Two Million Oregonians Live Where They Can Access Psilocybin Treatment
Psilocybin treatment comes to Oregon next year, but that doesn’t mean that everyone who needs it will be able to access treatment near where they live. For months, city and county governments have debated whether to recommend banning the treatment and referring the question to voters this November. The deadline expired last week, and as the dust settled, it became clear that about half of Oregonians will have access to treatment in their own communities—not only in the state’s most populous and progressive regions, but also in rural and conservative cities and counties.
Here’s who will have access to psilocybin treatment where they live:
27 Cities. Oregon’s population is concentrated in a dozen cities that collectively are home to over 1.7 million people. In total, 27 cities in Oregon—including 17 of the 20 most populous cities—will allow state-authorized service centers to operate within their borders. That means the vast majority of the state’s most populous cities will allow psilocybin treatment.
10 Counties. A sizable percentage of Oregon’s population lives outside of the city limits. County commissioners, not city councils, decide whether to allow service centers to operate in these unincorporated areas or to instead refer the question to county voters this November. Ten counties will allow service centers to provide psilocybin treatment. That’s a big deal. Take Washington County, where commissioners decided not to opt-out. The county’s unincorporated area is home to 200,000 people—if it were a city, it would be Oregon’s second most populous behind Portland.
2,000,000 Oregonians. That’s the number of people who will have access to psilocybin treatment in a community where they live. But that number could expand significantly in November. For example, a slim majority of Clackamas County voters backed Measure 109. Their commissioners are asking them to vote on it again in November, and they could vote for it a second time.
Several of Oregon’s more conservative and rural regions okayed psilocybin treatment within their borders:
Take Yamhill County, a rural farming community tucked in the Willamette Valley, that voted Trump in 2020. County commissioners signaled early on that they’d recommend opting-out, referring the question to voters in November. That changed as commissioners heard from people in the community who need help, mental health providers, and even the sheriff. “Our concern is always going to be public safety… you have your law-abiding people who need the treatment and who can benefit from the treatment … [and] I like what I’ve heard, the comments about the process and procedure and the plans that will be put in place [to make the treatment safe]. For what it’s worth, [in talking with] the sheriff’s across the state, this is not a topic we’re really talking about [or] come up in our meetings of major concerns…,” Yamhill County Sheriff Tim Svensen told the board of commissioners. This testimony helped the commission to—as County Commissioner Lindsay Berschauer put it—“really come full circle”.
A similar sequence of events unfolded in Albany. The Lebanon Express wrote that though “Albany councilors seemed poised to put a two-year moratorium on the ballot,” they changed their mind after “members of the public came forward to say they're against a moratorium.” One resident described her personal experience with psilocybin treatment, which she credited with decreased depression and a positive change in her mindset, as “the polar opposite of being dangerous or offensive.” Another resident shared “seven research articles about psilocybin [including findings] that show psilocybin to be an effective addiction treatment.” Ultimately, the city council unanimously refrained from recommending an opt-out question to the voters.
In Columbia County, Wayne Johnston, an Iraq War veteran, told commissioners that, “with the right therapy [and] the right therapist… [psilocybin] is a very, very strong medicine to help people in my situation.” Mira Mickiewicz, a local healthcare worker echoed the theme, telling the commission that everyone “deserves every possible chance to experience the healing that comes from this medicine….It's deep healing.” In an unexpected turn of events, the county commission decided to allow service centers to provide psilocybin treatment in their community.
For proponents of psilocybin treatment, the results of the opt-out process exceeded expectations:
Rules and process, not categorical opposition, led some cities and counties to recommend opting-out. A number of jurisdictions that did refer the opt-out question to voters did so not because they oppose psychedelic treatment per se, but rather because of their perception that more time is needed to deliberate and conduct rule-making around how the treatment itself is carried out. Part of the tension is a mismatch between the deadline for sending questions to the November ballot, which passed last week, and the timeline for the state to issue its final regulations, which happens at the end of the year. For example, in Clackamas County, the most populous jurisdiction to recommend opting-out, one commissioner acknowledged the “positive potentials coming from the use of psilocybin,” but said that in the absence of final rulemaking, he felt it safer to take a wait and see approach by temporarily opting-out.
Healthcare innovation takes time to take root. Sam Chapman, executive director of the Healing Advocacy Fund, explained to Breakthrough Bulletin that proponents of Measure 109 expected that while some localities embrace treatment immediately other places will need some time to come around. “Psilocybin treatment is an innovative healthcare program and like all new, promising healthcare advances, it takes some time for evidence and experience to mount—and when that happens more and more communities feel comfortable. The Affordable Care Act is a good example. An initial wave of states adopted Medicaid expansion in 2014, but another dozen or so opted in over time as it became clear that the measure would lift the number of Americans covered by health insurance to record highs.”
