Debate over Oregon psilocybin services data collection roils on, new DEA proposal could mean more ketamine telehealth, and are you experienced?
Plus: New bills in Vermont and Iowa as Utah’s bill stalls, and billing insurance for psychedelic therapy
Happy Friday, and welcome back to The Microdose, an independent journalism newsletter brought to you by the U.C. Berkeley Center for the Science of Psychedelics.
The Latest in Oregon: Debate over data collection roils on
In early January, Oregon senator Elizabeth Steiner (D) introduced Senate Bill 303, which would direct the Oregon Health Authority to require all psilocybin service centers and facilitators to collect and report anonymized data about their business and clients, including the reasons why people are seeking services, as well as the race, ethnicity, gender identity, and education level of clients. In the weeks following the bill’s introduction, critics raised concerns that the data collected under SB 303 could put clients at risk for prosecution by the federal government, and that such requirements could place undue financial and logistical burdens on service centers. If passed, the requirements would apply beginning January 1, 2024.
Last week, Oregon Senator Steiner submitted proposed amendments to the bill, which would remove some reporting requirements for client data including sex, education level, veteran status, and English proficiency, as well as for some categories of data about sessions, such as their cost and duration. It also explicitly states that such data cannot be sold. On Monday, the Oregon Senate Committee on Health Care held a hearing to discuss the bill.
Proponents of the bill say that such data collection is necessary to monitor adverse effects and to assess the efficacy of psilocybin sessions. “Currently, there is no mechanism for measuring outcomes for the Oregon psilocybin program,” Sam Chapman, director of the non-profit Healing Advocacy Fund, wrote in a letter of support submitted to the senate. “Without a framework
focused on measuring safety, quality, and equitable access, we won't know how many people are receiving services, whether the program is equitable, or meaningful information about the adverse outcomes relating to client experiences that may occur.” Writing on behalf of the American Psychedelic Practitioners Association, Hadas Alterman’s testimony pointed out that prospective insurance carriers might want safety data before offering coverage for facilitators. “The current rate is $5,000 a year for a facilitator who wants coverage. This will be unaffordable for most facilitators, and will be especially un-workable for facilitators who intend to offer low-cost services. We need insurance to unlock access, and we need data to unlock insurance,” she writes.
Opponents of the bill say that service centers can collect data without SB 303, but that requiring it places undue burden on the Oregon Health Authority (OHA) and service centers. “I don’t believe data collection should be mandated. That is government overreach,” writes Heidi Venture, a prospective facilitator and service center owner. Attorney Mason Marks writes in his testimony that 303 is “unnecessary — everything it purports to do can already be done voluntarily under rules adopted by the OHA in December of 2022.” Critics have also pointed out the potential costs of the bill, pointing to testimony from OHA’s administrator André Ourso that says it’s unclear where funding to implement SB 303 would come from.
New DEA proposal could mean more ketamine telehealth
Earlier this month, we reported on the Biden Administration’s announcement that it is ending the federal COVID-19 public health emergency declaration, leaving the future of telehealth services — and the mail-order ketamine industry — in question. But new regulations proposed by the Drug Enforcement Administration would maintain telehealth rules established during the COVID-19 emergency declaration, and would leave the door open to continued telehealth ketamine services. Under the new proposed rules, doctors can prescribe a 30-day supply of any Schedule III, IV, or V drug after a telehealth consultation, but refills would require in-person evaluations. Ketamine, a schedule III drug, could be prescribed in this way.
Public comment will remain open for 30 days, after which the DEA will make a final decision about adopting the proposed rules.
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Are you experienced?
As psychedelic treatment begins to enter the mainstream, the industry will need practitioners to support clients through their trips. In some cases, practitioners’ training programs include a psychedelic trip, which often occurs outside the U.S. Some believe that practitioners must experience psychedelics to fully understand what their clients are going through in treatment. A new paper published in Psychedelic Medicine explores how common it is for psychedelic therapists to have used psychedelics; they found that the vast majority of practitioners they surveyed had personal experience with the drugs.
The University of California, San Francisco researchers surveyed 32 therapists who were involved with a Usona Institute psilocybin clinical trial. Twenty-eight of those 32 reported having used a psychedelic; the most popular were psilocybin (81%), LSD (81%), MDMA (88%), and ketamine (50%). Half of the participants said they’d used psychedelics 10 or fewer times; three people said they’d had more than 50 trips.
Researchers also surveyed those same therapists on their beliefs about the efficacy of psilocybin therapy. Nearly 70% of them said they believed psilocybin would be substantially more effective in treating depression than a placebo; the other 30% said they believed psilocybin would be “somewhat” or “moderately” more effective than placebo, but none selected the option indicating that psilocybin might not be more effective than placebo. These therapists’ beliefs about the efficacy of psilocybin “contrast starkly with those held by non-psychedelic mental health professionals,” the authors write, citing a 2021 study in which only 22% of clinical psychologists said they were “open to or favorably disposed” toward psychedelic-assisted therapy.
The State of Psychedelics: New bills in Vermont and Iowa; Utah’s bill stalls
In Vermont, a bipartisan group of over 30 representatives have co-sponsored H.371, which would remove penalties for possessing, dispensing, and selling psilocybin, and would also establish a working group to investigate establishing a program allowing practitioners to administer psychedelics in a therapeutic setting.
And in Iowa, lawmakers introduced House Bill 240, which would remove psilocybin and psilocin’s Schedule I status in the state.
Billing insurance for psychedelic therapy
With experts speculating that MDMA and psilocybin could receive FDA approval in the next few years, the healthcare system will need to adapt to accommodate psychedelic-assisted therapy. In a paper published in Psychedelic Medicine this week, Cleveland Clinic psychiatrist Brian Barnett and former chief medical officer of the U.S. Medicaid program Andrey Ostrovsky, write that the medical community needs to incorporate psychedelics into its billing and coding systems. “Since specific billing codes for psychedelic therapy delivery do not exist, modification of existing codes or development of de novo codes will be necessary,” they wrote. “This reality has created uncertainty about reimbursement and the financial future of psychedelic medicine.”
In their paper, Barnett and Ostrovsky say that creating such codes will be difficult because there are “no similar existing medical services”; for instance, psychedelic therapy will likely require multiple providers to be present during sessions. But the best way forward, they say, is to develop new codes in collaboration with the American Medical Association’s Current Procedural Terminology (CPT) Editorial Panel, which sets standards for how medical professionals code and bill for services.
The Aspen Times covers a recent panel of psychedelic advocates held in Aspen to discuss the “long, messy road ahead” for Colorado’s Proposition 122.
Celebrated mycologist Paul Stamets finally has a namesake magic mushroom species:
VICE tours the first psychedelic therapy clinic in Britain.
Former MMA fighter Ian McCall tells DoubleBlind how psychedelics helped him manage and heal after experiencing traumatic brain injury.
From a New York Times profile of Elizabeth Koch, daughter of billionaire Charles Koch and founder of Tiny Blue Dot Foundation, which has supported psychedelics organizations like MAPS and Usona Institute through its funding.
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