New Study Highlights “high satisfaction” with regulated psilocybin services in Oregon and Low Rate of Adverse Events

By Jack Gorsline

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(PORTLAND, Ore.) Oregon's state-regulated psilocybin program has maintained a strong safety record while delivering measurable mental health improvements. But an impending financial crisis threatens to dismantle the nation's first legal psilocybin market.

A longitudinal cohort study published Aug. 19 in JAMA Open Network found that supervised psilocybin sessions at licensed community wellness centers are safe and clinically effective. Yet these findings arrive as state regulators consider steep fee increases that industry insiders warn could shutter the entire system.

The Open Psychedelic Evaluation Nexus (OPEN) cohort study received funding from the Substance Abuse and Mental Health Services Administration (SAMHSA), the National Institutes of Health (NIH), and the National Institute on Drug Abuse (NIDA). Led by Dr. Todd Korthuis of Oregon Health & Science University, the survey provides the first rigorous real-world evaluation of Oregon's psilocybin framework. Between November 2024 and March 2026, researchers tracked 346 clients across 24 of the state's 26 active licensed service centers, representing 92% of active facilities statewide. The study retained 90.2% of participants at the three-month mark, giving researchers representative data from operational facilities rather than a sterilized clinical trial.

"In this cohort study, people receiving state-regulated psilocybin services in Oregon experienced few safety events, high satisfaction with services, and overall improvements in mental health, wellbeing, and life satisfaction in the 3 months following a psilocybin experience," the study authors wrote.

At the three-month follow-up, participants reported sharp declines in moderate-to-severe psychiatric symptoms. Depression rates dropped from 42.2% at baseline to 16.5%. Anxiety prevalence fell from 45.1% to 13.2%, and post-traumatic stress disorder symptoms decreased from 48% to 16.8%.

The data also documented distinct socioeconomic barriers to access. The clientele accessing Oregon's centers is largely affluent, white, and formally educated: 86.7% identified as white, 76.6% held at least a bachelor's degree (including 41.2% with a master's or doctorate), and 29% reported household incomes exceeding $200,000. Among the 346 participants, 97.5% praised the quality of care, and 81% considered the session worth the financial investment, though 32.1% noted that the cost was a financial strain. If regulators double licensing fees, operators will likely pass those costs along to clients, further restricting access to the wealthiest participants. The study also recorded a critical safety benchmark: zero participants reported unwanted physical touch or sexual contact from facilitators, showing that state-mandated training and codes of conduct have effectively safeguarded client boundaries.

Many participants entered service centers for spiritual development, recreation, or personal growth rather than a formal psychiatric diagnosis.

"While many participants did not seek services specifically to address mental health, they reported decreases in depression, anxiety, and posttraumatic stress disorder symptoms; improved life satisfaction; and improved mental wellbeing that met the threshold for statistical significance," the researchers wrote.

Serious adverse events were rare, but the data revealed a distinct risk profile. Only four participants, or 1.2% of the cohort, experienced serious behavioral reactions that required emergency department care or hospital medical attention. All four shared the same characteristics: they were psychedelic-naive, had pre-existing vulnerabilities including high baseline PTSD or depression, and received moderate to high doses between 25 and 50 milligrams. Demonstrating the complexity of defining harm in psychedelic facilitation, three of those four participants still rated their session as highly meaningful, and two said their personal goals were met.

The study also exposed a major regulatory reporting gap. Facilitators reported only one of those four serious reactions to the state during the session. For two of the severe cases, facilitators recorded zero adverse reactions on the session day. Because Oregon mandates reporting only for safety incidents occurring within three days of a session, researchers cautioned that current state rules obscure adverse events like persistent anxiety or severe insomnia that emerge in subsequent weeks.

Despite these clinical outcomes, the program faces severe budgetary strain. Confronting funding shortfalls, the Oregon Health Authority proposed changes on June 26 that would double licensing fees for service centers, facilitators, and manufacturers. The agency also plans to merge the Oregon Psilocybin Services section into the Oregon Medical Marijuana Program by Sept. 1 to reduce overhead costs.

Industry advocates argue that the fee hikes will decimate the market rather than fix agency deficits. Sam Chapman, founder and executive director of the Center for Psychedelic Policy, said the state's plan will drive license holders away.

"The opposite is true," Chapman argued in an exclusive interview with Psychedelic State(s) of America, asserting that Oregon's financial distress stems from treating psilocybin facilitation like commercial cannabis rather than a specialized service.

"The fee-based licensure model is simply not sustainable," Chapman explained. "A primary downside of being first is that we lacked a custom playbook, so regulators leaned on cannabis structures. But those frameworks rely on selling physical retail products, which fundamentally differs from psilocybin’s model. The product here is the service itself, making the current infrastructure inappropriate."

For independent facilitators on the ground, the impact of this flawed regulatory structure goes beyond policy: it directly threatens client access and affordability. "This is just going to trickle downhill to the clients who are seeking these services," said Amy Charlesworth, a military veteran and independent licensed psilocybin facilitator in Oregon, in an interview with Psychedelic State(s) of America. "You're probably looking at the new average being around $2,000 to $3,000 for a single psilocybin session, which is completely unrealistic and not economical. This is probably going to drive a lot more closures and drive underground operations to be what people lean on to get accessible services for psilocybin therapies." 

Beyond the looming regulatory fee increases and existing socioeconomic barriers, the OHA is embroiled in an ongoing civil lawsuit over physical access to care. Facilitators sued the state in 2024, alleging that the requirement to administer psilocybin exclusively at licensed centers violates the federal Americans with Disabilities Act (ADA) by excluding homebound and terminally ill patients.

Addressing industry claims that the litigation is exacerbating the program's financial deficits, plaintiffs' attorney Kathryn Tucker argued that the OHA brought these expenses upon itself.

"[T]he State is obliged to follow federal disability rights law, the ADA. It could have avoided this suit, and served its citizens, by complying," Tucker stated. "Instead, it dug its heels in and made the cost of defense as great as possible, first by filing repeated motions to dismiss, seeking to avoid the merits of what its obligations are under the ADA. These efforts were rejected by the court."

With the case now at the merits stage and awaiting oral arguments, Tucker emphasized that a plaintiff victory would ultimately help, rather than hinder, the state's pioneering system.

"[I]f successful our case will greatly expand the market for psilocybin services, benefitting manufacturers and facilitators economically, aiding the financial viability of the program," she noted. "Most importantly, suffering homebound disabled and dying folk will be able to access care and possibly resolve debilitating anxiety and depression."

With public rulemaking hearings beginning this September, licensed operators and advocates have a narrow window to secure legislative funding fixes before the scheduled 2027 fee increases take full effect.

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