This report was originally published on our sister site, The Portland Mercury.

For 10 years, Portlander Angela Carter has made the annual summer trip to attend Burning Man, a legendary counter-cultural festival in the Nevada desert. But Carter wasn’t there only as an attendee—rather, they volunteered as a medic with the festival’s emergency services department. Carter’s primary responsibility: providing harm reduction for festival-goers taking hallucinogens, to make sure they had a safe and positive trip.

Their harm reduction work included practical concerns, like helping the trippers stay hydrated and fed, or making sure they weren’t taking any medications that would react negatively with the drugs. But it also meant sitting with them while they hallucinated, and guiding them as they processed new insights and emotions. Often, Carter witnessed people experience major breakthroughs while using psilocybin, the hallucinogen found in magic mushrooms.

“The brain is more active, there’s more connections being made: literal connections between neurons, and figurative connections between thoughts and understanding,” Carter told the Mercury. “People seem to draw from a broader perspective, and can look at things differently during a psilocybin experience. That helps them transform their thought process around depression, anxiety, and things that are affecting them deeply in their life.”

Carter’s observations about psilocybin are backed up by research from Johns Hopkins University, which suggests the substance is an effective treatment for anxiety, depression, and other mental illnesses. That’s also evident in the centuries-old tradition of Indigenous peoples using different hallucinogens as part of their cultural and religious ceremonies.

Last November, Oregonians passed Ballot Measure 109 by a 12-point margin, legalizing the therapeutic use of psilocybin when under the guidance of a licensed facilitator. While a handful of cities in the United States have decriminalized psilocybin possession in recent years, Oregon is the first US state to permit therapeutic use, and to create a framework for legally growing, processing, and selling magic mushrooms for this purpose.

But while Measure 109’s text provides the broad framework for how Oregon’s psilocybin program will work—requiring anyone taking psilocybin at the direction of a therapist to do so under the guidance of a trained facilitator—there is still much work to do before it goes into effect in 2023. Questions remain about what the facilitator requirements will be, how to best ensure patient safety, and how to make the program accessible and affordable for all Oregonians.

And because Oregon is the first state to attempt this, there’s no obvious roadmap to follow.

“It’s essentially writing regulations about an industry that’s never existed,” said Kim Stuck, the owner of an Oregon cannabis business consulting firm that recently started offering psilocybin consulting services. “There’s a lot of risk.”

That’s where the Oregon Health Authority’s (OHA) Oregon Psilocybin Advisory Board comes in. Made up of 17 Oregonians who are OHA officials, medical and legal professionals, academics, and advocates, the board is tasked with advising the OHA on how to regulate therapeutic psilocybin use. Its first meeting is Wednesday, March 31.

“The immediate first step [for the board] required by Measure 109 will be to compile all academic research on psilocybin therapy,” said Sam Chapman, Measure 109’s campaign manager. “This research will act as the foundation for the board’s work over the next two years.”

Chapman recently founded the Healing Advocacy Fund, a nonprofit that Chapman said aims to “ensure the measure’s implemented in ways that remain true to the measure that passed in November.” He said that on top of logistical concerns—regulating and labeling the actual substance, and setting safety standards for building codes—the main focus of both the advisory board and his organization will likely be figuring out how to make psilocybin therapy accessible for all Oregonians, “regardless of where they live or their ability to pay.”

“There’s no one right way to guide someone through a psychedelic experience. It takes understanding of culture and language and the nuance of identity.”

Alex Wilson, a member of Decriminalize Nature Portland, doubts whether Measure 109 can be effective in achieving that. Wilson was part of an unsuccessful campaign to get psychedelic decriminalization on the Portland ballot in 2020, and his group ultimately decided not to endorse Measure 109 last year, despite having some shared goals. The problem, Wilson said, is that Measure 109 places too heavy a regulatory structure on a substance that Oregonians should be free to “grow, gather and gift.”

“We don’t want to see medicine become a commodity,” Wilson said. “We don’t want to see anybody be able to gate-keep. Any system that’s highly regulated… all that cost is going to be put on the end user, the recipient.”

Wilson compared the opportunities and challenges presented by Measure 109 with medicinal cannabis, which opened the door for Oregon to legalize recreational cannabis in 2015. In Oregon and other states that have legalized pot, cannabis business opportunities disproportionately benefit white men, despite a long history of people of color being over-represented in the criminal justice system for drug possession charges. (That could start to change if a new cannabis equity bill passes the Oregon Legislature this year.)

One way to keep the cost of therapeutic psilocybin low and improve access to it, Chapman said, is to make sure the cost to become a licensed facilitator is low, so that expenses don’t get transferred to patients. He also said that part of the Healing Advocacy Fund’s work will include outreach to people of color and military veterans—two groups who Chapman thinks especially stand to benefit from the healing effects of psilocybin—to get their direct input on how Measure 109 should be rolled out.

Issues of accessibility and equity are also top-of-mind for Carter, who sits on the new advisory board. In addition to being a medic at Burning Man, Carter also works with QueerDome, a space for LGBTQ+ people using hallucinogens at the festival, and is a naturopathic doctor who specializes in hormone therapy for transgender and nonbinary people.

“I’ve had patients who have processed their gender [while using psilocybin],” Carter said. “It’s helped them come to terms with and accept their gender, and has relieved a lot of depression and anxiety in that respect.”

Because of their experiences providing harm reduction, Carter said they don’t believe a “one-size-fits-all” approach for facilitators would be a smart approach, and that they’d consider requiring facilitators to go through anti-racist, disability, and trauma-informed trainings before getting their licenses.

“There’s no one right way to guide someone through a psychedelic experience,” they said. “It takes understanding of culture and language and the nuance of identity.”

Carter added that being in a clinical setting could be alienating to some patients, and that they want to allow facilitators to bring patients outside during their experience.

“Being able to connect with nature can be a positive thing, and enhancing to their spiritual exploration,” they said.

Over the next two years, OHA’s advisory board will come up with a set of regulations, seeking input from the public along the way, before recommending them to OHA in December 2022. The board will likely encounter many new questions along the way, said Chapman, especially related to equity and accessibility. But if they can get it right, the final plan could potentially set the US on a new course when it comes to psychedelics use.

“It’s easier said than done,” he said. “But that is our work ahead of us, and if we’re able to accomplish this here in Oregon, it will set the golden standard for other states and countries to follow.”