More than 20,000 people have taken legal psilocybin in Oregon since 2023. That is six times more than every clinical trial of a classic psychedelic since 1951, combined. Until this morning, nobody could tell you what happened to them. Now we can. JAMA Network Open just published the first real-world longitudinal data on state-regulated psilocybin in US history. Researchers at Oregon Health & Science University followed 346 clients across 24 of Oregon's 26 licensed service centers, from before their session to three months after. Nine in ten stayed through the full follow-up. By three months, moderate-to-severe depression symptoms had dropped from 42% of participants to 17%. Anxiety from 45% to 13%. PTSD from 48% to 17%. The share satisfied with their lives rose from 63% to 82%. One month in, 92% said they benefited, and 58.6% ranked the experience among the 10 most meaningful of their lives! Remember, these were not clinical trial patients. Oregon requires no diagnosis and no prescription. The exclusion list is three items long: lithium, active psychosis, and active suicidal ideation. Most clients came out of curiosity (74%) or to work on themselves (71%). A licensed facilitator ran every session. Oregon requires facilitators to complete state training, not to hold a clinical license. The safety record from that wide-open door: four serious behavioral reactions in 346 people, 1.2%. One hospital transport. Zero serious medical reactions. Zero reports of unwanted touch or sexual contact from facilitators. And the four cases share a profile every practitioner should memorize: 1. All four were psychedelic-naive. 2. All four arrived with preexisting mental health conditions, seeking treatment. 3. All took 25 to 50 mg doses (equivalent to 3.5-7 g of dried cubensis). 4. Two were taking antidepressants. In a cohort this open, risk did not sort by molecule. It sorted by readiness. Screening and preparation is where this work is won. The honest caveats: no control group, and the cohort opted into research, about 5% of everyone the program served. Three weeks ago I wrote that my worst fears about Oregon's model were coming true: average client household income of $172,000, sessions at $900 to $5,000, the lowest quarterly client count on record, and a proposal to double licensing fees. This cohort draws the same picture: 1. 87% white. 2. 29% earning over $200,000. 3. 1/3 called the cost a financial strain 81% still said it was worth the money. The people who can access psilocybin say it is worth it. The price decides who gets in. Now we know exactly what everyone else is being priced out of.

We've been prescribing the same class of antidepressant for 40 years. Two doses of psilocybin outperformed six weeks of it on nearly every measure that matters for living a full life. That study is five years old, and it stops being academic next year. In 2021, Robin Carhart-Harris's lab ran a head-to-head comparison in the New England Journal of Medicine. Psilocybin therapy vs. escitalopram for major depression, with identical psychological support in both arms. On the primary measure, the scores looked comparable. In fact, major media headlines called it a tie. Unfortunately, that's where most people stopped reading. If you actually dig into the results, you'll discover psilocybin was a much better option, for myriad reasons: → 57% remission with psilocybin vs. 28% with escitalopram → 70% response rate vs. 48% → Psilocybin improved emotional depth; SSRIs blunted it → Psilocybin preserved sexual function, SSRIs impaired it In the 6-month follow-up, results held, with greater sustained gains in social functioning, connectedness, and meaning in life. SSRIs turn down the volume on suffering. They don't change the song. For five years, that finding lived in journals, confined to academic discourse and university halls. Earlier this year, an executive order directed federal agencies to accelerate psychedelic approvals. Six days later, the FDA issued its first National Priority Vouchers to Compass, Usona, and Transcend, compressing a 10- to 12-month review into 1 to 2 months. Compass is filing its NDA on a rolling basis now. Final submission is targeted for Q4, with launch expected in the first half of 2027 pending approval and DEA rescheduling. 1 in 6 American adults is on an antidepressant. Psilocybin demand won't arrive as new clients walking into clinics. It arrives as millions of medicated people asking their practitioner how to get off of SSRIs and ready to work with psychedelic therapy. Chronic SSRI use blunts the psychedelic response at the receptor level, so those who have been on SSRIs for YEARS will need to taper down - if not completely come off - to experience the full efficacy of psychedelic medicine. We spent a decade building training on how to start psychedelic work. There's almost none on how to safely stop the psychiatric medication a client is already on. David Rabin MD, PhD, has run this protocol in clinical practice for years. The screening, the taper, the ketamine bridge, and the criteria for when psychedelic work can safely begin. Next Wednesday, August 12, he's teaching the fundamentals live. You can register for free by using the link in replies below 👇 If psilocybin is approved next year, is this field ready for the tapers that come with it?