposing the measure, the campaign released a television ad featuring state Senator and medical doctor Elizabeth Steiner Hayward, who underscores that psilocybin is a “promising approach” for treating depression and anxiety and that Measure 109 “promotes safety for a therapy that can help people who are suffering.”
Still, the campaign’s most effective enemy hasn’t been doctors’ associations; it’s been the coronavirus. At the beginning of 2020, when the pandemic hit, the psilocybin campaign was still collecting signatures for its petition to get on the ballot. “We definitely felt challenged,” Sheri Eckert says. “Though we had gathered about 100,000 signatures already, we still had about 50,000 to go.” The campaign went from door-knocking to virtual. They held webinars. They mailed petitions to people’s homes. And they relied on grassroots organizing to encourage people to download, print, and mail their own signature sheets. And eventually, they prevailed: Tens of thousands of Oregonians sent their petitions supporting the ballot measure in by mail. In early July, Measure 109 officially qualified for the ballot.
Whether Measure 109 will succeed, Chapman says, comes down to reaching enough voters. Chapman notes the “vast majority” of people that the campaign hasn’t contacted likely haven’t heard of psilocybin therapy—and unsure voters are probably “no” voters. While there isn’t any recent public polling on Measure 109, Chapman says internal polling by the campaign shows that when voters are informed about what Measure 109 is—and isn’t—a majority will support it.
During a pandemic, one way to reach voters, it turns out, is through soap. As I wrote in June, Dr. Bronner’s advertised Oregon’s psilocybin campaign with social media and marketing efforts—including a limited-edition soap label in support of the initiative. Its primary contribution, though, has been financial support. To date, Dr. Bronner’s has donated “north of $2 million,” according to Bronner, totaling about half of the campaign’s total donations. “Where other funders were a bit more challenged by the current circumstance, we were in a position to step up that much more.” (Dr. Bronner’s also donated to Oregon’s Measure 110, DC’s decriminalization measure, and various cannabis campaigns across the country; if these measures pass, “and we get a new president,” Bronner says, “I will be celebrating like you won’t believe.”)
Beyond Dr. Bronner’s soap labels, the Yes on 109 campaign has put out television and digital ads, billboards, op-eds in local newspapers; sought editorial board endorsements (which they received from the Willamette Week and the Portland Mercury); and harnessed the power of “relational organizing,” a strategy of cultivating voters from supporters’ own contacts—friends, family, coworkers, and so on. “People are much more likely to take a phone call from someone they know than from someone they don’t,” Chapman explains. (My colleague Pema Levy has written a fascinating piece on relational organizing and how it could help Democrats defeat Trump in 2o20.)
Sheri Eckert says she is “nervous and hopeful” ahead of the election: “It’s going to be close.” But she’s also in awe of how far they’ve come. If it passes, Measure 109 will certainly add momentum to the broader psilocybin movement. But even just getting on the ballot is a feat in and of itself for drug policy reformers. As Bronner says, “I think we’re definitely at the cultural inflection point in integrating psychedelic medicine. And we’re seeing it happen here in Oregon.”