Deborah Howell (Host): As interest in psychedelic assisted therapy has exploded in America, the U.S. is grappling with how to commercialize and medicalize plant medicines that have already been used for healing for thousands of years. Welcome to Stoughton Health Talk. I'm Deborah Howell and I invite you to listen as we talk about the roadblocks in the legalization of medical psychedelic therapy and why psychedelics matter for the future of mental health care.

Joining me is Beverly Fergus, a master's degree student at the University of Wisconsin School of Pharmacy. Welcome back, Beverly. So great to have you with us as always.

Beverly Fergus: Oh, thank you so much for having me again.

Host: Let's dive in because we have a lot to cover on this one. Congress has made MDMA and psilocybin breakthrough therapies. What does that mean?

Beverly Fergus: It means that Congress decided to allow increased access to these drugs for research, since they have more potential than what is already available. These two drugs, MDMA, which is commonly known as Molly or Ecstasy, and psilocybin, which is magic mushrooms, are being studied for assisted therapies. Specifically for PTSD right now and depression, because currently SSRIs and therapy have been really underwhelming in their effectiveness for a lot of people.

Host: Does that mean both of them are legal to use?

Beverly Fergus: No, actually both of these drugs are still considered Schedule 1 with the Controlled Substances Act, which designates these as the most dangerous and illegal drugs. But as everyone has heard in the news, several cities and states have decriminalized psilocybin, the magic mushrooms, while extensive research and clinical studies are taking place.

Host: And what's happening in those places that have decriminalized psilocybin?

Beverly Fergus: States are trying to establish frameworks for the use of psilocybin assisted therapy, but there have been huge roadblocks, including bureaucratic nightmares, expensive treatments, taxpayer demands, and accessibility problems.

Host: Yeah, I think maybe it's because you hear about these Molly stories, as somebody slipped a Molly into someone's drink or something like that. And we're talking about a clinical setting, right?

Beverly Fergus: Right. Except that, actually not a medical setting. So, these decriminalized places are trying to set up service centers where people can come and get treatments, but they are not in medical situations where there would be insurance coverage and a hospital or medical setting.

Host: Okay, got it. So what's happened in the three years since Oregon voted to decriminalize psilocybin?

Beverly Fergus: It's hard to believe that so little has happened since Measure 109 was approved in November of 2020. This measure was a groundbreaking initiative to establish psychoactive treatments in centers that would be accessible to all citizens. Then the governor was Kate Brown, and she really instructed the original advisory board to make sure that there was equitable access for anyone who might benefit from the treatment, including all races, indigenous communities, and those unable to pay. The restrictions for these service centers included that the treatments could only be in the presence of trained facilitators, only in approved service centers, using a single approved strain of psilocybin, grown in state approved manufacturing facilities, and tested in state approved laboratories.

So that Oregon Health Authority, who was in charge of this, didn't get any of these places approved initially. Three years later, there are only three service centers, and it is costing the service centers 10,000 dollars a year to stay open, with 2,000 dollars per facilitator. So the whole program was also supposed to be run by those fees and the Oregon Health Authority just asked taxpayers for 6.6 million dollars to keep the program going for one more year. Even though right now these service centers are charging between three and a half to fifteen thousand dollars per treatment.

So the taxpayers are livid because right now they're going to be subsidizing a regulatory framework that only the rich can afford. It's no different than the out of country mental health retreats that the rich are taking part in now.

Many people are hearing about the potential for their mental health conditions. And now have nowhere to access the help. And so, the underground is now exploding.

Host: That's tragic. I know that Colorado has also done some work. Have they fared any better than Oregon?

Beverly Fergus: Not really yet. They're trying to learn from the mistakes of Oregon. They put together a governor appointed advisory board that many people think consist of the people who are really positioned to make the most money from it. Which is tragic. Not the people who are experts in this kind of therapy.

Host: Very frustrating. Which leads to my next question. What's going to be the answer for accessible assisted therapies?

Beverly Fergus: There's going to have to be a balance between medicalization of the psychedelics and communities that have already been using these plant medicines. We're going to have to pave some kind of way for accessibility for everyone, and that might possibly two separate pathways for use. A community based organization that can provide accessibility, and then the commercialization and medicalization, that is really the big question mark as the FDA is poised to approve this.

You know, we're going to have health insurance headaches, and who's going to actually figure out who qualifies for this help. Will the pharmaceutical companies keep the prices reasonable, even with insurance? We know how that's gone in the past.

So regulation is really going to be the key to address how this plays out.

Host: Are you hopeful, Bev?

Beverly Fergus: I am hopeful. I think that we have so many roadblocks that we're going to have to get through, but I really do believe that this is going to be an option for people. I have some hesitations about pharmaceutical companies and the government getting involved and limiting the access to this. But we actually need them to continue doing the research to prove that these assisted therapies are really going to make a difference in people's lives.

So I kind of think that we need both pathways, community based involvement and organizations to run some of these things for accessibility, but we also do need institutions that are doing the research and people who will only use this if it's medicalized and they can go to their doctor.

Host: Yeah. A two pronged solution. So my final question to you, Bev, is what lessons must the U.S. learn?

Beverly Fergus: I think that we need to learn several lessons and the first of them is that we need to engage with Indigenous cultures because they have so much wisdom and tradition. They've been using these plant medicines for thousands of years, and they can teach us a lot about what the capability of these medicines are.

I also think the other crucial piece is that we need to make sure that it is accessible to everyone. Oregon and Colorado are already showing us that we can't keep this accessible to so many people. Right now, it's a rich person's game. And I think that that's the most tragic is that we need to learn how to make it accessible for the people who can't afford it and oftentimes the people who need it the very most.

Host: Absolutely. You have such a way with bringing this all so clear in front of our eyes, Beverly, and you do give us hope for the future. Thank you so much for joining us today.

Beverly Fergus: Thank you so much for having me. I love educating people and I love doing this podcast with you Deborah.

Host: Well, good things come from seeds and we have definitely some good seeds planted. So if you'd like more information, please head on over to our website at stoughtonhealth.com. And that concludes this episode of Stoughton Health Talk.

Please remember to subscribe, rate, and review this podcast and all the other Stoughton health podcasts. I'm Deborah Howell. Have yourself a terrific day.

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