An interview with Massachusetts for Mental Health Options Educational Outreach Director Graham Moore
The leadup to the November election and Question 4 continue to heat up, with a growing number of municipalities—most recently Medford—backing psychedelic policy reforms and voting to endorse the New Approach PAC-backed statewide ballot measure for regulated access to these substances.
With the Mass for Mental Health Options campaign beginning last year amid numerous controversies, turmoil in the grassroots community has taken some attention away from the referendum, including over the past few months. But in the wake of the US Food and Drug Administration’s recent rejection of a long-awaited MDMA-assisted therapy treatment, the fate of Question 4 in the Bay State may also impact the short and long-term future of psychedelic policy reform—in New England, and even nationally.
For a better understanding of where the campaign stands on a number of psychedelic issues, some of which it has yet to address publicly, I reached out to Yes on 4 Educational Outreach Director Graham Moore. A Cambridge resident and longtime mental health awareness activist, his speech to Somerville City Council members in July detailed both his lived experience using psilocybin to treat his Obsessive Compulsive Disorder and the tragic impact that treatment-resistant depression has had on his life.
Moore: As educational outreach director, I am responsible for keeping the campaign grounded in the evidence and effectively communicating evidence-based, informative arguments for Yes on 4. I provide research support, engage in outreach, help craft campaign messaging, and whatever else is appropriate to fulfill the mission. A regular part of my outreach is attending Democratic and Republican town committee meetings and fielding questions from voters.
When/why did you first become interested in psychedelics?
It was shortly after a trip abroad to Ethiopia in college that my obsessive-compulsive disorder (OCD) became debilitating, and I left Vassar College in the first semester of my sophomore year on medical leave, eventually transferring to Northeastern University. In between Vassar and Northeastern, I met another young person who had left college due to mental illness. Her condition was major depressive disorder (MDD). She quickly became my best friend.
Unfortunately, her depression returned in force not long after we met, leading me and my mother to take care of her. My friend was hospitalized against her will for disclosing her symptoms, then discharged a few days later, having only been prescribed escitalopram (Lexapro), a slow-acting antidepressant. She died by suicide less than two months after that.
I went on to graduate from Northeastern University with a B.S. in Economics in 2016. By 2019, my OCD became debilitating again and, in 2021, at the urging of loved ones, I turned to the natural psychedelic psilocybin to recover. And it worked – I used psilocybin in consultation with my psychologist, who I have known for over 15 years, and, later, my psychiatrist, an OCD specialist at Massachusetts General Hospital (MGH), the top-ranked hospital for psychiatry in the country.
Psychedelics never particularly interested me until my mental health reached a low point at the end of 2020. In fact, I was scared of psychedelics. I had been sick for so long that it was basically impossible to imagine what it would be like to get much better. The possibility of “curing” my OCD with psilocybin was frightening because I felt like I was OCD. Eventually, however, I was backed into a corner. My family held an intervention and gave me three options: go back on the conventional medication I disliked because of perceived side effects, do an intensive inpatient program, or try psilocybin. With the encouragement of a friend who was a medical doctor, I chose psilocybin.
Overall, my personal circumstances have provided me with a broad view of the mental health landscape. I have a family member who is doing well using conventional psychiatric medication. I have a family member who is a psychiatrist. I have friends who are medical doctors. I know two people whose relatively short hospitalizations at McLean Hospital, one of the best psychiatric hospitals in the country, were successful. I know another person who has been inpatient at McLean, not getting better, for almost a year.
Motivated by the desire to free others from the afflictions I and those I care about have faced, I have done my best to become familiar with the body of evidence regarding psychedelics and mental health, including by communicating with medical experts and researchers at the cutting edge of the field. My true north is that no one should be legally prohibited from effectively treating a debilitating or life-threatening condition.
Similarly, when/why did you first become involved in psychedelic political advocacy?
Early in 2021, I had the conviction that psychedelic political advocacy was important. After I experienced what felt like a 90% reduction in my OCD symptoms overnight, it felt like a gross injustice that the treatment I used remained legally inaccessible for patients.
I did a bit of advocacy activity in 2021, including posting about my experiences online, but I got discouraged by the responses. For example, two posts were removed from OCD forums by moderators. Considering other factors in my life, I decided not to focus on advocacy that year.
Galvanized by news of the natural psychedelics ballot initiative, I first became intensely involved in psychedelic political advocacy in summer 2023. I recognized the political momentum in Massachusetts provided a unique opportunity to shape policy for the better and, if I did not stand up for myself and the people I cared about, I could not rely on anyone else to do it for me.
I joined with other grassroots advocates, including my now Yes on 4 colleague Jamie Morey, and started a new Meetup group to try to politically organize behavioral health patients. There’s no great clamoring among patients to keep psychedelic treatments legally inaccessible, but opponents of access paternalistically frame themselves as our defenders. We have to stand up for ourselves.
One of the biggest concerns surrounding psilocybin-assisted therapy is the high cost of treatment sessions. How do you think this issue can be addressed—be it legislatively, commercially, or otherwise—to make psychedelic medicine more accessible to a wider range of patients?
It is important that well-qualified, trustworthy individuals oversee the care. While this will be costly, the cost per patient can be reduced with group therapy. Additionally, costs will come down as more psychedelic therapy centers are established. Paying a typical social worker in Massachusetts for six hours of their time costs upwards of $500.
It is important to contextualize the high cost of regulated psilocybin-assisted therapy with the fact that, based on the evidence, most people will desire this treatment very infrequently. In clinical trials, just one or two high doses of psilocybin have appeared sufficient to produce long-lasting relief.
Mainstream media coverage of the psychedelic renaissance has often compared the legislative model that’s on the ballot in Massachusetts this fall to previously enacted regulatory models in Oregon and Colorado. What are the key differences and similarities between M4MHO’s proposed regulatory model compared to the Oregon and Colorado models?
Oregon’s model only regulates psilocybin/psilocyn, whereas Colorado’s model and the proposed model for Massachusetts regulate psilocybin/psilocyn, mescaline, dimethyltryptamine (DMT), and ibogaine. Colorado’s model is practically the same as what is being proposed for Massachusetts.
All three models offer a similar framework for regulated psychedelic therapy in that you cannot purchase psychedelics and take them home with you. Individuals must go through a screening process to determine if the therapy is appropriate for them and, if they are approved, they are administered a psychedelic substance under the supervision of a licensed facilitator.
The Coalition for Safe Communities, an opposition campaign backed by prominent drug prohibitionist Kevin Sabet, has recently shown up in Massachusetts. Chief among C4SC’s stated criticisms of H.4255 is that the home cultivation and personal distribution measures included in the bill are too broad and would lead to “more DUIs, endangering children and pets, and an unregulated unsafe psychedelics black market” … Based on the research data currently available on social side effects of psychedelic decriminalization, what would you say to voters who might be concerned that statewide decriminalization of psychedelics could bring unforeseen negative consequences?
“Decriminalization” is a bit of a misnomer. The measure does not decriminalize all activities related to psychedelics. Selling and purchasing psychedelics off the street will remain illegal under the measure. The measure prohibits retail sales. The measure prohibits possession of psychedelics by people younger than 21. The measure prohibits public use of psychedelics. And the measure requires individuals to keep cultivated psychedelic plants and fungi “secured from access by persons under 21 years of age.” It is more accurate to say that the bill removes criminal penalties for limited personal use of five naturally-occurring psychedelics.
As for the public health consequences of no longer prosecuting people for limited personal use of certain psychedelics, voters should look to Colorado, which passed a practically identical measure in late 2022. Impaired-driving related fatalities and the percentage of drug and alcohol-related arrests related to psychedelics went down in Colorado after the psychedelics measure passed. Similarly, the percentage of drug and alcohol-related hospitalizations related to psychedelics remained practically the same and was still lower than in 2020.
In fact, nowhere in the world has legal access to the substances in the measure been observed to harm public health.
You and I have previously had some discussions about the stigmatization surrounding psychedelic use by individuals with seemingly more severe mental health conditions (i.e. OCD, bipolar disorder, personality disorders, schizophrenia/psychotic disorders, etc.). Can you speak to some of the core issues, common misconceptions, and any noteworthy contradictory and/or /supporting research that you’ve encountered in your work as a psychedelic advocate?
OCD is not considered to be in the same category of baseline severity as manic disorders, psychotic disorders, and personality disorders. There appears to be no popular worry about psychedelics used by individuals with OCD, and the clinical research so far, at minimum, suggests psilocybin can be effective in treating OCD. As for psychedelics use by people with personality disorders, there has not been a lot of research, and it remains a niche issue.
Worry about psychedelics use by people with manic and psychotic disorders, however, is mainstream, so I want to be clear: people who have a manic or psychotic disorder, like bipolar disorder and schizophrenia, or appear to have an especially high risk of developing such a disorder, should not use the substances in Question 4 outside a clinical trial.
However, even for people with a personal or family history of a manic or psychotic disorder, believed to have the highest risks of adverse reactions to psychedelics, it is unclear if psychedelics are more dangerous overall than alcohol, tobacco, and cannabis. The results of observational and clinical studies point to a complicated picture.
For example, in research settings, the psychedelic LSD, when given to over 100 individuals diagnosed with schizophrenia, was not observed to typically change the course of the condition and, particularly at relatively low doses, sometimes appeared therapeutically beneficial.
When it comes to alcohol, the picture is not complicated; no one is suggesting bipolar or schizophrenic patients are better off by downing beers. But even though alcohol can cause psychosis, can exacerbate mania, and is especially harmful for anyone with a mental illness, some people claiming to care about mental health ignore the evidence to demonize psychedelics. The solution for people suffering from manic and psychotic disorders is not restricting effective treatment options for those suffering from other forms of serious mental illness.
Mental health patients should not be put in conflict with each other. It is the conventional healthcare system that is regularly failing people with serious mental illness across the board.
As psychedelic medicine continues to gain traction around the world, what do you see as the best and worst-case scenarios for its future in the United States?
The best-case scenario for psychedelic medicine in the United States is that, within a decade, everyone who could benefit from it has access. I think that is possible, and I see that playing out through a combination of state level reforms and federal rescheduling of certain psychedelics through the FDA pathway, culminating in mainstream cultural acceptance and eventual federal de-scheduling of cannabis along with certain, or all, therapeutic psychedelics.
A worst-case scenario is Question 4 loses in Massachusetts, killing momentum for ambitious statewide reform.
The MA Joint Committee on Special Election Initiatives issued their summary report of H.4255 in late April, in which the committee stated their conclusion that “the petition’s major goals—licensure and decriminalization—likely undercut each other by creating two separate systems for the use of psychedelic substances.” Even still, the M4MHO team was able to secure an additional 14,000 signatures to secure H.4255’s spot on the ballot as “Question 4.” What would you say to legislators who might be on the fence about a dual decrim/legalization regulatory structure for psychedelics in MA?
The limited personal-use provisions are not in opposition to the regulated therapy provisions. The point of providing regulated therapy by licensed facilitators is to deliver a reliably high level of care that cannot exist in the underground. Furthermore, the necessarily high cost and guardrails of regulated psychedelic therapy means it will never be in direct competition with the retail psychedelics black market. Removing criminal penalties for limited personal use is about freeing law enforcement to focus on serious crimes and not prosecuting people for healing. The measure does not allow retail sales, and people selling psychedelics on the street will still be breaking the law if the measure passes.
What would you say to parents, families, and individuals who might be against or still on the fence about the use, decriminalization, and/or legalization of psychedelics?
The most important reason for making these nonaddictive substances legally available is because the conditions they can be effective in treating, including PTSD, opioid addiction, and end-of-life anxiety and depression, are life-threatening and/or debilitating, without adequate conventional treatment options. We know there are not adequate conventional treatment options because our communities regularly experience suicides and fatal overdoses.
All the substances in the measure have demonstrated therapeutic value, as reflected by extensive histories of therapeutic use. In the cases of psilocybin and ibogaine, they are prescribable medications in Australia and New Zealand for treating treatment-resistant depression and (essentially off-label) opioid addiction. And, as mentioned before, nowhere in the world has legal access to any of the substances been observed to harm public health.
Tens of millions of people have already used natural psychedelics in recent decades, compared to the less than 10,000 people who used Prozac before it was approved as an antidepressant. From a public health perspective, we know more about the substances in the measure than any newly invented drug going through the FDA approval process.
Aside from yourself, who are some other leaders, innovators, and/or advocates in the psychedelic science community that you think more people should know about and hear from?
Haley Maria Dourron, a doctoral student in health behavior with neuroscience at the University of Alabama, Birmingham. Jesse Gould, Army Ranger veteran and founder and president of the Heroic Hearts Project. Jamie Morey, veteran spouse and founder of Parents for Plant Medicine and community engagement director for Yes on 4. Emily Oneschuk, Navy veteran and grassroots campaign director of Yes on 4. Ryan Munevar, founder and head of Decriminalize California. Dr. Sa’ed Al-Olimat, co-founder of the Psychedelic Pharmacists Association, vice president of the Psychedelic Club of Pittsburgh, and founder of PsiloHealth. Dr. Emily Kulpa, co-founder of the Psychedelic Pharmacists Association and a certified psychedelic facilitator in Oregon.
What’s next for your advocacy work—both personally and as a member of the M4MHO campaign?
I am going to continue serving as educational outreach director for Yes on 4 through the election, which will hopefully be a victory for Question 4. I am not sure what the campaign will look like after the election. As of now, I am not ready to comment besides that except to say I plan on continuing being an advocate for access to psychedelic treatments beyond the campaign.
