Prescriptions for MDMA and psilocybin in Utah?: 5 Questions for Republican State Senator Kirk A. Cullimore

Cullimore discusses Utah's new psilocybin and MDMA prescription bill, and how it will be implemented.

In March, the Utah State Legislature passed Senate Bill 266, which would create a pilot program allowing two healthcare systems in the state — the University of Utah, and Intermountain Health — to prescribe psilocybin and MDMA as “behavioral health treatments.” After the bill landed on the desk of Republican Governor Spencer Cox, he penned a letter to the state’s senate president and house speaker explaining that he would allow the bill to go into effect without his signature due to “overwhelming legislative support.” 

In his letter, Governor Cox noted that while he is “generally supportive” of the efforts, he was disappointed that the legislature passed the bill when the state had previously established a task force to advise the legislature on studying psilocybin. As written, SB 266 took effect on May 1, 2024 and the pilot program will sunset in 2027. While many psilocybin bills and ballot measures include in-depth detail about how programs will be implemented, SB 266 is short on specifics and includes fewer than 300 words. The Microdose spoke with Republican State Senator Kirk A. Cullimore, one of the bill’s co-sponsors, about the intent of the new law and how it will be implemented. 

How did this bill come together?

About a year ago, former Texas Governor Rick Perry came and visited with me and a couple other members of our legislature to talk about this issue and the traumatic effects of PTSD on veterans. After that, I had conversations with a number of people who had experiences with psychedelics in treating their depression, anxiety, or other mental health issues.Their testimonies of how beneficial it was for them, especially in being able to avoid or be less dependent on pharmaceuticals, was pretty compelling to me. It seemed to me like a compassionate solution worth exploring.

Then, some special interest groups here that initially helped push the bill forward, like the Libertas Institute; they do national work but they’re based here in Utah, and they provided some input. We also talked with a couple physicians at Intermountain Health, one of the biggest healthcare systems in Utah, who were interested in setting up a clinic and have been doing some research on psilocybin. But Intermountain Health, as an institution, was not willing to do that without knowing that there was some safety net of the law supporting this kind of clinic. Hearing from those physicians helped us craft the bill in a way that made it more palatable for legislators, and then the University of Utah health system became interested as well. Once two of the bigger, well-respected health institutes in the state were saying they saw merit in this, that lent a lot of credibility to the effort.

Utah was a bit of a dark horse for this kind of bill; more liberal states like California and Washington haven’t yet passed anything like it. What was the process of gaining consensus in the Utah Legislature for this bill? 

With the final vote, it appeared there was wide consensus on this issue, but there was a lot of trepidation that had to be addressed behind closed doors. There was a lot of concern about putting the state stamp of approval on psychedelic drugs. Some lawmakers and members of the public felt that our medical marijuana program has become broader than originally anticipated; there are concerns that some of the pitfalls people are seeing in states like Colorado, where recreational use has been legalized, has had perceived societal implications, like expanded cartel activity and that the perceived lifestyle that accompanies marijuana use is a burden on the system. I certainly don’t have the data in front of me to support this but this is how many people feel, so people were like, “Oh man, are we going to do this now with psychedelic drugs?” We had to provide some assurances that one, this is a pilot program, and two, it’s all done in a clinical setting; it’s not like setting up a whole system, like what we’ve seen with marijuana. 

Ultimately, I’m proud of Utah for passing this and being able to look at all the alternatives to address the mental health crisis.

When researchers conduct studies on Schedule I drugs like psilocybin, they are able to obtain substances from the federal government. But if clinicians are treating patients in a clinic outside the context of an approved study, they wouldn’t have access to government psilocybin or MDMA. State programs, like Oregon’s, have set up rules for manufacturing and selling psilocybin mushrooms; how are these Utah institutions going to obtain Schedule I drugs for these clinics? 

We didn’t get too prescriptive in the bill on that; that would be left up to the institutions. As I understand it, these would be treatment clinics, not research, though obviously they’d collect data while they’re treating people. 

I know you mentioned that Intermountain Health wanted a bit more reassurance that they could open clinics legally. This bill makes MDMA and psilocybin state-legal in these clinics in Utah, but Schedule I drugs are still federally illegal, and that could, in theory, put clinicians and patients at risk. While you were putting this bill together, were there conversations around the risk of federal intervention?

There hasn’t been that conversation yet. I would go back to the precedent that was set with marijuana; that’s still a schedule 1 drug, and there’s just kind of a detente where no one’s actually doing anything about states that allow marijuana. I think there’s a lot of confidence that the way these pilot programs are set up, they won’t be subject to federal enforcement; if state law specifically allows for these pilot programs, I don’t think there's a huge risk of federal enforcement. 

Oregon’s psilocybin program has had representatives of the Oregon Department of Justice weigh in on various issues as they set up their rules and practices. Have you or anyone working on this bill had conversations with federal agencies like the Department of Justice or the Drug Enforcement Administration, or your state’s Department of Justice?

I personally have not, and I’m not sure if others involved have either. We did seek legal opinions from our Attorney General’s office and they were a bit hesitant to publish any sort of legal opinions. We did have some concerns about running afoul of federal law, and if this could have any implications on Medicaid and Medicare programs. The general consensus was no, it should not affect those programs. This bill leaves the liability and risk to the health systems that decide to implement this, but all indications -— from other states and from the legal opinions we garnered here — are that there wouldn’t be federal repercussions for starting the pilot programs prescribed by the new law. 

This interview has been edited and condensed for clarity and length.