Psilocybin in Oregon may help address fears of death, but people can’t always access it

When Alison Grayson first met John, she was struck by his enduring sense of humor. Amid terrible nausea from chemotherapy, he still cracked nerdy jokes.

“When somebody is approaching a terminal diagnosis and end of life, but is still able to maintain that sense of humor and that individuality — he was just so thoroughly himself, and that holds space in my heart very much,” Grayson said. Working with John as a death doula, Grayson tried to help him find peace amid anxiety over reaching the end of his life. (John’s name has been changed to protect his medical privacy.)

Some studies have found that people with terminal cancer diagnoses can feel closure or comfort after taking psilocybin mushrooms. Grayson, who is licensed to guide people through psilocybin experiences under Oregon law, thought John might benefit from the experience as well. John was intrigued, and Grayson started the intake process for him to become one of her psilocybin clients. He would first undergo a screening session, and then, per state law, he could receive psilocybin at a licensed center.

Grayson waited for John’s symptoms to relent, a day when he might feel well enough to travel to a licensed service center, she said as she sat cross-legged in a plush, mid-century chair on the second floor of an old Craftsman in Portland’s Sellwood neighborhood. The house was a salon and a marijuana dispensary before becoming a psilocybin service center called Project Circle — one of the licensed locations where John could have had a session.

“We had everything lined up, but that window just never opened up for him,” Grayson said. John died weeks later. “If there were reasonable accommodations in place and I was able to serve him at his house, it would have been a different situation.”

Now, as the state’s psilocybin program is poised to enter its third year, facilitators are seeking ways to make the drug more accessible to a wider swath of the public — especially those they feel could benefit most from a psilocybin experience. Grayson is one of four facilitators who have brought a federal lawsuit against the Oregon Health Authority, alleging the agency’s psilocybin services program violates the Americans with Disabilities Act. According to the suit, two of the providers contacted OHA last year, asking for accommodations for people whose conditions prohibit them from traveling to a service center. OHA replied that home use is not allowed under state law.

Measure 109, a ballot initiative Oregonians passed in 2020, specifically dictates that people can only legally consume psilocybin in licensed service centers under the supervision of trained, licensed facilitators. Psilocybin trips can be intense experiences; consent forms require clients to acknowledge they may find the experience “challenging” or “uncomfortable,” and many people report seeing deceased loved ones, angels, or even God. The state’s psilocybin program also requires clients to undergo medical screening and a preparatory session before embarking on a supervised 6 to 8-hour trip. Afterward, they’re required to have at least one “integration” session to discuss the experience.

“Those safety precautions and the legalities in place are really beneficial,” Grayson said — but only if you’re able to get to a service center. If facilitators like Grayson provide psilocybin to clients outside of those centers, they could lose their licenses, their jobs, or even face federal criminal charges.

When leaving home is a ‘hardship’

John was among tens of thousands of Oregonians whose conditions may prevent them from traveling to service centers.

Psilocybin facilitator Kathryn Kloos, another complainant in the case, had a client who died before receiving psilocybin. Of the clients she’s seen at service centers, she said many would have been more comfortable had they been allowed to receive the drug at home or in hospice. For example, one client with Parkinson’s disease needed help using the bathroom and would have been more comfortable in a bed rather than the mats available at the center where she works.

“It was a hardship for him just to get to the clinic,” Kloos said.

Facilitators are not always trained to address the medical needs of patients with disability or illnesses, which can make their visits to service centers more difficult. Even those with appropriate medical training are prevented by program rules from acting in any capacity outside a facilitator role. (Those rules also limit touching clients.)

Jay Cusker, another complainant, recalled one of his early clients, who had a colostomy bag. During the trip, the client became agitated and the bag came open; Cusker thinks this could have been avoided through home treatment, which can reduce clients’ overall anxiety and the logistics they must juggle.

At Project Circle, the Sellwood psilocybin center, employees are trying to make as many ADA accommodations as they can: There’s a ramp connecting the sidewalk and front door, session rooms on the first floor, and mats placed on the floor for comfort and easier movement. But there’s only so much facilitators can do, and Project Circle co-founder Tracy Townsend said she sees few downsides to creating more avenues for people to access psilocybin, like allowing for use at home or in hospice centers.

“This is more a lack of imagination so far, rather than anyone who’s specifically opposed to such a change,” she said.

An unclear path to change

People involved with the Oregon Psilocybin Services’ rules-making process have long been aware of the issues. According to Oregon Psilocybin Advisory Board chair Angela Carter, the board — which recommended the rules that the program now uses — discussed the issue of disability accommodations as early as 2021, but “it got put on the back burner” as the group spent two painstaking years drawing up the program’s initial rules. The issue arose again at advisory board meetings held in early 2024, during which board members who work in end-of-life care discussed whether psilocybin might be provided in other settings.

“I think the whole board is open to the idea of — with the right safety measures in place — having people have a variety of different access points,” Carter said. “We even talked about mobile psilocybin facilitation centers at one point, but it’s not within the confines of current statutes.”

The Oregon Health Authority declined to comment on the use of psilocybin and end-of-life care due to the ongoing litigation.

The suit illustrates the tension between Oregon’s psilocybin program, in which regulated, supervised use of the drug is state-legal, and federal law, where psilocybin is still very much illegal. In September, the state’s attorneys filed a motion to dismiss the suit, saying federal court is not the right avenue for it — and that ordering the state to make disability accommodations for psilocybin services would “be an order requiring Defendants to allow Plaintiffs and others to violate federal law.” So far, there has been no indication the federal government intends to intervene in Oregon’s program, but should the plaintiffs succeed, it could attract newfound attention from federal authorities.

If the case is dismissed, the plaintiffs’ other options are even more challenging: They would have to convince legislators to introduce a bill or collect thousands of signatures for another ballot measure.

“While legislative reform is an option to cure the discriminatory exclusion of homebound disabled and dying people, no such legislative fix has been introduced,” said Kathryn Tucker, an attorney for the case’s plaintiffs. “A court has the power to mandate reasonable accommodation under state and federal disability rights laws, and that is the relief plaintiffs seek in Cusker versus OHA.”

While Grayson and the other facilitators are focused on disability accommodations for those with advanced or terminal illnesses, ADA protections also apply to people with a wide range of mental and physical disabilities, including ADHD and autism, PTSD, schizophrenia and depression. Should the court rule that OPS is in violation of the ADA, people with those conditions could be eligible to request psilocybin sessions in alternate locations. That’s because federal law requires public entities to ensure that people receive “reasonable accommodations” to access services.

“The only exception would be if there’s some kind of an undue burden, or that the accommodation being requested would fundamentally alter the nature of the services being provided,” said Michelle Uzeta, deputy director of the Disability Rights Education and Defense Fund. In other words, if providing accommodations is too cumbersome or drastically changes the services OPS provides, it could be exempt from making them.

What constitutes an exception is up to the courts to adjudicate, but facilitators agree that adapting psilocybin services for use outside a service center would at least require some crucial alterations and safeguards. For starters, regulations would need to create a way for psilocybin products to be transported to the session’s location. Current rules dictate how to transport products between a manufacturer and service center, and do not allow transportation to care facilities or private homes. Facilitators also can’t touch the product; a licensed worker at the center provides mushrooms to a client.

“If you were doing it at someone’s home, someone would need to prepare the tea or give clients the dried mushrooms, so at least a couple people would need to go to someone’s house,” Cusker said.

Alternative environments may also create complications for complying with existing safety regulations.

“If someone were to have firearms in the house, they need to be locked. If there are knives in the kitchen, they need to be put away,” Carter said. Perhaps children should not be in the house, and per other state laws, administration can’t take place within 1000 feet of a school or day care center. “There are a lot of considerations that might make certain places more difficult.”

But the trade-off could be worth it, Carter added. If people feel more comfortable in their own home, it could lead to a better overall experience.

“It’s just a matter of making sure that all of the other safety measures are in place,” they said. Carter suggested that mobile facilitation spaces, or giving a hospice location or home a temporary service center license, may get around some of these issues.

Without any changes to Oregon’s laws, people with severe or terminal illnesses have few options if they want to experience psilocybin. As a result, some are turning to underground drug sources and guides.

“There’s no safety precautions in place,” Grayson said. “Good work can happen underground, but a lot of people who are doing underground work aren’t necessarily doing it in a way that provides the highest level of safety for their clientele.”

For Uzeta, the disability lawyer, this psilocybin lawsuit is important regardless of people’s personal opinions on psychedelic use. “It really is a reflection of a bigger issue, which is that our health care system doesn’t necessarily accommodate people with disabilities,” she said. “We need to be thinking about ways to ensure that there’s equity in health care.”

Grayson hopes that her participation in the suit helps terminally ill people gain options for trying psilocybin. She didn’t have the chance to guide John through a psilocybin session, but she feels that fighting for others’ rights to access psilocybin is a way of honoring his wishes. “I feel like I’m carrying the legacy of my patients who didn’t have a chance to become clients,” she said.

Correction: A previous version of this story misspelled Alison Grayson’s name. OPB regrets the error.