Is the “psychedelic renaissance” coming to a treatment center near you? 

Oregon and Colorado have both legalized psychedelic assisted therapy and are currently working out the administrative framework to support this controversial treatment modality. NIDA, NIH and DARPA have all funneled millions of dollars into researching how drugs like psilocybin, ibogaine, MDMA and ketamine might be used to treat a variety of mental and behavioral health conditions. Well respected publishers like Time Magazine, the New York Times and Scientific American have penned glowing reviews of recent evidence showing the promise of hallucinogenic drugs in addressing PTSD, depression, anxiety and - yes - substance use disorder. 

But are these Schedule I drugs actually legal in the United States? Will these controversial treatments be integrated into the larger addiction treatment landscape and, if so, when? What are the barriers to implementing psychedelic therapy in addiction treatment centers in the United States? What does the evidence say about how safe and effective these modalities are for SUD patients?

Today, we’ll dive into these questions and consider what the future of psychedelic assisted therapy might hold for the addiction treatment community.

Psilocybin Assisted Therapy is Now Legal in Oregon and Colorado - Sort Of   

In 2020, Oregon became the first state to legalize psychedelic-assisted therapy, what the state refers to as “psilocybin services.” However, the process of implementing Measure 109, also known as the “Psilocybin Mushroom Services Program Initiative,” has proven to be a lengthy one. Oregon is still currently in the process of setting up a regulatory framework for the licensing of psilocybin manufacturing, service providers and facilitators. If all goes according to plan, the state will begin issuing licenses in January 2023. 

In 2022, Colorado followed suit with a bill of its own. Colorado expects to begin issuing licenses for “healing centers” and psilocybin manufacturing beginning September 2024. 

California has attempted to create a similar program, but so far has not succeeded in putting an initiative on the ballot. There is a push underway in that state to follow in the footsteps of Oregon and Colorado, but it’s unclear when or if those efforts will bear fruit. 

It’s been reported that the FDA is planning to OK psilocybin and MDMA for the treatment of depression and PTSD in the near future, as well.  

Do Psilocybin and Other Psychedelics Really Work for Addiction Treatment Patients?

The evidence for psychedelic assisted treatment is still emerging, but there are some positive signs that some hallucinogens may be effective tools in addressing substance use disorders.

For example, one study found that two doses of psilocybin reduced “heavy drinking” among those prone to such behavior by 83%. That same study also demonstrated that almost half (48%) of heavy drinkers treated with psilocybin abstained from all alcohol intake entirely in a follow up survey conducted 8 months after treatment was completed. Only 24% of those who took a placebo saw similar results.  

Other studies have shown a reduction in heavy drinking days. Another study demonstrated that synthesized ibogaine may be more effective than SSRIs in addressing depression. Several studies have indicated psilocybin assisted therapy might help with smoking cessation, as well.  

How Does Psilocybin Work for Addiction Treatment? Why Does it Boost SUD Patients’ Motivation for Change?

The truth is that researchers do not have a good understanding of how psychedelics may or may not work on the brain to produce a reduction in SUD symptoms. 

However, there are some well-educated theories to explain the apparent effects.

The most popular theory regarding psilocybin assisted therapy relates to the concept of neuroplasticity, or the brain’s ability to create new pathways and adapt to new stimuli, situations, and habits. Individuals with a high level of neuroplasticity find it easier to make changes in their lives, while those with a lower degree of neuroplasticity find that making changes and adapting to new situations is more difficult. It’s postulated that psilocybin temporarily increases the brain’s neuroplasticity, making it easier for the patient to make new connections and “retrain” old pathways to conform to newer, more helpful ones. This increase in neuroplasticity may make patient response to CBT more powerful, making it easier to replace unhelpful beliefs with healthier thinking patterns that support a robust recovery. 

How Might Psychedelic Assisted Therapy Impact the Existing Addiction Treatment Community? 

As more states legalize psilocybin services, it’s natural to wonder how this emerging addiction treatment modality might impact existing addiction treatment organizations and clinicians. It seems likely that “psilocybin services” will, at a minimum, become a popular adjunct to traditional addiction treatment with some patients in the near future. That said, it seems far-fetched to think that psilocybin services, or any other psychedelic modality, will replace the core services of addiction treatment: medical detox, CBT, individual and group counseling, and pharmacotherapy. 

A few issues are likely to impact the addiction treatment community’s relationship with psychedelic assisted therapy. They are: 

Slow-moving payer adaptations to psychedelic therapy. Consider how long it took to get payers to accept the popularity of telehealth. Acceptance of psychedelic assisted therapy by major health insurance companies and organizations  is many years off, assuming it ever comes. 

Resistance to medicalization. The existing state provisions for psychedelic therapy are carefully worded to avoid describing “psilocybin services” in medical terms. Oregon and Colorado want state oversight of psychedelic therapy - and the income that comes with that oversight. But the activist organizations behind the legalization of psychedelic therapy are invested in avoiding the codification of psilocybin therapy as a medical service. They emphasize that they want to create something new. In Oregon, mental health professionals may not draw on their mental health training to deliver psychedelic therapy. Existing mental health certifications will not qualify clinicians to deliver psilocybin therapy.

May not be accessible to marginalized communities. It’s likely that the cost and time investment involved in psilocybin therapy will prove to be barriers to treatment for the marginalized communities with the highest rates of substance use disorders. Out of pocket costs are likely to exceed $1000 per treatment episode. The fact that this modality won’t be covered by public payers (or private payers) for the foreseeable future means that only the wealthiest clients will likely be able to afford psilocybin services. 

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