New Hawaii Bill Would Create A Limited Therapeutic Psilocybin Program To Treat Certain Mental Health Conditions

Newly introduced legislation in Hawaii would create explicit legal protections around the therapeutic use of psilocybin, with eligible patients able to possess and consume the psychedelic under a trained facilitator’s care.

The measure is the result of a task force on breakthrough therapies that was formed last year to explore the issue, its sponsor, Sen. Chris Lee (D), told Marijuana Moment.

SB 3019 would not legalize psilocybin itself but would instead create an affirmative defense for qualified patients and their caregivers, effectively exempting them from state laws against psilocybin. A companion bill in the House, HB 2630, is sponsored by Rep. Della Au Belatti (D) and 13 others.

“There’s a lot of use cases where these kinds of things can really help improve quality of life, and significantly, at minimal cost compared to other kinds of alternative treatment,” Lee said of psychedelics like psilocybin and MDMA, both of which have been designated by the federal Food and Drug Administration (FDA) as breakthrough therapies.

In Hawaii in particular, he noted, there are large numbers of veterans with post-traumatic stress disorder (PTSD) and other behavioral health ailments, as well as older people seeking end-of-life care—groups that might benefit from facilitated psilocybin use.

Under the new legislation, mental health professionals would need to identify a person as having at least one of several listed eligible medical conditions, then write a recommendation for therapeutic psilocybin. Patients would be allowed no more than five grams of psilocybin per session and would need to complete a preparation session prior to the drug being administered.

Eligible conditions for treatment with psilocybin would include post-traumatic stress disorder (PTSD); treatment-resistant depression or major depressive disorder; end-of-life anxiety, existential stress and demoralization; eating disorders such as anorexia and bulimia, substance use disorders and obsessive compulsive disorder (OCD). Additional qualifying conditions could be added by the state Department of Health in response to requests from patients or mental health professionals.

“Psilocybin has shown promising potential for treating mental health conditions,” the bill says in its findings section, pointing to research showing the substance can effectively help treat a range of medical and mental health conditions. Voters in Oregon and Colorado, it adds, have already adopted laws licensing and regulating psilocybin, while other states have seen similar legislative efforts, task forces and proposals to expand research.

“The purpose of this Act,” the measure continues, “is to ensure that people who struggle with trauma and treatment-resistant mental health ailments are not penalized by the State for the use of psilocybin for therapeutic purposes when the patient’s licensed mental health professional provides a professional recommendation that the benefits of therapeutic use of psilocybin would likely outweigh the health risks.”

Facilitators would need to meet certain criteria, including being 21 or older, holding a high-school diploma or equivalent degree and being a Hawaii state resident. They would also need to complete a “psychedelic integration training program” whose curriculum has been approved by the state’s Office of Wellness and Resilience (OWR).

Lee described the office, formed several years ago, as a more “innovative” agency than the Department of Health, which he said has typically taken a “very traditional” approach to related issues, like cannabis.

“They’ve been enormously helpful,” the senator said of OWR’s assistance on the bill, “having a conversation—bringing experts and medical staff and others to the table—to figure out what makes sense for Hawaii. And that’s what led us to where we’re at today.”

All facilitators would need to support patients during three stages of psilocybin treatment: a preparation session, an administration session and a follow-up integration session. Patients would not be compelled under the proposal to return for an integration session, however.

The Hawaii bills would not, as introduced, create regulated psilocybin industry along the lines of systems in Oregon and Colorado. The legislation doesn’t directly address where patients or facilitators would obtain psilocybin, though it broadly defines “therapeutic use” as including “the acquisition, possession, cultivation, use, distribution, or transportation of psilocybin,” as well as psilocybin derivatives and paraphernalia.

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If police seize therapeutic psilocybin products, they would be required to return the property after defendants demonstrate in court that the products comply with the therapeutic psilocybin system. Falsely claiming protection under the law, if passed, would be a petty misdemeanor, subject to a fine of $500.

Asked how the system would work in practice—Could facilitators charge for psilocybin services? Would patients who could legally grow mushrooms at home really seek out facilitators in order to legally use the drug?—Lee said the bill needed to be intentionally vague for now.

“TBD is the short answer,” the lawmaker said. “Intentionally it’s simple, and we’re trying to keep it that way. Otherwise, there’s like, basically no chance.”

“The only way something is going to pass, reasonably, is if it’s as simple as possible, easy to understand, easy for departments to implement,” he added. “And so we didn’t want to get into the details of that side of the equation and potential industry and all of that.”

Lee noted that the proposal resulted from a task force convened last year to prepare the state to potentially allow regulated access to novel therapies like psilocybin and MDMA. “This came out of that working group and those discussions,” he said, “and all the different stakeholders were helpful along the way.”

The goal of OWR’s Breakthrough Therapies Task Force—made up of lawmakers, health professionals, law enforcement and drug policy reform advocates—was to assist the state in expanding therapeutic access to psychedelics that are pending approval by FDA.

Nikos Leverenz, of the Drug Policy Forum of Hawai’i and the Hawai’i Health and Harm Reduction Center, was a member of the task force and said the group “had far-reaching discussions on providing a legal framework to facilitate access to psychedelic assisted therapies under state law.”

“After some consideration, it was decided to forward a bill to help ensure that clinicians who use psilocybin have some level of legal protection, recognizing that it is still listed on Schedule I of the federal Controlled Substances Act,” Leverenz said in an email to Marijuana Moment, adding: “As with cannabis, the inclusion of psilocybin and MDMA on Schedule I of the Controlled Substances Act was misguided from the outset.”

Legislators have advanced bills and resolutions to encourage investigations into psychedelic therapy in recent sessions, but the legislation was not ultimately enacted.

Still, Lee said that given potential action at the federal level and growing support for reform nationwide, he’s feeling “pretty good” about the bill’s chances this session.

“We passed a resolution last year that created the working group to help sort this all out,” he said, “with the intention that we would be sorting it out. And also because it’s clear that at the federal level, there’s a lot of movement, and you have a window of opportunity to really figure out how to implement right before before that happens. We don’t want to be caught, you know, catching up after the fact, dealing with issues that were clearly avoidable.”

Asked why the bill takes a more limited approach of creating an affirmative defense around therapeutic psilocybin rather than a more comprehensive system to legalize and regulate the substance, Lee said that it’s partly due to political practicalities.

“Despite Hawaii being an overwhelmingly Democratic state, it’s very much a moderate Democratic state,” he said, “so getting stuff through the legislature, often which would seem obvious in other states, doesn’t always necessarily apply in Hawaii.”

Lawmakers passed a limited cannabis decriminalization measure in 2019, for example, that Lee spearheaded. He described as necessarily “fairly narrow.”

“Learning from that experience, and some of the stakeholders who came out, and where the support was and wasn’t,” he said, “really helped inform, I think, the approach this time around.”

Leverenz, the member of the state task force, also pointed to a defense bill signed into law last month by President Joe Biden (D) that contains provisions to fund clinical trials into the therapeutic potential of psychedelics for active duty military service members.

“With the latest National Defense Authorization Act providing research funding into the use of psychedelic assisted therapies for mental health conditions, there is growing recognition within the federal government that substances like psilocybin and MDMA can promote health and well-being,” Leverenz said. “Hawaii is home to many veterans, and policymakers should be broadly supportive of efforts to help provide them with needed relief. We are hopeful that Governor Green’s Department of Health and Department of Public Safety will also be on board.”

The psilocybin proposal is just one noteworthy drug reform issue facing lawmakers this session. The legislature is also set to consider a 300-plus page marijuana legalization bill drafted by the state attorney general’s office.

Democrats in control of Hawaii’s Senate said earlier this month that cannabis legalization is one of their top priorities this legislative session, framing the reform as a means to boost the state’s economy.

Last year the Senate passed a separate legalization bill that has stalled the House. But legislators have signaled that 2024 may be the year that legalization becomes law.

In November, the AG’s office defended an earlier version of the legislation it put forward earlier that month after Honolulu Prosecuting Attorney Steve Alm said law enforcement are firmly against legalizing marijuana. David Day, a special assistant with the attorney general’s office, said at the time that Alm’s concerns were overblown and the legalization measure that’s been put forward deliberately took into account law enforcement perspectives.

A separate legalization bill that advanced through the Senate in March is also still in play in the state’s two-year legislative session.

Advocates struggled under former Democratic Gov. Dave Ige, who resisted legalization in part because he said he was reluctant to pass something that conflicts with federal law. But since Gov. Josh Green (D) took office, activists have felt more emboldened. Green said in 2022 that he’d sign a bill to legalize cannabis for adults and already had ideas about how tax revenue could be utilized.

Last April, the Hawaii legislature also approved a resolution calling on the governor to create a clemency program for people with prior marijuana convictions on their records.

Military Veterans Who Received Psychedelic Ibogaine Treatment Saw ‘Dramatic’ And ‘Life-Changing’ Improvements In PTSD And Depression, Stanford Study Finds