Penumbra Psychedelic Consultation

What is the Oregon Psilocybin Services Act?

• Measure 109 was passed in November 2020, leading to approval of Oregon Psilocybin Services. This allows adults to use psilocybin in an outdoor or indoor licensed center, in a group or individual setting, approved by the Oregon Health Authority.
• Services do not require a medical diagnosis or referral and services are not a medical or clinical treatment (OAR 333-333-5040)
• Services cannot be provided in a health care facility, defined as: a hospital, outpatient clinic owned by a hospital, ambulatory surgical center, freestanding birthing center or facility that receives Medicare reimbursement as an independent diagnostic testing facility (OAR 441)
• Since it’s introduction, the Oregon Psilocybin Advisory Board has spent the past 2 years developing the rules for these services. This rule-making period ended in December 2022
• As of January 1, 2023, psilocybin, grown by licensed manufacturers, will be legal for consumption at licensed centers under the supervision of licensed facilitators for anyone 21 years of age and older
• Experts anticipate licensed psilocybin service centers will start services in Summer 2023

What is Being Consumed?

• Only psilocybin cubensis fruiting bodies, mycelium, extracts, or edible food product containing the aforementioned mushroom species
• Psilocybin cannot be combined with other intoxicants such as cannabis or alcohol. It also cannot be administered in any way other than enterally, which basically means orally
• One serving of psilocybin is defined and packaged as 25mg. A typical session will be 20-30mg with an optional secondary dose without exceeding a total of 50mg.
• Synthetic psilocybin is not permitted 

Who Can Consume?

• Anyone 21 or older
• No medical diagnosis is required
• The person does not have to be an Oregon resident
• The person does not require an assessment from a medical doctor

Who Cannot Consume?

• Those who have had Lithium in the past 30 days
• Those with active thoughts of causing harm or wanting to cause harm to themselves or others
• Those who have ever been diagnosed with active psychosis or treated for active psychosis
• Pregnant women are discouraged to get psilocybin but permitted with informed consent
• Those with a history of harming others or themselves are discouraged but permitted with informed consent
• Those currently receiving medical or mental health treatment are permitted but encouraged to consult with their doctor/provider

Who Are The Facilitators & What Are Their Duties?

• Must be 21 or older with a high school diploma or equivalent
• Must be an Oregon resident
• Must pass a criminal background check
• Must pay annual fees and licensing fees
• They must pass (75% correct) a multiple choice licensing exam
• Facilitators are not required to have any medical or therapeutic licensure
• Must complete an OPS-approved Training Program
  • There are a variety of programs, such as InnerTrek and Alma Institute, however all must be at least 120 hours. A portion of training hours shall take place in an in-person teaching format. Programs shall require students to complete practicum training. The goal of practicum training is to provide students the opportunity to facilitate and observe the facilitation of non-ordinary states of consciousness. They must also complete a comprehensive skill-based exam generated by the program.
• Facilitators must practice in their scope of practice and must avoid the practice of other disciplines including but not limited to medicine or psychotherapy. Therefor a facilitator who has a clinical degree may not participate in psychotherapy, evaluation, or medical assessment, for example
• Facilitators are trained in accessing emergency services when appropriate 

What Do Psilocybin Services Look Like?

• First, a client meets with a facilitator for a preparation session where the facilitator will ask about various medical and psychiatric history and provide education regarding psilocybin and its effects as well as discuss a support plan, emergency plan, description of fees, confidentiality, and determining dose of psilocybin. This may be done remotely using video conferencing. Clients are only required to have one prep session for the same service center for 12 months.
• Next, the client consumes the psilocybin in the service center while supervised by a facilitator at all times except for using a bathroom or meal break.
  • The administration session duration is limited based on dose taken. Microdoses (2.5 – 5mg) require a 1 hour minimum. Psychedelic doses (25 – 35mg) require a 5 hour minimum. “Heroic” doses (35 – 50mg) require 6 hours minimum. Clients cannot be forcibly kept in the administration area or service center after consumption
  • Clients must have a transportation plan arranged 
  • There is an on-call facilitator on stand-by. 
  • Supportive touch is permitted if informed consent is provided. This is limited to hugs or placing hands on a client’s hands, feet, or shoulders. Sexual or romantic contact is prohibited.
  • Nondirective facilitation is used, defined as a client-directed approach where the facilitator maintains consistent disposition while avoiding giving direct advise or directly interpreting a client’s statements, behaviors, or needs, unless appropriate for health and safety reasons 
• Lastly, the client may take part in an optional integration session with a facilitator where peer support and additional resources are provided. This may be done remotely.
• Service centers can be in unconventional non-commercial spaces as well as outdoors
• Group administration sessions are permitted with a limit at 25 persons. The client-to-facilitator ratio varies based on dose of psilocybin consumed, for example 25 – 35mg dosing sessions require a minimum ratio of 1 to 6 while 35 – 50mg dosing sessions require a minimum ratio of 1 to 2.

Other Pertinent Details

• Manufacturers cannot possess >200g of psilocybin at any time
• Service centers cannot possess >100g of psilocybin at any time
• Facilitators are trained in appropriate use of touch and physical contact as well as appropriate emotional and sexual boundaries
• Facilitators are trained in harm-reduction, de-escalation, and conflict resolution
• All service centers must have a social equity plan
• Service centers must be at least 50% owned by an Oregonian(s) resident(s). The cost of a service center license is $10,000
• The cost of a facilitator license of $2,000
• Service centers cannot be open beyond 11:59pm
• Psilocybin cannot be provided to anyone who is visible intoxicated
• Service centers have mechanisms in place to alert law enforcement when necessary, such as panic buttons, and will have video surveillance requirements, however administration rooms will not have video surveillance to respect privacy
• Client interpretation services are permitted
• Confidentiality policies are implemented in accordance to the Oregon Administrative Rules for Psilocybin Services
• Facilitators must not engage in a romantic relationship or have sexual contact with clients, clients’ partners, or immediate family members for a period of 1 year following last providing facilitation to the client’s psilocybin session