Psychiatrists & Decriminalize Nature Oppose Oregon Ballot Measure

On November 3rd Oregon voters will have the chance to vote for Measure 109, a state-regulated psilocybin therapy framework. It is the first state-level initiative that seeks to create a medical marijuana-like system for psilocybin. (In this article I refer to this measure both as PSI and Measure 109)

In May, we covered the Basic Framework:

  • The PSI proposes a legal framework for the manufacturing/cultivation, sale, and administration of psilocybin services (therapy, guided trips) in designated “psilocybin services centers.”

  • Retail sales are not part of this initiative:

    • SECTION 57… A client may purchase, possess, and consume a psilocybin product:
                  (1) Only at a psilocybin service center; and
                  (2) Only under the supervision of a psilocybin service facilitator

  • This is not a decriminalization or de-escalation measure. Personal possession, cultivation, or distribution are not subject to this initiative and would continue to be illegal at the state and federal level. (IP 44 is a simultaneous campaign in Oregon that seeks to decriminalize all drugs in the state.)

  • If passed, the first step would be the creation of an advisory board that would be responsible for completing the legal framework by 12/31/2022.

  • Manufacturers, service center operators, facilitators, and product testers will be able to apply for licenses by 1/2/2023.

Measure 109 has received endorsements from a broad coalition of healthcare professionals, political candidates, many progressive organizations, and notable corporate support from Dr. Bronner's soap company.

There have signs that voters would approve the measure as early as February of 2019.

Measure 109 is an attempt at pragmatism—that is, it tries to simultaneously make progress in eroding the War on Drugs while at the same time positioning psilocybin as a therapeutic agent that requires professional oversight.

As a result, it is facing opposition on two fronts.

Presumed Opposition

Most people I talked to presumed opposition to measure 109 would originate from biopharma lobbying or associated political action committees.

The logic is understandable since the two most commonly cited excerpts from COMPASS Pathways F-1 that I have seen posted around the web are the references to Usona's strategy of at cost or free FDA approved psilocybin and Oregon's Psilocybin Services Initiative.

Excerpt from F-1 document regarding Measure 109:

"...there is currently a campaign in Oregon to pass a bill in November 2020 for the legal medical use of “psilocybin products,” including magic mushrooms, to treat mental health conditions in licensed facilities with registered therapists. The legalization of psilocybin without regulatory oversight may lead to the setup of clinics without proper therapeutic infrastructure or adequate clinical research, which could put patients at risk and bring reputational and regulatory risk to the entire industry, making it harder for us to achieve regulatory approval. Furthermore, the legalization of psilocybin could also impact our commercial sales if we receive regulatory approval as it would reduce the barrier to entry and could increase competition."

According to Oregon Public Broadcasting, there is no registered opposition to measure 109.

However, psychiatric professional organizations are going hard in the paint.

Psychiatrist Groups Voice Opposition    

Consistent with COMPASS position that Measure 109 presents a risk to patients, this tweet notified me of the official oppostion from the American Psychiatric Association (APA), the Oregon Psychiatric Physicians Association (OPPA), and the Oregon Medical Association (OMA) to measure 109.

From Nicole Harrington Cirino, MD President of the OPPA:

“Measure 109 is unsafe and makes misleading promises to Oregonians who are struggling with mental illness…

We believe that science does not yet indicate that psilocybin is a safe medical treatment for mental health conditions…

This measure does not require a prescription, does not require that you’re in a medical facility or that it’s administered by either a mental health professional or a medical professional… In some ways, it is more like setting up dispensaries than actual medical treatment…

(Psilocybin is) really in its infancy in terms of development and studying… We have no idea what could happen, what it could cause if it’s going to interact with a medication or their medical condition.”

Cirino also notes that the demands that Measure 109 puts on the Oregon Health Association are unprecedented and implicate the organizer's naivete:

"The measure also directs the Oregon Health Authority (OHA) to develop an advisory board and iron out best practices, ethics, and regulations for psilocybin therapy, all within a two-year timeframe. Cirino said she doesn’t know of any precedent for tasking the OHA with something like that…

"A two year time period where they’re essentially acting like the FDA is really unrealistic,” she said. “They don’t have the resources for that or the expertise for that.”

Understandably, professional organizations of psychiatrists are opposing 109. On the one hand, it can be viewed as an example of the status quo in which the field of psychiatry is cozily in cahoots with big pharma. On the other it is the group with the most experience with extreme mental illness cases and are simply protecting vulnerable patients from an unknown risk profile.

These are both reasonable interpretations and not mutually exclusive.

However, there is one section Dr. Cirino's letter that stands out both for the dig at the the 109 leadership’s credentials and the implication for future ‘measure 109-like’ attempts to develop legal frameworks in other states:

"The society was formed by Portland-area psychotherapists Thomas and Sheri Eckert (both master’s-level psychotherapists). Missing from the planning or initiation of the initiative is any mention of or oversight by Oregon psychiatrists."

I wonder about the extent to which PSI organizers sought input and collaboration from the OPPA or the profession in general. Even if attempts were made to involve the OPPA, the outcome was likely never going to be collaborative and opposition from psychiatrists feels inevitable.

However, pushback from other grassroots psychedelic activist groups is where things get interesting.

Decriminalize Nature Does Big Pharma's Dirty Work

Decriminalize Nature (DN) is the grassroots organization with hundreds of chapters aiming to deprioritize entheogenic plant medicines in the eyes of local police and prosecutors in municipalities, cities, and states around the country and the world.

Chapters include the mothership in Oakland, Santa Cruz, Washington DC, Ann Arbor, Canada, and others.

Both DN and Measure 109 represent grassroots activism but differ in their philosophical foundations.

To put it bluntly, we might call Measure 109 'progressive' and DN 'radical’ and the philosophical divergence is best articulated as 'progressives seek to reform and change while radicals seek revolution’.

In the pursuit revolution, DN is ironically doing Big Pharma's bidding since the Portland and Eugene chapters and DN leadership are urging Oregon residents to vote 'no' on measure 109.

***There is a significant backstory that is best laid out by Lucid News here.***

The clearest depiction of the differences in approach is captured in this quote from Carlos Plazola, Chair of the National Decriminalize Nature Board from the DN Portland Press Release (emphasis added):

"We’re not against medical or clinical models, but we advocate that clinical models must only be passed subsequent to, or simultaneously with, decriminalization measures so as to not lock out the low-income and vulnerable people in society to the most effective and safest trauma healing medicines in existence”

This statement, at first glance, seems fair enough. The position has merit—the stuff grows out of the ground. People have been using plant medicines for a long time, regulation, permits, and manufacturing are just as bad as prohibition.

The other way of understanding this statement:"You're either with us or against us."

The implication is that any effort outside of the DN framework, such as commercial efforts like drug development, building clinical infrastructure and especially any other legislative action, is a perpetuation of race and class-based oppression.

The Measure 109 retort might be along the lines of: “Let's be honest, both DN and Measure 109 fall short of the shared ideal of ending prohibition by focusing on psychedelics to the exclusion of other substances—don’t let the perfect be the enemy of the good. I’ll do me, you do you."

I anticipate that after this bust-up and revelation of the DN tactics as outlined in the Lucid piece, many will have a reevaluation of the Decriminalize Nature project and a reassessment of the "best way forward."