Pubdate: Sun, 21 Mar 2021
Source: New York Times (NY)
Copyright: 2021 The New York Times Company
Author: Ezra Klein


Gov. Kate Brown of Oregon announced the members of the state's newly
formed Psilocybin Advisory Board this week. Why does Oregon need an
official board to offer advice about the active ingredient in magic
mushrooms, you ask? Because Oregon is about to become the first state
in the country to try to build a support infrastructure through which
psychedelic mushrooms can be woven into everyday life. This framework
is different from what we've seen before: not legalization, not
medicalization, but therapeutic use, in licensed facilities, under the
guidance of professionals trained to guide psychedelic experiences.

"Like many, I was initially skeptical when I first heard of Measure
109," Brown said in a statement. "But if we can help people suffering
from PTSD, depression, trauma and addiction - including veterans,
cancer patients, and others - supervised psilocybin therapy is a
treatment worthy of further consideration."

[Listen to "The Ezra Klein Show," a podcast about ideas that

Measure 109, the Oregon Psilocybin Services Act, approved as a ballot
measure in November, is the brainchild of Tom and Sheri Eckert, who
shared a therapy practice in Portland. In 2015, the Eckerts read an
article by Michael Pollan in The New Yorker titled "The Trip
Treatment." The article described the emerging research around using
psychedelics as a therapeutic tool and unearthed the largely forgotten
pre-Timothy Leary period in which psychedelics were widely used by
psychiatrists. In the past, the government had funded more than a
hundred studies, and as Pollan recounts in "How to Change Your Mind,"
his subsequent book, Anais Nin, Jack Nicholson and Cary Grant all
underwent LSD-assisted therapy. Bill Wilson, a co-founder of
Alcoholics Anonymous, who'd given up drinking with the aid of a
hallucinogenic plant called belladonna, considered bringing
LSD-assisted therapy into AA in the 1950s, but was met with
disapproval from his board.

This was a very different model of psychedelic use: There was a
trained mental health professional in the room and subsequent therapy
to help turn the insights into action. The early results were
promising, though the studies were poorly designed. At times, the fear
was that the compounds were too powerful and left people too malleable
to the suggestions of their guide. One early practitioner worried that
on psychedelics, "the fondest theories of the therapist are confirmed
by his patient," and that even though the healing was real, the
pathway was "nihilistic," bordering on something like hypnosis. This
era of study ended before these questions could be resolved, when
psychedelics slipped into the counterculture, where they were used
without therapeutic safeguards, and the Nixon administration targeted
them as part of its culture war. A remnant of healers who used
psychedelics in their work remained, but they were driven

The Eckerts had personal experience with psilocybin, and Pollan's
piece, and the research it led them to, made sense to them as
therapists. This was work they could do, should do, but the law made
it impossible. "It was a desire to specialize in this field, and we
realized we couldn't," Tom Eckert told me. "And then the question was:
Would we accept that answer or were we going to do something about

Sheri Eckert passed away unexpectedly, after a surgery in December,
but Tom recounted a hike they had taken together before embarking on
what they knew would be a consuming, multiyear political project. "We
decided to consult the mushroom," he said. They drove to Mount
Rainier, hiked through the woods and took psilocybin over a campfire.
Tom found his mind wandering to the far future, when historians would
look back on our era. "I got to thinking that they probably wouldn't
care so much about our politics and technologies," he said. "They'd
probably notice how estranged and detached we are from our own
consciousness." The couple couldn't have children but Tom remembers
Sheri's voice piercing the quiet. "An idea could be like a child," she

This is where I should stop for a moment, before I lose you. The only
thing worse than hearing about someone else's dream is hearing about
their mushrooms trip. But these experiences have an unusual power, a
power Oregon is trying to harness. "The definition of personality is
it's a trait, it doesn't change," Matthew Johnson, a professor
psychiatry at Johns Hopkins University and the associate director of
its Center for Psychedelic and Consciousness Research, told me. But
Johnson has conducted multiple studies in which participants ranging
from the very ill to so-called healthy-normals report profound changes
to outlook and even personality after one well-facilitated dose.

In particular, traits revolving around openness to change and
uncertainty seem to loosen, with people questioning their own
judgments, holding other viewpoints and tolerating more ambiguity with
greater ease. Openness to new experiences tends to diminish as we age,
so the potential of psychedelics to unlatch the windows of the mind
is, in Johnson's words, "a bit of a fountain of youth effect."
Psilocybin is also a reliable generator of profound, mystical
experiences in people who try it with the right intentions and the
right support - experiences that, months and years later, many recall
as among the most meaningful of their lives. "Until our work with
psilocybin, there was never an experimental manipulation which you
could schedule for a Thursday and change your personality," Johnson
told me.

But the more pressing case for psilocybin comes from research out of
Johns Hopkins, U.C.L.A., N.Y.U. and elsewhere that has shown it to be
a potentially effective treatment for major depression, end-of-life
anxiety and drug addiction. "One of the things I've come to is that
addiction medicine in 2021 is in desperate need of transformative
technologies," Todd Korthuis, a professor of medicine who specializes
in addiction at Oregon Health & Science University and a member of
Oregon's Psilocybin Advisory Board, told me. The studies so far are
preliminary, but they are "showing dramatic change in people's lives -
that's what we need for cocaine use disorder, methamphetamine use
disorder, even alcohol and tobacco."

Some of the early results are so remarkable that they fall into the
too-good-to-be-believed category, at least until far more research is
done. A recent study on major depressive disorder, published in JAMA
Psychiatry, found more than half of the subjects in remission four
weeks later, after just two treatments alongside psychotherapy. A
study on tobacco addiction, out of Johns Hopkins, found two-thirds of
the subjects who received psilocybin in combination with cognitive
behavioral therapy abstinent a year later. These would be miraculous
effect sizes if they hold up in larger samples and other contexts.
Even if further research finds psilocybin only 50 percent as effective
as these experiments suggest, it would be still be a

There isn't a simple explanation for why psychedelics possess these
powers. M.R.I. scans show the psychedelic brain aflame with activity,
with areas that rarely connect lighting up in electric conversation.
"I think that's what's responsible for this radically different
associative net, this different ability to absorb the gestalt,"
Johnson told me. You are hearing, thinking, processing differently
than normal, which can lead to new experiences and epiphanies. Some of
those are classic psychedelia, the kind of thing visualized in "Yellow
Submarine." Synesthesia, for instance, where you'll hear in colors.
But just as often, the experience defies those expectations: It's more
like a difficult, but powerful, therapy session.

I avoided psychedelics when I was younger, fearful of the loss of
control, and tried them later, desperately, when there was more
darkness in my mind than light. It was not an easy time for me, and
these were not easy experiences. They kicked down doors around my
anxiety, my marriage, my work, my family, my resentments, my
attachments, my self. Those rooms were often unpleasant to enter.
There was ecstasy and beauty, yes, but also fear and, often, so often,
intense nausea. Things I'd fought to ignore resurfaced. Disparate
parts of my life and beliefs and personality connected, and I became
more legible to myself. I am not cleansed of anxiety, but I am more
aware that my outlook, at any given moment, is just a dance of brain
chemistry and experience, and far from the only state possible. That a
few micrograms of chemical was all it took to upend my confident grip
on reality shook me in ways I'm grateful for. I hold my judgments and
worldviews more lightly, and I am friendlier to mystery and

But as with more traditional therapy, to the extent that these
experiences changed me, it is because I acted on the insights later,
once sobriety had returned. A trip is of little value if you refuse to
leave the hotel after you arrive. "You can have an amazing experience,
but if you don't do the work to ground it in a practice of
self-development, it may not have the impact you would hope," Eckert
told me. It "can fade, like a dream."

Or it can crack you. Psilocybin isn't addictive, and there is no known
lethal dose. "If you look at the safety profile of psilocybin, it's
dead last in terms of its risk of harm either to self or others,"
Korthuis told me. But these experiences can be psychologically
searing, even scarring. There is evidence that terror-filled trips can
cause lingering trauma or even trigger psychosis or suicide in rare
cases. Looking back, I wish I had had the option of skilled support,
both to get more out of the experiences and to protect me from harm.
These are not trivial chemicals. Here there be dragons.

The Eckerts wanted to bring back not the louche psychedelic use of the
late '60s and '70s, but the supported psychedelic use of the '50s and
early '60s. "We wanted to put psychedelic therapy and wellness on its
own foundation," Tom told me. Under Measure 109, no one will be able
to walk into a store and buy magic mushrooms. Instead, there will be
regulated centers, with trained and licensed facilitators who are
there both for the trip itself and to help people integrate the
experience afterward. There will be screening for psychological and
physical conditions that could make the experience unsafe and help
on-site for anyone who does fall into psychological or physical
crisis. "We wanted to think deeply about how we might integrate
psychedelics back into the culture," Eckert said.

The Eckerts' initiative caught the attention of a broader group of
organizations trying to shift the laws around psychedelics. They were
invited to present at a meeting of the Multidisciplinary Association
for Psychedelic Studies, or MAPS. There, they met with other key
groups that would become backers of their project: David Bronner, the
chief executive of Dr. Bronner's soaps, which uses some of its profits
to support drug reform initiatives, and Graham Boyd, a co-founder of
the Psychedelic Science Funders Collaborative, who brought his
experience winning ballot initiative campaigns to the effort.

MAPS, which is led by its founder, Rick Doblin, is at the center of
the decades-long effort to revive research into the medical benefits
of psychedelics and is currently deep in F.D.A. trials to get MDMA, an
empathogenic chemical associated with the drug ecstasy, approved as a
treatment for post-traumatic stress disorder. Doblin supports the
Oregon initiative, but he is cautious about the difficulties inherent
in getting it right. How will facilitators be trained? How will
patients be screened? Psilocybin remains illegal at the federal level,
and the federal government could choose to act on that at any time, he
noted. In the early years of state cannabis legalization, there were
raids on dispensaries. "I worry those with the most at stake in terms
of licenses will be fearful of participating, when those are the
people we most want to participate," Doblin told me.

Lurking in Doblin's comments is a concern I heard from many reformers
working to change the legal status of psychedelics: Too much, too fast
could imperil decades of hard work and steady progress. A few stories,
even exaggerated ones, of harmful trips and incompetent or predatory
facilitators, could turn this into a rerun of the '70s, when society
turned sharply against these substances. "There's a real Achilles'
heel," Boyd told me. "Public opinion can really turn against this.
Just because you've got science on your side doesn't mean public
policy will follow." It was his influence, in part, that got a
two-year implementation process included in the ballot initiative,
where regulators and scientists could come together to carefully
devise the program and to roll it out slowly, with plenty of public
education and legal consideration.

What's striking to me about Measure 109, though, is that it breaks
away from the medicalization-legalization binary that has defined drug
reform for the past few decades. It does not allow anyone to sell
psilocybin pills in stores. Nor does it restrict treatment to those
with a diagnosis of mental illness. The measure does not grudgingly
accept psilocybin as the lesser evil compared with, say, the drug war
or PTSD. Instead, it is based on the idea that psilocybin has the
potential to change our lives for the good, whether we are sick or
well, and so it is worth investing in the frameworks and safeguards so
that it can be used safely and productively. It would be foolish to
posit psilocybin-assisted therapy as an answer to all that ails our
society, or even our mental health system. But it would be one more
option for those who need it, and both evidence and anecdote suggest
it would be life-changing for many. That would be enough. That would
be so much.

"Oregon has always been a pioneer state," Korthuis told me. "It's been
a hotbed of innovation around drug policy for at least 25 years. This
is just the next contribution in that history."