by Dermott Smith
August 2022
Context
The traumatic impact of COVID 19 and the ongoing, systemic violence against
marginalized groups are just some of myriad reasons why mental health outcomes have
been in crisis recently. The mental healthcare infrastructure is incredibly strained, with
many more people needing mental healthcare than there are opportunities for
intervention. Illinoisians have the opportunity to expand their intervention options for
people suffering from trauma, isolation, malaise, and spiritual wounding. This policy
brief will argue for the adoption of the Illinois Compassionate Use of Natural Plants and
Fungi Act, legislation currently sponsored by Representative LaShawn Ford - IL 8th
District. This Act would create a regulatory framework for Illinoisians to safely and legally
consume plant and fungal medicine that have a rich tradition in cultures around the
world. The legislation has received the endorsement of a wide range of Illinoisians, such
mental health practitioners, harm reduction advocates, student groups, and veteran
advocacy groups.
Nearly every human society has used psychoactive plant and fungi material in a
healing capacity. For example, certain mushrooms containing the active ingredient
psilocybin have been widely consumed in religious contexts by Indigenous American
groups since antiquity. Currently, the Native American Church continues the tradition of
peyote ceremonies which are community rituals centered around dancing, chanting, and
drumming while consuming the peyote cactus, which contains the psychoactive drug
mescaline. Modern science reveals that many of these natural healing modalities
contain psychoactive chemicals that are popularly grouped together under the name
psychedelics or entheogens. Western scientific research into these substances has
rapidly expanded in the recent past, with many promising studies indicating that these
interventions can help people suffering from disorders such as anxiety, depression, and
addictions. Whether these substances are used for healing DSM-5 endorsed psychiatric
disorders or for spiritual healing, there is mounting evidence that lasting healing can be
achieved by the intentional, reverent, and safe consumption of these plants and fungi.
The Illinois Compassionate Use of Natural Plants and Fungi Act, in its current
iteration, would decriminalize the possession, use, cultivation, production, creation,
analysis, gifting, and delivery of natural plants and fungi. It would also establish the
Illinois Psilocybin Advisory Board to give guidance to the Department of Public Health
about the best practices around psilocybin use and future directions for treatment
modalities.
Pre-existing policies
There are a wide variety of legal frameworks and enforcement mechanisms used
to address entheogenic plant medicine use. Within the United States, differing policies
can be found at the federal, state, and local levels. Internationally, countries regulate
these substances in many different ways as well. At the federal level, most psychoactive
plant substances are scheduled by the United States Drug Enforcement Agency (DEA).
This scheduling prohibits the possession, cultivation, and use except within specific research or religious contexts. For example, the Native American Church was granted a religious exemption by the U.S. Supreme Court in order to practice their rich and
established spiritual tradition of consuming the peyote cactus, which contains the
Schedule I drug mescaline. Some research institutions in the U.S., such as Johns
Hopkins, Ohio State, and NYU, have been granted exceptions to study the effects of
these medicines, often examining their effects on behavioral disorders such as
depression. In order for participants to qualify for these research studies, they often
have to meet strict eligibility requirements and meet criteria for DSM-5 endorsed
disorders. At the federal level, religious freedom and research contexts are the only
ways that people can use plant medicine without fear of prosecution.
In 2020, Oregon became the first state to establish a new regulatory structure for
psilocybin use. Voters approved Ballot Measure 109, which directed the Oregon Health
Authority Public Health Division to regulate the manufacture, transportation, delivery,
sale, and purchase of psilocybin-containing products and the provision of psilocybin
services. Under this framework, licensed facilitators will be able to administer the
substance on site at regulated facilities, often with preparatory sessions and post-
administration sessions to increase the likelihood of therapeutic gains. Clients must be
21 years old or older and would not need a prescription or a medical referral. Providers
of state sanctioned psilocybin services would need to meet training requirements in
order to be licensed. Under Measure 109, providers are not allowed to advertise their
services as therapy. At present, Oregon is still gearing up for when the services are
legal in January 2023. Outcome research will be needed to see how well the regulatory framework ensures that patients are able to make informed choices about the services
they are looking for and that they remain safe.
Some local governments have also made changes to the way that these
substances are regulated. Examples of cities that have deprioritized psilocybin
enforcement are Oakland, Detroit, Denver, Ann Arbor, and Seattle. Cities have less
authority to create new regulatory regimes that would conflict with the state and federal
government. Rather, these cities have directed their police forces to de-prioritize
policing, arrest, and prosecution of psilocybin crimes.
Internationally, many policy frameworks exist around the regulation of psilocybin
and other plant medicines. The legal landscape in Canada has been shifting in recent
years, resulting in more people accessing psilocybin assisted psychotherapy legally.
Patients with mental health challenges such as depression, PTSD, and anxiety can
petition the Canadian federal government for a legal exemption to access psilocybin in
conjunction with therapy with a mental health clinician. Outside the therapeutic setting,
psilocybin exists in a legal gray area due to being decriminalized in many cities across
the country. Outside of North America, the cultivation, possession, and sale of
psychoactive plants and fungi is legal in some countries such as Brazil and Jamaica. In
both countries, retreat centers offer the opportunity for people to legally consume
various natural medicines such as psilocybin and ayahuasca, a traditional plant
combination that has been used in spiritual contexts in many parts of South and Central
America.
Identification and critique of policy options
Illinoisans have options to choose from in regards to plant medicine regulation.
The state could continue its policy of near total prohibition and law enforcement. Under
prohibition, only a small number of people in research studies will have the opportunity
to access a safe supply of medicine and access to clinicians who can be held
responsible for maltreatment. As interest in plant medicine continues to grow, people
will continue to use in underground settings. It is well documented that people with
experiences of marginalization disproportionately bear the burden of drug enforcement
laws. For example, people of all racial and ethnic backgrounds use drugs at similar
rates, but people of color are far more likely to be surveilled, arrested, and incarcerated
for drug sale and possession. While very few people are arrested for crimes related to
psilocybin and other plant medicines, the enforcement of prohibition will likely increase
as these medicines become more popular and accessible.
Decriminalization is another regulatory framework that could be adopted. Under
decriminalization, the possession, cultivation, and exchange of psychoactive plants and
fungi would not be prosecuted by law enforcement. Under most decriminalization
frameworks, this protection only extends to individuals, not businesses.
Decriminalization creates a substantial gray area. For example, mushroom dispensaries
are now openly operating (without business licenses) in some Canadian cities, similarly
to the cannabis dispensaries that popped up before full cannabis legalization.
Therapists, counselors, and spiritual leaders might face professional consequences for
incorporating plant medicine into their practices.
The medical model is another regulatory framework that could be adopted. The
most useful framework to compare with is how ketamine is regulated. Ketamine is a
dissociative anesthetic drug used in some therapy sessions. It produces profound
psychoactive effects at certain doses. Under the medical model, only licensed mental
health providers or medical clinicians are allowed to administer ketamine in conjunction
with therapy. This creates an incredibly high barrier for many seeking treatment. Private
ketamine clinics typically charge $400-$800 per session, making the treatment
inaccessible for many. One benefit to the medical model is that it offers protections for
clinicians and clients. Regulatory agencies can screen providers to ensure that they
have the proper training. Agencies can also investigate claims of abuse and hold
providers accountable.
The final framework to be considered in this analysis is Oregon’s Measure 109.
This framework blends decriminalization with parts of the medical model. In order for
providers to administer psilocybin legally, they must complete a training protocol and
have a background in some sort of counseling or chaplaincy field. Oregon will not
require a clinical license from these facilitators. Measure 109 is unlike the medical
model in that the services being provided cannot be considered therapy or used to treat
a specific mental health disorder. As noted earlier, there will be considerable research
needed to see whether this framework serves clients, providers, and the wider
community.
Policy Recommendation
The Illinois Compassionate Use of Natural Plants and Fungi Act would benefit
Illinoisians who are in need of a more holistic approach to mental healthcare and spiritual
wellness. Under this policy, the cultivation, possession, use, and gifting of natural plants
and fungi would be decriminalized. This would allow Illinoisians to access this healing
modality as practiced by people across the globe before drug prohibition regimes
removed people from their spiritual traditions. This would lower the barriers to access
that Illinoisians face when they try to access this type of healing through the research or
medical models. The Illinois Compassionate Use of Natural Plants and Fungi Act would
also establish the Illinois Psilocybin Advisory Board, which would empower policy
makers to have access to cutting edge research and best policy practices. The
guidance of this multi-disciplinary and diverse coalition will be vital to ensure that Illinois
has the proper infrastructure in place should it decide to license providers and to
regulate the provision of psilocybin services. These services will be a much needed
option to Illinoisians seeking alternative options to the struggling mental health care
system currently in place.