Psychedelics and Mental Health Therapy in Colorado: DORA and Potential Regulatory Response
By James Nechleba
Oct 6, 2021
Recent psilocybin studies have generated significant interest due to the unparalleled positive results for individuals suffering from major depressive disorders and substance abuse disorders. In an era where once-illicit psychoactive substances such as cannabis are safely regulated and available for use, the general public and medical professionals alike are keenly interested in further research and application of psychedelic substances to address mental health issues.
Mapping the New Territory of Psychedelics Use in Mental Health Therapy
With each group of people who find the courage to sojourn into a new frontier, novel ideas develop, traditional practices and definitions are refined, and new techniques are pioneered—leading to the promotion of new experts and authorities. However, as explorers of psychedelic therapy map this new territory, many mental health practitioners are reasonably concerned with issues they anticipate will come from professional regulatory bodies such as the Department of Regulatory Agencies (DORA), including possible criminal consequences.
Ultimately, regulatory agencies such as DORA can only enforce rules that currently exist. While Colorado doesn’t have laws directly relating to the application of psychedelics in mental health settings, the legal framework for using traditional psychopharmaceuticals should be considered the most promising standard for psychedelic therapy practitioners to follow in order to reasonably avoid issues with regulatory bodies. This is a reasonable conclusion based upon Colorado’s absolute prohibition on the prescribing of drugs by traditional mental health practitioners (the practice of medicine in Colorado includes the prescription of any drug). Further, medical practitioners can’t knowingly hold therapeutic sessions incident to their clients’ independent consumption of psychoactive substances, as that violates nearly every accepted code of conduct for mental health practice.
It’s worth noting here that the use of cannabis as a medical treatment requires a licensed doctor’s recommendation, so it isn’t much of a leap to presume that the medical use of substances like psilocybin would demand the same. As such, it’s critical that, when diving into psychedelic therapy, a mental health practice employs a psychiatrist (an M.D. or O.D.) as part of an organized team of mental health professionals.
Psychotherapy v. Psychology in Colorado and the Importance of Developing Clear Roles for Mental Health Practice Staff Members
Due to Colorado’s legal distinctions between the practice of medicine versus psychotherapy or psychology, mental health practices should also develop a concise map of roles and responsibilities for each licensed or registered staff member before it dives into the uncharted waters of psychedelic therapy. Mapping these roles and responsibilities will ensure that staff members do not inadvertently get involved in practices otherwise prohibited by state law and enforced by DORA.
The point where mental health practitioners and teams are most likely to encounter legal turbulence is actually during a given client’s psychedelic experience, simply due to the state’s definitions of psychotherapy and psychology. As any Colorado mental health practitioner can attest, the definitions of psychotherapy and psychology are not the same. Whereas the definition of “psychotherapy” is broader and generally relates to the goals and processes by which mental health is addressed, “psychology” encompasses the techniques used to achieve these goals. Moreover, while “psychotherapy” is written very broadly, the Colorado Legislature is explicit in its directions to DORA to interpret its definition and practice narrowly, only in as much as necessary to enforce it.
The state’s call to narrowly apply what is otherwise a broad definition is likely the result of the legislature’s implicit acknowledgment that psychotherapeutic concepts are functionally inseparable from religious practices.
Navigating the Intersection of Traditional Psychological and Psychotherapeutic Regulatory Infrastructure with the Metaphysical Religious Implications of Psychedelics
Fundamentally, there is very little difference between repairing the metaphysical soul, as opposed to the secular human psyche. In relation to psychedelic therapy, the use of psilocybin in controlled studies has consistently yielded results where individuals describe having a metaphysical experience. This is very suggestive of the theory that the key to long-term relief from psychological suffering may revolve around a metaphysical belief in one’s ability to transcend that suffering.
In fact, one of the strongest statistical indicators of an individual’s ability to recover from substance abuse issues, for example, is transcendent beliefs and/or religious faith. Accordingly, while mental health practices may consider employing members of religious ministry to aide in psychedelic therapy, organizational diligence in the selection of these individuals is of utmost importance. The Colorado State Board of Unlicensed Psychotherapists has rigorous criteria to assess whether statutory ministry exemptions to the Mental Health Practice Act apply.
Regardless, the intersection of traditional psychological and psychotherapeutic regulatory infrastructure and the metaphysical religious implications of psychedelics is exceedingly difficult to navigate legally. For example, within the discipline of Transpersonal Psychology, the goal is not to repair or restore an individual’s mental health, but instead their spiritual health, utilizing traditional psychological analysis and psychedelic-induced states to do so. This practice leads to improved mental health almost as a side effect. What that means is Transpersonal Psychology itself is not subject to regulatory oversight because its goal of metaphysical development rather than behavioral modification; however, the methods that Transpersonal Psychology uses to achieve this goal are subject to regulatory oversight because some are based upon psychological techniques. Complicating matters further, some of the induced metaphysical states apparently can be achieved without the use of psychedelics, but instead with breathing techniques—and we can’t reasonably expect that the State would regulate and police the simple act of breathing.
Ultimately, it’s logical to anticipate that the Colorado State Legislature will eventually construct statutes that directly relate to the use of psychedelics in mental health practices. It’s also reasonable to predict that the policies and behaviors of the most conscientious mental health practices will serve as the guidebook to constructing new statutes. Although there’s no way to guard against every misunderstanding of this new frontier in mental health, developing clear plans and definitions of mental health practice staff roles and responsibilities is critical in order to avoid violating current Colorado law. It’s an enormous responsibility to act without clear rules—a responsibility placed squarely upon the shoulders of individual, licensed professionals. To demonstrate the validity, safety, and applicability of psychedelic therapy and ensure its future, mental health practitioners must impose the highest standards upon themselves.