🫠 Psychonaut POV

Welcome to Tricycle Day. We're the psychedelics newsletter that follows the letter of the law. Spiritually, however, we remain ungovernable. 😤

Tasia Poinsatte is a stickler for the rules. Not in the middle-school-hall-monitor kind of way. It’s just that, as Colorado Director of the Healing Advocacy Fund, she’s seen all the sneaky ways regulatory language can determine who gets access to psychedelic medicine.

We asked Tasia what Colorado learned from Oregon’s rollout, how she’s trying to keep psilocybin therapy from becoming a luxury product, and what she wants other states to steal from Colorado's playbook.

Everyone's got opinions on psilocybin. And opinions are valid.

But we like data.

Do you have to quit your antidepressants first? Is it safe if you're carrying trauma? What are the odds it goes sideways?

Ask around and you'll get a dozen different answers. Ask for a source, and they’ll hit you with the “trust me, bro.”

So on Friday, we’re sitting down with Althea's Niko Skievaski to dig into those questions and more from an evidence base of thousands of real-world psilocybin sessions.

Come join our conversation. It’s free, and the live chat is already humming.

I was working with a political consulting firm out of Denver, where I supported candidate campaigns and ballot initiatives, mostly in Colorado but also in other states and internationally. In that capacity, I worked on the campaign to pass Proposition 122. That was my entry point, which sparked a personal interest in psychedelics, especially their therapeutic applications.

Around that same time, I learned about an opportunity with the Healing Advocacy Fund to help stand up Colorado's regulated program if Prop 122 passed. Healing Advocacy had already been active in Oregon since 2020, helping to build its psilocybin framework after Measure 109 passed. The focus was on bringing in the right stakeholders to make sure the framework could benefit people, while minimizing the risks of causing harm.

When Colorado passed Prop 122, the idea was to bring that same approach here and connect it to real-world learnings from Oregon. Oregon's program wasn't even live yet, which meant we'd be in conversation with them as they rolled out and apply what we were learning in real time. Getting safety right was a priority, but so was thinking creatively about equity and access.

A big piece was integrating psilocybin therapy with other mental health and wellness options from the outset. Oregon initially required mental health providers to set aside their clinical credentials while working in the psilocybin program. Colorado didn’t have that restriction. We wanted mental health providers to fully embrace this modality, with the professional and legal protections to talk openly with their patients and clients.

Another consideration was location flexibility. In Colorado, psilocybin therapy can take place at a therapist's office or at a psychiatric clinic that primarily offers other modalities but wants to add psilocybin as an option. That really brings down the overhead for some of these centers. You don’t have to stand up a separate brick-and-mortar just for psilocybin therapy.

Oregon has since incorporated some of those ideas into its framework, so both states now have a more integrated model. That kind of cross-pollination is necessary, because regulatory language can easily restrict things nobody intended to restrict. The first rules in Colorado, for instance, said no one under 21 could ever be present at a licensed location. All of a sudden, a therapist who works with children can't participate, not because they're giving kids psilocybin, but because a child might walk into the office. The deeper you get into it, the more you realize those things are everywhere.

There are a few pieces we specifically advocated for and got into the rules. Allowing group sessions is huge. The SB303 data out of Oregon shows group sessions are becoming an increasingly large proportion of total sessions there, and that's a significant way to keep costs down per individual. Allowing remote preparation and integration was also critical, because without it, out-of-state clients would face a major additional barrier.

Right now, the state programs are the only place where people can access psilocybin therapy at scale. Facilitators can only lower their prices so far and still make a living, and you don't want people practicing who can't take care of themselves, because that compromises the quality of care. So the goal is figuring out which costs we can reduce without compromising the safety foundation, and long term, building an evidence base strong enough to attract institutional investment, state funding, and eventually insurance reimbursement.

The case to insurers is that covering psilocybin therapy saves money downstream through reduced emergency service usage and lower healthcare costs. For employer-sponsored plans, the rationale can also include increased productivity, reduced absenteeism, and lower employee churn. Psilocybin therapy already compares favorably on cost to a lot of treatments that are covered by insurance, and companies like Enthea are already piloting ways to bridge that gap in Oregon.

Part of it is having as lean a regulatory structure as possible without compromising safety. But there's also a communications piece. It's important for people to understand that the facilitator and the support they provide is part of the therapy, not a supplement to it. There's a real skill set involved, and it takes a lot of hours to facilitate responsibly and well. The more we can communicate that effectively, the more we'll see a shift in how people think about investing in this kind of care.

I've spoken with people for whom the cost seemed high up front, but after the experience and seeing the changes in their life, they said it was worth every penny. I've also talked to friends who've gone to centers with sliding-scale pricing, and they’ve chosen to pay on the higher end because they have the means to do so and want to support providers that care about access. That model creates space for folks for whom cost is a genuine barrier.

Realistically, there isn't going to be a silver bullet that makes this equitable overnight. We're building something that hasn't been built before, that's still federally illegal, and that faces all the barriers that come with that. It's not going to be accessible to everyone out of the gate, but we have a plan for getting there.

One big lesson from Oregon is the value of planning for data collection from the start. Oregon implemented a data program after the fact, but Colorado has been building a more robust version from day one, starting with a pilot de-identified database in the Department of Public Health and Environment, with multiple state agencies investing time and expertise in getting it right. The goal is to roll that out this October so we can understand who is accessing care, for what reasons, and what outcomes they're seeing, without compromising anyone's privacy.

Oregon has already proven that psilocybin therapy can be done safely and benefit people in real-world contexts. Colorado's data program should strengthen that case significantly, and I'd encourage every future state to prioritize building similar infrastructure, because the evidence base is ultimately what's going to shift the conversation at the federal level.

I also hope future states emulate the flexibility Colorado has created around participation by mental health providers. There's still a lot of room to experiment, too. I'd love to see states let therapists offer psilocybin at their existing offices without requiring a separate location license. Colorado just passed a temporary premises option that lets healing centers hold sessions at outside locations, which opens the door to retreat settings. And there's an ongoing conversation around allowing more forms of supportive touch during sessions, which could be really meaningful for pain patients and people with neurological conditions who are often left out of this conversation entirely. The more flexibility we can build around a baseline of safety, the better.

Check out Healing Advocacy’s explainers on Oregon’s and Colorado’s psilocybin programs, or sign up for their newsletter.

That’s all for today, Cyclists! Whenever you’re ready, here’s how we can help.

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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.