A new study has found that Oregon’s licensed psilocybin centers largely follow recommended safety guidelines, offering reassurance about how the first regulated psilocybin programs in the U.S. function in practice — though the cost of treatment may keep it out of reach for many.
The study, led by researchers at Washington University in St. Louis and the University of Missouri, is the first independent look at how these centers vet their potential clients.
Since 2023, when Oregon became the first state to legalize regulated, supervised psilocybin — the psychoactive ingredient in “magic mushrooms” — it has drawn people with mental health conditions ranging from depression and anxiety to post-traumatic stress disorder and substance use disorders.
Some clinical trials have suggested that psilocybin, combined with psychological support or psychotherapy, can provide relief for some of these conditions, though the drug remains federally illegal. Until now, little has been known about what people actually encounter when they contact a psilocybin center — or what safeguards are in place.
To find out, researchers posing as prospective clients reached 15 of Oregon’s 22 active centers by phone and found that they consistently followed safety practices required by state law: no center allowed unsupervised or take-home use, and staff routinely asked about psychiatric history, medications and contraindications before discussing next steps. These findings complement a recent cohort study in which serious adverse reactions among 346 Oregon clients were uncommon.
The new study is officially published Oct. 12 in Health Affairs Scholar .
“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,” said co-senior author Kevin Xu, MD , an assistant professor of psychiatry at WashU Medicine. “Far from a dispensary model, I was surprised by how service centers asked detailed questions about callers’ mental health and risk factors. Services were also very expensive.”
The research team later interviewed center staff and found that high operating and licensing costs make these services hard to sustain for centers and hard to afford for people who might seek them. Indeed, four of the 26 centers Oregon had licensed closed before the study’s calls began, and another seven could not be reached by phone.
The research team, which included experts in medicine, social work and public health, designed the study to follow the path a real client would take: reviewing the center’s website, then calling to ask questions.
“This latest innovative study highlights our unique interdisciplinary approach to psychedelic science.”
— Ginger Nicol, MD, WashU Medicine
Three co-authors made scripted calls in which they posed as potential clients with depression and a history of alcohol use disorder or a family history of psychosis. They documented whether staff asked about medications, suicidal ideation and psychiatric history, as required by Oregon’s legal framework for psilocybin services. They also documented the price quoted for services.
“These interactions were not just, ‘Hey, give me mushrooms,’ and that’s it,” said co-senior author Leopoldo J. Cabassa, PhD , a professor at WashU’s Brown School who also co-directs WashU’s Center for Mental Health Services Research . “These were thoughtful conversations where the facilitator engaged people, asked good questions, and tried to get as much information as possible. Facilitators pushed past a simple checklist to actually understand a caller’s history before making a recommendation for services.”
Nearly every center flagged psychoactive medications that should not be combined with psilocybin, and no center advised callers taking antidepressants to stop them without first consulting with their primary care physician.
The median cost of a session was $1,900, and no center accepted insurance, which would limit accessibility if the treatment is legalized in other U.S. states.
“Oregon has dosed more people with psilocybin in a regulated model than anywhere else in the world,” said first author Dani Adams, PhD , an assistant professor of social work in the College of Health Sciences at the University of Missouri and Director of the Collaborative for Missouri Psychedelic-Assisted Therapy, who began this line of research while a postdoctoral fellow at WashU working with Cabassa. “But it is still out of reach for most Americans who are struggling with their mental health.”
Veterans in particular face high rates of PTSD, depression and suicide, which has fueled bipartisan interest in getting psychedelic-assisted therapy approved by the U.S. Food and Drug Administration (FDA). Cabassa noted that in the meantime, some veterans unable to access or afford regulated care in the U.S. have instead sought unregulated treatments abroad, highlighting the importance of getting domestic access right.
WashU has been a leader in psychedelic research on multiple fronts. Co-author Ginger Nicol, MD , a professor of psychiatry at WashU Medicine, co-directs the Center for Holistic Interdisciplinary Research in Psychedelics alongside Cabassa, and was the principal investigator on a landmark 2024 study in Nature that showed how psilocybin temporarily desynchronizes activity across the human brain, among the first studies to map the drug’s effects at that scale.
“This latest innovative study highlights our unique interdisciplinary approach to psychedelic science,” Nicol said. “The team recognized an opportunity and acted swiftly to collect data that fills a major gap in scientific knowledge.”
With the new study, Cabassa and Nicol noted, WashU’s footprint in the field has grown from understanding brain circuitry to real-world implementation.
“We have to figure out what safeguards are needed and make sure those are maintained as the system solves for accessibility,” said Cabassa.
Adams DR, Hartman M, Gong L, Shankar S, Ling R, Steinle JT, Siegel JS, Nicol GE, Grucza RA, Borodovsky JT, Cabassa LJ, Xu KY. “Am I a candidate for magic mushrooms?” A mystery shopper study of Oregon psilocybin service centers. Health Affairs Scholar. October 12, 2026. DOI: 10.1093/haschl/qxag231
The work was supported by NIH grants K08DA061258 and R25 MH112473. Additional funding came from the WashU PJ000033039 Funding Award, the WashU Center for Dissemination and Implementation, and WashU’s Here & Next Transcend Initiative. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
J.S. Siegel reported former employment by Sumitomo Pharma America; receiving consulting fees from Longitude Capital and Otsuka Pharmaceutical and being coinventor on a provisional patent (No. 020949/US 15060-1787) related to the use of precision functional mapping to assess target engagement of experimental therapeutics. G.E. Nicol reported receiving grants from COMPASS Pathways and Usona; receiving drug supply from Usona; and being a paid consultant for Carelon, Alkermes, Sunovion, and Novartis outside the submitted work as well as serving as codirector of the Washington University Center for Holistic Interdisciplinary Research in Psychedelics (CHIRP), a Transcend Initiative funded by the Washington University Here and Next strategic plan.
About WashU Medicine
WashU Medicine is a global leader in academic medicine, including biomedical research, patient care and educational programs with 3,100 faculty. Its National Institutes of Health (NIH) research funding portfolio is the second largest among U.S. medical schools and has grown 78% since 2016. Together with institutional investment, WashU Medicine commits over $1.6 billion annually to basic and clinical research innovation and training. Its faculty practice is consistently among the top five in the country, with more than 2,550 faculty physicians practicing at 200 locations. WashU Medicine physicians exclusively staff Barnes-Jewish and St. Louis Children’s hospitals — the academic hospitals of BJC HealthCare — and Siteman Cancer Center , a partnership between BJC HealthCare and WashU Medicine and the only National Cancer Institute-designated comprehensive cancer center in Missouri and southern Illinois. WashU Medicine physicians also treat patients at BJC’s community hospitals in our region. With a storied history in MD/PhD training, WashU Medicine recently dedicated $100 million to scholarships and curriculum renewal for its medical students, and is home to top-notch training programs in every medical subspecialty as well as physical therapy, occupational therapy, and audiology and communications sciences.
Health Affairs Scholar
“Am I a candidate for magic mushrooms?” A mystery shopper study of Oregon psilocybin service centers
12-Oct-2026
The work was supported by NIH grants K08DA061258 and R25 MH112473. Additional funding came from the WashU PJ000033039 Funding Award, the WashU Center for Dissemination and Implementation, and WashU’s Here & Next Transcend Initiative. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. J.S. Siegel reported former employment by Sumitomo Pharma America; receiving consulting fees from Longitude Capital and Otsuka Pharmaceutical and being coinventor on a provisional patent (No. 020949/US 15060-1787) related to the use of precision functional mapping to assess target engagement of experimental therapeutics. G.E. Nicol reported receiving grants from COMPASS Pathways and Usona; receiving drug supply from Usona; and being a paid consultant for Carelon, Alkermes, Sunovion, and Novartis outside the submitted work as well as serving as codirector of the Washington University Center for Holistic Interdisciplinary Research in Psychedelics (CHIRP), a Transcend Initiative funded by the Washington University Here and Next strategic plan.