Philip Todd Korthuis

Interest in psilocybin has accelerated, with public access in the United States expanding through a rapidly evolving landscape of decriminalization, increased availability of psilocybin-containing products, and state-regulated facilitated service models (Hutchison et al., 2025). However, uptake may be advancing faster than the evidence base. Regulatory oversight is needed to inform population-level risk. Most supervised psilocybin safety data derive from clinical trials that enroll carefully screened participants and deliver interventions in tightly controlled settings. This limits the generalizability of safety data to the broader populations likely to seek services if psilocybin products are authorized for medical use in the United States (Tan et al., 2022).

BACKGROUND: 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. METHODS: 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: 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. 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.

Background: Informed consent in psychedelic-assisted services is ethically complex, difficult to implement, and remains largely unstudied and unstandardized. Objective: The current study sought expert recommendations from experienced psychedelic facilitators on what constitutes informed consent best practices for supervised psychedelic experiences across various settings. Methods: Participants with expertise in facilitating psilocybin-assisted experiences or other expertise in the psychedelic field were recruited with purposive sampling. Qualitative interviews on informed consent best practices and recommendations were analyzed using Thematic Analysis. Results: Participants (N = 36; 71% white; 56% heterosexual; 53% female) reported facilitating psilocybin services (64%) for a mean of 15.2 (SD = 13.1) years in clinical trial, licensed service center, underground, or ceremonial settings. Participants viewed informed consent as a process (Theme 1), necessitating a strong therapeutic relationship, centering client empowerment, and occurring as an ongoing process. Potential risks and benefits should be comprehensively conveyed (Theme 2), including potential long-term psychological and social changes, and the potential for disappointing experiences. Participants recommended detailed consent processes around touch and boundaries (Theme 3), including explicitly establishing boundaries prior to psychedelic administration, maintaining those boundaries throughout, and recognizing subtle non-verbal cues that may indicate lack of true consent. Within facilitator trainings (Theme 4), participants emphasized cultivating a deep respect for client agency, and experientially learning relational and boundary setting skills. Conclusions: Findings may inform practitioner training, consent practices in varied settings, and policy development for state-regulated psychedelic services.

Aims: To test the efficacy of a participant‐referred “study buddy” intervention compared with standard retention strategies in retaining rural people who use drugs (PWUD) in longitudinal research. Design: Multi‐site, two‐arm, randomized controlled trial. Setting: Rural counties in Ohio, Oregon, and Kentucky, USA. Participants: People enrolled in the Peer‐based Retention Of people who Use Drugs in Rural Research (PROUD‐R ² ) study who were 18 years or older, resided in the study area, and used opioids or injected any drug to get high in the past 30 days between August 2020 and August 2022. Participants (n = 739) were 42% female, mostly White (89%) and non‐Hispanic (96%), unstably housed (57%), and reported lifetime injection drug use (93%). The most common drugs of choice were methamphetamine (42%) and heroin (38%). Intervention and Comparator: Participants were allocated (1:1, stratified by site), to: [1] standard retention approach involving appointment reminders and contact information updates by study staff (n = 365), or [2] the intervention arm, receiving the standard retention approach and asked to recruit a “study buddy” (n = 374). Study buddies were invited to view a training video and instructed to encourage their intervention participant to attend follow‐up appointments. Measurements: Intervention, control, and study buddy participants completed interviewer‐administered surveys at baseline and at 6 and 12 months. Outcomes included retention at 12 months (primary) and 6 months (secondary). Findings: Retention was 50.3% at 6 months and 46.1% at 12 months. Only 23.5% of intervention participants recruited a study buddy. In intent‐to‐treat analyses, the intervention did not increase retention at 12 (adjusted odds ratio [AOR] 1.08, 95% confidence interval [CI] 0.79–1.47) or 6 (AOR 0.96, 95% CI 0.69–1.34) months. Conclusions: Recruitment of self‐identified “study buddies” did not appear to statistically significantly improve retention of rural people who use drugs in this longitudinal study at 6‐ and 12‐month follow‐up relative to standard retention approaches.

Background and aim: Urine drug testing is often utilized alongside opioid agonist treatment to assess client progress by validating self‐reported substance use, monitoring for diversion and supporting clinical decisions for take‐home dosing. However, there is a paucity of evidence to support the practice of urine drug testing. We aimed to determine the association of alternative urine drug testing frequencies with opioid agonist treatment discontinuation, compared with no monitoring, among individuals receiving methadone or buprenorphine/naloxone treatment. Design: Population‐based retrospective cohort study and target trial emulation based on nine‐linked administrative databases. Setting: British Columbia, Canada, between 1 January 2010 and 17 March 2020. Participants: Individuals with no history of cancer or palliative care, aged 18 or older and no indication of pregnancy who initiated methadone or buprenorphine/naloxone. A total of 18 988 methadone and 11 910 buprenorphine/naloxone recipients were included in the incident user design (individuals with no past opioid agonist treatment experience). Measurements: We used a clone‐censor‐weight approach to estimate hazard ratios with 95% compatibility (“confidence”) intervals for treatment discontinuation (lasting at least 5 and 6 days for methadone and buprenorphine, respectively) and all‐cause mortality on treatment within 12 months for static urine drug testing strategies. Findings: Under static monitoring strategies, weekly urine drug testing was associated with a slightly reduced risk of discontinuation in the first year of continuous retention in treatment [methadone: adjusted hazard ratio (aHR) = 0.96, 95% compatibility interval (CI) = (0.95–0.98); buprenorphine/naloxone: aHR = 0.95 (0.94–0.97)] compared with no monitoring. The estimated associations of weekly urine drug testing with all‐cause mortality were similar in size but extremely imprecise [methadone: aHR = 0.95 (0.78–1.15), buprenorphine/naloxone: aHR = 0.99 (0.62–1.58)]. Less frequent testing demonstrated no observed difference on treatment discontinuation or all‐cause mortality compared with no monitoring. Conclusion: Compared with no urine drug testing, weekly urine drug testing may be associated with improved opioid agonist treatment retention; however, the high costs attributable to frequent testing may not be cost‐effective and requires further evaluation. There was no improvement associated with less frequent testing compared with no monitoring.