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Oregon is rolling out psychedelics. The state approved a broad decriminalization plan in 2020, and licensed treatment centers started to offer psilocybin this past summer. Anyone can make an appointment, including those who just want to do it recreationally. But the measure setting up the legal framework said part of the purpose was mental health and well-being. From Portland, Ore., Deena Prichep checks in on how the program pursues that goal. Please note, her report contains detailed descriptions of domestic violence.
DEENA PRICHEP, BYLINE: Sandra says that when she was in her 20s, she was in an abusive marriage. We're not using her full name so as not to identify other family members. She says she got out, built a family and didn't really talk or even think about what had happened until last year.
SANDRA: I was listening to a podcast, 'cause I love some true crime, and it was the coroner talking about this woman who was beaten so severely, and she had her orbital bones broken in her face.
PRICHEP: Sandra says those were the bones her ex-husband had broken in her face when he beat her. She says hearing that story triggered her first PTSD episode, and things just got worse.
SANDRA: Every day was reliving that pain over and over and over again. Panic attacks. My 7-year-old knows grounding techniques to get me out of a panic attack.
PRICHEP: She says she tried therapy and medication, but nothing worked. So in December, she flew to Oregon. Part of the reason Oregon legalized psilocybin was to help people like Sandra. Studies have shown psilocybin to have promise for treating anxiety, depression, end-of-life distress. But while Oregon based their guidelines and maximum doses on existing data, many in the field say there's still a lot to be learned about how best to achieve those results in the real world.
JEANETTE SMALL: We are talking about what kind of outcomes do we have with what level of dose.
PRICHEP: Jeanette Small is a psychedelic facilitator. She says on Zoom calls and in-person meetings, people in the field are sharing what's working, what's not and what patterns are emerging.
SMALL: What we have already seen is that people with complex PTSD, people with a lot of psychological wounding, generally speaking, will need to start at a much lower dose.
PRICHEP: Other facilitators report that people on medications like SSRIs may need a higher dose. But the thing is, all this could be best described as anecdata. It's experience and observations, not clinical trials with carefully selected subjects and tracking. It's not even until next year that service centers have to begin reporting adverse reactions or basic information on the number of clients served. There are ethical considerations when it comes to treating people in what's essentially a real-time experiment. But facilitators like Jeanette Small say the good it can do outweighs the unknowns.
SMALL: When people are struggling with things that we do not have anything else that works for them, you know, then the question is really, what is the more ethical perspective here?
PRICHEP: But some worry that the enthusiasm for psilocybin may be outpacing the science that can guide how best to use it. Daniel Nicoli is a member of the Oregon Psychiatric Physicians Association, which opposed legalization.
DANIEL NICOLI: We're certainly not saying we don't want psilocybin to be medicine. We are just saying we want the research in place.
PRICHEP: As a psychiatrist, Nicoli isn't pushing for the measure to be overturned. But he wants there to be more data collection about how this is playing out in Oregon, as well as more research for psilocybin treatment generally.
NICOLI: I mean, we have too much business in the mental health field. You know, especially post-COVID, people are really, really struggling. So we don't support - we want more tools out there.
PRICHEP: And many clients report that this tool is helping. Sandra ended up at a service center in Portland to try to treat her PTSD. And using psilocybin, she says she went back to the night her ex-husband almost killed her.
SANDRA: And I could see his fist just go up. But every time it went down to hit me in my face, it just turned to these beautiful leaves - leaves just everywhere. And I think, in my head, it changed that memory for me.
PRICHEP: Sandra had gone to therapy, downloaded apps, repeated affirmations that she was safe and strong and loved. But she says it took psilocybin for her to actually feel that and believe it.
For NPR News, I'm Deena Prichep in Portland, Ore. Transcript provided by NPR, Copyright NPR.
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