How Are State-Run Psilocybin Therapy Programs Going?

How are the first state-run psilocybin therapy programs going? Plus, psilocybin clinical trials for cancer patients dealing with anxiety.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

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• 0:17Ira Flatow?

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• 0:36Flora Lichtman?

  Hey, I'm Flora Lichtman, and you're listening to Science Friday. In a few states out West, you can book an appointment for psilocybin therapy, where a licensed therapist takes you on a guided trip using the drug that makes some mushrooms hallucinogenic. Now, under federal law, psilocybin is illegal, but a few years ago, Oregon greenlit the drug for supervised medical use. Colorado is next in 2025, and New Mexico is expected to begin a program later this year. It's being used to treat certain conditions, including drug-resistant depression, addiction, and PTSD. So today, we are checking in on this grand experiment, as some experts have called it. With a bunch more people taking the drug under state supervision, what are we learning

• 1:21Flora Lichtman?

  about its safety and efficacy? Who's taking it, and can clinics make money? First stop, Colorado. Alejandro Alonso Galva is here, editor in the newsroom at Colorado Public Radio. He's also the project editor of their series, "The Trip," which covers the state's psychedelic journey. Hey, Alejandro.

• 1:39Speaker 03

  Hello, nice to be with you guys.

• 1:41Flora Lichtman?

  Okay, give us a sense of sort of what the experience is like. If I booked a psilocybin therapy session, what would my experience be like? Like, should I picture a dentist's office, a spa? What's the vibe?

• 1:54Speaker 03

  Well, I guess it's kind of all depending on what your preference is. Some of these places might look like your standard dentist office or therapy office, except there'll be a room that has psilocybin and that room will be secure with cameras and things like that. Other places might look like something you imagine on a wellness Instagram account, right? With yoga rooms and very interesting decor. So it really does depend on the vibe you're looking for.

• 2:25Flora Lichtman?

  And then how long does the session last and is someone with you the whole time?

• 2:30Speaker 03

  Yes, so the way the state has set this up is that it's actually not one session. It is at minimum three sessions. Basically, you have to pass a screening kind of exam where you fill out any family history that might disqualify you from these treatments. You have to talk about any other drugs you might be taking, either pharmaceutical or recreationally. Once you pass that, then you have your first session, which is basically an intake where you talk about why you're wanting to take these drugs. You discuss any goals, any concerns, safety measures, right? How are you going to get home? Because these folks aren't allowed to drive to the healing centers.

• 3:14Flora Lichtman?

  Right.

• 3:15Speaker 03

  And then after that is done and all these sort of ground rules are set up, you have the actual administration of psilocybin.

• 3:23Flora Lichtman?

  Is it like a pill or an inhaler? How do you take it?

• 3:27Speaker 03

  So when it comes to taking the actual psilocybin, a lot of places are using capsules because they can regulate the amount of psilocybin inside those capsules. But it can really range. Some places are allowed to use what they call like the whole fruit, right? The mushroom being the fruit of the fungi. So, once the drug is administered, you're with a trained state licensed facilitator. They're with you the whole time and you go through that journey yourself. There's things like eye masks that allow folks to basically turn inward and really focus on what they're feeling, what they're thinking, what's going through their minds. One healing center we visited had zero gravity chairs, which were meant to mimic the womb

• 4:12Speaker 03

  in order to create a very kind of comfortable environment. Again, it really depends on your preference and how you want to go through this, what is for many people, a very personal, very spiritual journey.

• 4:24Flora Lichtman?

  Okay, and then there's a sort of post-op, it sounds like, appointment where

• 4:28Speaker 03

  Yes.

• 4:29Flora Lichtman?

  there's some integration happening with a therapist.

• 4:31Speaker 03

  And that's the key word. Yeah, that's the key word right there, integration. These sessions are required by the state. And basically, that is where the patient will discuss things that quote unquote came up during the actual psilocybin trip. That could be things like past memories, that could be things like traumas. And this is key because a lot of the folks that we spoke with were very adamant that this was seen as the most important piece in order to take the quote unquote lessons that folks have during the sessions and actually integrate them into their daily lives.

• 5:08Flora Lichtman?

  How much does it cost to do, you know, the set of three sessions?

• 5:12Speaker 03

  Yeah, this is where we really get to where the rubber meets the road. It's not cheap. And that is probably the biggest concern folks are having with the rollout of these healing centers. We're looking at thousands of dollars.

• 5:24Flora Lichtman?

  Thousands of dollars.

• 5:25Speaker 03

  Exactly, and it's not covered in the state of Colorado. This is not covered by insurance or Medicaid or even things like an FSA. So you're paying out of pocket. And that is raising concerns about accessibility. Folks that might need this the most might be the ones that cannot afford it. So, healing centers like Sanctum over in Aspen, you know, they're serving a community that is, you know, that's not a secret, full of millionaires and folks with a lot of disposable income. They're looking at ways to try and make sure that folks in Rifle and in the community in Aspen that actually serve that community can also participate. So they're looking at things like working with nonprofits, doing group session work

• 6:08Speaker 03

  that might lower the cost because instead of being one on one by yourself, you're in a group session, so perhaps that could make things cheaper. All sorts of kind of creative options to lower the cost.

• 6:21Flora Lichtman?

  I mean, are the clinics staying in business? I know that the New York Times has been reporting on Oregon, so you're reporting on Colorado, but a third of Oregon's clinics have reportedly shut down since the program opened in 2023. How are Colorado's clinics faring?

• 6:36Speaker 03

  We haven't heard anything yet in terms of folks going out of business. We've heard a lot about concerns over high costs for the customer. So it's yet to be seen how that will work. The one thing I want to differentiate between Oregon and Colorado. Oregon had one standard license. Colorado saw what happened in Oregon and decided to add micro healing licenses, micro healing center licenses. It's a different license that is supposed to be a lower cost, lower fees, lower requirements in order to try and help these clinics stay open.

• 7:13Flora Lichtman?

  Lower cost for the actual providers.

• 7:16Speaker 03

  Exactly.

• 7:16Flora Lichtman?

  Like, there's less administrative fees, so they can do it more cheaply.

• 7:19Speaker 03

  Exactly. The big difference between standard healing centers and micro healing centers is basically the amount of psilocybin allowed on site. A standard healing center can have over 750 milligrams. A micro healing center has to have below that amount. And again, the hope being that this license will allow for these businesses to operate at a lower cost and allow for businesses that do other things, like yoga, like your your classic wellness retreat centers, allow them to integrate psilocybin assisted therapy into the different things that they offer at these centers. And I think that's part of the business model. They're trying to offer different things to, you know, keep money flowing in until they kind of figure out

• 8:03Speaker 03

  how to make the specific psilocybin assisted therapy work.

• 8:07Flora Lichtman?

  Has there been any safety data coming back? Like, how safe is this treatment?

• 8:12Speaker 03

  A lot of the folks are very optimistic about the outcomes that we see with psilocybin, but they also say a lot more research is needed. And the state actually recently passed a law that basically says that the public health department must start to report the data when it comes to health outcomes, right? And that way, we can start to actually see. The results that go beyond just anecdotal evidence and start to see if these treatments truly do work for things like addiction, PTSD, traumatic brain injuries. Right now, a lot of what we've seen is very limited research because these drugs have been so restricted for years and years. And now we might begin to actually collect some

• 8:55Speaker 03

  data and find out if the anecdotes can be backed up by true science.

• 9:00Flora Lichtman?

  Yes, I think that is one of the most interesting parts of this. And I think that's why we've heard experts call it a grand experiment because, you know, time will tell how effective these drugs are. You'll have to come back and keep us posted on what happens in Colorado.

• 9:17Speaker 03

  Oh, I definitely can. Thanks for having me.

• 9:20Flora Lichtman?

  Thanks for coming on. Alejandro Alonso Galva, editor at Colorado Public Radio. Don't go away because after the break, we're checking in on some of that research with one of the largest psilocybin therapy trials currently running. Don't go away.

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• 11:31Flora Lichtman?

  Now to check in on the state of psilocybin research is Dr. Stacy Fisher, a professor of medicine at CU School of Medicine based in Aurora, Colorado. She is co-leading the US's largest clinical trial on psilocybin use for anxiety in advanced cancer patients. Stacy, tell us a little bit about this study and your research questions.

• 11:54Speaker 05

  Yes, so one of the things that we really struggle with in caring for patients is when people get to a point where they have tremendous existential distress or demoralization related to their diagnosis of advanced cancer. It kind of all started back when I was on clinical service, working in the hospital, and I had a very young patient. He was in his late twenties. He had a horrible, very aggressive gastric cancer, cancer of the stomach, that was causing an obstruction. And he had so much existential distress. His friends were getting married. They were having kids. They were getting new jobs. And he said, "I'm just sitting here in the hospital room with my mom

• 12:39Speaker 05

  because my friends have moved on. They're living their lives, and my life is ending." And it was the hardest space to be in because while we could listen to him, while we could validate his feelings, I had no tools in the toolbox to try to address or really relieve his suffering. And it was that same day, I got an email from the financial director of our cancer center.

• 13:08Speaker 05

  Sending me Michael Pollan's article from The New Yorker. And he said, Stacy, we gotta do this. And, and it really, that was like the first step on this journey. And the emerging evidence from some of the early trials that were conducted through the early 2000s show a tremendous and nearly immediate benefit to psilocybin in conjunction with therapy for treating anxiety, depression, demoralization. So based on this early emerging evidence from these trials, we submitted a grant looking at how do we conduct a large trial of psilocybin versus a placebo in conjunction with therapy

• 13:50Speaker 05

  to help people facing a serious cancer improve feelings of anxiety, depression, and existential distress. The grant was funded and the study began in 2021. And now we're here in our fourth year of the study. We've now recruited more patients than have been enrolled in any other cancer-focused trial in this space, and we're really excited.

• 14:18Flora Lichtman?

  I mean, I know the data's not in, but what are the range of outcomes you're seeing? Can you give us some anecdotes that feel representative?

• 14:27Speaker 05

  Absolutely. We're getting feedback from people saying things like, this was one of the only good things about having cancer, that I came in today and I experienced joy and love and connection. And one of our participants texted us the next day and he said, I look around my house and all I see is love, saying that this was one of the more powerful experiences in their lifetimes. That said, we've also had some people that have had really tough times that came in expecting to have some kind of... Nirvana, that didn't happen. And where they really kind of felt a little bit depressed

• 15:11Speaker 05

  or kind of felt cheated a little bit. And we've had people that said, well, meh. So even while they say, well, I didn't see God, but what we see actually is like this slow and steady improvement in anxiety. I think we have a lot of humility around this, that this isn't a treatment that is a panacea for everybody, that some people do come in and have a really difficult experience. And those especially who cannot surrender to the process, who want to try to maintain control or are not ready to lean in to what might be uncomfortable. This may not be the right treatment for them.

• 15:49Flora Lichtman?

  You know, what about standardization? I think we've all heard with some of these new hallucinogenic medical treatments, that there's variability in people's experiences, you know, based on who's administering, sort of who the therapist is, what the clinical setting is. Do we know, like, is there a standard dosage yet? And how confident are we in that? Is there a standard protocol?

• 16:19Speaker 05

  Great questions. In terms of the dosage, I think when you look across most of the research studies, they're using around 25 milligrams of a purified form of psilocybin, which was what we would consider to be a moderate to high dose. So enough that we would achieve what we call ego dissolution or that really full psychedelic experience. In terms of standardization around the therapy, that's a really tough question. I'm included in the school that that preparation and integration therapy is absolutely critical to achieving those benefits. But scientifically, we haven't really proven that to be true. And so eventually, we're going to need

• 17:03Speaker 05

  a more complicated design where we compare groups of people that are receiving the intensive therapy and then are maybe receiving something much more light or less hands on.

• 17:14Flora Lichtman?

  Okay, Stacy, as states expand these programs, what do you think people should keep in mind if they're thinking of, of, you know, booking an appointment?

• 17:25Speaker 05

  It's a great question. Um, I think one thing we have to keep in mind is that the people involved in the research studies have been carefully screened. They are highly selected. The people in these studies may not be broadly representative of the population at large. So I think as people are seeking this, to remember that if they have history or family history of serious mental health disorders like schizophrenia or psychosis, they could run into real problems with this kind of therapy. I think it's also important to make sure that they have a good rapport with the therapist. Um, I know in Colorado are

• 18:07Speaker 05

  the therapists here who are licensed undergo 150 hours of training plus 40 hours of experiential work. I think as states are thinking about that, to look to that to say, this is not something that should just be capriciously given. This is something we need to make sure that their infrastructures and guardrails are in place, that people have adequate training to offer the therapy around the dosing that we think is really important to achieving the benefits that we're seeing in those studies.

• 18:37Flora Lichtman?

  Do you feel like you're up against the sort of reputation of psychedelics in doing this work? Where people are like, oh, this really want to go on a trip. You know, this is not real medicine. Do you have to deal with that?

• 18:50Speaker 05

  A colleague of mine, early on in my work, said, well, shouldn't all this be harder? You know, is it, is it fair to have like one tablet and just have things go away? And I guess I would answer, um, you know, this is, this is rigorous science and the studies that we're conducting, I think are, are conducted under the highest scientific standards, ensuring that our results are reproducible. For instance, when we're assessing outcomes, I'm not assessing the outcomes. I'm not coming in to say, whoa, wasn't that a wonderful experience?

• 19:29Speaker 05

  How was that? In fact, it's someone in a room across the country who's assessing how their mood is. And so I think it goes a long way into kind of assuring those kinds of doubters. And in the question of, should it be that easy? I would say, I don't think it always is that easy. And in fact, People are getting a lot of therapy around this that makes a difference. Digging into some of their coping, some of their struggles, what makes life meaningful, which can be really hard conversations, especially when you're thinking about life potentially ending. Then this dosing happens where we kind of think like the miracle pill.

• 20:08Speaker 05

  Well, what's really going on is allowing neuroplasticity, allowing cognitive flexibility, so that when they get these eight hours of integration therapy in the four weeks following the dosing day, their brains have literally been changed in a way that they can achieve therapy outcomes that would potentially take years to achieve otherwise because of this period of neuroplasticity and this openness that really makes a difference in helping that therapy work.

• 20:41Flora Lichtman?

  Well, you'll have to come back and tell us about it when you have those findings.

• 20:45Speaker 05

  Love to. Thank you.

• 20:47Flora Lichtman?

  Dr. Stacy Fisher is a professor of medicine at CU School of Medicine. Thanks for being here with us today.

• 20:52Speaker 05

  Thank you so much. It was great to be here.

• 20:55Flora Lichtman?

  And we have a question for you. Have you taken psilocybin or another psychedelic drug medicinally? What was your experience like? What surprised you about the experience? Leave us a message at 8774PSYFRI. This episode was produced by D. Peter Schmidt. I'm Flora Lichtman. Thanks for listening.