“The more we can do on our end to ensure safety, the more likely it’ll be a successful program.”
By Lindsey Toomer, Colorado Newsline
As Colorado prepares to issue psychedelic mushroom licenses, health care professionals who have watched the rulemaking process unfold say education will be key to the program’s success.
Colorado’s voter-approved natural medicine program will allow licensed facilitators to conduct therapeutic sessions using psilocybin, the active ingredient found in mushrooms. While much of the process working toward implementation of the program has been similar to Colorado’s legalization of cannabis, the execution of the programs will look entirely different.
People will not be able to walk into a healing center and leave with psychedelic mushrooms or other psilocybin products for consumption at a later time, as is the case with cannabis dispensaries. Someone interested in participating will need to go through a screening process to determine any risks of taking natural medicine. If they are deemed an appropriate candidate for psychedelic therapy, they will take natural medicine in a secure, regulated environment with a licensed facilitator to supervise and walk them through the entire experience.
Regulations for the program are split between two Colorado agencies. The Colorado Department of Revenue regulates natural medicine businesses including healing centers, cultivation sites, manufacturers and testing facilities, and it will license their owners and employees. The Colorado Department of Regulatory Agencies regulates training and licensing for facilitators who will directly engage with people consuming natural medicine.
Both agencies have completed parts of the rulemaking process to implement the bill Colorado lawmakers approved last year to follow up on the voter-approved Proposition 122, which legalized mushrooms. A spokesperson for DORA said the rules are being drafted for facilitator licensing, which will roll out before the end of the year. Taisa Poinsatte, executive director of the Healing Advocacy Fund in Colorado, said DORA has already approved psychedelic training programs for facilitators through Naropa University in Boulder, the Changa Institute in Oregon and the Integrative Psychiatry Institute in Niwot. Someone who wants to become a facilitator will need to enroll with one of those programs and meet all the requirements before applying for a license.
The Healing Advocacy Fund is a nonprofit organization that advocates safe and equitable access to psychedelic therapies. It started in Oregon after voters in the state approved a state regulated psilocybin program in 2020.
The personal use provisions of the law say that an adult 21 or older can share natural medicines including psilocybin, psilocyn, ibogaine, mescaline and dimethyltryptamine (DMT) with others 21 and older for “counseling, spiritual guidance, community-based use, supported use, or related services.”
Those providing feedback to the state on how the regulated program should look come from various sectors of the medical field, including licensed therapists, nurse practitioners, pharmacists and more. They all see natural medicine as another item in the mental health care tool kit that can help Coloradans who are struggling. Research has suggested psilocybin could be used to treat PTSD, obsessive-compulsive disorder, substance use disorder and major depression.
“I really believe that this is a modality that can positively impact our options for mental health, and we’re just sort of scratching the surface of what’s possible,” Poinsatte said. “So it’s mental health, but there’s also a lot of promise for pain conditions, which is kind of an under-explored area, and so I really feel that it’s promising that Colorado is opening up opportunities to learn more about what might be possible here.”
Poinsatte said a key difference between Colorado’s program and Oregon’s is that mental health and health care providers in Colorado will be able to incorporate natural medicine as an option within their existing practices.
“I think that is going to create a much more flexible program in Colorado, and also we’re going to see a lot of licensed mental health providers directly participating as facilitators,” Poinsatte said.
Erica Messinger is a nurse in Dolores and is familiar with the deficit of mental health providers in rural Colorado. There’s always been a subset of people she works with, such as those with chronic medical conditions, who can’t implement effective changes for their health regardless of the techniques and medications they try, she said.
“These people went through all this trauma in their life, especially the veterans, and then there they end up with these health conditions on top of it because they’re making unhealthy choices about their life because that’s how they cope. That’s the only way they can cope,” Messinger said.
Messinger spoke with a woman who went through a therapeutic DMT session and told Messinger she “got more out of the last 15 minutes than I did the last 10 years of heavy therapy.” After researching more about psychedelic therapies, Messinger connected with other experts and has since supported the state with its regulatory process. She supported the Natural Medicine Advisory Board’s ethics and safety subcommittee as a non-voting member. The board is a 15-member panel of people who provide input on what the Colorado program’s framework should look like, bringing expertise from a variety of different specialties.
“This is very important medicine that needs to come through to help heal the incredible mental health crisis we have going on in the state of Colorado and throughout the rest of the country, and I need to make sure that this is as safe as possible,” Messinger said. “The more we can do on our end to ensure safety, the more likely it’ll be a successful program.”
Shift in understanding
Part of the regulatory process has been defining what an “adverse health event” is, and Messinger said education, particularly for first responders, will ensure that those interacting with people using psychedelics understand what an adverse reaction is, as opposed to a challenging experience. Because people trust first responders, if one doesn’t understand the medical uses for psychedelics, that first responder could “undermine public opinion about it,” she said.
“They’re the ones that are charged with keeping us safe, and they don’t have a lot of information right now on how to do this when this big thing is coming through,” Messinger said.
While Colorado towns aren’t able to block healing centers from operating within their jurisdictions, some have already implemented limitations on when they operate.
Messinger said the more people understand how psychedelics have helped people, the more the public perception of natural medicine will change.
Poinsatte said the shift is already happening in Oregon.
“What we’ve seen in Oregon is that local officials, once they hear direct input from their constituents that either have direct experience of healing or recovery themselves, or have worked with clients that have those experiences, it can really move them,” Poinsatte said.
Kristin Speer is a pharmacist certified in pharmacotherapy and has spent her career managing medications for people in hospice or palliative care. She was already familiar with prescribing ketamine to manage end-of-life symptoms like anxiety, depression and pain when she learned about psilocybin as another option.
She started to follow Colorado’s process of establishing a regulated program by attending meetings and public hearings, sharing input on safety based on her experience in pharmacology. Speer said Colorado has done “a wonderful job” of actively seeking input from diverse sources, including not just health care professionals but also Indigenous people who bring in a perspective of legacy uses of natural medicines.
“As we know, from a pharmacist perspective and from the consumer perspective, a lot of psychiatric medications are heavy with long-term side effects, and a lot of them are modestly effective at best,” Speer said. “However, I think the state is doing a good job in trying to educate the public and pulling communities together to be able to support educated and responsible use of these substances.”
Michaela Vogt is a therapist who runs a private practice in Littleton, with most of her work focused on depression, anxiety, trauma and addiction. She said psychedelic therapies help people connect what they learn through cognitive therapy to how they feel in their body.
Having also provided input at several meetings throughout the rulemaking process, Vogt said the state has developed a program that acknowledges safety concerns while also “championing moving mental health modalities and treatments into this next era of success that we’ve been lacking for so long.”
Speer, Messinger and Vogt all contributed to the development of a guide the state plans to offer as an example of how a screening session with a potential candidate for psychedelic therapy should go.
“This is all based on a passion of being so frustrated with therapies we have not working and watching people suffer,” Messinger said. “And that’s not why we got into these fields. We want to help people, and we found something that helps people.”
Vogt said education around the program and its benefits for participants will be key in changing the mindset around psychedelics. She said it will also be important for mental health providers who aren’t working with natural medicine to be able to accurately explain it as an option for patients.
“I think education is going to be the most crucial and valuable tool in rewriting the narrative around these psychedelics and getting out the information that is factual, allowing people to see real, true outcomes, not only in our clinical research settings, but in real, lived experience once more people start engaging with this,” Vogt said. “This isn’t some kind of radical, crazy thing—this is one more modality toward healing that can be used in conjunction with a lot of other healing modalities, both a medical setting and a mental health/behavioral health setting.”
Safety is No. 1
Some child advocacy organizations have expressed concerns about packaging and safety to ensure children cannot accidentally get into containers containing psychedelics. Poinsatte said these concerns are important, as safety is the No. 1 priority for the regulated program in Colorado. She said she’s confident that the risk is very limited with Colorado’s model.
“What we’re emphasizing about this program is that it is a highly regulated, therapeutic model for adults specifically,” Poinsatte said. “So no person under the age of 21 will be accessing through the state program, and the adults that are going to be accessing will be doing so with supervision throughout the entire psychedelic experience. The state has included a lot of additional safeguards to prevent the psilocybin from getting into the hands of anyone outside of that tightly controlled model.”
Both state agencies will accept licensing applications for natural medicine facilitators and businesses no later than December 31, with businesses opening next year. During the final DOR rulemaking hearing, program leaders emphasized that while the rulemaking process is coming to a close, rules and regulations will continue to evolve as the state learns more about implementing the program and other questions arise.
This story was first published by Colorado Newsline.
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