Abstract
New legal frameworks for supervised psychedelic services are emerging, with Oregon and Colorado implementing programs to train and license psilocybin facilitators. This study describes Oregon’s early psilocybin facilitator workforce and assesses state-approved training programs. The Open Psychedelic Evaluation Nexus (OPEN) reviewed Oregon Health Authority-approved training programs and surveyed facilitators who had completed or were enrolled in these programs between July and November 2023. Data collection included a review of public listings, contact with training programs, and facilitator survey. Results indicated that in the 16 active training programs, the mean tuition was $9,359 and half offered diversity scholarships. Survey respondents (n=106) were relatively diverse; many had an existing healthcare license. The majority reported that training expenses were a moderate-to-severe financial strain. Most were satisfied with training. The mean planned price for a session was $1,388 and the most common areas of specialization were trauma, mental disorders, consciousness exploration, and spirituality. Facilitators requested ongoing training opportunities. In conclusion, Oregon’s emerging psilocybin facilitator workforce and training programs are in early development. These findings are crucial for informing future policy and training program development to support a diverse and effective workforce.
Keywords: workforce survey, psilocybin, psychedelics, licensure, certification, Oregon
INTRODUCTION
The legal landscape for psychedelic substances is rapidly evolving as state and local governments decriminalize use and possession. Policies and public opinion regarding legal frameworks for supervised use are changing in part because widely publicized early trials with carefully screened participants receiving psychotherapy from highly experienced therapists suggest beneficial effects of synthetic psilocybin on depression (Goodwin et al., 2022; Raison et al., 2023), end-of-life anxiety and depression (Griffiths et al., 2016), and alcohol use (Bogenschutz et al., 2015, 2022). Ballot initiatives in Colorado and Oregon created legal frameworks that permit supervised psychedelic services for adults aged 21 and older outside of established healthcare settings. Facilitators, vary in qualifications and experience. These state initiatives establish facilitator and training program licensure requirements, regulations for service centers, cultivators of psilocybin-containing mushrooms, and laboratories that assess the potency and safety of the mushrooms and related products (Oregon Health Authority, 2024).
The Oregon Health Authority (OHA) began licensing facilitator training programs in 2022 and facilitators in 2023. People who complete state-licensed psilocybin facilitator training may apply for a license to facilitate non-directive preparation, administration, and integration services at a licensed service center. The OHA specified six requirements for licensed psilocybin facilitators: 1) 21 years of age or older, 2) high school diploma or equivalent, 3) Oregon residency (requirement expires in 2025), 4) passing a criminal background check, 5) completion of OHA-approved psilocybin facilitator training program, and 6) passing a licensing exam (Oregon Health Authority, 2024). While most recent clinical research on psychedelic-assisted interventions has involved trained healthcare professionals, there is limited data on facilitators leading indigenous ceremonies (e.g., Agin-Liebes et al., 2022) or retreats (e.g., Pilecki, Luoma, Lear, 2024). However, the Oregon model is neither of these; our study provides a crucial first step in understanding this new type of provider.
The safety, effectiveness, and equitable distribution of regulated psychedelic services depend on the composition of this emerging workforce, in addition to other factors. For example, in healthcare professions, therapeutic alliance is a key driver of psychotherapy outcomes (Baier et al., 2020). This study seeks a comprehensive description of the emerging psilocybin facilitator workforce in Oregon, the first U.S. state to implement a legal framework for supervised psychedelic services and, to our knowledge, the first workforce ever approved to legally provide psychedelic services outside a research setting. An assessment of demographics, background, training experiences, and practice intentions of facilitators may inform policy decisions, improve training programs, and lay the groundwork for future research on service delivery and outcomes.
METHODS
The Open Psychedelic Evaluation Nexus (OPEN) is a practice-based research network assessing the safety, quality, and outcomes of legal psychedelic services in community-based settings. OPEN completed a descriptive training program and workforce assessment of Oregon Health Authority-approved facilitator training programs and their students between July and November 2023. The assessment included an environmental scan of approved training programs and a survey of psilocybin services facilitators who recently completed or were currently enrolled in a licensed training program in 2023 and planned to provide services in Oregon.
Training Programs Website Review
We identified 22 facilitator psilocybin facilitator training programs from publicly available listings of training programs approved by the OHA and the Oregon Higher Education Coordinating Commission (Oregon Health Authority, undated). Sixteen of the 22 training programs had functional websites. Details about program characteristics including duration, cost, and diversity practices were abstracted from their public-facing websites. If any details were unavailable, training program directors were contacted to answer remaining questions. We attempted to contact the six approved training programs without functional websites, which were apparently not operational: four appeared to be out of business and two confirmed that they had no students.
Facilitator Survey
Facilitators were identified for study recruitment via training program directors. Nine of the sixteen operational programs sent an introductory e-mail with a web-link to the consent form and workforce survey to 410 students. The survey generated 128 responses, (31.2% response rate). Participants who answered yes to the first two questions on the survey (n = 106) were eligible for the study: 1) recently completed or currently enrolled in a psilocybin facilitator training program, and 2) licensed or planning to seek a license as a psilocybin facilitator in Oregon. In the initial surveys, demographic questions were at the end of the survey and resulted in incomplete data. The items were moved to the beginning of the assessment to improve the completion of respondent characteristics. The survey assessed facilitator demographics, other background characteristics, program satisfaction, program descriptions, and anticipated plans for practice following licensure. Oregon regulations prohibit use of other professionally licensed skills in conjunction with psilocybin services (Oregon Secretary of State Administrative Rules, 2024; e.g. a licensed clinical psychologist providing cognitive behavioral therapy in combination with psilocybin services) and professional boards remain ambivalent about their members seeking licensure as a psilocybin facilitator. Participants were asked how their professional licenses might interface with psilocybin services, and whether they had contacted professional boards for guidance. Because psilocybin services are considered illegal at the federal level and common business services such as banking and insurance are difficult to obtain, the survey asked about preferences for business services. Participants also completed open-ended questions about suggestions to improve their training experience. See online supplement (https://osf.io/78mqj/) for the full survey.
Data Analysis
Descriptive statistics (means, standard deviations, medians, frequencies, and percentages) summarized the demographic characteristics, training experiences, and occupational intentions, of participants. Medians and interquartile range (IQR) described skewed measures. The study data were processed and analyzed in R (version 4.3.1) with use of the ‘ggplot2’ package.
Coding of Open-Ended Responses
Two coders completed a content analysis of responses to three open-ended items: “Is there anything you would like to share about the diversity climate at your training program or ways to improve it?” “In general, what suggestions do you have to improve your training program?” and “Is there anything else you’d like us to know about your experience at your psilocybin training program?” Results were discussed and refined during weekly team meetings and finalized with a third study team member. Data coding used standard analysis practices for the analysis of open-ended survey text (Woike, 2007) to identify patterns of content.
Ethical Considerations
The Oregon Health & Science University Institutional Review Board approved the assessment. Participants reviewed an information sheet before starting the survey and consented to the study by checking a box. At the end of the survey, participants added their email address if they wished to receive a $20 gift card as compensation for their time, and to be notified of future research opportunities. Training programs received a $200 stipend for distribution of the survey.
RESULTS
Review of Training Programs
Webpage abstraction of the 16 active training programs revealed training program tuition costs ranged from $4,500 to $12,000 (mean=$9,359, SD = $2,277; n = 16) and ranged in intensity from 80 to 200 hours of course work plus a practicum experience. The modal training included 120 hours of course work plus 40 hours of practicum experience (consistent with OHA requirements for a minimum 120 hours of didactic curriculum and minimum of 40 hours of practicum, with an allowance for an accelerated curriculum for “qualified students”; Oregon Health Authority, 2024) with a mean duration of 8.1 (SD = 3.6; range 3–12; n = 15) months. Half of the programs offered scholarships to promote diversity, equity and inclusion. See the online supplement (https://osf.io/78mqj/) for additional information from this training program review.
Student Characteristics
Of the 106 eligible student respondents from 9 training programs who indicated they intended to practice in Oregon, the mean age was 42.8 (SD =11.4) years, with 64.4% being white and 35.6% people of color (Table 1). Reported gender identities were 40% women, 40% men, and 20% other including LGBTQ+ or preferred not to answer. Respondents were primarily heterosexual (60%), with graduate degrees (72.5%). Nearly two-thirds stated that they had some connection to a “higher power”, with a minority reporting engagement with religious organizations that utilized psychedelics (10%). About one-third reported they were competent to conduct services in a language besides English. Fifteen percent reported a disability, a rate somewhat higher than the general population of Oregon reported in the last census (11%) (Table 1).
Table 1.
Participant Characteristics
| Participant Characteristics | N (percent) Unless otherwise indicated |
|---|---|
| Mean age in years (n = 40) | Mean = 42.8 (SD = 11.4) |
| Race/ethnicity (n = 90) | |
| American Indian/Alaska Native | 1 (1.1) |
| Asian/Pacific Islander | 4 (4.4) |
| Hispanic | 7 (7.8) |
| Middle Eastern/North African | 2 (2.2) |
| Mixed Race | 15 (16.7) |
| Other | 2 (2.2) |
| Prefer not to answer | 1 (1.1) |
| White | 58 (64.4) |
| Gender (n = 40) | |
| Man | 16 (40.0) |
| Nonbinary/Agender/Questioning | 6 (15.0) |
| Prefer not to answer | 1 (2.5) |
| Transgender man | 1 (2.5) |
| Woman | 16 (40.0) |
| Sexual orientation (n = 40) | |
| Asexual | 1 (2.5) |
| Bisexual/Pansexual | 11 (27.5) |
| Gay/Lesbian/Homosexual | 3 (7.5) |
| Heterosexual | 24 (60.0) |
| Queer/Questioning | 1 (2.5) |
| Highest level of education (n = 40) | |
| Trade School | 1 (2.5) |
| Associate’s Degree | 3 (7.5) |
| Bachelor’s Degree | 7 (17.5) |
| Master’s Degree | 20 (50.0) |
| M.D./Ph.D or Higher | 9 (22.5) |
| Household income (n = 40) | |
| < $25,000 | 4 (10.0) |
| $25,000 - $49,999 | 6 (15.0) |
| $50,000 - $99,999 | 13 (32.5) |
| $100,000 - $199,999 | 10 (25.0) |
| > $200,000 | 5 (12.5) |
| Prefer not to answer | 2 (5.0) |
| Served in U.S. military (n = 40) | 1 (2.5) |
| Disability under federal definition (n = 40) | 6 (15.0) |
| Connection to a higher power is important to me (n = 103) | 63 (61.2) |
| Belong to church/religious organization that incorporates psychedelics into spiritual practices (n = 103) | 10 (9.7) |
| Competent in language to provide psilocybin services, other than English (n = 40) | |
| Spanish | 10 (25) |
| Japanese | 2 (5.0) |
| Portuguese | 1 (2.5) |
| Romanian | 1 (2.5) |
| Vietnamese | 1 (2.5) |
| Prefer not to answer | 2 (5.0) |
Notes: Number of participants varied across items depending upon where they were in the survey.
Training-related characteristics
About 1 of 7 respondents (15%) had received an Oregon facilitator license at the time of the survey (Table 2). A minority (24%) had completed a prior psychedelic services training program (usually for ketamine-assisted psychotherapy; 27%). The majority of respondents (56%) had completed the classroom portion of the program and 40% had completed the practicum portion of the facilitator licensing process at the time of the survey. Students reported they had spent (n = 49) or planned to spend if not yet finished with training (n = 34), a median of $9,500 (IQR = $5,400, $11,000) in pursuing training; 79% felt the cost of training was at least a moderate or severe strain on their finances.
Table 2.
Current and Past Training Experiences
| Training Related Measures | N (percent) |
|---|---|
| Currently licensed as a facilitator (n = 106) | 16 (15.1) |
| Intend to complete a psilocybin facilitator practicum (n = 50) | 38 (76.0) |
| Previously completed a psychedelic training program (n = 90) | 22 (24.4) |
| Previous training program (n = 22) | |
| Ketamine-assisted therapy | 6 (27.3) |
| MDMA-assisted therapy | 3 (13.6) |
| Other | 14 (63.6) |
| Completed classroom portion of Oregon-licensed facilitator training program (n = 90) | 50 (55.6) |
| Completed practicum portion of Oregon-licensed facilitator training program (n = 90) | 36 (40.0) |
| Financial strain due to training (n = 87) | |
| Minimal strain | 15 (17.2) |
| Moderate strain | 33 (37.9) |
| Significant strain | 32 (36.8) |
| Severe strain | 4 (4.6) |
| Prefer not to answer | 3 (3.4) |
| Possess a healthcare/mental healthcare licensure or certification (n = 103) | 59 (57.3) |
| License/certification (n = 59) | |
| Licensed professional counselor | 8 (13.8) |
| Acupuncturist | 7 (12.1) |
| Psychologist | 7 (12.1) |
| Clinical social worker or associate | 6 (10.3) |
| Doctor of medicine | 6 (10.3) |
| Naturopathic doctor | 4 (6.9) |
| Prefer not to answer | 4 (6.9) |
| Licensed massage therapist | 3 (5.2) |
| Art therapist | 2 (3.4) |
| Behavioral interventionist | 2 (3.4) |
| Doula | 2 (3.4) |
| Marriage & family therapist | 2 (3.4) |
| Doctor of osteopathy | 1 (1.7) |
| Nurse practitioner | 1 (1.7) |
| Chaplain | 1 (1.7) |
| Esthetician | 1 (1.7) |
| Alcohol and drug counselor | 1 (1.7) |
| Advocate | 1 (1.7) |
| Hakomi counselor | 1 (1.7) |
| Medical assistant | 1 (1.7) |
| Peer support specialist | 1 (1.7) |
| Hypnotherapist | 1 (1.7) |
| Psychotherapist | 1 (1.7) |
| Reverend | 1 (1.7) |
| Registered nurse | 1 (1.7) |
| Professional association/society member (n = 103) | 32 (31.1) |
| Prior experience with indigenous psychedelic practices (n = 103) | 53 (51.5) |
| Prior experience with psychedelic peer support of harm reduction services (n = 103) | 55 (53.4) |
| Prior experience facilitating altered states journeys (aside from Oregon requirement) (n = 90) | 62 (68.9) |
| Satisfied with training (n = 90) | 75 (83.3) |
| Feel prepared to work as a facilitator (n = 90) | 72 (80.0) |
| Feel well-trained to identify people who should not be offered psilocybin services (n = 90) | 77 (85.6) |
| Feel well-trained to counsel people about the risks of psilocybin (n = 90) | 80 (88.9) |
| Feel well-trained to deal with adverse outcomes associated with psilocybin services (n = 90) | 70 (77.8) |
| My training program values diversity, equity, and inclusion (n = 90) | 75 (83.3) |
Participants (57%) reported having a health care license or certification from a variety of professions, typically as a licensed professional counselor (14%), acupuncturist (12%), psychologist (12%), or doctor of medicine (10%). About two in five (41%) belonged to a professional society; 52% reported experience with indigenous practices, and 53% had experience with psychedelic harm reduction services.
Overall, 83% of participants reported satisfaction with their training experiences. Most agreed they were prepared and well-trained to: 1) work as a facilitator (80%), 2) identify people who should not be offered psilocybin services (86%), 3) counsel people about the risks of psilocybin (89%), and 4) handle adverse outcomes associated with psilocybin services (78%). Most (83%) noted their training program valued diversity, equity, and inclusion.
Participant intentions for future practice
Overall, 90% of participants reported they intended to offer psilocybin services in licensed service centers; a substantial number, however, preferred not to answer this item (9%). Most intended to work as a facilitator alongside an existing licensed practice (81%), but few had approached their licensing board about this (17%). Of the participants who had approached their licensing board, only 40% reported that their board was accepting of this dual licensure.
Respondents anticipated treating clients for trauma (83%), mental health disorders (69%), consciousness exploration (68%), spiritual development (61%), end of life care (59%), and addiction (52%). When asked “Do you have any populations, in particular, you would like to work with?” 47% expressed reported interest in focusing on gender/sexual minority clients while others wanted to pursue practices focused on Latino(a)/Hispanic clients (37%), American Indian/Alaska Native clients (37%), and Black/African American clients (31%) and non-English speaking clients (18%), with a substantial number who preferred not to answer this question.
Participants hoped to spend an average (after one outlier was removed) of 19 hours per week providing psilocybin services and to serve about 10 clients per month. Most wanted to provide individual services (92%) and group services (70%), with fewer participants interested in microdosing (34%) or clinical research (17%). Many intended to use other treatment modalities in combination with providing psilocybin services (36%). They intended to charge a mean of $1,388 per session (median = $900, IQR = 500, 1500) after one outlier was removed who reported that they planned to charge $200,000.
Most planned to be independent contractors (53%). Similar portions sought to own a service center (20%) or be a service center employee (21%). One individual reported they were currently a service center operator. Most participants were interested in banking services (63%) and insurance (86%) to cover their work as a facilitator.
Nearly all participants (93%) expressed a desire for continuing education in a wide range of educational formats. Most were interested in participating in activities intended to improve the safety and quality of psilocybin services (92%) and in volunteering for research participation (83%).
Qualitative Responses
Fifty-seven participants responded to the open-ended question “Is there anything you would like to share about the diversity climate at your training program or ways to improve it?” (see supplementary materials for more detail: https://osf.io/78mqj/). While many participants viewed their training program’s diversity positively, a minority also stated that programs were cost prohibitive, needed a more diverse student body, that educational content was not diverse, or that more diverse instructors were needed. Representative quotes included:
“Would be great if there were more scholarships. Would be great to have more BIPOC students and teachers of course.”
“The program started off centering White bodies. However, they made changes and brought in presenters that centered voices and knowledge of BIPOC.”
Sixty-two participants responded to the open-ended question, “In general, what suggestions do you have to improve your training program?” Respondents voiced the need for more mentorship or practicum opportunities and expressed concern about the significant cost of training. They requested more in-person training opportunities, curriculum on psychedelic risk reduction, and greater opportunities for educational support following training program completion. Example statements included:
“There should be more in person classes.”
“More active de-escalation techniques.”
“...It would be helpful to have some kind of extended internship program working in the service centers after graduation...more hands on experience would be beneficial.”
DISCUSSION
This study describes the emerging licensed psilocybin facilitator workforce in a the first state with a legal framework for psychedelic services. The findings may inform subsequent attempts to train a workforce to deliver psychedelic-assisted therapies as other states consider adopting similar policies Among respondents who reported demographic characteristics, the sample generally reflected Oregon’s race/ethnicity distribution. More than 40% of participants identified as a sexual or gender minority. If this sample is representative of the overall workforce, it appears that early efforts to train psilocybin facilitators may have achieved a somewhat more diverse workforce relative to the Oregon population on several dimensions relevant to marginalized populations. Some participants also expressed a particular interest in developing psilocybin services focused on diverse populations, including BIPOC and gender and sexual minority populations who have experienced limited access to other health services. Greater workforce diversity, culturally tailored services, and a broader range of languages utilized are three strategies that may improve access for marginalized populations.
The Oregon Psilocybin Services administrative rules require facilitators be at least 21 years of age with a high school education. Oregon’s early licensed facilitator workforce was generally older and highly educated, with three-quarters of respondents having a graduate degree. The majority came to facilitator training with significant health care licensure and prior training in psychedelics that may inform their delivery of psilocybin services. Early adopters, however, may be more highly experienced in psychedelic services and better resourced than subsequent cohorts of nascent facilitators. It will be important to compare these findings with future cohorts as well as psychedelic facilitators in other states. These comparisons can inform policy makers and training programs as they define their proficiency and eligibility criteria. We did not assess whether participants had personal experiences with psychedelics, which some experts believe may be important for psychedelic facilitation (Wilson-Poe et al., 2024). Future research should assess facilitators’ personal experience to better understand its influence on training outcomes and service quality.
Survey results suggest that financial factors may influence the diversity of the workforce. The mean training cost approached $10,000, which most respondents deemed a moderate to severe financial strain. This, alongside unpredictable employment prospects post-training may limit pursuit of facilitator training for less resourced individuals. The current results provide a baseline to compare how changing training costs may impact the downstream costs for clients to receive services. The predominance of facilitators with advanced degrees is likely to increase costs for psilocybin services as these professionals may require greater fees for their additional training and experience. One avenue toward more affordable services might be to reduce the cost of training, with diversity scholarships or through legislative changes, so that less affluent individuals can complete training and serve as state-licensed facilitators at a lower price point.
Most respondents were satisfied that their training prepared them to work as a facilitator, identify people who needed to be screened out, counsel people about the risks of psilocybin, and address adverse events associated with psilocybin use, while a significant minority were less satisfied that their training adequately prepared them for practice. Respondents, however, completed the survey at various points in their training; training satisfaction scores may have been lower for those who had not yet completed their training, which includes a practicum that only 40% had completed at the time of the survey. Qualitative responses indicated that while most were satisfied with their programs, a sizable minority suggested changes to their training programs, including reduced cost with assistance of scholarships, a more diverse student body, more diverse educational content, more diverse instructors who are also more transparent about their backgrounds, more mentorship or practicum opportunities, more in-person opportunities, more support post-program, more programming on risk reduction and diversity, fewer course materials, and stricter acceptance requirements. Training programs may consider modifying their curriculum, which for most programs was being taught for the first time, to consider ways to further integrate these educational factors. Undoubtedly, as the field evolves, there will be an ongoing need to adapt training and practicum curricula with emerging evidence.
Ninety percent of respondents reported planning to offer psilocybin services at a licensed psilocybin service center in Oregon; one percent in research settings, and 9% of respondents refused to answer. It seems possible that some of the respondents were reluctant to admit to plans to work in unsanctioned contexts. Some students might have initially planned on licensure but changed their mind during training as they learned more about likely barriers to work as a facilitator such as heightened professional liability compared to more established professions, difficulty in accessing banking and insurance, competition from other facilitators, the unclear status for those who would be dually licensed, or other factors. Future research should examine why some trainees would attend an expensive training program without an intention to practice through legally sanctioned means and explore levers for encouraging greater participation in legally sanctioned programs.
The study also highlighted the importance of addressing issues of dual licensure or certification, given that eight of ten respondents reported wanting to work with psilocybin alongside an existing license or certification, the majority wanted to work with mental health concerns, and one-third indicated they planned to incorporate other treatment modalities alongside their psilocybin services. The state rule forbidding using a second license while practicing as a psilocybin facilitator was implemented to minimize the potential for facilitators working beyond their scope of practice. The OHA does not actively surveil for violations, but could revoke someone’s facilitator license if a complaint was filed. Healthcare licensing boards and regulatory bodies in Oregon remain silent regarding dual licensure and must issue clearer guidance for people pursuing dual licensure in the future. Colorado has established a dual-licensure paradigm in their Natural Medicine Program, offering a separate tier of facilitator licenses for individuals who already hold healthcare licenses which may provide clarity for Colorado facilitators. Although 18 other states have some psychedelic policy bills in progress or workgroups exploring policy changes (Psychedelics Legalization & Decriminalization Tracker, 2024), it is unclear how other jurisdictions intend to address dual licensure, especially for providers authorized to prescribe controlled substances. The current study serves as an important baseline as states begin to grapple with the issue of dual licensure and highlights the unsurprising desire of facilitators to bring all of their professional skills to benefit their clients.
Perhaps reflecting that most participants already had existing non-psilocybin-related professional licenses, most participants only wanted to work part-time and were interested in working as contractors rather than service center employees. This suggests an industry dependent on gig labor rather than employees. The practitioners wanted banking services and insurance products that would work with their psilocybin facilitation business, highlighting the current shortage of such resources in psychedelic services. These findings were unsurprising, given the well-established banking, insurance, and tax issues that state-legal cannabis businesses face. Like cannabis businesses, state laws which legalize psychedelic services conflict with the federal Controlled Substances Act. It remains unclear how these business-related complexities may impact either the quality or the price of services offered to clients. For example, more risk averse facilitators with higher levels of education and mental healthcare expertise could be disincentivized to provide psilocybin services. Furthermore, facilitators may pass on the cost of expensive, specialized liability insurance to clients. Indirectly, this could result in service inequities for lower-income clients. Affordable banking and insurance products that limit increased costs to clients are urgently needed.
Most participants wanted to provide individual and group sessions with some expressing interest in microdosing services or participating in clinical research. Participants also reported interest in working with a wide range of presenting concerns (e.g., trauma processing, mental health disorders, consciousness exploration, spiritual development, end of life care, and addiction). While trauma processing was the most cited interest area, very little data supports the utility of psilocybin for the treatment of post-traumatic stress disorder (AlFardan, 2022). In addition, while many of desired specialty areas represent mental health conditions, in Oregon, service centers are not licensed to provide mental health treatment. Training curriculum should emphasize evidence-based uses of psilocybin and use in specific state-regulated contexts
Most participants were interested in continuing education in a range of formats. They were supportive of ongoing quality improvement efforts and scientific research on psilocybin services, suggesting that initiatives such as OPEN that aim to evaluate the quality of service delivery and improve it over time might be welcomed. This finding might be skewed by a sample of people who had volunteered for this research, presumably because they were supportive of scientific research.
These findings have important implications for various stakeholders. For policy makers, the high interest in dual licensure among healthcare professionals and the intended use of services for mental health treatment suggests a need for clear guidelines on how existing healthcare services can interface with psilocybin services. For training programs, the interest in serving marginalized populations and trauma indicates a need for curriculum focused on cultural competence and trauma-informed care. Our data suggest that extensive financial strain should inform policy makers considering how to balance quality training with workforce accessibility. The specific areas of intended specialization, such as trauma, mental health, and end-of-life care, offer insight into how the field may develop and where additional training or research may be needed.
Limitations of this cross-sectional survey include a limited response rate and missing demographic responses. We also received survey responses from students in 9 of 16 active training programs, limiting generalizability to the entire population of potential Oregon facilitators, assuming non-participating training programs had substantial numbers of Oregon students. The fact that this survey was conducted while many trainees were still in training may have also biased their answers to the questions about training programs, which may have been different at program completion. Finally, a complete evaluation of training programs was beyond the scope of the current study. A comprehensive national survey of all U.S. psychedelic facilitator training programs could improve understanding of educational best practices for the facilitator workforce as additional states adopt regulated psychedelic services. Still, we were able to gather substantial information on Oregon’s training landscape through review of public materials, which may inform future nationwide research.
CONCLUSION
The study provides important insights into Oregon’s emerging psilocybin facilitator workforce and their state-approved training programs. While the majority of participants expressed satisfaction with their training, the data highlight significant financial strains and a need for more diverse, ongoing educational content, and practicum opportunities. The survey revealed a relatively diverse demographic representation, yet also identified areas for improvement to ensure equitable access to psilocybin services for marginalized populations. Financial considerations, particularly the high cost of training, were identified as barriers that may impact workforce diversity and service affordability. The findings underscore the importance of continuous monitoring and development of training programs to support a competent and inclusive workforce, as well as additional studies to assess training needs. As psilocybin services expand, future research must explore the evolving dynamics of facilitator characteristics, training efficacy, and their implications for client outcomes and service accessibility.
Supplementary Material
Figure 1.
Populations of interest as a psilocybin facilitator
Figure 2.
Client goals of interest as a psilocybin facilitator.
Table 3.
Intentions for Future Practice
| Participant Intentions | Mean (SD) | N (percent) |
|---|---|---|
| Location intended to provide psilocybin services (n = 90) | ||
| Licensed service center in Oregon | 81 (90.0) | |
| Prefer not to answer | 8 (8.9) | |
| Research setting | 1 (1.1) | |
| Intend to offer psilocybin services alongside existing licensed practice (n = 59) | 48 (81.4) | |
| Approached licensing board regarding psilocybin services (n = 59) | 10 (16.9) | |
| Licensing board accepting of provision of psilocybin services (n = 10) | 4 (40.0) | |
| How many hours a week do you plan to provide psilocybin services?a (n = 90) | 18.6 (9.9) | |
| How many clients per month would you ideally like to serve? (n = 90) | 9.7 (8.5) | |
| How do you intend to offer psilocybin services? (n = 90) | ||
| Individual client services | 83 (92.2) | |
| Group services | 63 (70.0) | |
| Microdosing | 31 (34.4) | |
| Clinical research | 15 (16.7) | |
| Prefer not to answer | 3 (3.3) | |
| Intend to use other treatment modalities in combination with psilocybin services (n = 90) | 32 (35.6) | |
| Mean intended charge per client for a psilocybin service experienceb in USD (n = 22) | $1,388.14 ($1,626.76) | |
| Preferred employment status for providing psilocybin services (n = 90) | ||
| Contractor | 48 (53.3) | |
| Employee | 19 (21.1) | |
| Owner of own psilocybin center | 18 (20.0) | |
| Other | 3 (3.3) | |
| Prefer not to answer | 2 (2.2) | |
| Currently a licensed psilocybin service center operator (n = 90) | 1 (1.1) | |
| If not yet an operator, intend to become licensed as a psilocybin service center operator in the future (n = 89) | 21 (23.6) | |
| Interested in obtaining banking services to support my psilocybin practice (n = 90) | 57 (63.3) | |
| Interested in obtaining liability insurance for covering my psilocybin practice (n = 90) | 77 (85.6) | |
| Interested in receiving continuing education to support my psilocybin practice (n = 90) | 84 (93.3) | |
| Preferred ongoing educational activities (n = 90) | ||
| In-person hands-on workshops | 73 (81.1) | |
| Virtual learning collaborative with other psilocybin facilitators to review cases | 72 (80.0) | |
| Local conferences | 67 (74.4) | |
| In-person short seminars | 64 (71.1) | |
| Webinars | 60 (66.7) | |
| National conferences | 55 (61.1) | |
| Self-directed on-line learning modules | 39 (43.3) | |
| Other | 5 (5.6) | |
| Interested in participating in activities to improve safety/quality of psilocybin services (n = 90) | 83 (92.2) | |
| Interested in volunteering for research to improve psilocybin services (n = 90) | 75 (83.3) |
One outlier response removed of 208 hours;
One outlier response removed of $200,000.
Acknowledgments
The authors would like to express their appreciation for the training program directors and students who participated in this study.
Funding:
Partial funding for this work came via a task order through the SAMHSA CSAP Logistics, Assistance, and Planning Support contract managed by Leed Management Consulting, Inc. (LMCi) HHSS283201700609I/HHSS28342001. The content of this publication does not necessarily reflect the views or polices of SAMHSA or the U.S. Department of Health and Human Services (HHS). RC was supported by K01 DA55130 from the National Institute on Drug Abuse. XAL was supported by K12HS026370 from the Agency for Healthcare Research and Quality and the content is solely the responsibility of the authors and does not necessarily represent the official views of the funders.
Footnotes
Data Sharing Statement
The data that support the findings of this study are available on reasonable request from the corresponding author, JBL. The data are not publicly available as the participants consented for their data to only be used in this study.
Conflict of Interests Statement: CSS has received nominal honoraria for invited educational lectures for Innertrek, Alma Institute, SoundMind, Integrative Psychiatry Institute, and Naropa University psychedelic training programs, and served as a mentor 2020–2022 for the California Institute of Integral Studies psychedelic training program. The other authors have no relevant financial or non-financial competing interests to report.
References
- Agin-Liebes G, Zeifman R, Luoma JB, Garland EL, Campbell WK, & Weiss B. (2022). Prospective examination of the therapeutic role of psychological flexibility and cognitive reappraisal in the ceremonial use of ayahuasca. Journal of Psychopharmacology, 36(3), 295–308. [DOI] [PMC free article] [PubMed] [Google Scholar]
- AlFardan S. (2022). Psychedelics for post-traumatic stress disorder: A systematic review and meta-analysis. International Journal of Emergency Mental Health and Human Resilience, 25(3), 56–66. 10.4172/1522-4821.1000582 [DOI] [Google Scholar]
- Baier AL, Kline AC, & Feeny NC (2020). Therapeutic alliance as a mediator of change: A systematic review and evaluation of research. Clinical Psychology Review, 82, 101921. 10.1016/j.cpr.2020.101921 [DOI] [PubMed] [Google Scholar]
- Bogenschutz MP, Forcehimes AA, Pommy JA, Wilcox CE, Barbosa P, & Strassman RJ (2015). Psilocybin-assisted treatment for alcohol dependence: A proof-of-concept study. Journal of Psychopharmacology, 29(3), 289–299. 10.1177/0269881114565144 [DOI] [PubMed] [Google Scholar]
- Bogenschutz MP, Ross S, Bhatt S, Baron T, Forcehimes AA, Laska E, Mennenga SE, O’Donnell K, Owens LT, Podrebarac S, Rotrosen J, Tonigan JS, & Worth L. (2022). Percentage of Heavy Drinking Days Following Psilocybin-Assisted Psychotherapy vs Placebo in the Treatment of Adult Patients With Alcohol Use Disorder: A Randomized Clinical Trial. JAMA Psychiatry, 79(10), 953–962. 10.1001/jamapsychiatry.2022.2096 [DOI] [PMC free article] [PubMed] [Google Scholar]
- Goodwin GM, Aaronson ST, Alvarez O, Arden PC, Baker A, Bennett JC, Bird C, Blom RE, Brennan C, Brusch D, Burke L, Campbell-Coker K, Carhart-Harris R, Cattell J, Daniel A, DeBattista C, Dunlop BW, Eisen K, Feifel D, … Malievskaia E. (2022). Single-Dose Psilocybin for a Treatment-Resistant Episode of Major Depression. The New England Journal of Medicine, 387(18), 1637–1648. 10.1056/NEJMoa2206443 [DOI] [PubMed] [Google Scholar]
- Griffiths RR, Johnson MW, Carducci MA, Umbricht A, Richards WA, Richards BD, Cosimano MP, & Klinedinst MA (2016). Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial. Journal of Psychopharmacology, 30(12), 1181–1197. 10.1177/0269881116675513 [DOI] [PMC free article] [PubMed] [Google Scholar]
- Oregon Health Authority. (2024). https://secure.sos.state.or.us/oard/displayDivisionRules.action?selectedDivision=7102
- Oregon Secretary of State Administrative Rules. (2024). Retrieved September 10, 2024, from https://secure.sos.state.or.us/oard/viewSingleRule.action;JSESSIONID_OARD=MpW7mo5Key7IKld4ExOfzEBnF44WsgsK4g8shdOTD7FK7iuwv-3U!−1740369017?ruleVrsnRsn=297867
- Psychedelics Legalization& Decriminalization Tracker. (2024, June 6). Psychedelic Alpha. https://psychedelicalpha.com/data/psychedelic-laws [Google Scholar]
- Pilecki B, Luoma J, & Lear KM (2024). A pilot study of the effect of group-administered psilocybin on psychological flexibility and outcomes. Journal of Psychedelic Studies. [Google Scholar]
- Raison CL, Sanacora G, Woolley J, Heinzerling K, Dunlop BW, Brown RT, Kakar R, Hassman M, Trivedi RP, Robison R, Gukasyan N, Nayak SM, Hu X, O’Donnell KC, Kelmendi B, Sloshower J, Penn AD, Bradley E, Kelly DF, … Griffiths RR (2023). Single-Dose Psilocybin Treatment for Major Depressive Disorder: A Randomized Clinical Trial. JAMA, 330(9), 843–853. 10.1001/jama.2023.14530 [DOI] [PMC free article] [PubMed] [Google Scholar]
- Takeshita J, Wang S, Loren AW, Mitra N, Shults J, Shin DB, & Sawinski DL (2020). Association of Racial/Ethnic and Gender Concordance Between Patients and Physicians With Patient Experience Ratings. JAMA Network Open, 3(11), e2024583. 10.1001/jamanetworkopen.2020.24583 [DOI] [PMC free article] [PubMed] [Google Scholar]
- Wilson-Poe AR, Hoffman KA, Pertl K, Luoma JB, Bazinet A, Stauffer CS, McCarty D, & Korthuis PT (2024). Personal psychedelic experience as a training qualification for facilitators: A thematic analysis of qualitative interviews with psilocybin experts. Journal of Psychoactive Drugs. [DOI] [PubMed] [Google Scholar]
- Woike BA (2007). Content coding of open-ended responses. In Robins RW, Fraley RC, & Krueger RF (Eds.), Handbook of research methods in personality psychology (pp. 292–307). The Guilford Press. [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.