Welcome to the penultimate installment in my write-up of the proposed Oregon psilocybin program rules. This post focuses on facilitators and related client matters. It does not canvass the already-adopted rules related to facilitator licensing, which we covered back in April. As with earlier installments in this series (see links below), this post will highlight the major areas and skip or skim less prominent material.
The Oregon Health Authority (OHA) program has but one “personal” class of license: facilitators. The draft rules define “facilitation” as “the provision of services to a client by a licensed facilitator during a preparation, administration, or integration session.” The idea here is that someone who is 21 years old and wants to try psilocybin (for any reason) goes through a standard process under guidance by an OHA licensed facilitator, who need not be a doctor or therapist or health care practitioner of any sort. In fact, the rules are clear that “if a facilitator holds a professional license in another field [such as diagnosing or treating physical or mental health conditions] the facilitator shall not exercise the privileges of that license while providing psilocybin services to clients.”
The facilitator licensing fee clocks in at $2,000 annually – beyond what must be paid for training – and is therefore too expensive. Veterans and people on public assistance pay $1,000, but still. Either fee is more than what I pay for lawyering, and way more than what doctors pay annually for licensure. Expect to see some comments on this issue.
Beyond that, below are some of the rule highlights around facilitators and dosing.
Preparation Session Requirements (333-333-5000)
A facilitator must complete a “preparation session” with every client who will consume psilocybin at a licensed service center. The session must occur “at least twenty-four hours but no more than 90 days” prior to the first administration (psilocybin dosing) session.” These preparation sessions are private affairs where certain information is provided and ascertained, including critical client forms I covered in a previous post.
Additional items that must be sussed out in a preparation session are: 1) the price the client will pay for the psilocybin products (to the service center), and 2) the fees charged for the provision of services. These fees may be paid either to the service center or the facilitator. The chosen payment arrangement will have significant income tax implications under the dreaded IRC 280E for both the licensed facilitator and service center. That’s a much bigger conversation and I’ll cover it in a future post.
Other matters which may be arranged via “prior written consent” in the preparation session are:
- participation in a group administration session, including the opportunity to meet other clients and facilitators;
- use of supportive touch during an administration session;
- video or audio recording of an administration session;
- participation in a training practicum;
- the presence of an interpreter or client support person;
- client data sharing; and
- the use of different facilitators in any of the preparation, administration or integration sessions.
After completing the initial preparation session, no additional sessions are required to conduct any other administration session with a client over the ensuing 12-month period. The sole requirement is confirmation by the facilitator prior to each ensuing session, that the client’s information is still accurate.
Group Preparation Sessions (333-333-5020); Group Administration Sessions (333-333-5230)
Yes, you can go try psilocybin under supervision with your friends. Or with a bunch of strangers (up to 25 of them!) if you think that would be interesting. The role of facilitators in these sessions is to arrange for the various clients and co-facilitators to meet ahead of any administration session. If the session is to commence, then the rules set out certain client-to-facilitator ratios. These ratios depend upon how much psilocybin is consumed: at the lowest level of up to 5mg, the minimum facilitator-to-client ratio is 1 to 16; for 30 to 40mg of psilocybin, the ratio is 1 to 2. When you get between 40 and 50 mg, it’s 1 to 1.
In group sessions, there must be ample space for everyone to participate “without touching or coming into close physical contact with other clients.” In fact, no touching is allowed even with consent, unless it’s “supportive touch”, as that term is defined, and with prior written consent.
Anyone who wants to check out of an ongoing group session in favor of an individual session is allowed to do so, and no one can join once a session has commenced.
Consumption Limits (333-333-5240); Duration of Administration Session (333-333-5250)
So, OHA is going to allow people to try any amount up to 50 mg of psilocybin during an administration session. NOTE: that doesn’t mean 5mg of cubensis mushrooms. It refers to the weight of the psilocybin, only. This 5 mg – 50 mg range is the standard for both individual sessions and group sessions. If you’d like a handy chart and overview on the cubensis dosing curve, go here.
The length of an administration session correlates to how much psilocybin is consumed. At the low range, when a total of 5 mg of psilocybin or less is consumed, the minimum administration duration is an hour. At the high end, for “greater than 35 mg and up to 50 mg of psilocybin”, the minimum session duration is 6 hours. Facilitators are required to record the start and stop time of each session, and if one must continue beyond 11:59 p.m. – despite the general prohibition on this – a report must be made to OHA.
Integration Session (333-333-5250)
An “integration session” is the term for a meeting between facilitator and client that occurs sometime after the administration session. These are optional for clients. If an administration session occurs, facilitators must us a “non-directive approach.” This means the facilitator must “maintain a consistent disposition with the client, while avoiding giving the client direct advice or directly interpreting a client’s statements or behaviors.” Remember: it’s not therapy!