Safety, reasons for use, and patterns of psilocybin services in Oregon's first regulated year

The Oregon Psilocybin Services Act (Oregon Revised Statutes 475A), approved by voters as Measure 109 in November 2020, established the first state-regulated framework for psilocybin services in the United States (1, 5). This legislation legalizes supervised psilocybin administration for adults at licensed centers statewide, coinciding with growing interest in naturalistic and clinical trial exploration of psilocybin’s wholistic benefits and its therapeutic potential for conditions such as treatment-resistant depression, substance use disorders, and end-of-life anxiety (1–4).

The Oregon Health Authority (OHA) oversees the Oregon Psilocybin Services (OPS) section, which licenses manufacturers, laboratories, facilitators, and service centers (Oregon Health Authority, 2024). Unlike clinical trials, the act does not require a medical diagnosis for access but mandates administration in controlled settings to maximize safety (1, 5). The OPS framework utilizes a non-medical “facilitation” model consisting of three mandatory components: a preparation session for screening and intention setting, a supervised administration session at a licensed center, and an optional integration session to discuss the experience. This differs from most clinical trials by allowing for varied dosing and the presence of licensed facilitators who may not be medical or mental health professionals.

To ensure monitoring and inform policy, the Oregon Legislature passed Senate Bill 303 (SB 303), codified in ORS 475A.372 and 475A.374 (6). This requires licensed centers to collect standardized, de-identified client data, including REALD (Race, Ethnicity, Language, Disability) and SOGI (Sexual Orientation and Gender Identity) variables, to support equity and outcome monitoring (7, 8).

Despite growing scientific interest, little is known about the demographics and motivations of individuals seeking psilocybin services within a non-medical, state-regulated framework. Furthermore, while early reports focused on initial program rollout, there is a need for a comprehensive assessment of utilization patterns over a sustained period. This study aims to characterize statewide utilization and client demographics during the first full year of regulated psilocybin services in Oregon, examine self-reported motivations with an emphasis on wellness versus mental health use, and estimate rates of acute behavioral and medical adverse events to inform safety monitoring in non-medical psychedelic care models. To date, these publicly available data have not been synthesized to provide a comprehensive annual profile of service users, their reasons for use, and the associated acute safety profile, information that is critical to ongoing national policy discussions regarding regulated psychedelic access (9, 10).

Full-year data from the OPS program reveal a stabilized pattern of service delivery, with over 5,300 administration sessions completed in 2025. Although this report contains no data on benefit regardless of reason for psilocybin use, the low rate of serious adverse events, specifically the rarity of events requiring hospital transport during the first year of the program, suggests that supervised psilocybin administration may be implemented safely to carefully selected participants who meet medical and psychiatric inclusion criteria, in a regulated, non-medical context. This should be interpreted with caution given that the reports of safety are limited to acutely observable events, the distinction between “behavioral” and “medical” adverse events in aggregate reporting remains somewhat imprecise, and the low event volume should be interpreted with caution regarding the quality and completeness of reporting in a non-clinical framework (14, 15).

Adverse events, whether behavioral or medical, were rare. This aligns with OPS safety communications and clinical trial data, where serious adverse events are uncommon and most reactions are mild and self-limited (7, 16, 17). The low frequency of severe events requiring hospital transport highlights the potential safety of supervised psilocybin consumption within regulated environments, though caution remains essential in interpreting aggregate-level data. While service denial rates decreased between Q1 and Q2, the drivers of this trend, whether related to evolving intake procedures, shifts in client-center alignment, or increasing public familiarity with program requirements, cannot be determined from aggregate data and warrant further investigation.

The annual demographic profile consistently skews toward midlife adults (35–49 years) and women, mirroring trends in the broader “wellness” psychedelic landscape (18). The concentration of participants in these age brackets, combined with the significant “service tourism” component where 32.6% of clients originated from outside Oregon, suggests that financial resources may be a primary driver of access. The estimated high cost of regulated services likely favors more mature clients with higher disposable income, while younger demographics may continue to rely on lower-cost naturalistic use. Furthermore, the substantial representation of LGBTQ+ clients (reaching 32.4% in Q1) suggests the program provides a critical pathway for a population that historically experience higher rates of mental health distress (19). This engagement may reflect a specific openness within the LGBTQ+ community toward alternative wellness modalities and “novel experiences” within a regulated framework (20). While aggregate data preclude a direct correlation between sexual orientation and specific motivations for use, this engagement may be influenced by Oregon’s regulatory requirements for facilitator training, which mandate education on LGBTQIA2S+ cultural resilience and affirming care (OAR 333-333-3050) (21). Whether this reflects a specific seeking of identity affirmation or a response to a culturally competent service model remains a vital question for longitudinal research.

Racial and ethnic diversity remains a significant challenge for the program, likely exacerbated by the high cost of regulated services. White and European-descended clients accounted for 84.1% to 91.5% of the reporting population across all quarters, significantly exceeding Oregon’s ‘White alone’ census benchmark of 61.6%. This demographic skew mirrors the persistent lack of diversity in formal psilocybin clinical trials, where White participants have been reported to represent up to 87.2% of study cohorts (22). The parallel between Oregon’s regulated ‘wellness’ model and the clinical research environment suggests that structural barriers, such as the high out-of-pocket cost of services, may be more significant drivers of exclusion than traditional medical inclusion or exclusion criteria. While African American participation (approx. 2.2%–2.4%) lags national demographics, it aligns closely with Oregon’s specific population (approx. 2%). Conversely, Hispanic/Latino representation in the study (approx. 6%–9% overall; 5.6% by Q4) appears significantly lower than both the state and national census benchmarks of 18.7% and 20%, respectively (23). Interpretations of this disparity must consider the 32.6% service tourism rate; the inclusion of out-of-state and international clients introduces a demographic variable distinct from the state census. Our finding that approximately one-third of clients are travelers suggests that a ‘wealth gap’ in access persists, where the financial resources required for participation, including service fees, airfare, and lodging, disproportionately favor more affluent demographics. To address these barriers, the Oregon framework includes specific equity mandates, such as requiring all facilitators to complete 12 hours of ‘Cultural Equity’ and ‘Social Justice’ training (OAR 333-333-3050) (21). Additionally, the state has implemented a tiered licensing fee structure for veterans and low-income providers to increase provider diversity and reduce costs (OAR 333-333-4060) (24). While these policy tools are foundational, our findings underscore that training and fee adjustments alone have not yet resulted in a participant base that mirrors state or national diversity, highlighting the need for continued focus on affordability and community-specific outreach.

The reported reasons for use highlight a convergence of therapeutic and non-clinical motivations. While “general wellness” and “change of perspective” were the most frequent drivers, aligning with naturalistic use studies (25, 26), approximately 20% to 25% of clients cited anxiety or depression. This aligns with clinical literature demonstrating psilocybin’s efficacy for these conditions (2–4, 18, 27–30), yet it occurs here within a service-oriented framework that does not require a medical diagnosis (5). This suggests that many clients may be functionally seeking therapeutic outcomes through a non-medical pathway, particularly given the high prevalence of unmet mental health needs (16, 17). Emerging interests in creativity and spirituality are also supported by prior research on psilocybin’s transformational effects (31, 32).

The substantial representation of out-of-state and international clients (nearly one-third of the annual total) highlights the national and global reach of Oregon’s first-in-the-nation regulatory framework. The peak in domestic tourism during Q3 suggests a growing national awareness of the program, even as overall quarterly session volumes stabilized. This high rate of “psychedelic tourism” further complicates the assessment of health equity when using state-level census data as a benchmark, as the resources required for interstate or international travel likely correlate with higher socioeconomic status. These findings emphasize that the OPS program serves as a critical access point not only for Oregonians but for a broader geographic population seeking supervised psilocybin services in a regulated environment.

Psilocybin-assisted therapy has shown rapid, lasting benefits for depression, anxiety, substance use disorders, and end-of-life distress in multiple studies (2, 33–35). Oregon, facing high rates of mental illness and unmet needs, created the first statewide system for supervised psilocybin services with strict safety standards (1, 16, 17, 36). The OPS model demonstrates that statewide supervised psilocybin services can be implemented safely, with transparent data supporting ongoing policy development and public confidence. Despite not being a medical program, many clients seek help for mental health concerns, suggesting future collaboration with healthcare systems may be needed to ensure continuity of care (34). As data collection expands, researchers will be able to assess equity and identify barriers to access, especially for marginalized groups. However, OPS lacks validated outcome measures, highlighting the need for future longitudinal research on symptom and functioning changes. The continued utilization of group sessions (Table 1) also raises questions about their cost-effectiveness, social benefits, and safety compared to individual administration, warranting further study.

Oregon’s psilocybin services program stands as a pioneering statewide model for regulated psychedelic services that seeks to promote safety, informed consent, privacy, and equity. Full-year statewide data from 2025 reveal a stabilized pattern of utilization following initial growth, characterized by consistently low rates of acute adverse behavioral and medical events. While the program has successfully reached notable proportions of LGBTQ+ and gender-diverse individuals, racial and ethnic diversity lags significantly behind state demographics, and the high rate of service tourism (32.6%) suggests that geographic and socioeconomic barriers to access persist.

The findings suggest that the OPS program serves a dual role: it functions as a regulated wellness modality for personal growth while simultaneously acting as a functional alternative for individuals seeking to address mental health distress outside of traditional medical pathways. These findings provide foundational evidence for policymakers, clinicians, and researchers in other jurisdictions considering similar regulatory frameworks. However, addressing the “wealth gap” in access, refining the precision of safety reporting, and implementing longitudinal research on clinical outcomes remain essential to fully understand the long-term public health implications of supervised psilocybin services.

The authors acknowledge the Oregon Health Authority’s Public Health Division, Oregon Psilocybin Services Section, and all participating service centers for their transparency and pioneering public health approach in psychedelic regulation.

The author(s) declared that financial support was not received for this work and/or its publication.

Publicly available datasets were analyzed in this study. This data can be found here: Oregon Psilocybin Services Data Dashboard Archive: https://www.oregon.gov/oha/PH/PREVENTIONWELLNESS/Pages/Psilocybin-Data-Archive.aspx↗.

The studies involving humans were approved by The University of Arkansas for Medical Sciences Institutional Review Board IRB Number: 299603. The studies were conducted in accordance with the local legislation and institutional requirements. The ethics committee/institutional review board waived the requirement of written informed consent for participation from the participants or the participants’ legal guardians/next of kin because Study utilized only publicly available, aggregate, de-identified data.

FY: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Supervision, Validation, Writing – original draft, Writing – review & editing. JT: Conceptualization, Formal analysis, Supervision, Writing – review & editing. FM: Writing – review & editing, Validation, Formal analysis, Supervision. SD: Conceptualization, Supervision, Writing – review & editing.

The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

This article has been corrected with minor changes. These changes do not impact the scientific content of the article.

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The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpsyt.2026.1777387/full#supplementary-material↗