5 Questions for Hadas Alterman

The legal status of psychoactive substances is changing quickly. Last year, Oregon legalized psilocybin for therapeutic use, and cities like Oakland, Seattle, Denver, and Washington DC have decriminalized possession of once-illegal drugs like psilocybin and ayahuasca. To help clients navigate this rapidly shifting regulatory landscape, the Plant Medicine Law Group specializes in the psychedelic and cannabis industries. The group’s clients include non-profits and “eco-system companies,” like retreat planners and digital start-ups that connect users with psychedelic services. The group has also worked with new ketamine clinics hoping to add psychedelics treatments to their offerings once they’re legalized. The Microdose talks with co-founder and Psychedelic Bar Association board member Hadas Alterman about the future of psychedelic law and lessons learned from the process of legalizing marijuana. (A disclaimer from Alterman: the content of this Q&A is provided as general information and does not constitute legal advice in any way.)

There are big changes across the industry, but clinics in particular will have to adapt quickly as new medicines are legalized for therapeutic use. What do you advise your clinic clients about creating a sustainable business?

This is probably obvious, but it's really important to do everything legally by the book. Do things honestly, have all of your ducks in a row; don't put yourself, your employees, or your patients in a bad position. Having the peace of mind that you are doing things in integrity is incredibly important because that allows you to move through integrity with all of the other nuances of what you're doing. 

Then consider that there is a fine line between honoring origins and outright cultural appropriation. There's also a fine line between being very excited about the promise of these medicines and overpromising what you can deliver. 

Last year, Oregon was the first state to decriminalize drug possession and legalize psilocybin for therapeutic use. What might the next few steps toward widespread psychedelics legalization look like?

These changes are happening at the state level first. Oregon is going to have a functional psilocybin services program before the federal government legalizes psilocybin for therapeutic use, and I actually think that it is in many ways a good thing. There are people in state agencies who understand how to write regulations and how to prop up programs and work with other agencies. That's useful. 

There has never been a more exciting – or bewildering – time in the world of psychedelics. Don’t miss a beat.

The cannabis industry has followed a similar state-by-state legalization process. What lessons can the psychedelics world take from what’s happened with cannabis?

If you look at the different political movements behind decriminalization, medicalization, and then full legalization in each state, what you find is that in states where there was a robust, diverse coalition of stakeholders and interested parties advocating for change, that was reflected in the way that the laws and regulations were created. 

For example, Florida never had a broad campaign for medical use; it was sort of done behind closed doors. Now there's something like seven companies that own the entire industry in Florida, which is not good for anyone other than those seven companies. But in New York, many different people — medical advocates, patient rights advocates, activists, business people — came together to say, “Let's change this. Here is how we want it to be changed.” 

Who gets to have a voice in those conversations has enormous bearing on what the outcome is. If we’re taking pre-existing regulatory frameworks for alcohol and tobacco or even cannabis and just switching the subject to psychedelics, are we really considering the bigger picture? This isn't just about recreation, and this isn't just about business. This is about healing. And when we think about healing, are we thinking healing just in terms of Western medicine and that paradigm, or are we also thinking about Indigenous cosmology? How do we make sure that traditional uses are still honored? 

There’s a delicate balance to strike in regulating these drugs: lax standards could put people in danger, but excessive standards could limit equitable participation in the industry. What regulatory challenges do you see on the horizon?

Something that I think is really difficult is how to delegate practitioner authority. I've sat in session with a good psychologist and left with profound realizations, and over time that compounds into actual healing. And then I've sat in sessions with unlicensed coaches that have really just taken my money and made my life worse. I've also sat in a ceremony facilitated by shamans that don't have a “license” in the way we would understand it, but certainly have the authority and the wisdom and the ancestral knowledge and cosmic blessing to guide people through the work. 

How do we put people into categories such that the public is not going to be deceived and that people can have reliable expectations around standards of care? How do you stop frauds? Spotting frauds is going to become more important because as the industry develops, we have to find a way to prevent people from being taken advantage of or manipulated. The regular old dichotomy of license versus no license isn't going to work because if we rely on that, we shut people out. 

What’s your experience been like in navigating these tricky regulatory issues, and what advice might you have for others diving into regulatory discussions?

I'm on the equity subcommittee of the Oregon Advisory Board, which is the group that is creating recommendations for the Oregon Health Authority to implement regulations for psilocybin services. These conversations are often incredibly frustrating; there are times where it feels like, Wow, we just spoke for an hour, and I don't know that there even was a conclusion. But an important thing to remember is that we are really trying to create something new. That requires time and a lot of patience. There's no way to fast forward, to do this in a way that's not going to be painful for people — we're going to have to touch on things that make everyone in the room uncomfortable. And unless we're willing to sit with that discomfort and reflect on why it's arising, we're going to have a really hard time creating something capable of attaining the goals we’ve been talking about. 

This interview has been edited and condensed for clarity.