Oregon’s psilocybin services are often described as quite expensive in both media coverage and academic discussions. However, when making this claim, we should ask: expensive compared to what? Whether or not psilocybin services are considered too expensive may, in fact, depend in large part on whether their use is being thought of as healthcare, a luxury experience, a quasi-therapeutic activity, or something else entirely.
In 2020, Oregon was the first state in the U.S. to legalize access to psilocybin, a psychedelic from so-called “magic mushrooms.” Oregon’s policy is non-medical, as the program requires no physician referral to access services. Clients are administered psilocybin at dedicated service centers under a facilitator’s supervision. These facilitators must have completed an approved training program (~168 hours), but are not required to be licensed clinicians.
Because Oregon’s policy is the first of its kind, it has become a key reference point in debates about how other states might design psychedelic policy. A recurring focus in these discussions is price, as a single dosing session typically costs clients between $850 and $3,000 (which usually includes a preparation and follow-up session).
However, labeling psilocybin services as expensive depends on a comparison, and our choice of comparator can shape our conclusion. We should ask what we might be comparing these services to when evaluating expense (David Nutt explored a similar question about the safety of MDMA compared to other risky, non-drug activities such as horseback riding; ecstasy and “equasy”). The comparator we choose matters, as it shapes whether Oregon’s prices are seen as reasonable and can help define what price Oregon should aim to deliver for psilocybin services.
The choice of comparator depends partly on the kind of experience people believe is being sold. Much turns, then, on what people believe they are paying for, and why they are seeking out psilocybin services in the first place.
Despite Oregon’s policy being non-medical purposes, many clients of these centers report using these psychedelic services for medical-type reasons, such as for depression and anxiety. One natural comparison may then be to existing medical treatments for the same conditions.
For example, we could compare psilocybin service centers to pharmacotherapy for depression or anxiety, which can cost around $30 per month for a generic medication like sertraline without insurance, in addition to ~$250 for semi-regular consultations with a psychiatrist (without insurance). On that basis, psilocybin services might appear quite expensive. However, the picture changes if the comparison is to psychotherapy, which can cost roughly $139 per hour (without insurance). Assuming a total duration of around 15 hours, psilocybin services cost about $200 per hour at the high end of the price range and about $56 per hour at the low end. In that context, psilocybin services may not look so expensive.
At the same time, the medical comparison raises a different concern: psilocybin has not been FDA-approved as a medical treatment, at least at the time of this writing. The price of psilocybin services may be especially concerning if some clients seek them in response to serious mental health conditions. With this in mind, $3,000 may start to look like a lot to pay for a drug with no formal regulatory approval.
However, many clients also report seeking psilocybin for non-medical purposes, such as for creativity enhancement or for a change in perspective. And psilocybin services are explicitly described by the Oregon Health Authority as not being a medical treatment. People may then be comparing psilocybin services to the prices of other recreational activities pursued for personal growth, well-being, or creativity –especially those that involve some degree of risk and feel similarly intense or transformative. Think perhaps of a 3-day course to summit Mt. Rainier ($3475 or ~$1158 per day), or a full day diving trip with a private divemaster ($718 from one company). In these comparisons with other luxury, intense, and often meaningful recreational experiences, the price of psilocybin services may appear on par or a little bit more expensive.
A third possibility is that psilocybin services fall somewhere in between medical and purely recreational activities: they can offer medical benefits, but can also be undertaken for more recreational reasons. Some might then compare psilocybin services to quasi-therapeutic activities like massages, which can similarly be done for wellness-related reasons while offering medical-type benefits (e.g., relief of back pain).
In 2021, the average massage cost about $76 per hour, while massages at hotels and resorts averaged about $123 per hour. Compared with psilocybin services, which range from roughly $56 per hour at the low end to $200 per hour at the high end, the prices appear broadly comparable.
Finally, people may simply be comparing Oregon’s psilocybin services with unsupervised psilocybin use. As one example, psilocybin can be purchased in D.C (where it is decriminalized) for about $40. From this perspective, the question may become whether Oregon’s regulated supply of psilocybin, facilitator supervision, regulatory oversight, and legal access pathway are worth roughly $2,960 for the additional safety they provide. Some may be answering “no”, leading them to describe services as “expensive”.
There may be no single “right” comparison for Oregon’s psilocybin services, and comparisons alone are not enough to determine whether services are appropriately priced. Psilocybin services may also strike people as expensive simply because their price puts them out of reach for many.
Rather, the goal of this comparison exercise is to show that judgments about whether the program is “too expensive” may depend partly on the kind of experience being sold: is the price being charged in Oregon the price of healthcare, the price of a luxury experience, the price of a quasi-therapeutic activity, or something else?
Psilocybin services present an interesting case in that Oregon is trying to price a novel access pathway and container for a psychoactive experience that hasn’t previously legally existed on the market. Making these comparison sets explicit helps ground debates about Oregon’s program in more careful analysis rather than intuition alone.
Katherine Cheung (@Katherine_Chg) is a PhD student in Bioethics and Health Policy at Johns Hopkins University
Caleigh Propes (@CaleighPropes) is a PhD Candidate in Bioethics and Health Policy at Johns Hopkins University
David B. Yaden, PhD (@ExistWell) is an Associate Professor and the Roland Griffiths Professor of Psychedelic Research at Johns Hopkins University School of Medicine in the Department of Psychiatry and Behavioral Sciences at the Center for Psychedelic and Consciousness Research