Hawaii Panel Advances Therapeutic Psilocybin Bill That Would Protect Patients From Penalties

Lawmakers in Hawaii are continuing to advance a bill that would provide some legal protections to patients engaging in psilocybin-assisted therapy with a medical professional’s approval.

The measure, HB 2630 from Rep. Della Au Belatti (D), would not legalize psilocybin itself. Instead, it would create an affirmative legal defense for psilocybin use and possession in the case of doctor-approved use under the guidance of a trained facilitator.

Hawaii’s House Consumer Protection and Commerce Committee on Wednesday voted 7–0 to advance the proposal, with one member who voted yes expressing reservations on the bill and five other members absent.

Two other House panels have previously signed off on the bill, which next proceeds to the House Finance Committee.

Amendments adopted before the latest committee vote made a handful of changes to the underlying measure. Among them, lawmakers added a definition for “primary caregiver” and specified that therapeutic psilocybin use must be recommended by a licensed medical professional rather than a licensed mental health professional, as an earlier version of the bill provided.

A primary caregiver would be defined as a person 18 or older other than the patient or their licensed medical professional “who has agreed to undertake responsibility for managing the well-being of the qualifying patient.” In the case of an underage patient or an adult lacking legal capacity, “the primary caretaker shall be a parent, guardian, or person having legal custody,” the amended bill says.

One member of the panel, Rep. Richard Onishi (D) initially planned to vote no on the measure, expressing reservations that nothing in the bill seems to require explicitly that psilocybin be taken under the supervision of a facilitator.

“I have this huge concern that the patient is going to be able to take this without any supervision as it’s currently in the bill,” Onishi said before the vote. “Without a provision that they have to be supervised, I cannot support this bill.”

Committee chair Rep. Mark Nakashima (D) offered to add a note to that effect into the committee report, however, and Onishi then agreed to vote in favor of the bill with reservations.

The proposal has support from some state agencies, such as the Disability and Communications Access Board and governor’s Office of Wellness and Resilience (OWR), as well as a variety of reform advocates, including the Drug Policy Forum of Hawaii, the Hawaii Health and Harm Reduction Center and the Clarity Project.

“While this bill is not as far-reaching as policies enacted or under consideration in other states, one hopes that this calibrated approach will facilitate therapeutic use until the federal government removes psilocybin from the Controlled Substances Act (CSA),” the Drug Policy Forum’s board president, Nikos Leverenz, wrote in submitted testimony on the bill.

Opponents include some medical groups, including the Hawaii Medical Association and Hawaii Academy of Family Physicians, which said there’s still too little information about the safety and efficacy of psilocybin. To support those positions, both groups pointed to studies published in 2016 and 2017.

The Hawaii Medical Association said in written testimony that doctors in the state “continue to support cautious and scholarly research on psychedelic therapeutics and encourage the state to ensure that psilocybin goes through the same review process as any pharmacologic intervention.”

The measure is the product of a task force on breakthrough therapies that was formed last year to explore the issue, Sen. Chris Lee (D), sponsor of the Senate’s companion version, told Marijuana Moment last month.

Prior to the bill’s passage through its earlier stop before two committees, members adopted another amendment to add a defective date, which is a procedural method of ensuring that the legislation receives additional discussion before being enacted. The joint panels also accepted some technical amendments to the bill.

A representative of the state Department of Health (DOH) was invited to weigh in on the measure, but they said the department does not currently have a position on the reform proposal.

Under the legislation, medical 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 OWR.

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.

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As drafted, the Hawaii legislation would not 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.

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.

Hawaii legislators have advanced bills and resolutions to encourage investigations into psychedelic therapy in recent sessions, but the legislation has not been ultimately enacted.

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 last 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.

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Photo courtesy of Wikimedia/Workman.