Colorado's Psilocybin Therapy Experiment: Costs, Sessions, and Research

Colorado has opened a structured path for psilocybin therapy under state supervision, requiring a screening phase, a three-session minimum, and post-trip integration with licensed facilitators. Treatments are commonly delivered via capsules, though some centers use whole mushroom forms, and patients must arrange their own transportation due to safety rules. Costs run in the thousands and are not covered by insurance, Medicaid, or FSAs, raising concerns about accessibility. The program is watching safety outcomes as data collection begins. Separately, CU School of Medicine is leading the US's largest trial on psilocybin for anxiety and demoralization in advanced cancer, with early anecdotes of meaningful moments but acknowledging variable responses and the need for rigorous data. The episode also explores licensing differences and the business realities hospitals and clinics face.

Overview

Colorado is expanding its psilocybin therapy program under state supervision, with a structure that includes screening, intake, actual psilocybin administration, and follow-up integration sessions. The experience can vary by clinic, from traditional therapy settings to wellness-focused spaces, and the state requires a minimum of three sessions per patient. Psilocybin is often delivered in capsules to regulate dose, though some centers use whole fruit. A trained state-licensed facilitator accompanies patients throughout the journey, and post-trip integration is viewed as critical for turning insights into daily life changes. Costs are a major hurdle, with thousands of dollars out of pocket and no insurance coverage at present, prompting clinics to explore group formats and nonprofit partnerships to broaden access. “Emerging evidence from early trials shows a tremendous and nearly immediate benefit to psilocybin in conjunction with therapy.” - Dr. Stacy Fisher, CU School of Medicine

Session Design and Safety

The Colorado framework emphasizes a multi-step process: a screening exam to assess risk factors, an intake session to discuss goals and safety measures, and then the actual dosing with integrated safety plans such as non-driving rules. Eye masks and comfortable environments are common, and some centers experiment with decor and seating to ease the journey. After dosing, patients participate in integration sessions designed to help translate experiences into long-term coping strategies. Dosage in research contexts generally hovers around 25 mg of purified psilocybin, a level chosen to achieve ego dissolution and a robust psychedelic experience while enabling study of outcomes. "In terms of the dosage, most studies use around 25 mg of purified psilocybin,” - Dr. Stacy Fisher, CU School of Medicine

Costs, Access, and the Micro-License Approach

Accessibility is a central concern as Colorado considers how to sustain clinics and reach broader populations. The price tag remains a barrier, with patients paying out of pocket for a three-session set, and neither insurance nor Medicaid currently covering the therapy. To address sustainability, Colorado introduced microhealing center licenses intended to lower costs and permit integration of psilocybin into broader wellness offerings. These licenses cap psilocybin on site and reduce administrative barriers, aiming to keep clinics open while the system learns how to optimize psilocybin-assisted therapy as a medical treatment rather than a purely experiential service. "This is not cheap, and that is probably the biggest concern… thousands of dollars exactly, and it's not covered in Colorado.” - Flora Lichtman

Safety, Data, and Real-World Learning

Safety data remain preliminary as states begin to collect health outcomes beyond anecdotes. Colorado recently passed a law requiring the public health department to report treatment outcomes, signaling a shift toward evidence-based conclusions about efficacy for conditions like addiction, PTSD, and traumatic brain injuries. Experts acknowledge that the current data base is limited because research has been constrained by decades of regulatory restrictions; the new data will help determine whether story-like improvements persist across larger populations. Clinicians emphasize careful screening for histories of schizophrenia or psychosis and the need for robust training for therapists administering and guiding the sessions. "The people involved in the research studies have been carefully screened… not broadly representative of the population at large.” - Dr. Stacy Fisher, CU School of Medicine

Research Frontiers: The Cancer Anxiety Trial

Beyond Colorado, clinical research is advancing. Dr. Stacy Fisher is co-leading the US’s largest psilocybin trial for anxiety and existential distress in advanced cancer, exploring whether psilocybin plus therapy can alleviate demoralization and distress in patients facing life-limiting illness. Early feedback includes moments of joy, love, and connection, while some participants experience more nuanced or muted responses. The trial uses a design that emphasizes preparation, dosing, and optional integration, with ongoing questions about how best to standardize therapy across sites and how to balance intense experiences with comprehensive integration. "This was one of the only good things about having cancer that I came in today... I experienced joy and love and connection.” - Dr. Stacy Fisher, CU School of Medicine

Takeaways and Next Steps

The conversations around Colorado’s psilocybin program highlight a cautious optimism: the potential for meaningful therapeutic change exists, but outcomes depend on careful patient selection, rigorous training, and strong integration. As data accumulate, researchers will assess whether the observed improvements are reproducible and durable, and policymakers will refine guardrails to ensure safety and accessibility. The balance between medical legitimacy and patient-centered care will continue to shape how psilocybin therapy is practiced, studied, and funded in the coming years.