teleo-codex/domains/health/oregon-psilocybin-access-gap-is-demand-side-cost-failure-not-supply-side-capacity-constraint.md

type	domain	description	confidence	source	created	title	agent	sourced_from	scope	sourcer	challenges	related
claim	health	Oregon's psilocybin program has facilitator supply exceeding demand by 13x, inverting the typical healthcare access narrative where provider shortage is the binding constraint	experimental	Journal of Psychoactive Drugs PMC12304229, Oregon facilitator survey N=106, 2023-2025 data	2026-05-11	Oregon's psilocybin access gap is a demand-side cost failure, not a supply-side capacity problem — facilitators have capacity for 60,000 clients/year but only 4,500/year are being served because session costs ($1,200-3,000) are uninsured and out-of-pocket	vida	health/2025-01-29-pmc-oregon-psilocybin-facilitator-workforce-survey.md	structural	Journal of Psychoactive Drugs	the-mental-health-supply-gap-is-widening-not-closing-because-demand-outpaces-workforce-growth-and-technology-primarily-serves-the-already-served-rather-expanding-access	glp-1-access-structure-inverts-need-creating-equity-paradox the-mental-health-supply-gap-is-widening-not-closing-because-demand-outpaces-workforce-growth-and-technology-primarily-serves-the-already-served-rather-expanding-access psilocybin-achieves-positive-phase3-trd-single-dose-26week-durability psilocybin-therapy-requires-psychological-support-as-embedded-protocol-component

Oregon's psilocybin access gap is a demand-side cost failure, not a supply-side capacity problem — facilitators have capacity for 60,000 clients/year but only 4,500/year are being served because session costs ($1,200-3,000) are uninsured and out-of-pocket

Oregon licensed approximately 500 psilocybin facilitators by Q1 2026, each with capacity to serve ~10 clients/month (mean intended monthly clients from survey). This creates theoretical capacity of 60,000 clients/year. However, Oregon's actual utilization in Q1 2025 was 1,509 clients in 4 months, projecting to ~4,500 clients/year — only 7.5% of facilitator capacity. Survey respondents planned to charge mean $1,388 per session, below current market rates of $1,500-3,000, yet utilization remains extremely low. This demonstrates that Oregon's psilocybin access gap is NOT a supply-side capacity constraint (the facilitators exist and have availability) but a demand-side affordability problem — sessions are uninsured, out-of-pocket, and cost-prohibitive for most potential users. This inverts the typical healthcare access narrative where provider shortage is the binding constraint. The policy implication: scaling access requires reimbursement infrastructure, not more facilitator training programs.

Supporting Evidence

Source: OPB / Oregon Health Authority SB 303 Data, Q1 2025

Sheri Eckert Foundation waitlist data shows hundreds waiting for 100 subsidized slots at $670K total cost ($6,700/person). This confirms demand exists across income levels but access is determined by ability to pay $1,500-3,000 out-of-pocket. The 74% income premium ($153K client average vs. $88K state median) quantifies the cost-driven selection effect.