Question 4: Both sides explain the option to legalize psychedelics in Massachusetts

Jeremy Siegel: This is GBH’s Morning Edition. This November, Massachusetts voters will decide whether to legalize plant based psychedelics. If ballot Question 4 passes, it would make Massachusetts the third state in the country to legalize psychedelics for therapeutic use. Here to argue in favor of a yes vote as part of our ongoing series of conversations on this year’s ballot questions are Emily Oneschuk, the grassroots campaign director, and Dr. Roxanne Sholevar, a psychiatrist and psychedelic therapies researcher at Dana Farber. Good morning to both of you.

Emily Oneschuk: Good morning, Jeremy. Thanks for having us.

Dr. Roxanne Sholevar: Good morning, Jeremy.

Siegel: So, Emily, I’ll begin with you. What would a yes vote on question four do, exactly?

Oneschuk: So a yes vote would set up a regulated therapeutic framework for people to access natural psychedelic therapies, similar to what has already been passed in Oregon and Colorado. So it’s not retail sales. So this is: you’d go to one of these healing centers, you’d have a session, and then you’d work with a facilitator to integrate your experience.

Siegel: So this would allow for there to be centers that exist where people can go and buy psychedelics just to use them for therapy or medicinal use?

Oneschuk: So you wouldn’t be buying the psychedelic per se, so you’d be working with a facilitator and they would be the ones handling the substance and working you through the process of ingesting with it, sitting with it, and then working through whatever came up during your experience.

Siegel: So, Emily, this would also allow for psychedelics to be grown at home. Why is that?

Oneschuk: Decriminalization and the homegrown provision is important because eight cities and towns have already decriminalized. And without the home grow provision, you’re just setting up a black market, basically.

Siegel: Doctor Sholevar, psychedelics are illegal at the federal level. Are they safe for medicinal and therapeutic use?

Sholevar: So that is a question that is very much still being answered. However, I can say that across all of the research studies done looking at psychedelics with patients who have serious medical illness, including cancer, in all of those studies published since 2011, we have not seen any major adverse medical events for any of the patients. Psychological safety is a separate question, I think. When I think about the psychological effects of psychedelics, I think in both the acute period, which is basically what is happening with someone when they have ingested the psychedelic and are having at times hallucinations, changes in their thinking, their mood, their perception. But psychedelics also induce a really powerful personal experience that can have pretty significant disruption to the way that the person is feeling about themselves and their life. That disruption is not necessarily a bad thing. It’s often what leads to, you know, what many of us describe as the transformative nature of psychedelics. But it also can have ramifications in terms of important decisions people might make, the type of therapeutic relationship they’re in with the people that are taking care of them — people are suggestible and vulnerable, which again, I think is part of what makes psychedelics potentially helpful, but also what should give us a lot of caution.

Siegel: So, Emily, if questioned for past and this became law, would it work in the way where essentially someone may see a psychiatrist like Dr. Sholevar, who recommends that they try psychedelics, something like magic mushrooms for therapy, and then they would go to a center and and they would figure out what’s next? Like, how would this operate in practice if you’re someone who’s seeking this kind of therapy?

Oneschuk: So the way it’s currently written, you don’t need a diagnosis to access this therapy. And I do want to say there is an 18 to 24 month rulemaking process where things like that will be kind of figured out and set in stone, that relationship between, you know, your health care provider and these therapies. We’re learning from Oregon and Colorado — how does the established medical network work with these substances? But as you know, the way it works in Oregon, you don’t need a diagnosis. You do have to go through a very thorough medical screening. So it’s pretty accessible, you know, with a lot of precautions. I would just like to kind of add sort of sort of like how I came to this as a veteran. I was in the Navy. I got out after a lot of difficult experiences. I had the violent loss of my younger brother combined with a lot of difficult times in the Navy, and I had turned to all of the traditional options available to me within the VA. And when those didn’t work, I sought out kind of like my last alternative, which was psychedelic therapy.

Siegel: Dr. Sholevar, given the potential benefits, I’m sure accessibility is something that many people want. But also you outlined some of the potential dangers of psychedelics. Given that, should something like this be passed in Massachusetts?

Sholevar: So I see the question that the ballot measure is posing as having two distinct parts that I think are going to have slightly different implications for what it means in the clinical setting. The first is that if there were to be a public access model that were implemented, just like Emily described, and that its production involved consultation with experts in the field to try to think about setting up robust but also accessible structures for patients to go and get supervised care. The second one is that people would be able to grow their own and use their own natural psychedelics, which is something that is happening also definitely outside of the medical system. But my hope is that the way that could promote harm reduction is by decreasing the pressures for there to be like black market production and procurement of natural psychedelics, but also that patients and providers would feel increasingly comfortable talking about the use of psychedelics at home. Because right now there’s so much fear and anxiety both coming from patients and coming from health care providers, myself included, about having open conversations with our patients about what they’re doing, why they’re doing it, any concerns they have. There’s an important distinction between recommending something as a medical treatment, which we’re not allowed to do and technically may still not be able to do if this remains federally illegal. However, there is nothing illegal about discussing and talking with the patient about what they’re doing, and I really do think it’s our responsibility as health care providers to do that.

Siegel: Dr. Roxanne Sholevar and Emily Oneschuk of the Yes on 4 Campaign, thank you both so much for your time.

Oneschuk: Thank you, Jeremy.

Sholevar: Thank you, Jeremy.

Siegel: And as part of our series, we are also speaking with the opposition to this ballot question. Stay tuned for that conversation and find more at GBHnews.org. You're listening to GBH's Morning Edition.

Paris Alston: This is GBH’s Morning Edition. Natural psychedelics are legal in two states, Oregon and Colorado. This November, Massachusetts voters will have to decide if they want to follow in those states’ footsteps by voting yes or no on ballot question 4. Chris Keohane of the Coalition for Safe Communities, which opposes the ballot question, joins us now to discuss. And a note that he’s also working with this year’s No on Question five campaign on whether to raise the minimum wage for tipped workers. Chris, good morning. Thanks for being here.

Chris Keohane: Good morning. Thanks for having me.

Alston: So just so voters are clear, what would a no vote do here?

Keohane: A no vote would create no change to the current Massachusetts laws.

Alston: And in your view, what would happen if Massachusetts voters vote yes, and legalize psychedelics?

Keohane: Well, the way this ballot question is written, it creates a large gray area, particularly around the home growth component of this ballot question. Now, I’d like to point out that myself and many of the folks in our coalition are opposing this because of the way it was written. We’re not challenging the medicinal benefits for the people that genuinely need the help. But this was written to enable for-profit facilities to open up. And in places like Oregon, they’re charging between $750 and $3,500 per trip to the offices. These offices are composed of unlicensed facilities. A non-medical professional could be running a facility where people are tripping on psychedelic drugs. And beyond that, this ballot question allows for a 144 square feet of home growth in an individual’s home. That is the square footage of the average bedroom here in Massachusetts. That’s an astronomical amount of psychedelics to be grown. And it specifically allows for people to hand over to friends and family extra psychedelics that they don’t use.

Alston: So you have alluded to the fact that there have been studies that have shown promise, and this is something that advocates of the measure are touting as benefits to legalizing this, promise in treating conditions like anxiety, depression, PTSD, etc. So how would you like to see a question like this worded better to allow people to get treatment that could help them if they need it?

Keohane: It would have needed to be put in front of medical professionals that could supervise what was happening. And beyond that, it wouldn’t be part of this mega for-profit group. You know, the yes side of this ballot question is touting veterans and other people that have various sicknesses. I’d like to know how many people in the state of Massachusetts are going through the painful issues that they talk about can afford $750 to $3,500 per visit. They are providing false hope to the people that need it the most and me, It’s frankly offensive.

Alston: Now, this is all reminiscent of the ballot question in 2016 over whether to legalize cannabis in Massachusetts. What similarities or differences do you see this time around?

Keohane: Well, one of the major differences is when the ballot question passed for marijuana, it had a section in it that specifically allowed for communities to opt in or opt out on the way the vote went in their community. That isn’t in this ballot question. This were to pass, all 351 cities and towns of Massachusetts would have to allow facilities like this into their neighborhoods. And that was not part of the marijuana ballot.

Alston: And in some cases, we know with the marijuana legalization, obviously with the host community agreements for those communities that did decide to allow it in there, it hasn’t exactly come to fore the way that many people would have hoped. So is there a possibility that even if this is legalized, it’s not going to be sort of this instant implementation and there may be some hiccups that would allow more time for the rollout of legal psychedelics to be better suited to what you were talking about earlier, about a better way to approach this?

Keohane: Based on the way the ballot question is written, it specifically talks about a license that they create. You know, this is basically the equivalent of a University of Phenix online degree. And I just don’t see how it could possibly be implemented in a proper way.

Alston: Now, I do want to clarify that psychedelics, if legalized, would not be available at dispensaries like we see cannabis being made available now in Massachusetts. It would only be sold by licensed providers. I understand that you’re saying these are not medical professionals who would guide consumers through the process of taking them, but the fact that they would be licensed implies that there would be hopefully a thorough process in certifying them to do so. Why is that not enough?

Keohane: Well, the way they’ve described it is that it’s roughly 160 hours of training, and that seems woefully too low. I just don’t see, without a real trained medical professional, how these can possibly be safe facilities.

Alston: I know that the No side has also pointed out that legalization may lead to more use by people who are under the age of 21. Where does this sort of fit in the larger conversation about drug decriminalization and legalization?

Keohane: Well, the ballot question itself starts to address the known dangers to children and pets, because it says if you were to grow in that 144 square feet of available grow, in your home, it would need to be behind a locked door, which I think we can all agree that’s not exactly the safest. Even insurance companies are starting to say that if they were to find growth like this in the house, it wouldn’t provide home insurance. When you talk to veterinarians, they say that the rise of drugged pets is through the roof lately. And in children, it speaks for itself. They have no idea what they’re walking into. Some of this could lead to catastrophic issues.

Alston: Well, that is Chris Keohane of the Coalition for Safe Communities, which is pushing a no vote on ballot question 4, which would legalize psychedelics in Massachusetts. Chris, thank you so much.

Keohane: Thank you. Thanks for having me.

Alston: And you can find the yes side on this ballot question and others at GBHNews.org And stay tuned later this month. Boston Public Radio will host live debates between both sides of all five ballot questions. You’re listening to GBH News.