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An Unsolicited Opinion: On psilocybin ballot initiatives






On Feb. 1, Denver’s Elections Division announced that the Denver Psilocybin Mushroom Decriminalization Initiative had garnered enough valid signatures to appear on the ballot on May 7, 2019. Denver voters will get to decide whether to make “personal use and personal possession of psilocybin mushrooms by persons twenty-one (21) years of age and older the city’s lowest law-enforcement priority.” The initiative would still leave delivery of psilocybin a crime.

Psilocybin, a hallucinogen found in certain types of mushrooms, is currently classified by the Drug Enforcement Administration as a Schedule I drug under the Controlled Substances Act. This means the federal government views the drug as having a high potential for abuse and no accepted medical use.

While Denver could be the first U.S city to decriminalize psilocybin, there are organizations in other cities and states with similar ambitions, most notably the 2020 Psilocybin Service Initiative in Oregon. In contrast to Denver’s initiative, the Oregon initiative would establish a regulatory framework that would allow licensed providers to administer psilocybin to individuals of at least 21 years of age who have obtained medical clearance from a doctor. While the two initiatives are different in application and scope, activists in Oregon and Denver point to the same research to make their case that psilocybin is safe and has therapeutic benefits.

While research on the safety and therapeutic potential of psilocybin does exist, and is indeed very promising, advocates for psilocybin legalization tend to speak about the body of evidence as larger than it is. A 2017 article published in The Mental Health Clinician reviewed existing studies and noted that while a large-population study found no evidence of a connection between psychedelic use and mental health problems, most studies demonstrating the efficacy of psilocybin as a therapeutic treatment have had smaller sample sizes. The article notes that the lack of research results from the adoption of the Controlled Substances Act in 1970, which prevented researchers from studying hallucinogens until 1992, when the National Institute on Drug Abuse partnered with an advisory committee from the Food and Drug Administration to allow new research of psychedelics.

In October 2018, COMPASS Pathways announced in a press release that it had been granted Breakthrough Therapy designation for its psilocybin therapy for treatment resistant depression. The company explained that the Food and Drug Administration “designates a drug as a Breakthrough Therapy if preliminary clinical evidence shows that it may demonstrate substantial improvement over available therapy.” According to the FDA’s website, a Breakthrough Therapy designation “is intended to expedite the development and review of drugs for serious and life-threatening conditions.” A team of researchers at Johns Hopkins recently announced that if psilocybin is approved as a medicine, evidence suggests it should be moved to Schedule IV of the CSA.

So does this preliminary evidence serve as adequate justification for decriminalization or legalization of psilocybin? Advocates believe so, but I think both the Denver initiative and the proposed Oregon initiative have issues, which their proponents have not effectively addressed.

Advocates in Denver maintain that decriminalizing personal use of psilocybin will allow people struggling with issues like addiction, anxiety and depression to treat themselves. But self-medication is always a risky business, and as Dr. George Greer, president of the Heffter Research Institute, points out in a recent CNN article, “the problem with the mushroom when used for treatment is that the dose can vary widely and unpredictably.”

The integrated therapeutic model of the Oregon initiative would address these concerns. However, it seems fair to assume that the scope and regulatory framework of the initiative increases the likelihood of federal interference. Under current federal law, many participants in the initiative’s proposed framework could be charged with federal drug trafficking crimes.

Ultimately, while I’m excited by the prospect of psilocybin as a therapeutic treatment, I question the efficacy of using local or state initiatives to accomplish this goal. Without definitive research and any indication from the federal government that it will allow states to regulate psilocybin use without interference, the fight to legalize psilocybin is a fight to be had in couple of years. The FDA is already moving on psilocybin, and at some point in the near future, there is a real possibility that psilocybin will be approved as a medicine and rescheduled. Changes at the federal level would give psilocybin advocates greater leverage in their fight to legalize its use at the local and state levels.

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