New research identifies best practices for supervised psilocybin

Last year, Oregon became the first state in the nation to provide state-regulated access to supervised mind-altering magic mushroom services, increasing the likelihood that many Oregonians who had never experienced psychedelics would be introduced to psilocybin.

“There are no measurements of best practices because the field is so new,” says Todd Korthuis, MD, MPH, professor of medicine (general internal medicine and geriatrics) at the School of Medicine at Oregon Health & Science University.

Now, for the first time, a new publication from OHSU and other institutions documents a set of practices collected by experienced psilocybin facilitators to ensure the safety and effectiveness of psilocybin services offered to the general public.

The study appears in the Journal of Psychopharmacology.

Researchers recruited 36 highly experienced psilocybin experts with experience facilitating psilocybin within clinical trials, in ceremonial settings and in traditional Indigenous practices. Together, the experts identified measures that they believed represented best practice. Researchers used a method known as the Delphi approach to reach consensus; the approach uses several rounds of information gathering among a group of experts to draw conclusions.

The research identified 22 key metrics for high-quality services, including key service delivery processes, safety indicators and customer outcomes.

As other states and localities join Oregon and Colorado in legalizing psychedelics, the new publication provides the first set of core measures to monitor for safety, quality and effectiveness. Because Oregon’s program is the first of its kind, no established standards exist for measuring the safety or effectiveness of these services.

“It ultimately gives policymakers and program managers a harmonized set of measures they can use to say how safe and effective these services are in the community,” said Korthuis, senior author of the study.

In Oregon and Colorado, voters have approved supervised use of psilocybin for people 21 and older.

Other states may choose to allow the use of psilocybin and other psychedelics in the context of medical therapy. Psychedelics have been tested experimentally in clinical trials for the treatment of mental illness, including the use of psilocybin to treat depression and alcohol use disorders, or the use of MDMA, colloquially known as Ecstasy or Molly, to treat post-traumatic stress disorder. But it’s unclear how the safety and benefits observed in carefully controlled experiments will translate into widespread, state-approved access in the community.

New tools for the emerging psychedelic services sector

Researchers used a methodology common in assessing different types of medical interventions.

“Although psilocybin use in Oregon occurs outside the health care system, it can clearly impact people’s health whether they seek it for that reason or not,” said Korthuis, who is also chief of addiction medicine at OHSU. “It is critical that policymakers and the public have a way to understand the effects of these policies.”

The research identified core process and outcome measures ranging from the obvious to the eye-opening.

For example, of the 22 measures, experts in the study recommended that facilitators prepare for the session by asking about boundaries and preferences around touch, as some clients may express a desire for human touch, such as holding their hand, to help them in navigating the experience. .

Among the outcome measures, clients must rate the overall benefits and harms of the experience, and facilitators must complete a safety checklist that documents issues such as whether the client left before the session was completed or whether a referral for medical attention was needed.

The safety checklist and other measures provide important tools for the brand new psychedelic services industry. The results of this study will help researchers, policymakers, and service providers decide what data to collect to monitor their programs. Using the same set of measures, all state-level programs can be easily compared and combined, to get an overall picture of safety and success.

The researchers included members of a collaborative group of therapists and scientists known as Open Psilocybin Evaluation Nexus, or OPEN. Based at OHSU, the organization focuses on research to assess the safe and equitable implementation of psychedelic services, including psilocybin, approved by Oregon voters in 2020.