Clackamas County voters may be asked to decide a two-year ban on places to grow and supervise the use of psilocybin mushrooms in connection with mental health.
County commissioners are scheduled to decide July 28 whether to put it on the Nov. 8 ballot. They did decide on Thursday, July 14, to shelve an alternative that would have proposed a permanent ban on production facilities and service centers where the psychoactive drug can be administered. The Oregon Health Authority, which is still writing the program rules, is scheduled to start accepting license applications early in 2023.
Oregon voters authorized the nation's first psilocybin program in a 2020 ballot initiative, which also provided for a two-year phase-in. But the law also allows counties and cities to opt out, subject to voter approval in general elections that are conducted every two years. Deadline is Aug. 19 for city councils and county boards to act this year.
County commissioners asked their lawyers on July 6 to prepare potential ballot measures.
"The basis for this type of opt-out would be a delayed implementation to allow time for the state's rules to be completed and allow the psilocybin program to take shape," Assistant County Counsel Nate Boderman said July 14.
The proposed ban would run through Dec. 31, 2024.
Clackamas County would be Oregon's most populous to vote on such a measure, which would apply only in unincorporated areas outside cities. Other counties and cities expect to refer similar measures. But the 2020 initiative, known as Measure 109, failed in 17 counties east of the Cascades — it passed only in Deschutes County — and in six of 18 counties on the west side. It passed statewide with 55.8%, and in Clackamas County with 52.4%.
Unlike marijuana legalization that Oregon voters approved in 2014, Measure 109 does not make legal adult possession and use of psilocybin mushrooms, does not allow their cultivation by individuals and does not allow retail sales through dispensaries. Psilocybin can be grown only in state-licensed production facilities — which must be compatible with local land-use requirements — and administered at "service centers," also licensed, by facilitators who have undergone 120 hours of training. They do not have to be medical personnel, and they are not considered therapists.
Commissioner Sonya Fischer said the use of psilocybin for mental health treatment was still evolving.
"We have a mental health crisis," she said. "We need to create a society where we are providing services and be accessible. But I am concerned about manufacturing in the county," she added, because of the potential for psilocybin getting into the black market.
No other commissioner seconded her motion to proceed with a two-year ban on production facilities, yet allow service centers. So she joined the majority to advance a two-year ban for a second reading on July 28.
"I have a lot of angst in approving something for which we do not even know what the rules are," Chairwoman Tootie Smith said. "I think it's just not good public policy to go ahead and approve something for the vast majority of a county of 400,000 population, of which a small percentage may partake of this, before we know what's really going on."
What experts said
Dr. Sarah Present is Clackamas County's health officer and is a primary care physician at the Beavercreek Health Clinic. She also sits on the state Psilocybin Advisory Board that was created by the 2020 measure.
Though she did not speak for the board, she said, "I do not have major concerns about the public health aspects of this."
Early studies in the United States and elsewhere, she said, "suggest a benefit of psilocybin-assisted therapy in a clinical setting for anxiety and depression and the potential for substance use disorders."
Questioned by Smith, Present said Oregon's program is not a clinical model because it does not rely on medical professionals to conduct it — and psilocybin is considered a "breakthrough therapy," but not approved, by the U.S. Food and Drug Administration. It's still classified under federal law as a drug with no medical use — the same as marijuana, which is legal for adult recreational use in 19 states, including Oregon, and for medical use in some form in all but three states.
Angela Albee is manager of the psilocybin services section, which falls under public health within the Oregon Health Authority.
She said that under state rules, only one specific species can be cultivated for the program — although many types of psychedelic mushrooms are found throughout the Northwest — and sales can be made only to the licensed service centers that will administer the sessions where the psychoactive drug is taken, either dried or as extracts.
"It's not going to be cheap," she said.
Licensing fees for production, service centers and their facilitators will have to support the program without tapping the tax-supported state general fund.
Dr. Todd Korthuis is head of addiction medicine at Oregon Health & Science University. He told commissioners via video link that psilocybin shows promise in curbing alcohol abuse and stopping tobacco use, but results are not yet conclusive for treating other addictive drugs such as cocaine, methamphetamine and opioids.
"The bottom line for me as an addiction medical provider … is that I do not worry about psilocybin," he said. "I spend a lot of time worrying about the effects of fentanyl on our kids and general population. I spend a lot of time worrying about vaping and methamphetamine. Psilocybin is at the bottom of that list."
Before people can take part in the psilocybin program, they must participate in pre-sessions to justify their use of the drug — and can be screened for conditions that may make them unsuitable. Their sessions will keep them in service centers until they are no longer under the influence, which can take hours, depending on the dosage. They also can take part in post-usage "integration" sessions to review what happened with them, but the sessions are voluntary.
"I can say that prescribed carefully by the right person, in the right dosages and in the right setting, this could be a benefit. I don't doubt that," Commissioner Paul Savas said. "But my concern is the misuse of it," particularly if people leave while still under the influence and put themselves or the public at risk.
Commissioner Martha Schrader had a similar reservation.
"My concern is that in an altered state of consciousness, you can have a bad dream or a good dream," she said. "But it's really a safety issue if someone goes off and has a horrifying vision of some kind."
Commissioner Mark Shull said, "Constituents do not want to see another administrative burden on the state that is costly to the taxpayers."
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