Oregon's Psilocybin Centers Passed the Safety Test. Then Came the $1,900 Bill.

The callers said they were interested in psilocybin. They described depression, in some cases alongside a history of alcohol use disorder, in one case a family history of psychosis. They asked about cost. Then they wrote down everything the person on the other end of the line did and did not ask them.

Those scripted calls — placed by three of the study's own co-authors to 15 of Oregon's active licensed psilocybin service centers — produced the first independent account of what actually happens when a member of the public tries to buy a supervised psychedelic session in the United States. The results, published October 12 in Health Affairs Scholar, cut in two directions at once.

The screening, by and large, worked. The economics, by every measure the researchers collected, did not.

What a mystery shopper heard

Oregon legalized regulated, supervised psilocybin in 2020 and began licensing centers in 2023, becoming the first state to build a legal market for a drug that remains a Schedule I controlled substance under federal law. Colorado has since followed. Nobody had systematically tested whether the state's statutory safeguarding — mandatory screening for psychiatric history, medications and contraindications — survives contact with a prospective customer.

The Washington University in St. Louis and University of Missouri team designed the study to walk a real client's path: review the center's website, then call and ask questions a person with depression and a drinking history might ask. They logged whether staff probed medications, suicidal ideation and psychiatric history, as Oregon's framework requires, and they recorded the price quoted.

First author Dani Adams, an assistant professor of social work at the University of Missouri who began the work as a postdoctoral fellow at WashU, framed the stakes plainly. Oregon, she noted, "has dosed more people with psilocybin in a regulated model than anywhere else in the world" — and it is nonetheless, she added, out of reach for most Americans struggling with their mental health.

Where the model held up

On the safety questions, the findings were almost uniformly reassuring, and the researchers said so explicitly.

No center offered unsupervised use or take-home psilocybin. Every center asked about psychiatric history, current medications and risk factors before discussing next steps. Nearly all flagged psychoactive medications that should not be combined with psilocybin, and no center advised a caller on antidepressants to stop taking them without first speaking to a primary care physician — a deceptively important detail, since abrupt antidepressant discontinuation is its own clinical risk.

Kevin Xu, a WashU assistant professor of psychiatry and co-senior author, described arriving with a specific worry. "Going in, we wondered whether Oregon's model might work like a dispensary in practice — that you could call a center, pick up psilocybin and take it home with little screening along the way," he said. What the callers encountered was closer to an intake interview. "Far from a dispensary model, I was surprised by how service centers asked detailed questions about callers' mental health and risk factors."

Co-senior author Leopoldo Cabassa, a professor at WashU's Brown School, made the distinction sharper: the facilitators pushed past a checklist to understand a caller's history before recommending anything.

The findings land alongside a separate JAMA Network Open cohort study of 346 Oregon clients, in which serious adverse reactions were uncommon. Taken together, the two papers describe a young regulated program that is, so far, running roughly as designed on the clinical-safety dimension.

The number that breaks the model

Then there is the bill. The median cost of a session was $1,900. Not one center accepted insurance.

That single fact determines who can access the program, and it is not a rounding error in a country where the conditions psilocybin is being studied for — depression, anxiety, post-traumatic stress disorder, substance use disorders — disproportionately affect people with limited financial margins. A regulated psychedelic session is, in practice, a cash-pay luxury service sitting inside a public-health framework.

Four centers closed before the calls started

The attrition data make the sustainability problem concrete. Oregon had licensed 26 centers. Four had closed before the study's calls began, and another seven could not be reached by telephone, leaving 15 of the 22 remaining active centers that the researchers were able to contact. Roughly a third of the state's licensed capacity had evaporated or gone dark before anyone tried to use it.

Interviews with center staff, which the team conducted after the mystery-shopper phase, pointed to the same mechanism from the operator's side: licensing and operating costs are high enough that the business is hard to sustain, which in turn keeps prices high enough that many prospective clients never become actual ones. The accessible version of the story is about the $1,900. The structural version is about a cost floor that has not moved.

Cabassa framed the question as one of sequencing. "We have to figure out what safeguards are needed and make sure those are maintained as the system solves for accessibility," he said — a warning that the pressure to bring costs down is precisely when safety guardrails get thinned.

The only place this study could be run

It is worth being clear about why this research exists at all, and why it looks the way it does.

Psilocybin is not FDA-approved for any indication. Oregon and Colorado permit supervised use under state programs that sit entirely outside the clinical-trial system, which means the normal evidence apparatus — institutional review boards, adverse-event reporting, protocol oversight — does not attach to them. That is the regulatory space the mystery-shopper method was designed to probe, because no other instrument reaches it. Official inspection records capture licensure compliance; they do not capture what a nervous caller with a drinking history is actually told on the phone.

WashU has been building toward this question from the neuroscience side for years. Co-author Ginger Nicol co-directs the university's Center for Holistic Interdisciplinary Research in Psychedelics and led a 2024 Nature study showing how psilocybin temporarily desynchronizes activity across brain networks — among the first work to map the drug's effects at that scale. The new paper extends the same institution's footprint from mechanism to implementation: what the brain does under psilocybin, and what a person experiences trying to obtain it legally.

Why state programs are not the same as approved medicine

The study's most politically loaded passage concerns veterans. PTSD, depression and suicide rates among veterans are high enough that bipartisan coalitions in Congress have pushed to accelerate FDA approval of psychedelic-assisted therapy, and federal agencies have moved to fund and fast-track trials. In the interim, Cabassa noted, some veterans who cannot afford or access regulated care in the U.S. have instead sought treatment abroad, in unregulated settings.

That is the cost of a $1,900 cash-pay floor with no insurance pathway: the people most motivated to try the therapy are pushed outside the system that screens for exactly the contraindications the Oregon centers were found to check so carefully. For veterans and others managing concurrent trauma and substance use, integrated dual diagnosis care remains the established route, and it is built around insurance-funded treatment rather than cash payment.

The comparison with medication-based addiction care is instructive. When medication-assisted treatment for opioid use disorder scaled up, the decisive lever was payer coverage — Medicaid billing, prescriber eligibility, the removal of prior authorisation. A cash-pay $1,900 session has no equivalent lever, and no state program has yet built one.

What the study cannot tell us

The paper is candid about its own boundaries, and readers should hold them in mind.

Fifteen centers is a small sample drawn from one state, and the callers used three scripted personas — meaning the study measured responses to depression plus alcohol use disorder or family psychosis history, not to the full range of callers a center might encounter. The mystery-shopper method captures what happened on one telephone call. It cannot verify what happens during an actual session, and it says nothing about outcomes.

Most importantly, it does not answer the question the program was built to settle. The JAMA companion study found serious adverse reactions uncommon among 346 clients, which is genuinely reassuring at that scale, but 346 people over a few years is a fraction of what regulatory approval requires. Oregon's experiment is providing implementation evidence — how a legal market behaves — long before it can provide efficacy evidence. Those are different kinds of knowledge, and the cost data suggest the implementation evidence is arriving with an access problem baked in.