Utah's Psychedelic Therapy Legislation: Progress and Challenges

By Dr. Steven Christiansen, Medical Strategy Director, Utah Patient Coalition

The Human Cost of Inaction

My advocacy for psychedelic therapy comes from both professional interest and profound personal loss. Several years ago, while at BYU, I became friends with a young woman struggling with severe depression. Despite her efforts to navigate the mental health system, I watched helplessly as conventional treatments failed her. She had been hospitalized after a previous suicide attempt and was allegedly receiving appropriate care—therapy, medication, follow-up appointments—all the interventions our current system offers.

And yet, one day, she took her own life.

That loss changed me. It transformed academic interest into an urgent mission.

Over the next several years, I researched the various treatment options available. My background in biochemistry helped me understand the science, but it didn't prepare me for the harsh realities of healthcare innovation. I discovered that available treatments rarely represent the best possible solutions. They represent only what can successfully navigate the labyrinth of regulation, market forces, and implementation challenges. Even brilliant innovations fail to reach patients for countless reasons: regulatory hurdles, manufacturing limitations, marketing missteps, or simply because they don't fit neatly into existing healthcare systems. The gap between what's scientifically possible and what actually reaches patients represents an enormous lost opportunity for those who need help now.

While this maze of regulatory hurdles, commercial constraints, and implementation challenges persists, people like my friend remain in crisis. The sheer complexity of bringing new treatments to market doesn't just slow progress—it costs lives. This disconnect between what science makes possible and what actually reaches suffering patients represents countless missed opportunities for those who simply cannot afford to wait for our system to catch up.

I've come to visualize mental health as a graph with the vertical axis representing well-being and the horizontal axis representing time.

For many people with depression, their well-being line gradually trends downward, then upward with conventional treatments. But for others, available help is to slow or non-existant, leading them to approach a depth of mental health symptoms approaching what I call a "suicide threshold"—an invisible line where, once crossed, their decline becomes catastrophic and potentially irreversible. Like an event horizon for a black hole: once this line is passed, recovery can feel hopeless and suicide risk skyrockets.

Our current treatment model asks these individuals to endure weeks or months of medication trials, frequent therapy sessions, and gradual adjustments—a luxury of time they simply don't have. When someone is approaching or has crossed that threshold, they need immediate, effective intervention. This isn't just about finding better treatments; it's about acknowledging the fundamental mismatch between our slow, methodical approach to mental health and the acute urgency of suicidal crisis.

Psychedelic-assisted therapy offers something our conventional treatments often can't: rapid, relief. The research shows effects within days rather than weeks or months. For someone standing at the edge of that threshold, this difference isn't just a matter of convenience—it's the difference between life and death.

Utah's Mental Health Emergency: The Catalyst for Change

Utah is facing a mental health crisis of unprecedented proportions. As a biochemist by training and an advocate for expanded mental health treatment options, I've witnessed firsthand the limitations of our current mental health infrastructure. The statistics paint a sobering picture of why Utah needs innovative solutions:

In 2023, 21.7% of Utah's population reported experiencing anxiety, ranking our state fifth highest in the nation for anxiety rates. According to Mental Health America, adults in Utah are more likely than any other state to have some form of mental illness, with 29.19% of our adult population affected. Even more alarming, Utah faces a severe suicide crisis with a 2022 rate of 22.9 per 100,000 people—61% higher than the national average of 14.2 per 100,000.

Among our veteran population, approximately 38% of the 140,000+ veterans living in Utah are diagnosed with mental health disorders. Additionally, an estimated 180,000 Utah adults (1 in 13) suffer from treatment-resistant depression (TRD), having seen little improvement from conventional treatments. During February 2021, at the height of the pandemic, 40.9% of adults in Utah reported symptoms of anxiety or depression, with 26.4% unable to access needed counseling or therapy.

As Senator Cullimore, the sponsor of recent psychedelic therapy legislation, aptly stated: "We have a mental health crisis and there are a lot of people that are seeking help and they've just not found the help they needed through traditional methods and traditional medicines."

The Problem with Current Treatment Options

Our conventional mental health treatments work for many people, but they're far from perfect. Talk therapy, while effective, typically takes three to twelve months to work—if it works at all. Traditional antidepressants like SSRIs often require weeks or months to take effect, and many patients need to try multiple medications before finding one that helps. After a patient has tried four different antidepressants without success, they're diagnosed with treatment-resistant depression.

For those with treatment-resistant conditions, options become increasingly limited and expensive. Transcranial magnetic stimulation (TMS), while FDA-approved, costs approximately $10,000 and is only covered by insurance after a patient has failed multiple medication trials.

These limitations become critical barriers for those experiencing severe depression or suicidal ideation. Years of trial-and-error treatment approaches are untenable for someone in crisis. We desperately need what is called "abortive interventions"—rapid-acting treatments that can quickly stabilize a patient in crisis.

The Promise of Psychedelic Therapy

The research on psychedelic medicine shows remarkable potential, particularly for conditions resistant to conventional treatments:

Psilocybin has been shown to significantly reduce treatment-resistant depression, with effects seen within one week and lasting up to at least three months.
A single controlled session with 2-3g of psilocybin can provide benefits lasting weeks to months, compared to traditional medications that must be taken daily (Griffiths et al., 2006).
For PTSD-related anxiety, 76% of participants no longer met diagnostic criteria after treatment (Mithoefer et al., 2019).
Patients experienced sustained improvements in mood and anxiety after just 1-2 sessions, minimizing the need for ongoing therapy (Griffiths et al., 2016; Ross et al., 2016).
Regular, spaced-out use of psychedelics correlates with overall reduced rates of suicide, suggesting a potential long-term protective effect (Hendricks et al., 2016).
Both MDMA and psilocybin have demonstrated rapid effects in reducing suicidal thoughts, offering crucial intervention options (Jones, 2022).

Even the Diagnostic and Statistical Manual (DSM-5-TR) acknowledges that research doesn't support classic serotonin-based psychedelics as independent risk factors for mental health problems. In fact, it notes that some population surveys have found lifetime hallucinogen use associated with lower odds of mental distress and suicidal behaviors. (DSM5-TR, page 597)

Utah's Legislative Journey: SB 266 (2024)

Utah's first step toward psychedelic therapy came in 2024 with Senate Bill 266, which passed unanimously in both chambers. Governor Cox allowed it to become law without signature on March 21, 2024. This initial legislation:

Established Utah's first psychedelic therapy program
Limited implementation to Intermountain Health and the University of Utah
Created a three-year pilot program with 2026 reporting requirements
Focused on psilocybin and MDMA in FDA Phase 3 testing
Required "direct supervision and control" during administration
Restricted participation to adults 18+
Included a sunset clause of July 1, 2027

Despite this promising start, SB 266 contained several flaws that have prevented its implementation. The bill's designation of the program as a "clinical trial" rather than a "clinical study" created procurement issues, as there was no legal pathway for Intermountain or the University of Utah to obtain Schedule I substances for trials. The requirement for direct medical supervision also significantly increased costs.

The result? One year after passage, neither Intermountain Health nor the University of Utah has taken any action to implement the program. The legal concerns and procurement challenges have effectively paralyzed implementation.

The 2025 Legislative Effort: SB 248

This year, we proposed Senate Bill 248 to address the shortcomings of the original legislation. Key improvements included:

Expanding beyond healthcare systems to qualified practitioners, including psychiatrists with clinical study experience and palliative care practitioners
Changing "direct" to "indirect" supervision requirements, allowing nurses to monitor patients after administration (reducing costs)
Extending the sunset clause from 2027 to 2029
Adding legal protection for providers
Creating an automatic rescheduling mechanism if federal drug scheduling changes

Unfortunately, SB 248 did not pass this legislative session. Several factors contributed to this setback:

Budgeting concerns: While the bill only requested approximately $30,000 in funding, it wasn't structured to generate revenue
Public opinion remains divided along cultural and generational lines
Insufficient fundraising to support advocacy efforts
Religious opposition in Utah's conservative environment

Looking Ahead: The Path Forward

Utah's psychedelic therapy landscape remains what Winston Churchill might call "a riddle wrapped in a mystery inside an enigma." Several fundamental challenges must be addressed:

Federal Schedule I status creates significant legal barriers
No procurement pathway has been established
Cost barriers exist for both manufacture and administration
Political and religious concerns remain unaddressed
Funding is needed for implementation
Cultural stigma persists in Utah's conservative environment

Despite these setbacks, there's reason for cautious optimism. Several developments could change the landscape:

Potential FDA approval of MDMA therapy (possible by 2026)
Other states creating specialized regulatory frameworks that could serve as models
Growing recognition of the mental health crisis and need for innovative solutions

Building Bridges Across Religious and Political Divides

Being religious myself, I recognize the unique dynamics at play in Utah's legislative environment. Our path forward must include genuine engagement with religious leaders and communities. This isn't merely a political calculation—it is essential for creating sustainable change that serves all Utahns.

The best outcome for our state is a scenario where both conservatives and liberals, both religious and non-religious, can work together to address our shared mental health crisis. This isn't about political positioning, but rather finding common ground in the shared goal of reducing suffering and saving lives.

We must effectively communicate the scientific evidence and therapeutic potential of psychedelic medicine to key stakeholders, especially local religious leadership. I've found that focusing on the compassionate applications—helping veterans with PTSD, providing relief to those with terminal illness, and preventing suicide—resonates across political and religious divides.

Our responsibility as advocates is to build these bridges through respectful dialogue, evidence-based education, and a willingness to address concerns head-on. Progress will be slow without coalition-building that includes religious communities, but with them, we can create a model for thoughtful, compassionate policy that other states might follow.

Our path forward requires:

Building a broader coalition including medical professionals, veterans' groups, and mental health advocates
Engaging key stakeholders, including religious leaders
Preparing for opportunities created by federal rescheduling
Focusing initially on specific populations like veterans and those with terminal illness
Designing clearer implementation mechanisms

Conclusion

Utah stands at a crossroads. Our mental health statistics demonstrate a clear need for innovative approaches, and the research on psychedelic therapy shows remarkable promise. While our legislative efforts have faced setbacks, the unanimous passage of SB 266 in 2023 demonstrates bipartisan recognition of the problem.

As we prepare for future legislative sessions, we must focus on building broader coalitions, addressing practical implementation challenges, and emphasizing the human cost of inaction. With Utah's suicide rate 61% higher than the national average, we cannot afford to wait.

The path forward may be complex, but the potential to save lives and alleviate suffering makes this effort worthwhile. As a biochemist, an advocate, and a member of the Utah community, I remain committed to advancing evidence-based solutions to our state's mental health crisis.

Dr. Steven Christiansen serves as Medical Strategy Director for the Utah Patient Coalition and was a speaker at the Psychedelic Society of Utah's recent conference.

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