🫠 Psychonaut POV

PRESENTED BY SCHOOL OF PSYCHEDELICS 🤝

Welcome to Tricycle Day. We’re the psychedelics newsletter that doesn’t care how old your meat suit is. Your ageless spirit, in its infinite wisdom, led you to reading this very email, and that’s what counts. 🫠

Mikki Vogt talks a big game about safety, but her personal journey tells a different story. She facilitated sessions before full legalization, helped write the rules, and then opened Colorado's first licensed psilocybin healing center. If you ask us, it takes a pretty healthy appetite for risk to pioneer a whole new industry, no?

We asked Mikki how psychedelic policymakers balance safety and accessibility, who’s actually showing up for psilocybin sessions, and what needs to happen next to make this market sustainable for everyone.

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How did you end up opening Colorado's first licensed psilocybin healing center? What pulled you into this work?

I'd already been working with psychedelics in the field for four or five years when we opened the center. As a therapist, I’d been following the research coming out of Johns Hopkins and Imperial College London. Eventually, I was introduced to an underground healer and got to have an experience with her that was super transformative. For me, it was the eye-opener that this is where I'm supposed to be; this is what I'm supposed to be doing.

I started doing this work with clients in my private practice who I'd been seeing for therapy for years. I was seeing profound outcomes. We were able to push past stuck points that we'd been struggling with in therapy for months, sometimes even years. It really deepened their therapeutic process and created access to a felt sense of what they'd always tried to intellectually integrate.

Inspired to bring these experiences to more people, I became a member of the Psychedelic Public Policy Partnership. I also got connected with the clinical trial team at CU working with patients dealing with cancer-related existential distress and served as a therapist on the trials. Through those groups, I co-authored the standardized safety screening that's now used in Colorado and really engaged with the rulemaking process with DORA. That gave me an opportunity to get ahead of the game, create a business plan, and think through our model for services and training. By the time January 1, 2025 rolled around, we were ready to hit the ground running.

As you said, you worked with the state agencies to build Colorado's psilocybin program. What were the biggest challenges in getting it off the ground?

What we were constantly facing was how to balance safety and accessibility. Those two things were sometimes at odds with one another. If we're adding step after step to qualify people, we're also adding cost after cost. The question became: how do we overcome creating hurdles as we're trying to remove hurdles?

The dual model in Colorado means you don't necessarily need a diagnosis or to prove medical necessity to engage with these services. So that introduced another set of questions: Can we require a background screening? Can we require access to health information? Or is this going to be a trust-based agreement with the participants? How do we encourage people to be as candid and transparent as possible without demanding information that we're not allowed to demand?

Safety was our number one priority. But from a layman's perspective, mushrooms are easy to grow, they're inexpensive, and they're everywhere. People might wonder, “why would I pay so much money to access something that I can grow in my backyard?”. So that raises another question: How do we emphasize the value of a regulated system and the value of facilitation, without claiming this is another healthcare modality to justify the cost?

One more challenge was balancing structure with adaptability. With minimal research on best practices, how do we create regulations that are rigid enough for accountability, but flexible enough that they can be shifted as we learn more about what works?

Now that The Center Origin is actually operational, what has surprised you most about how this work translates from theory to practice?

I assumed it was going to be younger individuals who showed up—people in their twenties, thirties, forties. What I have found surprisingly is that the majority of my participants are in their fifties, sixties, seventies, or eighties. Some say they’ve always been interested, and now that it's legal they feel comfortable enough to proceed. Others say they remember psychedelics from their youth, but now they’re coming with a different intention.

The other surprise has been the amount of out-of-town clients. I would say 50% of our clients have been from out of state, even out of country. One of our very first sessions was with a participant from the UK.

In Colorado, because we have this model where it doesn't have to be clinical, I expected a lot of people to come for spiritual exploration, self-expansion, or ego dissolution. That hasn’t been the case. I'd say at least 80% of our client population is clinical. They are coming because of diagnosed mental health issues, chronic pain, or TBIs.

The other assumption I got wrong was that I thought psilocybin therapy was a very progressive idea and would appeal to a more politically liberal demographic. Actually, it’s one of the most nonpartisan topics out there. It doesn't matter what side of the aisle you sit on. People are fascinated by the psychedelic experience. It transcends age, race, political viewpoint, culture, and religion. There are very few things in our world that bring people from all walks of life together for a relatable experience.

You mentioned co-authoring Colorado's standardized safety screening tool. What red flags are facilitators watching for? When do you turn someone away from a psilocybin session?

There are luckily very few absolute red flags. You can't participate if you're taking lithium. That’s a hard contraindication. I would not advise using psilocybin if you have a personal history of psychosis, either, especially if you've had psychotic responses to other substances or been hospitalized for psychosis.

Active suicidal ideation within the last 30 days is another hard line for me. That doesn't mean they're ineligible forever, but it does mean they need to be stabilized using some other modality first. Psychedelics often remove existential distress from the idea of dying. So if you've got somebody who is actively suicidal, they can either come out reconnected, feeling part of something greater, which is beautiful, or we remove the one stop gap that has prevented suicidal action: the fear of death.

Alcohol dependence requires significant consideration, too. If you're in a session for five to eight hours and not drinking, that could put you in acute withdrawal syndrome. With psilocybin, we're lowering the threshold for seizures and increasing stress on the body. Another rule-out is severe and unmanaged cardiovascular history. Psilocybin raises blood pressure, so unmanaged hypertension or a history of cardiac events is concerning.

We created a response tool that goes along with the safety screener. If someone endorses a risk factor, what's next? Do you need to refer? Is this within your scope? This is especially important for non-clinical facilitators who don't have intake triage training. It gives them the next step-by-step, so there's no guesswork about the appropriate response.

Colorado's program is still brand new. What needs to happen next to make this sustainable and accessible?

Education, education, education. By that, I mean providing foundational information not just to the general public, but to providers who may not be implementing psychedelic therapy in their own practice but need to be familiar with what it is, what it isn't, and who might be a good candidate. There's a lot of hype and sensationalism out there, which means providers will inevitably have clients coming to them asking questions. They need to be prepared to field those questions and provide guidelines on how to access these services safely.

Promoting accessibility is also huge. We need to get psilocybin therapy mainstreamed into our healthcare continuum to make it accessible to high-need populations. These are often people using Medicaid, who don't have insurance coverage, who don't have an extra couple thousand dollars lying around. Those are often the people who would benefit most from this experience.

Then, taking the longer view, we need to be gathering the right data now in this applied setting to eventually show the FDA. They’ll want to know, based on real-world evidence, what the true risk factors are. Broader education and more robust data are the key levers right now. That's what will allow us to offer these services even more safely, effectively, and accessibly.

Want more from Mikki?

Learn about The Center Origin’s process for journey work and consultation program for current and aspiring facilitators.

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DISCLAIMER: This newsletter is for educational and informational purposes only and is not intended as a substitute for professional medical advice. The use, possession, and distribution of psychedelic drugs are illegal in most countries and may result in criminal prosecution.