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By: Kathryn Tucker, JD[1]

Background

We have been leading efforts to open access to the investigational psychedelic drug psilocybin for therapeutic use for patients with life threatening illness through state and federal Right to Try (RTT) laws.[2] RTT laws recognize that these patients do not have the time to await the slow process of new drug approval to be completed and allow access so long as an investigational drug meets certain criteria, including that it has successfully completed a Phase I clinical trial and remains under investigation.

On behalf of Dr. Sunil Aggarwal, a Seattle palliative care physician, and a number of his patients with advanced cancer, we contend that RTT laws provide that these patients ought be able to access psilocybin for therapeutic use now, before completion of later stage clinical trials or the long process of rescheduling.[3] Psilocybin meets the requirements of RTT laws to be deemed an ‘eligible investigational drug’; under the letter and spirit of these laws, it is intended to be available for this population of patients while still under investigation.[4]

This advocacy effort seeks to open a path for access to psilocybin (and potentially other investigational psychedelic drugs, including MDMA) for therapeutic use, bringing a powerful new palliative care tool to relieve debilitating non-physical suffering for those with life-threatening conditions.

The Federal Litigation on the Scope and Application of RTT Laws

Dr. Aggarwal was denied permission to access psilocybin for therapeutic use by the DEA in early 2021. He then filed suit in the Ninth Circuit Court of Appeals in early 2021 asserting the DEA had the obligation to accommodate RTT as the law of the land.  The court declined to reach the merits,  ruling that the DEA’s rejection of the request for access was not sufficiently ‘final’ to enable judicial review.[5] Following that ruling in January 2022, we submitted both a Petition Requesting Waiver, to elicit a sufficiently final decision to enable judicial review, if necessary, and a Petition to Reschedule psilocybin from Schedule I to Schedule II.[6] On June 28, 2022, the DEA again rejected access to psilocybin pursuant to RTT in response to the Petition Requesting Waiver. Accordingly, we return to the Ninth Circuit, seeking assignment to the same three-judge panel, to reach the merits and ask the court to compel the DEA to accommodate RTT.

The Freedom of Information Act (FOIA)

Due to the DEA’s failure to timely respond to these Petitions, we filed a number of Freedom of Information Act (FOIA) requests related to its handling of the Petitions, seeking disclosure of documents which would provide reasoning for such failure. These FOIA requests were labeled “unusual” and “complex”, despite their narrowness; accordingly, we have filed a lawsuit challenging the DEA’s unlawful pattern and practice in labelling virtually all FOIA requests in this manner, which subverts good government and principles of transparency pertinent to the operations of federal government agencies.

An amendment to the federal RTT has been introduced in the US Congress to make abundantly clear that eligible investigational drugs which are Schedule I substances are to be accessible pursuant to RTT, notwithstanding any prohibitions on dispensation, use, transportation, and distribution in the Controlled Substances Act.[7]

[1] Special Counsel at Emerge Law Group, Co-Chair Psychedelic Practice Group. Founding board member of the Psychedelic Bar Association, Co-Chair, Litigation and Advocacy Committee.  Liaison to the American Bar Association. Founding Advisory Board Member, the Initiative on Psychedelics and Healing, Global Wellness Institute.

[2] These laws have been adopted by 41 states and the U.S. Congress. A tremendous efficiency of this advocacy is that it takes advantage of and utilizes the benefit offered by these already existing laws. To give some perspective: enactment of a single state law to open access to psilocybin in a state with a relatively small population costs approximately $5M (e.g. Oregon M109, 2020).

[3] Media interest in the case:  https://www.truffle.report/seattle-doctor-lawyer-speak-out-on-landmark-dea-psilocybin-lawsuit/https://www.seattletimes.com/seattle-news/health/new-legal-push-in-washington-state-aims-to-speed-magic-mushrooms-to-dying-patients/https://www.marijuanamoment.net/8-states-side-with-cancer-patients-in-psilocybin-mushroom-lawsuit-against-dea/; https://www.scientificamerican.com/article/two-cancer-patients-battle-to-make-psilocybin-accessible-for-palliative-care/ ; https://www.ourmbclife.org/episodes/psilocybin-assisted-therapy-legal-and-advocacy 

[4] For more extensive discussion about RTT laws and their application to psilocybin see https://emergelawgroup.com/avenues-to-access-psilocybin-therapy-in-oregon-a-new-palliative-care-tool-for-patients-suffering-anxiety-and-depression/; https://emergelawgroup.com/nations-first-legal-challenge-to-allow-psilocybin-therapy-in-end-of-life-care-under-right-to-try-laws-moves-forward/

[5] Advanced Integrative Med. Sci. Inst., PLLC v. Garland, 24 F.4th 1249 (9th Cir. 2022).

[6] Both can be reviewed here:  https://emergelawgroup.com/establishing-a-pathway-to-access-psilocybin-for-use-with-patients-with-advanced-illness-update/.

[7] The “Right to Try Clarification Act”.

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By Kathryn Tucker, JD[1]

In January 2021, Dr. Sunil Aggarwal, a respected palliative care physician and founder of the Advanced Integrative Medical Science (“AIMS”) Institute in Seattle, sought authorization from the DEA to obtain psilocybin for therapeutic use with his dying cancer patients. Psilocybin is an investigational drug shown to be remarkably effective in relieving debilitating anxiety and depression suffered by terminally ill patients. The Washington and federal Right to Try (“RTT”) Acts provide for dying patients to have access to investigational drugs that have completed Phase I clinical trials and remain under investigation, recognizing that these patients do not have the time to await the slow process of new drug approval.

Because psilocybin is a Schedule I controlled substance, no supplier would provide psilocybin to Dr. Aggarwal without DEA’s approval. In February 2021, DEA rejected Dr. Aggarwal’s request for access.  This decision contravened RTT laws; accordingly, Dr. Aggarwal sought judicial review of DEA’s determination in the United States Court of Appeals for the Ninth Circuit. Extensive briefing, including amicus participation by a multitude of parties ranging from Cato Institute and ACLU, and a bipartisan group of States, was submitted. Oral argument was heard in September 2021. The court dismissed the petition on January 31, 2022, concluding that DEA’s rejection of Dr. Aggarwal’s request was not sufficiently “final” for purposes of judicial review, hence the court lacked jurisdiction to reach the merits.[2]

Following the ruling Dr. Aggarwal immediately requested that DEA provide a “final decision” on this urgent matter, so that he could either be granted access and provide care to his patients with this investigational drug or return to court. By letter issued on June 28, 2022, the DEA, again, rejected access:

“This latest request effectively restates the grounds that you previously submitted to DEA…. Accordingly, DEA considers your latest correspondence as a request for reconsideration of the agency’s letter to you dated February 12, 2021. DEA finds no basis for reconsideration of its February 12, 2021, letter because the legal and factual considerations remain unchanged.”

This June 28 letter seems to fly in the face of the agency’s argument in the litigation that it had not issued a final decision. It appears to be the agency doubling down on a decision that no access pursuant to RTT would be granted. In an abundance of respect to the administrative process, Dr. Aggarwal has asked the DEA to confirm that its June 28 letter is indeed ‘final agency action’ so that there can be no doubt about this when we return to court.

If we must return to court we will ask that the same three judge panel hear the case, as the issues were fully briefed and argued to that panel in 2021. We will seek expedited review, because of the urgency presented by the inexorable progression of terminal illness faced by Dr. Aggarwal’s patients.

[1] Special Counsel at Emerge Law Group, Co-Chair Psychedelic Practice Group. Founding board member of the Psychedelic Bar Association, Co-Chair, Litigation and Advocacy Committee.  Liaison to the American Bar Association. Founding Advisory Board Member, the Initiative on Psychedelics and Healing, Global Wellness Institute.

[2] See RCW 69.77 et seq. (Washington RTT); Trickett Wendler, Frank Mongiello, Jordan McLinn, and Matthew Bellina Right to Try Act of 2017, Pub. L. No. 115-176, § 1, 132 Stat. 1372, codified at 21 U.S.C. § 360bbb-0a (Federal RTT).

[3] AIMS v. Garland, 21-70544.

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By Kathryn Tucker, JD[1]

On Mother’s Day 2022, my client Erinn Baldeschwiler, a young mother of two with Stage IV terminal cancer travelled from Seattle to Washington D.C. instead of spending the day with her children, even thought it was likely her last Mother’s Day given the inexorable advance of her illness.  Accompanied by her palliative care nurse, Erinn made the trip to the door of the headquarters of the Drug Enforcement Administration (DEA), a federal law enforcement agency which for more than 16 months has blocked her from access to psilocybin, an investigational drug shown in clinical trials to be enormously effective in relieving anxiety and depression in dying patients.  Provisions of state and federal right to try (RTT) laws intend for investigational drugs shown to have promise in early clinical trials to be accessible to patients with advanced illness. Patients like Erinn. But DEA has steadfastly refused Erinn access.

On the Monday following Mothers’ Day, bright, breezy and sunny, Erinn stood at a podium in front of the DEA high-rise building and told DEA employees shuttered inside: “I am running out of time. The crowd, Americans from all across the United States who had also traveled to DEA’s door in solidarity with Erinn and the multitude of Americans confronted by advanced illness, chanted: “DEA stop the delay, DEA get out of the way”. Signs and posters held by demonstrators proclaimed what clinical trials show: “Immediate, Substantial and Sustained Relief.” Psilocybin provides relief from debilitating anxiety and depression in the face of imminent death and the loss the patient faces. For Erinn that loss includes missing out on seeing her children grow up. The unspeakably sad loss of not being able to be here for them. As her counsel, I spoke from the podium just before Erinn, to explain the efforts her legal team had made, what the RTT law provides, and how the DEA was thwarting the law and exceeding its scope of authority.

Erinn and her palliative care physician Dr. Sunil Aggarwal, Co-Founder and Director of Seattle’s Advanced Medical Science Institute, came to me in October of 2020 with the hope of gaining access to psilocybin, a drug currently sited on Schedule I of the Controlled Substances Act. This designation means no distributor would supply the drug without permission from the DEA. Our request for such permission detailed that the drug was an ‘eligible investigational drug’ under the terms of RTT laws. Nonetheless, our request was flatly denied:  DEA would permit no access for therapeutic use. I assembled a team of attorneys with special expertise to develop a lawsuit to be filed in federal court to compel the DEA to comply with the RTT laws.[2]  A multitude of amicus briefs were filed in support of our case, including by 8 States, leading psilocybin researchers, prominent palliative care physicians, and progressive and conservative think tanks alike.  DEA sought to avoid review by arguing its decision to deny access had not been “final”. In a ruling which did not reach the merits the court accepted that argument in a ruling issued on January 31, 2022 dismissing the case.

We immediately asked the DEA for a final determination, so that either access could be had or we could return to court.  Despite the fact that a year of legal briefing detailed the Agency’s clear obligation to accommodate RTT, several months later the Agency has yet to respond. The dynamic reality  of terminal illness means that the Agency’s delay means relief will be forever denied. This is what brought Erinn to the nation’s capital on May 9, 2022.

The idea of holding a public demonstration to shine a bright light of public scrutiny on the DEA’s failure to accommodate the law of the land was David Bronner’s. David is the CEO of Dr. Bronner’s Magic Soaps. David (for whom the CEO title stands for Cosmic Engagement Officer) is a well-known champion of opening access to psychedelics. David professes that the catalyst for him to get his team involved to  organize and host the demonstration was hearing me speak about Erinn’s case on the Psychedelics Today podcast.[3]

Hours into the demonstration, police arrived, arresting and handcuffing Erinn, arms behind her back, placing her in a police van. She, along with 16 other demonstrators (including David Bronner) engaging in peaceful protest of the DEA’s obstruction of the law of the land, was taken to jail. All the demonstrators were released that night, with summons for a future court appearance.

Next morning, notwithstanding the exhausting previous day, Erinn met me at the Dirksen Senate Office Building for a meeting with Senator Patty Murray’s staff. The meeting lasted more than an hour. This was our first in person meeting; we had met over Zoom several times, seeking Senator Murray’s involvement in ensuring that the DEA respect state and federal RTT laws and allow access to promising investigational drugs, in this case psilocybin.  Senator Murray, a 30 year Senate veteran, is Chair of the U.S. Senate Committee on Health, Education, Labor, and Pensions (HELP).

We urged that Senator Murray intercede urgently: Laws intended to benefit Erinn and others similarly situated are being thwarted by the DEA, leaving multitudes of patients to endure suffering which could be relieved with access to this drug. Having been one of the attorneys who successfully sued the Justice Department when then U.S. Attorney General John Ashcroft (and then his successor Alberto Gonzales)  attempted to thwart operation of Oregon’s pioneering Death with Dignity Act by invoking application of the federal Controlled Substances Act to override Oregon’s law, I felt particularly well suited to educate Murray’s staff that binding federal precedent of the Supreme Court of the United States forbids a federal agency from intruding into the regulation of the practice of medicine, a matter reserved largely to the sovereignty of the states.[4]  Washington State, Senator Murray’s home state, had enacted its RTT law in 2017 by unanimous vote. The US Congress had amplified that enactment in adopting the federal RTT a year later. It is incumbent on Senator Murray, I urged, for her to stand up for Erinn and other patients, and for the sovereignty of her home state; federal elected officials have the duty to oversee a federal agency overreaching the bounds of its authority. Especially when that overreach denies much needed relief to dying patients. Erinn, I told the Senator’s staff, was running out of time.

A short film about Erinn and  the demonstration at the DEA can be viewed at this link:  https://vimeo.com/713486783/8b7f4b4eda

For those interested in following Erinn’s case, and the continuing effort to open access to psilocybin therapy for peace and comfort at the end of life, visit:  https://righttotrypsilocybin.com/.  Join the petition and contact your federal elected officials to enourage them to ensure that RTT laws are respected and that dying patients are able to access this palliative care investigational medicine

The legal team leading the effort to forge a path to access pursuant to RTT laws will continue to press the DEA to issue a waiver allowing access, and/or to reschedule psilocybin from Schedule I to Schedule II of the Controlled Substances Act. Other strategies to ensure access are also being explored;  We will continue to move this advocacy forward until access is ensured.

[1] Special Counsel at Emerge Law Group, Co-Chair Psychedelic Practice Group. Founding board member of the Psychedelic Bar Association, Co-Chair, Litigation and Advocacy Committee.  Liaison to the American Bar Association. Founding Advisory Board Member, the Initiative on Psychedelics and Healing, Global Wellness Institute.

[2] Counsel joining me in representing Erinn and the other plaintiffs include Matt Zorn, Yetter Coleman LLP;  Shane Pennington, Vicente Sederberg LLP; and James Williams, Andrew Kline, Thomas Tobin and Holly Martinez, Perkins Coie LLP.

[3] Psychedelics Today webinar/podcast, “The Right to Try Act and the Battle for Psilocybin Access”, https://psychedelicstoday.com/2022/04/05/pt307/(4/5/22)

[4] Gonzales v. Oregon, 546 U.S. 243(2006)(landmark decision of the US Supreme Court which ruled that the United States Attorney General cannot enforce the federal Controlled Substances Act against physicians participating in Oregon’s Death with Dignity Act.)

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Oregon’s Psilocybin Services Act (“PSA”) is the first state law legalizing access to psilocybin for adults. Psilocybin remains illegal to manufacture, distribute, dispense or possess under the federal Controlled Substances Act.  Those with terminal illness are one population known to benefit particularly from psilocybin therapy.  Clinical trials have shown that patients with advanced cancer may receive substantial and sustained relief from existential distress with this therapy.[1]  Hence many patients with advanced illness and those who care for them have keen interest in the PSA.  Many hope that psilocybin services will be an important new tool in the palliative care toolbox, easing suffering that serious ill patients may experience.

Following enactment of the PSA, having been involved in the effort to bring support to the measure from the end-of-life community, I convened a Psilocybin Services Act End of Life Interest Group (the “Group”), comprised primarily of health care professionals whose practice focuses on this patient population, including hospice and palliative care physicians, nurses, and mental health specialists.  The Group also includes the Director of the Oregon State Hospice Association and several attorneys whose practice focuses on law and policy relevant to end-of life-care.  Some of the Group’s members also serve on the Psilocybin Advisory Board. The Group convenes monthly to discuss and consider how to ensure that the needs of patients with advanced illness are addressed in the implementation of the PSA.  The Group has developed and shared comments with the Rules Advisory Committees that are drafting proposed rules under the PSA to recommend to the Oregon Health Authority in connection with the implementation of the PSA.  The Group intends to also develop discussion papers, available to inform the public and those involved with provision of psilocybin services.

Subjects of interest to the Group to date include:

  • ensuring that the training and licensure of facilitators recognizes the special needs of serving this population;
  • ensuring that those whose illness would prevent them from visiting a psilocybin service center are able to obtain reasonable accommodation;
  • establishing special end-of life-care focused psilocybin service centers;
  • exploring questions of involvement of medical professionals in psilocybin services in light of federal prohibition; and
  • developing research into the impact of psilocybin services on patient interest in aid in dying.

If you have an interest in this area or any ideas for the Group, please contact me, Kathryn Tucker at kathryn@emergelawgroup.com.

Members of the Psilocybin Services Act End of Life Interest Group are:

  • Daniel Abrahamson, JD
  • Stephanie Barss, FNP, PMHNP
  • Jennifer Blechman, MD, FAAHPM
  • Sam Chapman, Executive Director, Healing Advocacy Fund
  • Ray Gertler, Ph.D.
  • Nick Gideonse, MD
  • Barb Hansen, MA, RN, CEO Oregon Hospice & Palliative Care Association
  • Pilar Hernandez-Wolfe, PhD
  • Rachel Rackow, MD
  • Steve Rosonke, MD
  • Kevin Roux, M.Ed., MSN, RN
  • Kathryn Tucker, JD

[1]Charles S. Grob et al., Pilot Study of Psilocybin Treatment for Anxiety in Patients with Advanced-Stage Cancer, 68 Arch Gen Psychiatry 71, 71 (2011) (anxiety levels measured at one, three, and six months after treatment “demonstrated a sustained reduction in anxiety”); Roland R. Griffiths et al., Psilocybin Produces Substantial and Sustained Decreases in Depression and Anxiety in Patients With Life-Threatening Cancer: A Randomized Double-Blind Trial, 30 J. of Psychopharmacology 1181, 1195 (2016) (single dose of psilocybin produced large and significant decreases in depression, anxiety or mood disturbance, and increases in measures of quality of life, life meaning, death acceptance, and optimism in patients with a life-threatening cancer diagnosis; effects sustained at 6 months); Matthew W. Johnson & Roland R. Griffiths, Potential Therapeutic Effects of Psilocybin, 30 Neurotherapeutics 734, 734 (2017); Stephen Ross, Therapeutic Use of Classic Psychedelics to Treat Cancer-Related Psychiatric Distress, 30 Int’l Rev. Psychiatry 317 (2018) (review of clinical trials from 1960–2018 researching therapeutic use of psychedelic treatment in patients with serious or terminal illnesses and related psychiatric illness; psychedelic-assisted treatment can produce rapid, robust, and sustained improvements in cancer-related psychological and existential distress.). See also Tara C. Malone et al., Individual Experiences in Four Cancer Patients Following Psilocybin-Assisted Psychotherapy, Frontiers in Pharmacology (Apr. 3, 2018), https://www.frontiersin.org/articles/10.3389/fphar.2018.00256/full (participants with anxiety, depression, and other existential distress achieved relief with psilocybin treatment, and benefits were sustained throughout follow-up). See generally Lauren Slater, How Psychedelic Drugs Can Help Patients Face Death, N.Y. Times (Apr. 20, 2012), https://www.nytimes.com/2012/04/22/magazine/how-psychedelic-drugs-can-help-patients-face-death.html (“[T]he results showed that administering psilocybin to terminally ill subjects could be done safely while reducing the subjects’ anxiety and depression about their impending deaths.”).

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See our Cannabis Industry page for more information.

PSYCHEDELICS INDUSTRY

Emerge Law Group is a leader in the psychedelics industry.  There is tremendous excitement about the potential for psychedelic drugs to benefit a wide variety of populations, including veterans struggling with PTSD and terminally ill patients suffering with anxiety and depression.  Until recently, psychedelic substances have been accessible only in the underground; they are illegal under state and federal law to manufacture, distribute, or possess.  These substances have, since 1970, been treated as having no legitimate medical use, and no commercial application.  As such, businesses have not invested in this area or required legal services, outside of the criminal context.

Today, psychedelics are proceeding toward legalization on multiple paths.  Researchers in a multitude of clinical studies are proving the medical safety and efficacy of these medicines, with the objective of changing the treatment of these substances under the federal Controlled Substances Act, opening legal access to them.  Private and public companies are now actively raising money to develop intellectual property and capitalize on the market opportunities associated with psychedelic drugs.  Opportunities to be early actors in this new arena are tremendous.

See our Psychedelics Practice Group page for more information.

BUSINESS AND CORPORATE

Our business transactions team is made up of highly experienced transactional attorneys who have practiced at large law and accounting firms, worked as in-house counsel for public companies and investment banks, and owned and operated start-up companies. We understand complex legal matters and provide high quality legal services in a cost-effective manner.  Our clients value our experience, knowledge and judgment.

ENTITY FORMATION

Our team routinely advises clients regarding:

CORPORATE GOVERNANCE

Emerge attorneys also advise on-going concerns with: