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Question 4 on the Massachusetts ballot would legalize four types of psychedelics, including psilocybin and ayahuasca, with the intention of providing mental health relief. Oregon and Colorado are the only other states to pass similar legislation.
Several Massachusetts cities, including Northampton and Easthampton, have already decriminalized psychedelics, which means people are usually not arrested for possessing them.
NEPM’s Kari Njiiri asked reporter Karen Brown how the ballot initiative would be different.
Karen Brown, NEPM: This will be statewide, and go much further, allowing people to grow their own hallucinogens on a limited scale. Like with cannabis, an appointed commission will regulate psychedelics. But unlike cannabis, there won’t be retail stores for magic mushrooms. There will be centers for psychedelic therapy, overseen by certified guides who have completed a state training. Individual cities won’t be allowed to ban the psychedelic centers — which they can do with pot shops.
Kari Njiiri, NEPM: What are supporters saying this law will do?
Primarily, they say it will give more people access to psychedelics when other forms of mental health treatment haven’t worked.
Emily Oneschuk is with the group Massachusetts for Mental Health Options, which is pushing for the initiative. As a veteran, she herself has struggled with PTSD, and and severe grief after her younger brother was killed.
When she got out of the military, she had a mental health crisis. And she says psychedelics were the only thing that helped.
“Everything didn't just disappear, but it was like the first crack in this fortress that I had made that let you know some light in and helped me start to remember that I could feel good again,” Oneschuk said.
Studies do show that many people benefit from psychedelic therapy. But the Massachusetts Psychiatric Society — which is against the measure —says the evidence is limited and that, for depression, some studies show antidepressants to be just as effective.
Not all groups who oppose this oppose it for the same reasons. Can you explain some of the health concerns?
The Massachusetts Psychiatric Society says there are a number of dangers. For instance, they say that people with certain mental health conditions can have a bad reaction to hallucinogens and the law doesn’t guarantee that the guides will have the medical training to deal with that.
And another group against Question 4 — called Bay Staters for Natural Medicine — is actually strongly in favor of legalizing psychedelics for mental health treatment and they worked on previous failed legislation that would have done that. But they say Question 4 is just not designed safely.
James Davis is with that group. He points out there are cardiac risks for at least one of the four substances that would be legalized
“Ibogaine is incredibly helpful for some people weaning themselves off of opiates or alcohol. And yet people do die of [cardiac] issues,” Davis said. “They die of a heart attack using ibogaine, which is why we should be creating a medical infrastructure around their use, or at least one that pairs nicely with our conventional mental health care system.”
What about the economics of Question 4? Who stands to make money?
Well, that’s a question people are asking. Opponents like James Davis say the cost of going to the healing centers could be prohibitive for many people, especially since it’s unlikely to be covered by insurance. And since the federal government considers psychedelics illegal, Medicaid wouldn’t cover it.
Interestingly, the Massachusetts Psychiatric Society says the training to become a guide — at 120 hours — is too short and not rigorous enough, while Davis thinks it’s actually too long and expensive.
“This is kind of a stick-up for people who care and want to be facilitators to give money to these training companies,” he said. “And in Oregon, there's often times more training companies than there are actual care centers where you can have a psychedelic experience.”
And what do supporters of the ballot question say about those economics?
They point out that the proposed law includes a 15% excise tax on psychedelic services, which could help cities and towns, although it’s not clear how lucrative those services will be.
And Emily Oneschuk, spokesperson for the "yes" camp, says the cost will be similar to other forms of alternative health treatment that also aren’t covered by insurance.
“It’s funny, people are concerned about cost and they're concerned about the businesses making too much money,” she said. “I'm like, ‘Well, they need to exist. So someone has to make a little money.’”
I should note, the pro side of the ballot question has collected some $7 million for their campaign. The opponents — just about $100,000.
So when you think about something as complex as health care and mental health, should it be decided by ballot initiative?
Well, that’s a concern of many mental health professionals, some of whom say they are skeptical the government commission will have enough expertise in psychedelics to make good rules. In fact, it’s not clear whether regular licensed therapists will even be eligible to become psychedelic guides.
But Emily Oneschuk says, while the personal use of psychedelics would be legal by this December if the question passes, the state will have two years to come up with regulations to iron out issues like that.
“That time is really important because we have a lot to learn from other states. Oregon and Colorado have gone before us,” she said. “Massachusetts is like a hub of innovation and healthcare, and I think that with that period of time, we can pull a lot of resources and a lot of minds together to build a system that really serves the state.”
Do we know how voters are thinking about this question so far?
The polls say it’s pretty evenly split. One UMass poll found 43% pro and 43% against. It’s also worth noting that if it passes, state lawmakers can rewrite it significantly, like they did with cannabis eight years ago. And if it fails, they can start from scratch and pass their own version.