By Kate Ruder
from KFF Health News
Colorado regulators are issuing licenses for providing psychedelic mushrooms and are planning to authorize the state’s first “healing centers,” where the mushrooms can be ingested under supervision, in late spring or early summer.
The dawn of state-regulated psychedelic mushrooms has arrived in Colorado, nearly two years since Oregon began offering them. The mushrooms are a Schedule I drug and illegal under federal law except for clinical research. But more than a dozen cities nationwide have decriminalized or decriminalized them in the past few years, and many eyes are turned toward Oregon’s and Colorado’s state-regulated programs.
“In Oregon and Colorado, we’re going to learn a lot about administration of psychedelics outside of clinical, academic, and underground settings because they are the first to try this in the U.S.,” said William Smith, an assistant professor of psychiatry at the University of California School of Medicine.
Psychedelic mushrooms and their active compound psilocybin have the potential to treat people with depression and anxiety, including those unresponsive to other medications or therapy. The National Institute on Drug Abuse, part of the National Institutes of Health, says the risk of mental health problems caused by ingesting mushrooms in a supervised clinical setting is low, but may be higher outside of a clinical setting. Robert K. Reberry II, said in a social media post last year, before his nomination as U.S. health secretary, that his “mind is open to the idea of psychedelics for treatment.”
Medical experts say more research is needed, particularly in people with a diagnosis or family history of psychotic or bipolar disorder. Adverse effects of psilocybin, including headache and nausea, typically resolve on their own in two days. However, extended difficulties from using psychedelics can last weeks, months, or years; anxiety and fear, existential struggle, social disconnection, and feeling detached from one’s surroundings are most often managed. The decriminalization and legalization in Oregon and Colorado, psychedelic mushroom expos were reported to polson control centers ticked up in these states and nationally.
In February, about 40 people organized by the psychedelic advocacy group the Noble South Society gathered in Boulder to talk about the coming changes in Colorado. They included Mandy Grace, who received her state license to administer psychedelic mushrooms, and Amanda Clark, a licensed mental health counselor from Denver. Both praised the therapeutic power of mushrooms.
“You get discouraged in your practice because the current therapies are not enough for people,” Clark said.
Colorado voters approved Proposition 122 in 2022 to legalize natural psychedelics, after Oregon voters in 2020 approved legalizing psilocybin for therapeutic use. Colorado’s programs are modeled after, but not the same as, Oregon’s, under which 21,246 psilocybin products have been sold as of March, a total that could include secondary doses, according to the Oregon Health Authority.
As of mid-March, Colorado has received applications for 53 healing center licenses, nine cultivation licenses, four manufacturing licenses, and one testing facility license for growing and preparing the mushrooms. The rules were developed over two years by the governor-appointed Natural Medicine Advisory Board.
Psychedelic treatments in Oregon are expensive, and are likely to be so in Colorado, too, said Tasia Smith, Colorado director of the nonprofit Healing Advocacy Fund, which helped shepherd Oregon’s regulated psychedelic therapy. In Oregon, psychedelic mushroom sessions are typically $1,000 to $3,000, are not covered by insurance, and must be paid for up front.
The mushrooms themselves are expensive, Pontashel said, but a facilitator’s time and support services are costly, and there are state fees. In Colorado, one dose over 21 milligrams, facilitators will screen participants at least 24 hours in advance, the patient will sign consent forms, and then a trip-sitter consultant may be present. Preparations, lasting several hours, plus a later meeting to integrate the experience with mental health emergencies, need training in screening, informed consent, and postsession monitoring, Smith said. “Because these models are new, we need to gather data from Colorado and Oregon to ensure safety.”
Facilitators generally pay a $420 training fee, which allows them to pursue the necessary consultation hours, and roughly $900 a year for a license, and a healing center pays $3,000 to $6,000 for initial license fees to the DPO. But the up-front cost for facilitators is significant: The required 150 hours in a state-accredited program and 50 hours of hands-on training can cost $10,000 or more. Clark said she wouldn’t pursue a facilitator license due to the prohibitive time and cost.
To increase affordability for patients in Colorado, Pontashel said, healing centers plan to offer sliding-scale pay options, and discounts for veterans, Medicaid enrollees, and those with low incomes. Groups are also preparing other options to lower costs. Colorado law does not allow retail sales of psilocybin, unlike cannabis, which can be sold both recreationally and medically in the state. But if a user is 21 and older to grow, use, and share psychedelic mushrooms for personal use.
Despite the retail ban, adjacent businesses have surfaced nearby. In the warehouses and laboratory of retreat brands in Arvada, brown bags of sterilized grains such as corn, millet, and sorghum and plastic bags of soil substrate are stocked with mushroom starter kits and ready-to-grow kits.
Companies sell spores for the mushrooms in Colorado and across the country — including at the expo in Boulder.
Colorado officials said they do not license or inspect spore kits.
Winfield said he looks forward to working with people who have grown and harvested psychedelic mushrooms. In addition to selling grow kits and offering cultivation classes for the public, Winfield said.
Winfield and co-founder Shawn Cox recently hosted a psychedelic potluck with experts studying and cultivating psychedelic mushrooms and discussed genetics, extraction, and specialized equipment.
Psychedelic mushrooms have a long history in Indigenous cultures with legal provisions for their use in spiritual, cultural, or religious ceremonies are included in Colorado law, along with recognition of the cultural harm that could occur to federally recognized tribes and Indigenous people if tribal medicines were commercialized or exploited.
Several studies over the past five years have shown the short-term benefits of psilocybin for treatment-resistant major depressive disorder, and the Food and Drug Administration designated it a breakthrough therapy. Late-stage trials, the last step for FDA approval, are underway.
Smith said psilocybin is a promising tool for treating mental health disorders but has not yet been shown to be better than other advanced treatments. Joshua Woolley, an associate professor of psychiatry and behavioral sciences at the University of California-San Francisco, said he has seen high potential for psilocybin as an investigational aid in clinical trials.
“People can change hard-set habits. They can become unstuck. They can change things in new ways,” he said after testing patients with a combination of psilocybin and psychotherapy.
Colorado, unlike Oregon, allows integration of psilocybin into existing mental health and medical practices with a clinical facilitator license, and through micro-healing centers that are more limited than the amounts of mushrooms they can store.
Still, Woolley said, between the federal ban and new state laws for psychedelics, this is uncharted territory. Most drugs used to treat mental health ailments are regulated by the FDA, which determines whether a drug is “safe in these hands” by starting up its own program to regulate mushrooms and aging and administration of psilocybin.
The U.S. Attorney’s Office for the District of Colorado declined to comment on its policy toward state-regulated psychedelics programs or personal use provisions. But Pontashel hopes the same federal hands-off approach to marijuana will be taken for psilocybin in Oregon and Colorado.
Winfield said he looks forward to hiring staff with personal, skilled experience in the world of psychedelics, such as growing mushrooms and helping others with their mental health journeys.