As some of the experts chosen to usher Oregon into the age of psilocybin mushroom therapy sat down last week for a Zoom meeting, two of them had a bone to pick.
At issue: whether the Oregon Psilocybin Advisory Board would get to hear from the “Godfather of Microdosing” this week.
The exchange took place between two academic heavy hitters, both appointed by Gov. Kate Brown to the psilocybin board. Dr. Atheir Abbas is an assistant professor of behavioral neuroscience at the Oregon Health & Science University School of Medicine, while Dr. Mason Marks is an assistant professor at the University of New Hampshire School of Law and a senior fellow at Harvard Law School’s Project on Psychedelics Law and Regulation.
About 15 minutes into the two-hour public Zoom meeting, convened by the research subcommittee rather than the full board, Abbas called on Marks, whose hand was raised.
“So, in terms of speakers,” Marks began, “I’m not sure if this would require a vote of this committee or not, but I would like to have Dr. James Fadiman come to the—”
Abbas interrupted: “I’m sorry, I’m going to cut you off, Mason. So that is not on the agenda. You’ve been bringing this up—”
Marks shot back: “No, I think this is quite relevant to what we’re talking about here, as you haven’t been returning my emails in the past 24 hours.”
The pair was arguing about James Fadiman, one of the country’s foremost psychedelics researchers and author of The Psychedelic Explorer’s Guide. He is often credited with bringing microdosing into the mainstream—hence his “Godfather” nickname.
Microdosing, in fact, was the central agenda item of the Jan. 20 meeting. In 2020, Oregon voters approved supervised, therapeutic psilocybin trips. But the measure they passed doesn’t say anything about taking small doses of the same psychedelic drug on a regular basis over an extended period.
Last week’s argument over whether Fadiman would speak highlights a rift among board members—who are tasked with establishing the rules for the state’s psilocybin policy by the end of 2022—about a pivotal question that remains unanswered: Is microdosing allowed?
Fadiman, who happened to be present as a public participant at last week’s research subcommittee meeting, chimed in on the matter.
“There is going to be microdosing throughout Oregon regardless of what this committee does,” Fadiman said, about an hour after witnessing the argument between the subcommittee chairs. “The question is, can it also help people use it more safely and more effectively?”
Next year, Oregonians 21 and up will be allowed to trip on a psychedelic drug derived from “magic mushrooms” while under the supervision of licensed, state-sanctioned facilitators.
That’s thanks to Ballot Measure 109, which Oregon voters passed by a 12% margin in November 2020, making the state the first in the country to legalize the manufacturing, delivery and administering of psilocybin.
In general, Measure 109 is crafted around “macrodosing,” or taking a psilocybin dose intended to induce a psychedelic experience. The measure’s backers have argued that two or three of these hourslong trips can lead to a healing, sometimes life-changing experience, particularly for patients struggling to overcome trauma, addiction or both.
Those potential benefits are among the factors that helped sway more than 1.27 million Oregonians to vote yes.
“Microdosing was not a focus of ours during the development of Measure 109, which is why the term is not defined or used in the measure,” says Tom Eckert, the Psilocybin Advisory Board chair. He and his wife, Sheri Eckert, who died in December 2020, were the chief petitioners for Measure 109. The pair also founded the Oregon Psilocybin Society.
“Our intention was not to create a dispensary-type model,” Eckert adds. “Measure 109 supports science-based services at licensed facilities under the care and supervision of trained and licensed facilitators.”
Microdosing, generally speaking, is the practice of taking a fractional dose of a psychedelic—in this case, psilocybin—semi-regularly for a period of several weeks or months.
If done correctly, the dose should be small enough that individuals can go about their daily activities, like work and even driving, while simultaneously benefiting from the drug’s healing effects, Fadiman tells WW. “I have a recent report of a surgeon who said she microdosed before surgery,” he adds.
Microdosers are not seeking a “trip” or a transformative experience; rather, they are trying to treat certain ailments like depression, anxiety, post-traumatic stress disorder, tinnitus or cluster headaches. “The research is clear that most people who microdose feel it’s beneficial. The research doesn’t find really any harm,” Fadiman says. “There are a number of studies that microdosing improves cognitive functioning, physical health, emotional stability and so forth.”
Microdosing of psilocybin has not yet made it past Phase 2 of clinical trials, which leaves some medical professionals skeptical.
One of those professionals is Abbas, the OHSU doctor who chairs the research subcommittee. He says psilocin, the active metabolite of psilocybin, activates certain serotonin receptors, some of which are located in heart valves.
Activating these receptors “has been definitively linked to an increased risk of irreversible valvular heart disease,” Abbas tells WW.
Some researchers, including Fadiman, say the data Abbas referred to is not applicable, because it originates from research into a weight loss drug called fen-phen, which the U.S. Food and Drug Administration pulled from the market in the late ‘90s due to the heart valve risks.
“[That drug] affects the same area of the brain that psychedelics do,” Fadiman says. “But it was given at a dose of 1,000 times the amount of a microdose, and microdoses aren’t given that often.”
Pros and cons aside, the ballot measure itself omits microdosing as a concept: “The term microdosing is not used or defined in the statutory language of Measure 109,” Abbas says.
Rather, the measure states that the Oregon Health Authority, following advisement by the Psilocybin Advisory Board, “shall adopt rules establishing: (a) The maximum concentration of psilocybin that is permitted in a single serving of a psilocybin product; and (b) The number of servings that are permitted in a psilocybin product package.”
For Marks, that language leaves the door open to microdosing.
“It’s true that microdosing is not mentioned in Measure 109, but neither is macrodosing. There’s no dosing mentioned at all,” he tells WW. “People are going to be microdosing no matter what. Legalizing microdosing, and regulating it, is really a form of harm reduction from a public health perspective.” (Marks says he was speaking as an individual and not on behalf of the board.)
Dr. Rachel Knox, a member of the psilocybin board, said during Thursday’s meeting that it’s important for the state to include education about microdosing in its training curriculum.
“I think that all facilitators should be able to answer questions about microdosing because, guess what, the clients are going to come in and ask about it,” Knox said. “One hundred percent of facilitators in Oregon should have some competency around microdosing and administering it.”
Others were skeptical: That sounded like a lot to ask of facilitators.
“Not everybody is going to be able to be an expert on microdosing,” Regina Moore, co-founder of the Psychedelic Pharmacists Association, said during the Jan. 20 meeting. “I’m hearing lots of talk that is making this feel more and more like something that should exist in the medical system, which I personally don’t think was really the main intent of the measure.”
The clock is ticking while board members work to reach consensus: They have until the end of June to send their recommendations to the OHA, Eckert says.
And Fadiman? He says permitting microdosing presents Oregon the opportunity to collect important data on an underresearched subject.
“We would automatically get that research done without any work, which I admit I like,” Fadiman says. “I like it when the system allows you to kind of learn something and, in this case, it could.”