Psilocybin-Assisted Therapy in the Green Mountain State
Written by Kathryn Keener and Diana Csank
Cannabis laws are loosening, and recent legislative measures in some U.S. states and local governments indicate increased receptivity around psilocybin use, too. For example, in Vermont, beginning in 2018 individuals 21 years of age and older could legally possess an ounce or less of cannabis or two mature plants. And in May 2024, Governor Phil Scott signed S.114, which created the Psychedelic Therapy Advisory Group (PTAG).
The PTAG is comprised of medical professionals tasked with reviewing studies about the impact of psychedelics on mental health and advising whether Vermont should implement a psychedelic-assisted therapy program. The PTAG opted to study psilocybin specifically—rather than psychedelics broadly—because there exists comparatively more research aimed at understanding how psilocybin could be used to improve mental health and treat addiction.
While in their final report the PTAG did not recommend Vermont establish any programming, members indicated “curiosity and hope for the potential strong application of the research on psychedelics as medicines and therapy.” PTAG member Dr. Rick Barnett, Psy.D., who specializes in addiction therapy and co-founded the Psychedelic Society of Vermont, avoids overstating the case for psilocybin-assisted therapy—noting that there remain many unknowns—but when interviewed said, “Keeping psilocybin criminalized is becoming more and more preposterous.”
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From a federal standpoint, cannabis—commonly known as marijuana—and psilocybin—commonly known as magic mushrooms—are illegal. Both became classified Schedule I substances when President Nixon signed the Controlled Substance Act into law in 1970. Schedule I status is reserved for substances with “no currently accepted medical use and a high potential for abuse.” While a recent proposed rule would reclassify cannabis to Schedule III, no such consideration has been extended to psilocybin.
But Indigenous Peoples have long employed psilocybin in medicinal and ceremonial contexts. In contrast to our Westernized approach, many Indigenous groups embrace naturally occurring psychedelics as sacred plant teachers; these teachers are animate beings—with whom humans can be in relationship—rather than inanimate drugs. Engagement with Indigenous researchers and communities as the psychedelic renaissance unfolds will be paramount to avoiding “biocolonialism” and “biopiracy.”
As the term “psychedelic renaissance” suggests, even within a Western framework, psychedelic-assisted therapy is not new. During the 1950s and early 1960s, therapists administered psychedelics, including psilocybin, to complement psychotherapy targeted at mood disorders and addiction. A number of factors contributed to the mid-1960s decline of psychedelic-assisted therapy studies, including tighter regulations from the Food & Drug Administration (FDA) following the Thalidomide tragedy; the difficulty of creating studies that incorporate placebo effectively; the Sandoz Company halting production of the lab-produced compound used in trials; and the oft-cited Nixon administration’s war on drugs.
Today, cannabis is poised for rescheduling. Drug law experts also expect eventual rescheduling of psilocybin, but it remains to be seen how long the process will take. Drug law expert Robert Mikos surmises psilocybin will follow a rescheduling path like that of cannabis, though he notes that public support around psilocybin use, as compared to cannabis, is more limited.
Because it currently retains Schedule I status, psilocybin is subjected to strict regulatory burdens when it comes to conducting clinical trials. And clinical trials are expensive. As Hadas Alterman, Esq., founding partner at Plant Medicine Law Group and former Director of Communications & Policy at American Psychedelic Practitioners Association, explains,
“FDA clinical trials cost hundreds of millions of dollars. And if a drug manufacturer is going to invest hundreds of millions of dollars in the new drug approval process, they need to be able to see a return on their investment. Not only is this cost ultimately externalized onto the patients, but the dynamic creates bad pre-market incentives, which is one of the things delaying access now.”
Alterman suggests short-term therapies, like MDMA-Assisted Therapy, are disadvantaged when compared to pharmaceuticals prescribed for extended use, like SSRIs. “There are so many hurdles to access lifesaving treatment,” Alterman laments.
Despite the difficulties around receiving approval and funding for studies, researchers at leading institutions believe that psilocybin—like cannabis—may be a viable, low-risk treatment for a range of ailments. For example, a 2022 Johns Hopkins study revealed that psilocybin-assisted treatment produced substantial antidepressant effects for participants with major depressive disorder. Multiple studies suggest psilocybin-assisted therapy appears a useful method for alleviating end-of-life anxiety in terminally ill cancer patients. Other disorders under consideration for psilocybin-assisted treatment include anorexia nervosa, post-traumatic stress disorder, obsessive compulsive disorder, and addictions.
Lauren Alderfer, PhD., a Vermont resident, award-winning international mindfulness educator, and the author of Mindful Microdosing, advocates for legal access to psilocybin-assisted therapy. For Alderfer and her husband, a lifelong humanitarian who is contending with Alzheimer’s, the impact of microdosing has been significant. “My husband sleeps better, is more cogent, and experiences greater well-being as a result of microdosing.” Additionally, Alderfer credits psilocybin with helping her maintain patience and well-being while providing care for her husband. The couple perceives ensuring legal access to psilocybin is an ethical imperative. “Demand is rising,” Alderfer says; “Let’s help pave the way.”
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Recently, some locales have spearheaded psilocybin reform irrespective of federal guidelines.
For example, in 2022 Coloradans voted in favor of Proposition 122, which decriminalizes psilocybin, dimethyltryptamine (DMT), ibogaine, and mescaline. Also, several cities—Ann Arbor, Berkeley, and Somerville and Cambridge, Massachusetts, to name a few—have decriminalized use of psilocybin, meaning the substance is still prohibited but that penalties, when they exist, are civil in nature and less severe than criminal sanctions. Notably, citizens residing in our Nation’s capital voted to decriminalize adult use in 2020, making psilocybin “among the lowest law enforcement priorities for the District of Columbia.”
As for therapeutic programming, Oregon was the first state to develop a framework where patients can experience psilocybin-assisted therapy in state-licensed healing centers. Oregon’s Proposition 109—the Psilocybin Services Act—passed in 2020 and centers began offering their services in the summer of 2023. But in Oregon, psilocybin-assisted therapy remains difficult to access and expensive.
As Dr. Rick Barnett, Psy.D., explains, “A well-curated psychedelic experience involves preparation, time for the patient to establish rapport with the person serving the medicine, and good follow-up care.” Hadas Alterman, Esq. concurs: “Therapy takes hours and hours and hours. There’s preparation; five therapy sessions—each eight hours long; and integration afterward. Plus, the industry standard is to involve two different guides.” Alterman proposes that centers could reduce costs by transitioning from offering individual therapy sessions to facilitating group therapy. “The economics are tricky,” Alterman says.
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In their final report, the PTAG remarked on the challenge of evaluating new legal frameworks and determining what is likely to be successful in Vermont. Some members of the PTAG communicated misgivings about delaying access to psilocybin-assisted therapy given the pervasiveness of mental malaise and addiction in Vermont and nationally. Despite failing to reach consensus about recommended programming, however, the PTAG showed interest in continuing to meet and expanding membership.
“To say psilocybin is going to come along and be this game-changing thing . . . I don’t think we know what works in these different paradigms,” Dr. Rick Barnett states. “But it’s really promising as another tool to peel back some of the layers of the psyche for change.”
Ultimately, the PTAG final report is not binding on the Vermont legislature. But if the PTAG recommendations are any indication, psilocybin use is one instance where the Brave Little State will proceed cautiously.
Author Bios
Kathryn Keener is a 3L J.D. student at Vermont Law and Graduate School. She is a clinician at the Environmental Justice Clinic, student ambassador, member of the Native American Law Student Association, and one of the 2024-2025 Symposium Editors for the Vermont Journal of Environmental Law. Kathryn extends sincere thanks to interviewees Lauren Alderfer, PhD., Dr. Rick Barnett, Psy.D., and Hadas Alterman, Esq. for sharing their time and expertise. Kathryn is also grateful for Professor Diana Csank’s encouragement and guidance in writing about what was once a taboo legal topic that is gaining purchase in the mainstream.
Diana Csank is an Assistant Professor in the Vermont Law and Graduate School Environmental Advocacy Clinic. A graduate of Stanford University and Tulane University Law School, where she was a student-clinician in the Environmental Law Clinic, Diana has more than fifteen years of environmental, energy, and litigation experience. For more than seven years, Diana was a Staff Attorney at the Sierra Club, where she directed challenges to fossil-fuel power-plant permitting in five southern and mid-Atlantic states, coordinated challenges to fossil-gas pipeline projects in proceedings at the Federal Energy Regulatory Commission, and handled interventions in state rate cases at public utility commissions in support of the clean energy transition. Diana previously held legal positions at the White House Council and Environmental Quality during the Obama Administration, where she helped supervise the Council’s cohorts of law clerks. Before attending law school, Diana worked on green building issues for the New York City Economic Development Corporation.