Table of ContentsView AllTable of ContentsLegalized Use and RamificationsNew Legislative DevelopmentsPsilocybinAyahuasca/DMTKetamineLSDMDMA

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Legalized Use and Ramifications

New Legislative Developments

Psilocybin

Ayahuasca/DMT

Ketamine

LSD

MDMA

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Key TakeawaysA growing body of evidence supports the use of psychedelic substances for treatment-resistant conditions like depression, PTSD, and alcohol use disorder.As stigma decreases, some states have legalized certain psychedelics for therapeutic use.Several other states have decriminalized these substances, putting them on track for eventual legalization.

Key Takeaways

A growing body of evidence supports the use of psychedelic substances for treatment-resistant conditions like depression, PTSD, and alcohol use disorder.As stigma decreases, some states have legalized certain psychedelics for therapeutic use.Several other states have decriminalized these substances, putting them on track for eventual legalization.

Verywell Mind discourages the use of any psychedelic substance without the supervision of a medical professional.

The use ofpsychedelic substances(psilocybin, ketamine, MDMA, LSD, and Ayuhuasca/DMT) for mental health treatment has become one of the hottest topics of research and conversation in the psychology community, and state legislatures are taking notice.

More than 25% of Americans ages 18 and older deal with mental health issues.For some, conventional therapy methods don’t offer effective treatment, even with medication, and it’s become clear that new options for care are necessary.

As medical evidence continues to demonstrate the effectiveness of psychedelics in addressing pervasive conditions like depression andPTSD, the old-school view of them as dangerous drugs is losing traction.

This is apparent in a recentVerywell Mind surveywhich found that 1 in 3 Americans would consider using FDA-approved psychedelics as a part of their approach to getting help.

“In a medical setting under supervision…psychedelics can be effective for depression, post-traumatic stress, and substance use. These are potential options for upwards of 30% to 40% of patients who cannot find an effective mainstream solution,” explainsDavid A. Merrill, MD, PhD, psychiatrist and director of the Pacific Neuroscience Institute’s Pacific Brain Health Center at Providence Saint John’s Health Center.

So far only Oregon and Colorado have voted to legalize certain psychedelic substances for therapeutic use, but several others have passed decriminalization measures that set them on the path toward potential legalization in future elections.

What Is Psychedelic Therapy?

Psychedelic substances have a long-standing history of being used for medicinal purposes.But the prevalence of perceived misuse led the federal government to label psychedelics as a schedule 1 substance in 1973, effectively making them illegal.

However, as interest and clinical evidence grows, so does legality. Now, the landscape of psychedelic legalization is incredibly complex due to the variance between states, cities, and the individual substances themselves.

There’s currently no state or city in which all forms of psychedelics are blanketly legal.

Oregon Paves the Way for “Magic Mushroom” Mental Health Treatments

On November 8, 2022, Colorado passed the Natural Medicine Act which legalized the use of five psychedelic substances including psilocybin, ibogaine (a psychedelic derived from the root bark of the iboga tree), mescaline (peyote), and ayahuasca for individuals aged 21 and older.

David A. Merrill, MD, PhDIn a medical setting under supervision…psychedelics can be effective for depression, post-traumatic stress, and substance use. These are potential options for upwards of 30% to 40% of patients who cannot find an effective mainstream solution.

David A. Merrill, MD, PhD

In a medical setting under supervision…psychedelics can be effective for depression, post-traumatic stress, and substance use. These are potential options for upwards of 30% to 40% of patients who cannot find an effective mainstream solution.

Certain approvals and FDA legality loopholes exist for the purpose of both continued research and qualified circumstances.

Colorado also passed a bill in early 2022 that would allow for the prescription use of MDMA should it receive FDA approval anticipated in 2023.

In the mental health space, legalized use is what will give practitioners the ability to incorporate psychedelics in treatment. Experts say while their use could be beneficial, it’s important to consider the ramifications.

“It’s always going to come with this double-edged sword. If you loosen up regulations around access, you have the potential for misuse or problematic use, which happened historically and, in many ways, led to psychedelics becoming illegal in the first place,” says Dr. Merrill.

What This Means For YouDr. Merrill recommends using psychedelics only with the direct supervision of a licensed professional; in fact, working with two facilitators is an even better scenario.People who are at risk of psychosis or hallucinations may not want to use psychedelics. It’s critical to disclose any personal or family history to your provider before starting treatment.As you and your therapist consider the best solutions for your mental health care, there may be options available outside of conventional therapy and medicine. While additional research needs to be done, psychedelics may provide a viable and beneficial alternative should they become legal in your state.

What This Means For You

Dr. Merrill recommends using psychedelics only with the direct supervision of a licensed professional; in fact, working with two facilitators is an even better scenario.People who are at risk of psychosis or hallucinations may not want to use psychedelics. It’s critical to disclose any personal or family history to your provider before starting treatment.As you and your therapist consider the best solutions for your mental health care, there may be options available outside of conventional therapy and medicine. While additional research needs to be done, psychedelics may provide a viable and beneficial alternative should they become legal in your state.

Dr. Merrill recommends using psychedelics only with the direct supervision of a licensed professional; in fact, working with two facilitators is an even better scenario.

People who are at risk of psychosis or hallucinations may not want to use psychedelics. It’s critical to disclose any personal or family history to your provider before starting treatment.

As you and your therapist consider the best solutions for your mental health care, there may be options available outside of conventional therapy and medicine. While additional research needs to be done, psychedelics may provide a viable and beneficial alternative should they become legal in your state.

Below is an overview of where those psychedelic drugs currently being researched for mental health treatment are legal, decriminalized, and somewhere in between:

Most Comprehensive Microdosing Study to Date Finds it Improves Mental Health

Psilocybin, the psychoactive compound found in “magic mushrooms,” has been used for ceremonial and medicinal purposes among Indigenous peoples for millennia. Psilocybin has a hallucinogenic effect on the brain.

More recently—due to its prevalence in psychiatric research—psilocybin has a strong body of evidence backing its efficacy in easing symptoms of treatment-resistant depression and alcohol use disorder.

Besides ketamine, psilocybin is the only psychedelic substance that has received full legality in any US state.

Where It’s Decriminalized

Where It’s Illegal

Psilocybin is illegal in all other states.

The hallucinogenic properties of DMT were discovered in the 1950s.Preliminary research shows it may help interrupt some of the negative brain processes associated with depression, substance abuse, and PTSD.

Ayahuasca and DMT are technically illegal in all states except for Colorado, but the passage of the1993 Religious Freedom Restoration actmade it possible to receive religious exemption. Many indigenous peoples have historically utilized these substances in their rituals, so there is an additional layer of complexity when it comes to approved usage.

Unfortunately, the process of petitioning the DEA and receiving approval from federal courts is complicated and tedious.

To reiterate, Ayahuasca and DMT are still technically illegal in all 50 states and the District of Columbia, but religious exemption is possible.

New Research Shows Psychoactive Brew Ayahuasca Improves Mood and Wellbeing

Ketamine is a legal psychedelic option for medical purposes and is effective in the treatment of debilitating depression.

Ketamine is legal for medical andtherapeutic usagein all 50 states and the District of Columbia.

Ketamine is the only psychedelic substance currently legal across the board.

LSD(Lysergic acid diethylamide) is not currently legal or decriminalized in any US state.

Some studies have found it beneficial in helping to treat depression, but additional research is needed.

LSD remains one of the more stigmatized psychedelics, which may contribute to its lag in legalization or FDA approval.

LSD is not currently legal or decriminalized in any US state.

LSD remains illegal in all 50 states.

Before being banned in 1985, MDMA was gaining traction among psychologists for its potential benefit in the context of talk therapy sessions, though minimal clinical evidence existed.

Now, following several clinically significant studies, there is substantial evidence to support its use for the treatment of PTSD,and—as previously mentioned—the FDA granted special expanded access approval of the substance in 2022.

It is not currently legal or decriminalized for use outside of a hospital setting.

It is illegal in all 50 states and the District of Columbia beyond specifically approved medical use.

“There’s a lot to be learned from the history of psychedelics. One would hope that we’d be able to learn from that and find a path forward where we can allow safe positive use of these drugs in clinical settings,” Dr. Merrill concludes.

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23 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.John Hopkins Medicine.Mental health disorder statistics.Doblin RE, Christiansen M, Jerome L, Burge B.The past and future of psychedelic science: An introduction to this issue.J Psychoactive Drugs. 2019;51(2):93-97. doi:10.1080/02791072.2019.1606472Smith WR, Appelbaum PS.Two models of legalization of psychedelic substances: Reasons for concern.JAMA. 2021;326(8):697. doi:10.1001/jama.2021.12481Colorado General Assembly.Proposition 122: Access to Natural Psychedelic Substances.Ballotpedia.Oregon Measure 109, Psilocybin Mushroom Services Program Initiative.Feduccia, A. A., Jerome, L., Yazar-Klosinski, B., Emerson, A., Mithoefer, M. C., & Doblin, R.Breakthrough for trauma treatment: Safety and efficacy of mdma-assisted psychotherapy compared to paroxetine and sertraline. 2019.Frontiers in Psychiatry,10, 650.General Assembly of the State of Colorado.House Bill 22-1344.Bogenschutz MP, Ross S, Bhatt S, et al.Percentage of heavy drinking days following psilocybin-assisted psychotherapy vs placebo in the treatment of adult patients with alcohol use disorder: A randomized clinical trial.JAMA Psychiatry. 2022;79(10):953. doi:10.1001/jamapsychiatry.2022.2096Barker SA.N, n-dimethyltryptamine (DMT), an endogenous hallucinogen: Past, present, and future research to determine its role and function. Front Neurosci. 2018;12:536. doi:10.3389/fnins.2018.00536Frecska E, Bokor P, Winkelman M.The therapeutic potentials of ayahuasca: Possible effects against various diseases of civilization.Front Pharmacol. 2016;7. doi:10.3389/fphar.2016.00035Gonzalez D, Cantillo J, Perez I, et al.The Shipibo ceremonial use of ayahuasca to promote well-being: An observational study.Front Pharmacol. 2021;12:623923. doi:10.3389/fphar.2021.623923DEA Diversion Control Division.Guidance regarding petitions for religious exemption from the Controlled Substances Act pursuant to the Religious Freedom Restoration Act.Krupitsky, E. M., & Grinenko, A. Y.Ketamine psychedelic therapy (Kpt): A review of the results of ten years of research.1997.Journal of Psychoactive Drugs,29(2), 165–183.Wu Tsai Neuroscience Institute.‘Nothing less than transformational:’ Ketamine brings relief to people with severe depression.Stanford University. July 26, 2019.Mandal S, Sinha VK, Goyal N.Efficacy of ketamine therapy in the treatment of depression. Indian J Psychiatry. 2019;61(5):480-485. doi:10.4103/psychiatry.IndianJPsychiatry_484_18Drug Enforcement Administration.Ketamine.History.com.LSD.Prochazkova L, Lippelt DP, Colzato LS, Kuchar M, Sjoerds Z, Hommel B.Exploring the effect of microdosing psychedelics on creativity in an open-label natural setting.Psychopharmacology. 2018;235(12):3401-3413. doi:10.1007/s00213-018-5049-7Fuentes JJ, Fonseca F, Elices M, Farré M, Torrens M.Therapeutic use of LSD in psychiatry: A systematic review of randomized-controlled clinical trials.Front Psychiatry. 2020;10:943. doi:10.3389/fpsyt.2019.00943Drug Enforcement Administration.LSD.National Institute on Drug Abuse.What Is the History of MDMA?Mitchell JM, Bogenschutz M, Lilienstein A, et al.MDMA-assisted therapy for severe PTSD: A randomized, double-blind, placebo-controlled phase 3 study.Nat Med. 2021;27(6):1025-1033. doi:10.1038/s41591-021-01336-3Multidisciplinary Association for Psychedelic Studies.Expanded Access Program for MDMA-Assisted Therapy for Patients with Treatment-Resistant PTSD (EAMP1).2022.

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

John Hopkins Medicine.Mental health disorder statistics.Doblin RE, Christiansen M, Jerome L, Burge B.The past and future of psychedelic science: An introduction to this issue.J Psychoactive Drugs. 2019;51(2):93-97. doi:10.1080/02791072.2019.1606472Smith WR, Appelbaum PS.Two models of legalization of psychedelic substances: Reasons for concern.JAMA. 2021;326(8):697. doi:10.1001/jama.2021.12481Colorado General Assembly.Proposition 122: Access to Natural Psychedelic Substances.Ballotpedia.Oregon Measure 109, Psilocybin Mushroom Services Program Initiative.Feduccia, A. A., Jerome, L., Yazar-Klosinski, B., Emerson, A., Mithoefer, M. C., & Doblin, R.Breakthrough for trauma treatment: Safety and efficacy of mdma-assisted psychotherapy compared to paroxetine and sertraline. 2019.Frontiers in Psychiatry,10, 650.General Assembly of the State of Colorado.House Bill 22-1344.Bogenschutz MP, Ross S, Bhatt S, et al.Percentage of heavy drinking days following psilocybin-assisted psychotherapy vs placebo in the treatment of adult patients with alcohol use disorder: A randomized clinical trial.JAMA Psychiatry. 2022;79(10):953. doi:10.1001/jamapsychiatry.2022.2096Barker SA.N, n-dimethyltryptamine (DMT), an endogenous hallucinogen: Past, present, and future research to determine its role and function. Front Neurosci. 2018;12:536. doi:10.3389/fnins.2018.00536Frecska E, Bokor P, Winkelman M.The therapeutic potentials of ayahuasca: Possible effects against various diseases of civilization.Front Pharmacol. 2016;7. doi:10.3389/fphar.2016.00035Gonzalez D, Cantillo J, Perez I, et al.The Shipibo ceremonial use of ayahuasca to promote well-being: An observational study.Front Pharmacol. 2021;12:623923. doi:10.3389/fphar.2021.623923DEA Diversion Control Division.Guidance regarding petitions for religious exemption from the Controlled Substances Act pursuant to the Religious Freedom Restoration Act.Krupitsky, E. M., & Grinenko, A. Y.Ketamine psychedelic therapy (Kpt): A review of the results of ten years of research.1997.Journal of Psychoactive Drugs,29(2), 165–183.Wu Tsai Neuroscience Institute.‘Nothing less than transformational:’ Ketamine brings relief to people with severe depression.Stanford University. July 26, 2019.Mandal S, Sinha VK, Goyal N.Efficacy of ketamine therapy in the treatment of depression. Indian J Psychiatry. 2019;61(5):480-485. doi:10.4103/psychiatry.IndianJPsychiatry_484_18Drug Enforcement Administration.Ketamine.History.com.LSD.Prochazkova L, Lippelt DP, Colzato LS, Kuchar M, Sjoerds Z, Hommel B.Exploring the effect of microdosing psychedelics on creativity in an open-label natural setting.Psychopharmacology. 2018;235(12):3401-3413. doi:10.1007/s00213-018-5049-7Fuentes JJ, Fonseca F, Elices M, Farré M, Torrens M.Therapeutic use of LSD in psychiatry: A systematic review of randomized-controlled clinical trials.Front Psychiatry. 2020;10:943. doi:10.3389/fpsyt.2019.00943Drug Enforcement Administration.LSD.National Institute on Drug Abuse.What Is the History of MDMA?Mitchell JM, Bogenschutz M, Lilienstein A, et al.MDMA-assisted therapy for severe PTSD: A randomized, double-blind, placebo-controlled phase 3 study.Nat Med. 2021;27(6):1025-1033. doi:10.1038/s41591-021-01336-3Multidisciplinary Association for Psychedelic Studies.Expanded Access Program for MDMA-Assisted Therapy for Patients with Treatment-Resistant PTSD (EAMP1).2022.

John Hopkins Medicine.Mental health disorder statistics.

Doblin RE, Christiansen M, Jerome L, Burge B.The past and future of psychedelic science: An introduction to this issue.J Psychoactive Drugs. 2019;51(2):93-97. doi:10.1080/02791072.2019.1606472

Smith WR, Appelbaum PS.Two models of legalization of psychedelic substances: Reasons for concern.JAMA. 2021;326(8):697. doi:10.1001/jama.2021.12481

Colorado General Assembly.Proposition 122: Access to Natural Psychedelic Substances.

Ballotpedia.Oregon Measure 109, Psilocybin Mushroom Services Program Initiative.

Feduccia, A. A., Jerome, L., Yazar-Klosinski, B., Emerson, A., Mithoefer, M. C., & Doblin, R.Breakthrough for trauma treatment: Safety and efficacy of mdma-assisted psychotherapy compared to paroxetine and sertraline. 2019.Frontiers in Psychiatry,10, 650.

General Assembly of the State of Colorado.House Bill 22-1344.

Bogenschutz MP, Ross S, Bhatt S, et al.Percentage of heavy drinking days following psilocybin-assisted psychotherapy vs placebo in the treatment of adult patients with alcohol use disorder: A randomized clinical trial.JAMA Psychiatry. 2022;79(10):953. doi:10.1001/jamapsychiatry.2022.2096

Barker SA.N, n-dimethyltryptamine (DMT), an endogenous hallucinogen: Past, present, and future research to determine its role and function. Front Neurosci. 2018;12:536. doi:10.3389/fnins.2018.00536

Frecska E, Bokor P, Winkelman M.The therapeutic potentials of ayahuasca: Possible effects against various diseases of civilization.Front Pharmacol. 2016;7. doi:10.3389/fphar.2016.00035

Gonzalez D, Cantillo J, Perez I, et al.The Shipibo ceremonial use of ayahuasca to promote well-being: An observational study.Front Pharmacol. 2021;12:623923. doi:10.3389/fphar.2021.623923

DEA Diversion Control Division.Guidance regarding petitions for religious exemption from the Controlled Substances Act pursuant to the Religious Freedom Restoration Act.

Krupitsky, E. M., & Grinenko, A. Y.Ketamine psychedelic therapy (Kpt): A review of the results of ten years of research.1997.Journal of Psychoactive Drugs,29(2), 165–183.

Wu Tsai Neuroscience Institute.‘Nothing less than transformational:’ Ketamine brings relief to people with severe depression.Stanford University. July 26, 2019.

Mandal S, Sinha VK, Goyal N.Efficacy of ketamine therapy in the treatment of depression. Indian J Psychiatry. 2019;61(5):480-485. doi:10.4103/psychiatry.IndianJPsychiatry_484_18

Drug Enforcement Administration.Ketamine.

History.com.LSD.

Prochazkova L, Lippelt DP, Colzato LS, Kuchar M, Sjoerds Z, Hommel B.Exploring the effect of microdosing psychedelics on creativity in an open-label natural setting.Psychopharmacology. 2018;235(12):3401-3413. doi:10.1007/s00213-018-5049-7

Fuentes JJ, Fonseca F, Elices M, Farré M, Torrens M.Therapeutic use of LSD in psychiatry: A systematic review of randomized-controlled clinical trials.Front Psychiatry. 2020;10:943. doi:10.3389/fpsyt.2019.00943

Drug Enforcement Administration.LSD.

National Institute on Drug Abuse.What Is the History of MDMA?

Mitchell JM, Bogenschutz M, Lilienstein A, et al.MDMA-assisted therapy for severe PTSD: A randomized, double-blind, placebo-controlled phase 3 study.Nat Med. 2021;27(6):1025-1033. doi:10.1038/s41591-021-01336-3

Multidisciplinary Association for Psychedelic Studies.Expanded Access Program for MDMA-Assisted Therapy for Patients with Treatment-Resistant PTSD (EAMP1).2022.

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