Oregon’s first psilocybin facilitators are eager to deliver therapy

In a former church on a rural slice of land in Clackamas County, the first ever psilocybin facilitators in the U.S. are attending their last day of classes.

These are the trained practitioners who will help people in Oregon take psychedelic mushrooms under the state’s soon-to-launch psilocybin program.

While they’ve learned a great deal about psilocybin over the last six months at InnerTrek school, there are still plenty of unanswered questions. Where will they find work? There won’t be any licensed service centers open until at least this summer. How much will psilocybin facilitators make? Some say $80,000 per year, others predict much less. And will their workplaces be raided by federal authorities? Psilocybin remains a Schedule I illegal drug.

But for now, the group is mostly focused on ethics.

Teacher Gina Gratza sets up a scenario where a woman who has just taken psilocybin becomes agitated. She’s shouting, “Get away. Get away!”

“After 20 minutes, she begins to rock herself back and forth. She begins to calm her system. She looks up at you and asks you to put your hand on her stomach. What do you do?” Gratza asks the group.

A male student says he definitely would not touch her. The Oregon Health Authority dictates facilitators are only allowed to touch a clients’ hands, feet or shoulder. The students have been taught that touch feels unusually significant during the heightened sense of awareness that comes with psilocybin consumption. And there have been reports of inappropriate touching during sessions with psychedelic substances.

Another student says she’d tell the client that they could each touch their own stomachs and then they could hold hands.

“That’s a beautiful response,” Gratza says.

These psilocybin facilitators are being trained to usher people through the process of taking the hallucinogenic drug, from an initial interview, where they say what they’re hoping to get from the facilitation, to a meeting afterward to discuss how participants change their approach to life as a result. Because this is the first class ever to graduate in Oregon, these students are setting the tone for the future.

They’ve learned all kinds of things about psilocybin: from the ethics of touch to mushroom dosing.

“We had a whole class on informed consent. We had a whole class on trauma informed presence,” said 79-year-old student Lusijah Marx, who is a clinical psychologist.

Marx started her career as a nurse in Iowa, then became a nurse practitioner with OHSU. For years she’s been a psychologist with the Portland nonprofit Quest Center for Integrative Health, which provides health care to low-income individuals.

She said her cohort of students contains doctors, nurses, grief counselors, family therapists, social workers and naturopaths, as well as people who haven’t been in the health care field, like a real estate agent and a software engineer.

But what they all have in common, she said, is a belief that psilocybin can be an effective treatment for maladies like depression, anxiety and post-traumatic stress disorder.

Each of the 107 students at InnerTrek school paid about $8,000 for the six-month course. InnerTrek was set up by Tom Eckert, one sponsor of the 2020 ballot measure that legalized psilocybin therapy.

“What’s revolutionary here in Oregon is this is not just piggybacking on the medical model or a different profession,” he said. “This is a new ecosystem.”

Measure 109 directed the Oregon Health Authority to license the manufacture, transportation, delivery, sale, and purchase of psilocybin for therapeutic purposes or personal discovery.

Most of the InnerTrek students paid an additional $3,000 to take a trip to Mexico, so they could consume psilocybin legally.

Marx said she took the trip and the drug hoping to think about the pros and cons of a new career as a psilocybin facilitator. Instead, she found herself focusing on her conservative upbringing.

“I was looking at my Scandinavian, Midwestern roots, the amount of rigidity around work, and being productive, and being quote: ‘A good person,’” she said.

Marx saw herself in a rigid cage. “What came to me in my psilocybin experience was ‘spacious ease.’ You can live with spacious ease.”

She said psilocybin gave her permission to stop during the workday and enjoy the moment.

“There’s a lighter way of living. I love it,” she said.

Now that her classes are done, Marx has taken InnerTrek’s final exam. Next, she’ll need to pass the state’s official licensing test.

“It’s like how many grams can a person receive? And what are the rules around touch? And if you were going to do a group, how many people could be in it? There’s just a lot of different rules,” she said.

Marx expects to pass. The problem she sees is if she starts dosing people with psilocybin, she might get in trouble with federal authorities, the Oregon Psychology Board or her employer, the Quest Center. She can’t use psilocybin at Quest because it receives federal funding via Medicare and Medicaid.

So, Marx has come up with a work-around. She’s hoping to work with Quest to use another psychedelic, ketamine, which is legal for use by registered medical practitioners and can put a patient in an altered state of mind. It’s widely used as an anesthetic.

By using ketamine instead of psilocybin, Marx won’t have to worry about federal raids. She won’t be able to fill insurance claims for the drug because she’ll be using it off-label, but she will be able to bill insurance for therapy and other aspects of the work, if Quest Center agrees to move forward.

Insurance isn’t paying for psilocybin therapy at this time.

Still, within a year, Marx hopes to be involved in a psilocybin therapy center with other InnerTrek graduates, once they have seen how the legal issues play out.

For Marx and many new facilitators, this work is not about money. They think psilocybin therapy will be a game changer for intractable medical issues like post-traumatic stress disorder, depression and anxiety. They say they especially want to make sure marginalized people can get services. But, Marx said, they have wondered about potential wages.

“One person calculated it out, (and) said, ‘I’d probably make the same amount of money as I might as a barista,’” she said.

While that student estimated they’d make roughly $35,000 a year, InnerTrek is more optimistic, telling students someone could make up to $80,000 depending on how many clients they see.

Gratza, the InnerTrek teacher, said salaries are just one of many unknowns in this brand new system.

“It’s not like regular therapy,” she said. “You’re in there for six hours and depending on someone’s experience, it may make you feel like, ‘I need a few days off before the next one.’”

Being a new industry, there is plenty of uncertainty surrounding psilocybin therapy. On March 1, the Netherland’s-based Synthesis Institute notified its students in Oregon that the business was out of money and that their education was being indefinitely paused before a single student had graduated.

Students like Lesley Clarke, who paid $9,600 for the course, are now unsure if they’ll be able to find work, and what the collapse of a major education provider means for the psilocybin field.

“It’s not just about what’s happening to the students, it’s about what happens period,” Clarke said.

Oregon legislators, too, are anxious to know what’s going to happen with the state’s psilocybin experiment. State Sen. Elizabeth Steiner, D-Portland, has introduced Senate Bill 303, which would create a voluntary, anonymous data collection system.

“We’re on the cusp of having more psychedelic research and evidence around outcomes, being conducted in one year, than has happened in the last 50 years,” said Nathan Howard, InnerTrek’s director of operations.

Hundreds of psilocybin facilitators from around the state have now graduated or are near the end of their programs.

Meanwhile, everyone is waiting to see how many service centers the Oregon Health Authority will license and where they will be.

And answers to many of the students’ questions about their role in Oregon’s psilocybin therapy system won’t come until this summer, when they can begin administering their first doses to clients.