What can Colorado learn from Oregon about psilocybin?: 5 Questions for Healing Advocacy Fund’s Colorado director Tasia Poinsatte

Poinsatte discusses what’s happening in Colorado and how Healing Advocacy Fund is learning from Oregon’s psilocybin services program.

Tasia Poinsatte started working in Colorado politics in 2019, consulting on progressive campaigns and local and statewide ballot initiatives. The firm she was working for was tapped to work on Proposition 122, or the Natural Medicine Health Act (NMHA), which proposed a state-regulated psilocybin program and removing penalties for adults over 21 for the possession, use, and sharing of psilocybin, DMT, ibogaine, and mescaline (but not peyote). Poinsatte was immediately interested — though she didn’t have a specific role in supporting the campaign, she attended community events and learned as much as she could about the issue. 

In November 2022, Colorado voters passed the NMHA. Shortly after that, the nonprofit psychedelics advocacy group Healing Advocacy Fund reached out to Poinsatte. The group originally formed to support the implementation of Oregon’s Measure 109, which established psilocybin services in that state, and with NMHA’s success, they were looking to expand their work to Colorado. Poinsatte became the organization’s first Colorado director. The group has plans to expand their focus on state psychedelics initiatives to the entire U.S.)

The Microdose spoke with Poinsatte about what’s happening in Colorado and how Healing Advocacy Fund is trying to borrow lessons from Oregon’s psilocybin services program.

Based on the timeline for Colorado’s psilocybin program, all the rulemaking around state-legal psychedelics should be complete by November 2024. Are things on track?

We’re starting to get some specific dates — just last week, the Natural Medicine Advisory Board submitted its recommendations to the state for the regulated program. The state will then start drafting rules based on those recommendations, which they'll present next month. From there, we're going to go into a formal stakeholder engagement process where there'll be more opportunities for any and all members of the public to come out and comment on those draft rules. That will take us through the spring and into the summer. 

They're aiming to have final rules for major components of the program by June, and the earliest date they could begin accepting license applications is December 31st of this year. What that means in practice is that the program is going to be formally launched in early 2025 with the submission of first applications, and we’ll potentially see our first healing psilocybin centers opening up in mid-2025. 

Oregon’s psilocybin program has been up and running for a year now, and the Healing Advocacy Fund has been closely involved with its roll-out. What lessons have you learned in Oregon, and how might that shape the burgeoning design of Colorado’s program?

Here’s one concrete example: there has been some confusion, especially amongst licensed clinicians and mental health practitioners in Oregon, about the extent to which they can participate. Some have interpreted the rules as requiring a separation between psychotherapy and facilitation: that if somebody is acting as a facilitator, they must take off their other hat as, say, a licensed physician, the second they start to act as a facilitator with a client. Essentially, in that role, they're no longer a physician. What happens if there’s some sort of medical emergency and that physician is specifically not allowed to act as a physician because they're in this facilitator role? It gets a little complicated. What we’ve heard from licensed professionals and clinicians in Oregon is that they want that to change, because they want to participate — but with the current rules, some don’t feel comfortable participating. 

In Colorado, we see that as problematic; that doesn’t really support safety. So we suggested that the language in Colorado include more robust protections for licensed mental health providers to participate in the program, specifically not allowing disciplinary action for doing something that was made legal under Proposition 122, as long as that person is still in alignment with standards of care and scope of practice within their profession. What we want to make in Colorado is a system where people who have these other training, expertise, and backgrounds feel comfortable participating, and that their participation will be as protected — or at least, as protected as it can be, since there are still challenges in working with a Schedule I substance. It's never going to be perfect until there are some changes at the federal level, but we’re doing what we can at the state level to increase that comfort and support. 

We’re also considering a tiered licensing model in Colorado. 

What does that look like, and why are you proposing that? 

This proposal is also based on the experiences of facilitators in Oregon. I performed a qualitative analysis in which I ended up speaking with 24 people across a range of different perspectives, and getting all of their thoughts and input about what is core to safe facilitation. To what extent is that captured in Oregon's requirements, and if it's not captured, what changes should we consider for Colorado to really do more robustly support safety? 

One specific recommendation that came out of that was that we add a core piece to the training model. There were concerns that the 40 hour practicum in Oregon was just not sufficient for somebody that doesn't already have a background in facilitation to develop the depth of skill and awareness, to really do this work well. Facilitation is serious work, and there's a lot at stake — our rules and regulations should reflect that gravity, so we recommended a more substantial hands-on component to the facilitation training process.

All throughout this process, we were trying to think how we could balance that with the very real concerns around equity and access: who's going to be able to afford to get trained and what does that look like if we add more of an experiential component? So we recommended a few different pathways: either expand the practicum component, or create an associate’s license. The idea there is that after practicum, facilitators can have a period of time where they can start to practice but continue to be in consultation with somebody who has more experience. They’d work directly with that person, so as challenging events start to come up, they can get direct input about safety and ethics. 

In the recommendations they just submitted to the state, the advisory board ended up recommending a six-month training license where people could start to practice, so they can actually start to have an income but they are still in training. They’d need to be very clear with any participants that they are in their training period, but they’d be working in consultation with other professionals.

The Natural Medicine Health Act set up an advisory board. What kind of relationship does your organization have to that board? For instance, how did you end up sharing the results of this qualitative analysis you did with them?

The advisory board in Colorado is housed within the Department of Regulatory Agencies, specifically the Department of Professions and Occupations. That department has very strict policies for all of their advisory boards, and one of those is that advisory board members cannot directly communicate with anyone — members of the public or other board members — about board related matters outside of an advisory board meeting. What that means in practice is that we are not in communication with the advisory board members, but we have been able to reach out when we feel that we can provide specific input that is of value. That qualitative analysis is a perfect example; we didn't actually ask the state regulators if they wanted us to do it, we just decided it would bring value, so we did it and then reached out to the state regulators asking for an opportunity to present it to the advisory board. They looked at the report and gave us a slot to present at a board meeting. 

What other issues do you see on the horizon as Colorado continues its psilocybin program rule-making process?

There’s one issue that connects to everything we've been talking about: this question about gathering information about the program in Oregon and reporting it to the state. That's another area where there was a definite lesson learned from Oregon. At first, we were getting only small amounts of information out of Oregon because we didn’t have a system for gathering and reporting basic data. We knew that there hadn’t been any huge newsworthy negative outcomes, but we also didn’t know about any positive outcomes. Now we're starting to have a little more context: we know over 900 people have accessed services in Oregon, and it seems like things are going fairly well, which is a data point that's relevant to Colorado. 

We are definitely thinking about how we can really get ahead of the data collection question in Colorado, and set up a structure so that we know what is happening in real time, so that the data can help inform decisions around safety and access. That was the goal of Senate Bill 303 in Oregon, which established rules around data collection, and so in Colorado, we’ve gotten to learn from looking at Oregon’s process. But the advisory board recommendations haven’t specifically addressed that, so I think that question is going to see a lot more engagement in the next six months or so in Colorado.

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