I’ve been waiting for the dust to settle to publish this blog regarding the Natural Medicine Health Act (NMHA), the ballot measure filed by Natural Medicine Colorado.¹ I see what the NMHA does as one seamless policy: making natural medicines—psychedelic plant and fungal medicines containing psilocybin, DMT, ibogaine or mescaline (excepting peyote)—available to all adult Coloradans in two powerful healing modalities: via a regulated access model in a therapeutic context; and the self-regulating community healing model in a decriminalized context.
Different organizations and folks are aligned with one or the other of these two modalities, and there has been historical distrust that unfortunately flared pretty fiercely in Colorado during the drafting process. New Approach is a progressive PAC that we fund most of our drug policy reform efforts through, focused on ending the drug war and integrating psychedelic medicines and therapy into U.S. and global culture. New Approach’s center of gravity rests with the regulated access model, which is important to support in policy because the majority of the psychedelically naïve population requires a therapeutic program that looks and feels like what’s coming out of Johns Hopkins, in order to feel comfortable accessing psychedelic healing. For example, many of my parents’ generation are not going to participate in an ayahuasca or mushroom ceremony in a decriminalized context. They need a well-regulated, well-structured program that feels safe and reassuring, with training standards and accountability for facilitators, as well as quality standards for the medicine (click here to read facilitator training criteria for Oregon’s Psylocibin Service Initiative, which was passed in 2020 and sets up a similar regulated access program).
Another major reason for regulated therapy is for people suffering from acute and complex trauma, like childhood sexual abuse, where a community healing context may not be comfortable for a given person to do the deep work, disclosure and release necessary, versus working with a trusted trauma therapist in a therapeutic context, ideally in an ongoing therapeutic relationship. And another huge reason for the regulated access model, is we can collect real-world data that shows psilocybin therapy is a cost-effective intervention for conditions like alcoholism and cluster headaches, so that it can be insured and covered under Medicaid. And for a medicine like ibogaine that has so much promise for opiate addiction, it’s important to have a well-regulated program with medically trained staff pre-screening for cardiac contra-indications, and monitoring blood pressure and heart health real time.
Importantly, the group therapy / ceremonial healing model can and will exist within the regulated program as well, along with a hopefully more religious-spiritual-community approach as outlined in this excellent analysis by Jon Dennis in Psychedelics Today. Group / community healing models are much more affordable, and the mutual support and care in community is helpful for proper integration of big psychedelic experiences. Someone I was just talking to made the analogy that not doing proper integration after a profound psychedelic experience is like not doing proper rehabilitation after getting an organ transplant: for big life changing shifts to really take hold, proper integration is crucial.
It’s also important to clarify that all adults, not simply those with a mental health or neurological diagnosis, can access regulated psilocybin therapy and services. We all struggle in life, and the point of the regulated access program is to provide access to adults outside of the medical pharma frame, in an affordable way without a formal diagnosis. The regulated access model does not require facilitators to have prior therapeutic training or credentials, recognizing that the best facilitators are often not ones with formal medical or therapeutic degrees. The regulated access program requires that would-be facilitators engage in an approved year-long training program, and is agnostic about whatever healing modality or tradition they’re coming from, whether that’s indigenous, energy healing, or other. The regulated access program ensures a common core curricula in the approved training programs, but otherwise they are free to have their own focus, such as an emphasis on helping BIPOC or LBGTQIA communities. The regulated access model revolutionizes and democratizes mental health treatment, allowing for a facilitator to professionally offer services without having to go through years of expensive schooling, enabling more equitable pathways for people from all walks of life to serve marginalized communities in culturally appropriate ways, informed by common experiences and traumas. Facilitators are still required to have relevant and rigorous training from an approved training program, to properly help clients prepare, facilitate and integrate their psychedelic experiences, and are professionally accountable for any malpractice. This is a much-needed provision given the potential for therapeutic abuse, an issue that the psychedelic movement has been confronting recently. With the regulated program, facilitators who engage in any kind of abusive behavior can be reported, investigated and lose their licensure. There is no such recourse in the underground. Finally, there is a process to determine appropriateness of fit for a given person and facilitator—for someone dealing with more complex trauma or mental health challenges, a facilitator with more extensive therapeutic training would be appropriate.
The NMHA also creates an equity fund to financially sponsor and support BIPOC and other marginalized and financially disadvantaged communities to access facilitator training as well as treatment under the regulated model. And NMHA requires the Advisory Board to annually report and present data to Colorado First of how psilocybin therapy is cost-effectively addressing different mental health and neurological challenges, whether end-of-life anxiety, alcoholism or other, so that in time people suffering from these conditions can be covered under the state Medicaid program.
As great and important as the regulated access model is, it’s also the case that many of us can and do competently prepare, hold space and integrate healing medicine experiences for and with each other in self-regulating communities. We should not lock medicine up only inside a regulated therapeutic program, anymore then we should lock it up exclusively inside FDA-approved medical pharma frames. Wherever politically possible, the self-regulating community healing model in a decriminalized context is crucial to also support in policy. No matter how equitable we make a regulated access program, it’s going to have a real cost for both facilitators as well as patients to access, and it’s important to allow people to affordably grow their own medicine and sit and heal together outside of any formal regulated program. Roberto Lavato’s recent article in Alta, “The Gentrification of Consciousness,” really hits the nail on the head, showing how important that we enable self-regulating community healing circles to coexist side by side with equitable therapeutic programs. There is also a potential deeper benefit for long-term mental health in regularly ingesting medicine with the mutual support and care of your community, versus occasionally seeking a therapeutic experience that’s not supported and integrated inside a community of peers. Group, ceremonial and community / church models economically and culturally expand access for individuals, and can provide community for longer term integration of therapeutic experiences and for longer term community healing and integration work. This is complementary and helpful to fully realizing the positive benefits of therapeutic access and healing. Additionally, best practices for churches and community healing groups, including dealing with difficult situations, have been developed by the Sacred Plant Alliance which will soon be opening up for membership. And simply by virtue of being aboveground, people can avail themselves of the police for any abusive behavior that may occur, and not fear criminal reprisal themselves when reporting. Online training and resources are also flourishing for people to learn the basics of good preparation (set and setting), facilitation and integration practices, and we all have the right to grow and use medicine at home, in nature, or at a concert. The grassroots in Colorado, reflected in SPORE and Decriminalize Nature Colorado, prefer the self-regulating community healing model for these reasons, alongside a deep and understandable distrust of well-capitalized for-profit interests engaging in the regulated psychedelic space as they have in cannabis.
That distrust flared fiercely in the drafting process, triggered in part because New Approach was proposing very high but defined limits on quantities of medicine that a person could possess. While many read into this a nefarious plot to interfere with the self-regulating community healing model, their intent was in fact to support community-healing while also making the ballot measure more palatable to more conservative statewide voters than the relatively more progressive urban voters in Denver who barely passed decrim in 2019. I personally had been counseling that this was a red line with the movement base and that we could and should take the calculated political risk of not defining limits for personal cultivation and use. Kevin Matthews, Veronica Lightninghorse and others facilitated close dialog with other community leaders, including from SPORE, MYCOalition as well as Decriminalize Nature Colorado, and the initial draft was substantially revised based on community input, including removal of numerical limits for personal possession, group sharing and communal healing. Concurrently, the ad hoc coalition of leaders that had formed around the Natural Medicine Health Act was formalized into the Natural Medicine Colorado steering committee, which includes Kevin and Veronica as the chief proponents, as well as Jaz Cadoch, Josh Kappel, Sean McAllister, and Michael Huttner.
While distrust persists, there’s growing recognition that the self-regulating community model and the regulated healing access model can and should exist side by side. Many people aren’t comfortable and ready to sit, heal and pray in group ceremony versus working one-on-one with a trained therapist, especially when processing acute complex trauma. But hopefully eventually that same person does enough healing and processing to feel comfortable engaging in a self-regulating community setting. While I understand the ongoing distrust, I think NMHA gets it right with a lot of community input, with decriminalization prioritized immediately, and regulated access slotting in two years later.²
Regarding who is going to open and own regulated clinics, the NMHA has strong equity language giving priority and financial assistance to individuals from BIPOC communities highly impacted by the drug war. NMHA also restricts any one entity from owning more than five clinics. So while Field Trip and other national players will have clinics, homegrown training programs and clinics, BIPOC-led and focused and otherwise, will be given priority to establish and thrive. For example in Oregon, we’re excited to be supporting the Alma Institute, which is a BIPOC and LBGTQ focused training and facilitation program, and look forward to supporting similar efforts in Colorado.
Separately, we know that our allies at the Drug Policy Alliance in consultation with in-state coalition partners in Colorado, are interested in pushing an all drug “treatment not jail” decrim effort in Colorado, maybe California and elsewhere, in 2024. Kassandra Frederique, the ED of DPA, recently let me know the reason she has dedicated her life to ending the drug war has nothing to do with her personal interest in any kind of drugs beyond the occasional drink of alcohol, and everything to do with what is holding Black people back in America. Specifically, the way the drug war is weaponized against people of color to arrest, incarcerate and saddle them with records and otherwise oppress and hold them down. Washington state and DC both have strong all-drug “treatment not jail” efforts proceeding this year that we’re supporting; and in Washington state there are no numerical limits for any drug. But disappointingly there isn’t separate allowance for cultivation and sharing of plant medicines to truly allow the community healing model to thrive outside of Seattle, which decriminalized cultivation and community healing with plant medicines in September. The Washington state effort also doesn’t exempt peyote in the right way, which is the issue I’ll close with.
Both the Native American Church and National Congress of American Indians have called on the drug policy reform movement to refrain from decriminalizing peyote, due to the collapse of peyote in the wild, and to support the indigenous-led conservation efforts underway. I myself had thought that we could leverage state law to help with the situation, but that strategy wasn’t welcome versus the national strategy these indigenous organizations are already leading. I’ve come to see that my ideas for cultivation of peyote outside of supporting peyote-using communities directly in their conservation efforts, including cultivation as they see appropriate, was replicating colonial patterns by imposing my views on the situation. There’s over 45 peyote-using tribes and cultures on this continent, some of whom are already embracing cultivation under the federal American Indian Religious Freedom Act, while others prefer to engage in sustainable ecologically appropriate harvesting and replanting techniques in the wild. Whatever they choose we’re ready to support. Supporting all the peyote-using tribes north and south of the border in their efforts to conserve and protect their medicine for the generations to come, is a central task of the Indigenous Medicine Conservation Fund that is launching this spring. The fund will raise money to support indigenous-led conservation projects around keystone medicines including peyote, ayahuasca / yage and iboga. The NMHA requires the Advisory Board to include at least one indigenous representative and to annually report on impacts to keystone medicines and indigenous cultures, and reciprocity efforts underway to help address. Including this in the NMHA hopefully will inspire other decriminalization efforts to also do so.
Peyote in Colorado is already restricted under state law and allowed only for sincere religious use.³ Things recently flared there again between myself and national Decriminalize Nature leadership initiated by my misunderstanding whether the separate Decriminalize Nature Colorado measure exempted peyote. It does, which is a promising precedent showing deference to expressed indigenous wishes in this regard, at least in Colorado for now, and hopefully soon nationwide. Recognizing that personal issues may be as much at issue as anything, for the record, I want to affirm the importance of the ethos that Carlos and Larry of Decrim Nature hold for the movement, and share via footnote⁴ what I wrote to CA Senator Scott Wiener in October after hearing with appreciation further efforts that DN was taking in Oakland to legalize community-based sales in a way that prioritized local smaller players vs bigger well-capitalized ones not based in Oakland.
Senator Wiener not too surprisingly wasn’t too responsive to this, as at this juncture any effort to further liberalize 519 will jeopardize passage and we’ll be lucky if we don’t have to further constrain or jettison synthetics like LSD and MDMA. But I’m sharing this on the real to convey that in spite of our differences and difficulties over peyote policy, and resulting drama and discord, I still have a lot of admiration otherwise for what Carlos and Larry are doing. And while it’s been an intense process, the NMHA has been deeply informed by individuals and groups subjected to historical and ongoing exploitation and injustice, in dialog with groups committed to allyship and positive change, towards healing for all.
OK bam! Onwards, hopefully with more peace, unity and understanding!
¹ Natural Medicine Colorado has the Title and Summary now for two versions of the NMHA that will go forward, one with and one without record sealing (expungement of past “crimes”). The team is currently poll testing to confirm that isn’t fatal to passage to include. Prior versions submitted to test how Title and Summary language would look to inform subsequent drafting are already being withdrawn.
² In consultation with the ace drafting team and addressing those with the most concerns directly: NMHA creates a regulated access program to provide natural medicine to adults through a licensed and regulated system. It directs the Department of Regulatory Agencies (DORA) with the authority to implement and oversee this system. Section 12-170-104 specifically directs the department to “regulate the manufacture, cultivation, testing, storage, transfer, transport, delivery, sale, and purchase of natural medicines by and between healing centers and other permitted entities and the provision of natural medicine services to participants.” “Natural medicine services” is a defined term that means services provided by a “facilitator” and a “facilitator” is defined as a person “licensed by the department.” This grant of authority to the department only extends to the entities and persons licensed under the act to engage in various activities. Thus the department’s rulemaking authority and the direction in the Act as to how the department should exercise that authority, including that it do so in the interest of “public health and safety,” is within this circumscribed sphere.
Separate and apart from the regulated access program, the NMHA includes a “personal use” section, 12-170-109, that decriminalizes cultivation, personal and non-commercial sharing and group use of medicines without specified numerical limits. These are not offenses and are protected from any civil or criminal fine penalty or sanction under both state or local law. The Act does not give the department (or any other regulatory authority) oversight over this section or the power to define, restrict, rule make, or otherwise exercise authority over the conduct set forth in the section.
The Colorado Constitution vests the legislative power of the state in the general assembly or to the people through the process of initiative. C.R.S.A. Const. Art. 5, § 1. Legislation can delegate specific authority to an agency to create and enforce rulemaking to implement legislation but an agency can’t exercise legislative authority on its own outside of a legislative granting of specific authority. When an agency is directed or permitted to make rules, it must do so within the parameters of article 4 of title 24, C.R.S. Thus, the Department of Regulatory Agencies can’t exercise authority over natural medicines outside of a specific delegation of authority in legislation. The Act provides the Department authority only over the regulated access program. It does not grant the Department authority over the personal use provisions. Amendment 64, enacted via initiative in 2012 was structured in this exact same way. It gave authority to the Department of Revenue to oversee and implement a program to license and regulate commercial cannabis. It also included a personal use section structured just like the one in this Act that protected noncommercial cannabis related activities by persons 21+. Amendment 64 did not give the Department of Revenue authority over personal use and thus the Department has not enacted rules or regulated personal use of cannabis. This Act will function the same way.
³ I think the existing Colorado policy is a “middle path” recognizing sincere religious use without opening up to everybody. Speaking personally for myself, if someone is non-native and already has a special relationship to the divine mediated by peyote, then that person should either be part of a Native American Church chapter, or should be growing medicine under the Religious Freedom Restoration Act vs consuming any from the wild gardens; there’s no need to change state or local laws in deference to the expressed wishes of primary native institutions. Under no circumstances should wild peyote be consumed by a non-native person outside of an NAC or other indigenous peyote ceremony; other mescaline containing cacti are available like San Pedro / Huachuma.
⁴ From my email sent 10/19/22 to Senator Wiener:
I wanted to highlight that Decrim Nature in Oakland is pushing forward with a community based economy for mushrooms. https://www.marijuanamoment.net/oakland-psychedelics-activists-launch-initiative-to-legalize-community-based-sales-with-support-from-city-council/
I’m reminded of Wendell Berry’s excellent essay “The Problem of Tobacco” that goes deep into one of the nation’s most successful social programs, the Burley tobacco growers co-op. This program provided small farmers a reliable income from tobacco, though limiting what any one farm could grow and controlling supply against demand to keep good prices. I can’t find the essay itself online but here’s a couple articles about it
It’s not quite apples to apples, or mushrooms to mushrooms, but in important ways Carlos and team are trying to regulate and constrain the local mushroom economy for the benefit of small local producers and resellers. We took a similar approach in important respects at a statewide level with Oregon’s 109 program, limiting the size of grows, the number of licenses any one person could have, majority in state capital to finance etc.
This development reminded me that the ACLU of Washington state that is helping drive the broad based all drug decrim there in 22, has proposed that they include in the statewide measure a clause that recognizes more lenient drug policy at the local level (see below relevant correspondence… we’ll also be working with DPA in CO in a similar way re Denver policy). I wanted to check in with an idea and proposal, that we amend 519 to similarly recognize more lenient drug policy at the local level, and I think we should for political reasons say with regards to plant based entheogens only. This might still be a step too far in your estimation which we’ll entirely defer to… and the time to do this probably should have been when we were reviewing limits, which would have been a way of slicing things that probably would have kept the drama with DN minimal. But maybe its not too late and we can do in a somewhat subtle not a big deal kind of way? Sure would be awesome if it’s in the cards and look forward to your take…. while I know Carlos’s personality can be difficult, I don’t want that to get in the way of seeing the solid policy and possibilities here.