The Nuts and Bolts of Psychedelic Medicines For People Living with Cancer

The Nuts and Bolts of Psychedelic Medicines For People Living with Cancer

Let me tell you up front: this is going to be a boring read.

Because it's about the nuts and bolts of psychedelic medicine access. Implementation details. Cost structures. Insurance reimbursement. The kinds of policy minutiae that make people's eyes glaze over.

And I get it. When you're living with cancer and exploring whether psychedelic medicines might help address your suffering, you probably don't want to read about regulatory frameworks or business models or overhead costs.

But before you walk away, let me make a case. Those boring little nuts and bolts? They're actually really important. Worth your time. Worth your attention.

Think about getting on an airplane. You're thinking about your destination, not about the nuts and bolts that hold the wings onto the fuselage. But at 35,000 feet? Those nuts and bolts turn out to be really important. They're literally the things holding everything together.

The same principle applies to psychedelic medicine access. We can celebrate when states legalize or decriminalize these medicines. We can cheer when research shows promising results. But if we don't pay attention to the implementation details—the boring nuts and bolts of HOW access actually gets provided—we risk building a system that looks good on paper but doesn't actually work for the people who need it most.

Stick with me here. Because in my recent podcast conversation with Ashley Lukens—a cancer thriver who founded Clarity Project to advance psychedelic access in Hawaii—she helped me understand why these details matter so much.

The Tide Has Turned, But the Work Has Shifted

"I think it's less convincing people these days," Ashley told me. "It's more working out the nuts and bolts of access."

This is actually good news. A few years ago, the psychedelic medicine conversation was still stuck in the convincing phase—trying to overcome decades of stigma and misinformation from the drug war. Trying to get people to see these medicines as potentially therapeutic rather than inherently dangerous.

But something has shifted. Research from institutions like Johns Hopkins and NYU has been compelling. Media coverage has become more nuanced. Public opinion has evolved. Even government officials are coming around.

Ashley described meeting with a senior official in Hawaii who said: “No, you don't need to convince me. I think it's a great idea. Let's do it. Let's figure it out."

That's a major win. The door is opening. But now comes the harder work: actually figuring out how to build access frameworks that work. And this is where those boring details become critical.

Because as Ashley pointed out, there's a real tension in creating safe, legal psychedelic medicine access: "These are not medicines for everybody and this is not a medicine for everything."

The nuts and bolts matter because they determine whether we get access right—balancing safety with affordability, protecting both patients and providers, creating systems that actually serve the cancer community rather than just looking good in press releases.

When Cost Becomes a Barrier

Oregon became the first state to legalize psilocybin services when voters passed Measure 109 in 2020. On paper, it looked like a breakthrough—a regulated framework for trained facilitators to guide people through psilocybin experiences in licensed facilities.

But then came the reality of implementation.

"I want to talk about the Oregon model," Ashley said. "When you ask people who got it in Oregon now, the first thing they'll say to you is: ‘It's like $2,000 bucks a pop and who can afford that?’"

Two thousand dollars. For a single session.

Let that sink in for a moment. Cancer treatment is already expensive—even with insurance, the co-pays and deductibles add up quickly. Many of us are making difficult financial decisions, balancing treatment costs against other life expenses. We're navigating a healthcare system where costs can feel overwhelming.

And now—when psychedelic medicines show genuine promise for addressing the psychological suffering that comes with cancer—the cost of legal access puts it out of reach for many of us who might want to explore these options.

"That's been this challenge that we've been facing as we've tried to create safe legal access," Ashley explained. "What's the cost of that going to be? And it turns out like actually having a state-regulated psychedelic program is millions and millions and millions of dollars."

This is the nuts and bolts reality that we need to confront.

Why Is It So Expensive?

Here's the thing: it's not Oregon's fault that legal psychedelic access is expensive. Ashley was clear about this, breaking down the actual cost drivers in a way that helped me understand the economic challenge.

She explained, "It's the therapy that's the expensive part. And you're talking about dosing someone in a six hour setting. So that's six hours. A therapist is pretty inexpensive, maybe $125 an hour. And you have no insurance reimbursements. And you have to pay for the physical location of the dosing."

Do the math: Six hours at $125 per hour is $750 just for the therapist. Add facility costs. Add the medicine itself. Add preparation sessions and integration follow-up. The numbers add up quickly.

"It's not surprising," Ashley said. "It's not Oregon's fault that it's expensive. It's an expensive model because of the people that are required to make it successful."

The Insurance Problem

Part of what makes psychedelic access so expensive is that insurance companies may not cover it. This is another one of those nuts and bolts details that has massive implications for real-world access.

Right now, if you want legal psilocybin therapy in Oregon, you're likely paying out-of-pocket. All of it. The full cost. No insurance reimbursement. And while there are ongoing efforts to provide insurance coverage and financial assistance, the reality is that this support is very limited. 

For cancer patients managing the financial burden of treatment, this creates a significant barrier. Some of us might want to explore medicines that could help with our depression, our anxiety, our existential concerns about mortality. But the cost makes it impossible to consider.

This isn't sustainable. If psychedelic medicines are going to truly serve the cancer community, we need pathways to insurance coverage. We need reimbursement frameworks. We need economic accessibility, not just legal accessibility.

Otherwise, we're building a system where only people with significant financial resources can benefit from these potentially valuable medicines. And that's not equity. That's not justice. That's just another way the healthcare system creates barriers for patients seeking treatment.

The Banking Problem You've Never Heard Of

Here's a nuts and bolts detail that surprised me: even if you want to operate a legal psychedelic medicine business in a state that has legalized these services, you face operational challenges that have nothing to do with clinical care.

"Even with marijuana," Ashley explained, "because it's still a schedule one substance, cannabis companies can't use the normal banking system."

Both cannabis and psychedelics remain Schedule I substances under federal law, despite some states legalizing them. This creates a bizarre situation where businesses operating legally under state law can still considered illegal by the federal government—and that means federal banking regulations prohibit financial institutions from working with them.

Think about what that means. You're running a legal business in a state that has legalized your services. But you can't get a business bank account. You can't use standard payment processing. You can't access traditional business loans or lines of credit. You're forced into complicated workarounds that increase costs and operational complexity.

This is the kind of behind-the-scenes challenge that most people never think about. But it matters enormously for whether providers can actually build sustainable practices. And if providers can't operate sustainable businesses, there won't be services available—regardless of what state laws say.

Safety Versus Affordability

Throughout my conversation with Ashley, I kept bumping up against this fundamental tension: safety costs money, but expensive services limit access.

We know from research that set and setting matter tremendously for psychedelic experiences. Having a trained facilitator present increases safety. Having appropriate preparation and integration support improves outcomes. Creating comfortable, supportive physical environments makes the experience better.

All of this requires skilled people, dedicated time, and appropriate spaces. Which costs money.

But when those safety measures price out many potential patients, what have we actually accomplished? We've created legal access that many people can't afford to use. We've built beautiful frameworks that don't serve all the people they're supposed to help.

"Sometimes those goals of safety and broad access work against one another because safety is expensive," I said to Ashley during our conversation.

She agreed. "Totally."

This is the tightrope we're walking. We need safety protocols that actually protect vulnerable patients. But we also need affordability that makes access real rather than theoretical for those who want to explore these options.

Finding that balance? That's the hard work of implementation. That's where the nuts and bolts really matter.

Why Cancer Patients Should Care

I know what you might be thinking. You're dealing with cancer. You're managing treatment side effects, navigating scan anxiety, confronting mortality. Why should you care about policy implementation details?

Because these details determine whether you'll actually have the option to access psychedelic medicines if you want to explore them.

They determine whether you'll pay $50 for a session or $5,000. Whether you'll find services within driving distance or have to travel to another state. Whether your oncologist can refer you to legal providers or whether you'll need to navigate underground networks. Whether insurance might eventually cover these treatments or whether they'll remain out-of-reach for anyone without substantial financial resources.

The implementation details determine whether psychedelic medicine access becomes something available to cancer patients who want to explore these options—or just another treatment approach reserved for those with privilege and wealth.

Not every cancer patient will want to use psychedelic medicines. That's absolutely fine. But we should all have the choice to decide for ourselves. The nuts and bolts of implementation determine whether that choice is real or illusory.

Ashley and I both come from a place of tremendous gratitude for conventional cancer treatment. The surgeries, the chemotherapy, the radiation—these interventions saved our lives. We're not rejecting the medical system that kept us alive.

But we're also recognizing gaps in that system. Particularly around the psychological and existential suffering that comes with cancer. The depression. The anxiety. The fear of death. The isolation. The despair.

Psychedelic medicines show real promise for addressing these dimensions of cancer suffering. But only if we can actually access them when we want to. And access depends entirely on getting the nuts and bolts right.

What Clarity Project Is Building in Hawaii

Ashley's work with Clarity Project in Hawaii gives me hope that better models are possible. She's thinking carefully about how to build infrastructure before legalization happens—training facilitators, working with the state on harm reduction programming, exploring frameworks that prioritize accessibility.

"What we're trying to do here in Hawaii is build the infrastructure that can support a legal rollout should it happen," she explained.

This proactive approach matters. Rather than waiting for a law to pass and then scrambling to implement it, Clarity Project is working to learn from other states' experiences. To think through the cost challenges before they become insurmountable. To design systems with affordability in mind from the beginning.

Will they get everything right? Maybe not. Implementation is messy. Democracy is slow. There will be trial and error, adjustments and refinements. But that’s OK. States are the laboratories of democracy and we need to accept that some experiments will succeed and others will fail. 

But by paying attention to the nuts and bolts now—while there's still time to shape the frameworks—there's a chance to build something that actually serves the cancer community rather than just checking a political box.

The Work We All Need To Do

Here's what I'm asking of you: pay attention to the boring details.

When your state considers psychedelic legalization, don't just celebrate the headline. Read the actual bill. Ask about cost structures. Ask about insurance coverage. Ask about legal protections for providers. Question whether the framework will create real access or just theoretical access.

When advocacy organizations ask for your support, ask them about their positions on facility requirements. On facilitator training. On rural access. On economic justice.

Bring the wisdom of the cancer community to these conversations. We understand what accessibility really means. We know the difference between health systems that look good and health systems that actually work. We've navigated enough of the healthcare bureaucracy to recognize when implementation details matter.

The door is opening for psychedelic medicine access. The tide has turned on stigma and prohibition. But as Ashley said, the work now is "working out the nuts and bolts of access."

That work needs our voices. Our experience. Our insistence that access means something more than just legal permission—it means affordable, available, appropriate services that actually meet the needs of cancer patients who want these options.

Not Sexy, But Essential

I warned you this would be boring. Policy details. Cost structures. Implementation challenges. Not the consciousness-expanding mystical content you might expect from a conversation about psychedelic medicines.

But here's the truth: the profound healing experiences only happen if people can actually access these medicines. And access depends entirely on getting the boring details right.

Every cancer patient who might want to explore psychedelic medicines deserves better than a beautifully written law that fails in practice. We deserve systems that actually work. That actually provide real access. That actually create genuine options for those who want them.

And that means paying attention to the nuts and bolts. Even when—especially when—they seem boring and technical and far removed from the urgent reality of living with cancer.

Because when you’re cruising at 35,000 feet, those boring little details turn out to be the things holding everything together.

Let's journey together—and let's demand implementation frameworks worth building on.

For more on psychedelic medicine access and cancer support, reach out to our community at community@healingcancerjourneys.org