News

Tripping Over the Details

As the law inches toward implementation, Deschutes County is considering banning psilocybin manufacturing and therapy centers

By Jack Harvel

Oregon voters chose to become the first state in the nation to allow psilocybin, AKA magic mushrooms, for use in therapy when they approved Measure 109. The bill passed in Oregon with over 55% of the vote, including 52% of voters in Deschutes County.

Psilocybin is deemed a Schedule 1 narcotic by the U.S. Drug Enforcement Administration, but a growing body of research suggests it can be used to treat addiction, depression, anxiety and post-traumatic stress disorder.

“I started hearing from some veterans and some other people with PTSD on online forums like Reddit, where I’m part of some groups. A number of people have had some really, really profound success with therapeutic psilocybin in a clinical setting,” said Ben Carnahan, a Navy veteran who has PTSD. “I’ve had a lot of experience with various treatments for PTSD myself with varying degrees of success. So I’m definitely interested in something that sounds like it’s pretty effective.”

The most common treatments for PTSD is called Eye Movement Desensitization Reprocessing, or EMDR, which involves recalling traumatic incidents while doing side-to-side eye movements or tapping one side of the body. There are also four medications recommended to treat PTSD: Zoloft, Paxil, Prozac and Venlafaxine. Carnahan’s symptoms manifest as nightmares, general anxiety and sometimes acute panic attacks that lead to an overwhelming sense of fear that can take hours to come down from. He’s tried traditional treatments that have been somewhat successful, but limited.

“For someone like me, where it seems there’s actually a diagnosis of complex PTSD, where it’s caused from multiple traumas over a period of time, EMDR can have limited success. There’s a few different drugs that I tried while I was still in the Navy. I had a psychiatrist working with me, but none of those were effective at all, and some of them made it worse,” Carnahan said.

Measure 109 will go into effect on Jan. 1, 2023, and as the deadline approaches some counties are attempting to opt out of the program. Umatilla, Linn and Jackson Counties have all approved ballot measures that would ban psilocybin manufacturing and clinical use on unincorporated county land. Voters will decide whether to approve those ballot measures in November. On June 13 Deschutes County Commissioners considered a similar proposal.

Psilocybin agriculture, processing and clinical use is already restricted in its location per Measure 109: it’s not allowed in residential areas or within 1,000 feet of a school. Any county decision would be limited to county land and wouldn’t impact psilocybin centers in municipalities like Bend and Redmond. Just six months out from the law’s implementation there are still some unanswered questions.

“The fact that Measure 109, passed a year and a half ago, and the rulemaking hasn’t been done yet, it doesn’t help a lot in terms of easing concerns about the land use impacts and implications of these kinds of facilities,” Deschutes County Commissioner Phil Chang told the Source.

County Commissioners are approaching psilocybin as a land-use issue, one that’s on the radar for counties across the state. The Oregon Psilocybin Advisory Board has met monthly since March 2021. It recommends practices to the Oregon Health Authority, and its biggest focus is in regard to safety and best practices around things like diagnosis, dosage, environment and qualifications of clinicians. The information is helpful for people on the therapeutic side but might not satisfy questions around land use.

“Somebody’s going to be able to come into the Community Development Department on the first business day of January and ask for a land use compatibility statement,” Deschutes County Commissioner Tony DeBone told the Source. “The rules are such that we don’t have any guidance, is it a conditional use? Is it an outright use? Which zones is it allowed in? Could somebody buy a farm and add some more buildings to it and call it a treatment center... but it would really be a resort day spa, psilocybin service center, so people need to think through that just a little bit.”

Local governments can restrict the time, place and manner of psilocybin services, but most rules regulating psilocybin clinics aren’t set to be adopted until December. Rather than waiting on the state’s time, place and manner guidelines, some counties — especially more conservative rural counties — are attempting to jump ship during the November elections.

“For the most part, most localities are either just taking the state’s rules or just setting some kind of basic time, place and manner restrictions in addition to wherever the state sets up. And that’s mostly because psilocybin therapy healing centers are more like going to a doctor’s office,” said Ben Unger, founder and principal of The Lab Strategies—the general consultant for Measure 109.

Unger said he hopes as more people learn about Measure 109 the anxiety around it fades. Unlike legal cannabis, psilocybin is going to be in a tightly controlled market that’s unavailable recreationally. In terms of land use, the footprint of psilocybin facilities is far lower than cannabis.

“There’s going to be very few licensed production centers; you just don’t need that many because psilocybin grows pretty easily in comparison to how people do other things indoors,” Unger said. “What we’re going to see is a few handfuls of production facilities around the state, but it’s not going to be a big number. And those facilities are going to be very small, especially in comparison to cannabis.”

The facilities themselves, too, are relatively small by comparison. Chang said he’d spoken to a local setting up a psilocybin facility that could meet the demand of Deschutes County on a small parcel.

“I was just talking to a local business partnership, who since Measure 109 passed, they’ve been working on a business plan. They have like a whole conceptual design for a facility,” said Chang. “It’s like 600 feet of production space, and then 1,400 square feet of service center for therapy rooms. That’s like a small house with a shop.”

Deschutes County Commissioners will hold a public hearing on Wednesday, July 13, to decide whether it’ll refer a ballot measure to the November election. The Oregon Psilocybin Services Section at OHA also will tackle the issue in three listening sessions scheduled for July 13-15.

The Proto-Psilocybin Industry

An Oregon law legalized psilocybin therapy, but some companies have already gotten in on the trip-sitting game

It’s common for people engaging in psychedelics to keep a sober friend nearby to make sure you don’t burn the house down, hurt yourself or do something you might regret. Somewhere between the therapeutic approach laid out in Measure 109, the Oregon law that legalized psilocybin-assisted therapy, and a sober buddy there’s a growing industry of psychedelic guides. Unlike Measure 109, psychedelic guides don’t administer mushrooms; clients must source the psychedelics themselves. They also go a step further than the buddy system by developing plans and setting expectations.

“If you’re just trip sitting, you’re basically trying to just make sure that they’re physically safe. If you’re facilitating that’s a step up of involvement from there, where you’re likely involved in their journey before it actually happens, from a preparation standpoint with intention setting, and helping them to develop tools to navigate an altered state of consciousness, what to expect, themes, all of that,” said Nick Levich, a cofounder of Psychedelic Passage, a company that facilitates psychedelic experiences.

Psychedelic Passages works under a harm reduction model, not a medical one. It exists in an unregulated space. Licensed mental health professionals could lose their license if they work with psilocybin.

“Nobody on our team is a licensed mental health professional, and we don’t claim to be. Our network of facilitators, our coaches, some had PhDs in psychology, some are registered nurses. There are all kinds of different backgrounds, and there’s no formal requirements,” Levich said.

Though the company isn’t staffed with mental health professionals, many people seeking their services are seeking an experience outside of recreational purposes. Levich said the common reasons people seek Psychedelic Passage’s service are anxiety, depression, post-traumatic stress disorder, addiction, brain injuries or self exploration.

“We have a lot of people that come to us because they’re, they’ve hit a wall in therapy, their medication isn’t giving them the release that they seek anymore, or they’re having overwhelming side effects,” Levich said.

The number of times clients return for another psychedelic experience varies widely. Sometimes there are breakthrough cases that only need one trip to overcome symptoms, but more often it can take a handful of trips to get at the root of the problem. Measure 109 will open a new avenue for psilocybin as medicine, but Levich says it likely won’t have an impact on his work.

“We don’t operate out of clinics — we make house calls primarily — and we’re working with clients who already have sourced their own medicine and are looking for us to come in and assist with their experience,” he said.

Navigation Center Opens

Shepherd’s House Lighthouse Navigation Center on Second Street connects people with case management

By Jack Harvel

Bend’s navigation center officially opened its doors on July 12, less than four months after the City of Bend approved a proposal submitted by Shepherd’s House to convert its overnight shelter into a 24-hour service center. It’s called The Lighthouse, meant to evoke a guide to safety that’s not the final destination.

The center had a soft opening in late June, when it started rolling out services. It’s funded by $2.5 million from the state through House Bill 2006 and $1.4 million through money allocated to the City from the American Rescue Plan Act. The building’s been renovated to create a space for navigation center services in what was an extra sleeping area. The area is stocked with tables to interact with other guests and case managers, computers and books.

“The sheltering services continue, and that’s where we’re providing the safe housing and food and clothing as people need it to get off the streets, and hopefully start to build relationships and be able to get to the point where they want to turn the corner and regain some things in their lives,” said David Notari, director of development at Shepherd’s House. “The Navigation Center is a concept that really provides the opportunity for that to happen in practical ways.”

The sleeping area is fitted with new bunkbeds to maintain the shelter’s capacity of about 100 guests. The Oregon legislature created the concept of a navigation center with House Bill 2006, which required them to be low-barrier, open seven days a week and provide case management, behavioral and physical health referrals, referrals for substance abuse disorders, help acquiring IDs, documentation and benefits, job training, aid in applying for housing, trauma-informed counseling and daily meals.

At The Lighthouse everyone entering the program is assigned a case manager who’ll try to find what services are most needed for each individual. Since starting case management at the beginning of June, and the opening of the day-use area on June 27, Shepherd’s House has over 65 participants in the program. There’s also been a slight uptick in people staying at the overnight shelter, according to Notari. The state’s requirements give a level of leniency to providers in implementing programs.

“That’s kind of guiding some of the data that we’re looking to track, and obviously required trainings in terms of safety and activity and trauma informed care,” said Evan Hendrix, associate director of the Lighthouse Navigation Center. “Everything else that we’re doing in regards to what’s happening here is programmatic derived from Shepherd’s House kind of culture and history and some of what we’ve learned along the way.”

That culture is collaborative, and the center is working closely with nearly a dozen partners in the public and nonprofit sectors. The increased services call for increased staffing. Shepherd’s House hired out some positions but is still reliant on volunteers.

“We’ve hired staff, which that helps, but the need for meal service is huge. Now, we’re serving over 200 meals a day. That’s a heavy lift, so we need help in those areas. The basic services that are offered, the cleanup services, the admin services, those things are always areas that we could use volunteers in,” Notari said.

Shepherd’s House’s contract with the City lasts three years and includes two possible two-year extensions.

NEWS Sluka Stepping Down

The CEO of St. Charles Health System is transitioning to an advisor role after eight years leading the company

By Jack Harvel

St. Charles Health System CEO Joe Sluka is stepping down after eight years in the role, transitioning to a strategic advisor position. He’s being replaced in the interim by Dr. Steve Gordon, a health care executive and former member of the St. Charles Board of Directors who’s served in leadership roles for PeaceHealth in Vancouver, Wash., Providence Health and Services in Portland and Salem Health.

“I am so proud of this organization and the more than 4,500 employees who put their hearts into caring for our communities every single day. This is a very difficult decision,” Sluka said in a press release. “At the same time, after leading through more than two years of a global pandemic and the corresponding recovery I feel it is time for me to step aside, recharge and provide the opportunity for new operational leaders to guide St. Charles forward.”

Sluka pointed to accomplishments like the implementation of a lean management system, construction of a new patient tower, transition to a new health record platform, and the expansion of Madras and Prineville campuses as highlights of his time as CEO. Though he’s stepping down as CEO, Sluka will remain active in the hospital system.

“I am energized to build on Joe’s legacy and advance and strengthen St. Charles despite the current challenges the health care industry faces,” Gordon said in a press release. “I will continue to work closely with Joe in his strategic advisor role and am grateful that I’ll have his support, insight and ideas moving forward.”

Sluka’s also overseen a fair bit of controversy recently. In June about 300 health care providers voted to join a union. A few weeks prior to that the hospital cut 181 fulltime positions amid a medical financing crisis that’s affecting hospitals across the nation.

Sluka will transition leadership of the health system to Gordon this week, as the St. Charles Board begins a national search for a permanent replacement.

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TASTING ROOM

A medida que la ley va en camino hacia la implementación, el Condado de Deschutes está considerando prohibir la producción de psilocibina y de los centros de terapia.

Por/By Jack Harvel / Translated by/Traducido por Jéssica Sánchez-Millar

Los votantes de Oregon eligieron pasar a ser el primer estado en la nación en permitir el uso de la psilocibina, también conocida como hongos alucinógenos, para el uso en terapia, al ser aprobada la Medida 109. El proyecto de ley fue aprobado en Oregon con más del 55% de los votos, incluyendo al 52% de los votantes en el Condado de Deschutes.

La Administración para el Control de Drogas de los Estados Unidos considera que la psilocibina es un narcótico de Clasificación 1 pero una investigación (a growing body of research) sugiere que puede usarse para el tratamiento de adicciones, la depresión, la ansiedad y para el trastorno de estrés postraumático. La Medida 109 entrará en efecto el 1 de enero del 2023 y a medida que se acerca la fecha límite algunos condados están intentando optar por no participar en el programa. Los condados de Umatilla, Linn y Jackson han aprobado las medidas electorales que prohibirían la producción de psilocibina y el uso clínico de psilocibina en condados no incorporados. El 13 de junio, los Comisionados del Condado de Deschutes consideraron una propuesta similar a esa.

La agricultura, la producción y el uso clínico de psilocibina ya están restringidos en su zona según la Medida 109; no se permite en las zonas residenciales o dentro de los 1,000 pies de distancia de una escuela. Cualquier decisión del condado se limitaría a los terrenos del condado y no afectaría a los centros de psilocibina en los municipios de Bend y Redmond. A solo seis meses para la implementación de la ley todavía hay preguntas sin responder.

“El hecho de que la Medida 109 aprobada hace un año y medio y la elaboración de normas todavía no se ha llevado a cabo, no ayuda a calmar las preocupaciones sobre los efectos del uso de la tierra y las implicaciones de este tipo de instalaciones,” dijo el Comisionado del Condado de Deschutes Phil Chang.

Los comisionados del Condado están tratando a la psilocibina como un problema en relación al uso de la tierra, que está en la mira de los condados en todo el estado. La Junta Asesora de Psilocibina de Oregon se ha reunido cada mes desde marzo de 2021. Le da recomendaciones al Departamento de Salud de Oregon y el enfoque principal es en relación a la seguridad y a las mejores prácticas en torno al diagnóstico, la dosis, en ambiente y a las titulaciones de los profesionales clínicos. La información es útil para las personas con respecto al punto terapéutico, pero puede no satisfacer las preguntas sobre el uso de la tierra. “Alguien podría acudir al Departamento de Desarrollo Comunitario el primer día hábil del mes de enero y solicitar una declaración de compatibilidad del uso de tierra,” dijo Tony DeBone, Comisionado del Condado de Deschutes. “Son tales las reglas que no tenemos pautas a seguir, ¿es un uso condicional? ¿es un uso total? ¿en qué zonas está permitido? ¿alguien podría comprar una finca y construir edificios en la finca y llamarle centro de tratamiento… pero en verdad sería un spa de día, un centro de servicio de psilocibina, es por eso que la gente necesita pensar un poco más en eso.”

Las autoridades locales pueden restringir el momento, el lugar y la forma de ofrecer servicios de psilocibina, pero la mayoría de las reglas que regulan las clínicas que ofrecerán servicios de psilocibina no se implementarán hasta el mes de diciembre. En vez de esperar que el estado nos indique el momento, lugar y las normas, algunos condados, en especial los condados rurales más conservadores, están intentando abandonar esto durante las elecciones de noviembre.

“En general, muchas de las localidades están adoptando las reglas del estado o simplemente están estableciendo algún tipo de restricciones en relación al momento el lugar, aparte de las propuestas del estado. Y es más que nada debido a que la mayoría de los centros de sanación de terapia con psilocibina van a ser establecimientos médicos,” dijo Ben Unger, fundador y director de The Lab Strategies, consultor general para la Medida 109.

Unger dijo que espera que a medida que las personas aprendan más sobre la Medida 109, la ansiedad en torno a esta desaparecerá. A diferencia del cannabis de uso legal, la psilocibina estará dentro de un mercado altamente controlado que no estará disponible para uso recreativo. En relación al uso de la tierra, la necesidad de espacio es mucho menor que la del cannabis.

“Habrá muy pocos centros de producción autorizados; no se necesitan muchos porque psilocibina crece muy fácilmente,” dijo Unger. “Vamos a ver unos cuantos lugares de producción en todo el estado, pero no serán muchos. Y esas instalaciones serán muy pequeñas, en comparasión a las de cannabis.”