Colorado Crafting Psychedelics Training for First Responders

With Colorado's legal psilocybin program set to roll out in 2024, state officials and first responders are now working on training programs to help differentiate bad trips from medical emergencies.

A little over a year after voters approved Proposition 122, legalizing medical psilocybin and decriminalizing personal use of several psychedelics, the Colorado Department of Revenue's new Natural Medicine Division (NMD) has been tasked with licensing and regulating psilocybin production and sales. However, the new division must also draft guidelines for law enforcement and medical professionals responding to psychedelic-related incidents, which can vary heavily based on the substance, dose and user.

While the Colorado Department of Regulatory Agencies (DORA) is responsible for creating training requirements for licensed psychedelic therapists and administrators, lawmakers determined that the NMD should work with first responders such as police officers, paramedics, dispatchers, mental health professionals and even veterinarians. Although the NMD's guidelines aren't enforceable, as DORA's are, NMD executive director Dominique Mendiola envisions a statewide collaboration similar to what took place following marijuana legalization.

Mendiola, who also leads the state Marijuana Enforcement Division, sees parallels between creating policy for legal marijuana and psychedelics, including challenges surrounding the enforcement of home cultivation and illegal activity, as well as proper medical treatment for over-intoxication.

"Whether or not they are required, we want to ensure what we are doing ultimately enhances awareness about these new laws and supports consistency in how first responders enforce new laws and how they serve the public," she said during a November 13 NMD meeting, adding, "A part of this is understanding what already is out there."

Colorado followed Oregon, becoming the second state to legalize medical psilocybin, and there are over twenty state-approved training programs in Oregon for NMD officials to draw from — but Oregon didn't decriminalize the personal cultivation and possession of psilocybin, DMT, mescaline and ibogaine. Psilocybin facilitators and production facilities are expected to begin applying for business licenses in Colorado by late next year, with DMT, mescaline and ibogaine up for state review for medical legalization by 2026.

Thanks to a federal grant from the National Highway Traffic Safety Administration, Colorado employs an expert who is trained to teach law enforcement about "basically every type of drug, including psychedelics," according to Colorado District Attorneys' Council legislative liaison Tim Lane.

Lane recognizes that the NMD is likely "looking to do more" than focus on impairment recognition, though, and first responders could potentially be charged with handling situations that are complicated to navigate.

"Many times individuals who are having a challenging experience are reverting to past trauma and essentially a post-traumatic stress disorder or trauma response," psychedelics industry consultant Jordan Liester said during the meeting. According to Liester, current response tactics have a "gap" in training, because they're prone to mistaking a traumatic episode for psychosis.

Erica Messinger, a registered nurse who specializes in community and rural health, emphasized the need for screening processes for people seeking psychedelic therapy.

"Certain things, like if they haven't had a diagnosis of a particular condition, mental health or medical, because they haven't been to the doctor in twenty years, or particular medications that they choose not to divulge during a screening process," Messinger explained during the most recent NMD hearing. "I would suggest that any sort of interactions of psychedelic or natural medicine with any sort of drugs should be part of the training program, so that they understand when there's an actual reaction that a wellness facilitator wasn't aware of."

There are certain substances that can counteract the over-consumption of psychedelics, such as benzodiazepines and serotonin receptor blockers, but Messinger says it's important for first responders to understand "when and how to use those versus, you know, letting them kind of ride it out in a challenging experience."

Ensuring safer interactions between first responders and people who've consumed psychedelics could require fewer armed police officers and more mental health professionals, according to the NMD, which is also creating materials for law enforcement regarding Colorado's psychedelics possession laws, in order to avoid legally disputed searches, seizures or arrests. Currently, there are no possession limits for adults 21 and older, though there are criminal penalties for selling psychedelics or providing them to minors.

According to Mendiola, the NMD training materials will emphasize practices to avoid arrests, hospitalization and involuntary mental health commitments, but she recognizes that behavioral experiences are intended with some psychedelics.

The NMD plans to hold three more public listening sessions about legal psychedelics implementation before the year ends. Along with DORA and the state Department of Public Health and Environment, the new agency will submit public rulemaking recommendations early next year.