Oregon Psilocybin Advisory Board: June 22, 2022 Meeting

The Oregon Psilocybin Advisory Board (OPAB) was established by Measure 109 and is responsible for making recommendations to the Oregon Health Authority (OHA) for psilocybin services in Oregon.

OPAB has met monthly since March of 2021, and the last monthly meeting was set for June 22, 2022. After that, OPAB will meet every two months. In a typical meeting, board members vote on what recommendations OPAB will make to OHA.

In the June 22 meeting, OPAB discussed the psilocybin client information form, the informed consent document, risk assessment and safety planning, psilocybin amounts for products and dosage, product handling, integration sessions and facilitator licensure. OPAB voted on recommendations under these topics for OHA’s consideration.

Informed consent document

Informed consent is an agreement with sufficient knowledge of relevant facts, and is often required for legal services, scientific research and medical treatment. For example, a medical patient must agree to undergo surgery before the procedure can begin. After the patient hears all of the information relevant to the surgery (the risks, benefits, and alternatives), the patient can then give informed consent to the healthcare provider.

Under OHA rules, psilocybin facilitators will be required to obtain informed consent from clients prior to an administration session. The Licensing Subcommittee voted to recommend this informed consent document to OPAB in November, 2021.

At the June 22 meeting, board members generally agreed on the document, but voiced concern that “trying to leave a service center before it is safe” is not listed as a side effect of psilocybin, and suggested adding an “agreement to not leave until cleared by the facilitator” to the document. Other members explained the content in the document is exhaustive, and the format should actually be simplified to ensure no lines are missed.

After some debate, OPAB voted to recommend this document to OHA.

Client information form

The “client information form” will be a tool for facilitators to adequately assess prospective clients. Facilitators are responsible for screening prospective clients and rejecting anyone who may be harmed by psilocybin services. The client information form will guide facilitators in gathering necessary information to make these determinations. OPAB discussed a list of required content for this form.

The list of content includes mental and medical history such as suicidal ideations, trauma, substance use, and current medications. It also explores the prospective client’s social support and living situation, as well as the person’s mobility concerns and possible language needs. The full list of content is available here on page 8.

Board members noted much of this information is medical in nature and HIPAA will apply some, but not all, of the content. Members felt the form is most appropriate as a set of “yes or no” questions, guiding the facilitator in a discussion while keeping the form simple. OPAB voted to approve the client information form, so long as it is reformulated as a “yes or no format.”

Risk assessment framework and safety planning framework

These frameworks work in tandem, and OPAB explained one is meant to help facilitators know what information to solicit from clients, while the other would indicate what to do with that information.

First, the risk assessment framework is meant to further guide a facilitator in deciding whether psilocybin is safe for a prospective client. The facilitator will either find a person eligible for psilocybin services at that time, or not eligible now but may be re-screened at a later date.

The framework requires a facilitator to find a person “ineligible” if psilocybin services are likely to cause harm to the person or others. For instance, an active psychosis, pregnancy, or unsafe living situation all make a person ineligible. Further, if a person cannot provide informed consent due to impaired decision-making capacity, or is using contraindicated medications, the person is ineligible. Contraindicated medications are those which interact negatively with psilocybin; OPAB noted that more research is needed for an exhaustive list of these medications.

Other information, such as alcohol use and childhood trauma, requires further screening to determine if a person is ineligible. You can view the full list here on pages 9 and 10.

OPAB then discussed the safety planning framework, i.e., what to do with the risk assessment information. All eligible clients will receive a safety plan for their unique needs. Facilitators and clients will discuss physiological “warning signs” of distress, like a racing heart. They will then make a plan to resolve the distress using coping strategies, useful distractions like music (you can read a related post on music here), supportive people to contact, and ways to avoid self-harm.

OPAB voted to recommend both frameworks to the OHA, so long as facilitators stay within their scope of practice.

Amount of psilocybin in products and dosage

Before manufacturers can know how much psilocybin to put in products, they will need a standard way to measure it. The Products Subcommittee recommended psilocybin be measured in milligrams. While a standard measurement provides consistency, some board members noted such standardization may be limiting because it is culturally colonial. For instance, some may traditionally measure psilocybin in terms of stems or caps rather than grams.

Nonetheless, OPAB voted to recommend “milligrams” as the measurement standard.

Similarly, before a facilitator knows how much psilocybin a client should have, they need a standard dose. The Products Subcommittee recommended 10 mg doses for extracts and .5 grams for fruiting body and mycelium products. The Research Subcommittee, on the other hand, recommended 25mg doses. The Licensing Subcommittee did not specify a standard dose, but recommended administration sessions should not have a minimum or maximum dose or duration.

OPAB voted to forward the Research Subcommittee and Licensing Subcommittee recommendations to the OHA.

OPAB also discussed microdosing, or sub-hallucinogenic products. Ultimately, the OPAB endorsed the licensing subcommittee’s recommendation that there be no minimum nor maximum dose and that facilitators end administration sessions when appropriate based on the dose, their professional judgment, and how the dose has affected the client. The board decided not to recommend distinguishing between psilocybin products designed for macrodosing versus macrodosing.

Product handling

Mixing psilocybin products with other substances, like alcohol, may cause unpredictable or negative results for the client. Further, if a product is mishandled it could become ineffective or contaminated and should only be handled by those trained to do so. Thus, the Training Subcommittee recommended a rule prohibited facilitators from preparing, handling, or administering the products unless the facilitator is also the service center operator.

Similarly, the Equity Subcommittee recommended rules prohibiting clients or facilitators mixing psilocybin products with homemade food products, alcohol, and prescribed or over-the-counter drugs. However, this does not prohibit all mixing; for instance, clients will be able to mix psilocybin with tea such as tea.

OPAB voted to recommend all of the above measures to the OHA.

Integration sessions

An integration session is a meeting between a client and facilitator to discuss the client’s administration session experience. While most integration sessions will be simple reflection or life coaching, a client’s administration session could unveil repressed memories or cause a vulnerable emotional event. That client may want to discuss childhood trauma or other topics commonly reserved for licensed therapists and psychologists. If a facilitator is not also licensed to provide such services, the facilitator should avoid acting as a mental health therapist, psychologist, counselor, etc.

Thus, the Training Subcommittee recommended facilitators only act within their “scope of practice” according to the required training, and avoid any activities reserved for therapists and psychologists (unless they are licensed as such). If the client wants to discuss topics outside the scope of practice, the facilitator may refer the client to supportive services and other resources.

Next meeting

OPAB will meet again on August 4, 2022. You can attend the meeting via Zoom here.