The Intersection of End of Life Issues and the Oregon Psilocybin Services Act

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.”).