As Evidence For Treatment Potential Grows, So Has Psychedelic Legality

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

The use of psychedelic 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 and PTSD, the old-school view of them as dangerous drugs is losing traction.

This is apparent in a recent Verywell Mind survey which 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,” explains David 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.

Legalized Use and Ramifications

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.

Drag your mouse over the map below to see specifics on legality by state.

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

New Legislative Developments

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.

The Act will also allow healing centers that are regulated by the state to access and administer the drug. The passage makes Colorado the second state to legalize the use of any psychedelics; Oregon was the first in 2020.

Other states have started by decriminalizing certain psychedelics—mainly in select cities. That means while the drugs are still technically illegal, they are the lowest priority for law enforcement and criminal charges don’t apply if a person has a small amount of the substance.

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

MDMA, for instance, was granted “breakthrough therapy designations” by the FDA in 2017 and expanded access in 2022 for its potential to treat PTSD, and was approved for continued use and phase III trials in researching its efficacy in conjunction with psychotherapy.

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.

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

Psilocybin

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 legal for therapeutic use

• Colorado
• Michigan (Ann Arbor/Washtenaw County)
• Oregon 

Where It’s Decriminalized

• California (Oakland, Santa Cruz)
• Washington D.C.
• Massachusetts (Cambridge, Northampton, Somerville)
• Michigan (all other cities)
• Washington (Seattle)

Where It’s Illegal

Psilocybin is illegal in all other states.

Ayahuasca/DMT

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.

Where it’s legal for therapeutic use

Ayahuasca and DMT are technically illegal in all states except for Colorado, but the passage of the 1993 Religious Freedom Restoration act made 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.

Where It’s Legal

• Colorado (as of November, 2022)

Where It’s Decriminalized

• California (partially decriminalized)
• Washington D.C. (decriminalized)
• Massachusetts (partially decriminalized in Cambridge, Northampton, Somerville)
• Michigan (partially decriminalized in Ann Arbor and Washtenaw county)
• Oregon (decriminalized)

Where It’s Illegal

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

Ketamine

Ketamine is a dissociative anesthetic and analgesic that has been used by doctors and veterinarians since its legalization in 1970. Research around ketamine’s potential for the treatment of psychiatric disorders has been ongoing since the 1980s.

Officially, it was approved by the FDA for psychiatric use in 2019 in the form of a nasal spray, Esketamine for treatment-resistant depression, and for use in larger-scale clinical trials for mental health treatment in early 2022.

While still considered a psychedelic, ketamine’s neurobiological mechanisms differ from psilocybin, DMT, and LSD (known as serotonergic psychedelics). Rather than producing a hallucinatory effect or changing your perspective on a situation, ketamine works by inhibiting the brain’s NMDA receptors and lifting the existential emotional burden felt by the patient.

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

Where it’s legal for therapeutic use

Ketamine is legal for medical and therapeutic usage in all 50 states and the District of Columbia.

Where It’s Illegal

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

LSD

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

It was used by the CIA during the Cold War in the 1960s for a variety of psychological experiments. LSD has also seen a burst of popularity in the context of microdosing for the purpose of boosting creativity, but there isn’t enough evidence to support those claims.

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.

Where It’s Legal

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

Where It’s Illegal

LSD remains illegal in all 50 states.

MDMA

MDMA (3,4-Methyl​enedioxy​methamphetamine) is often recognized by its street names “Molly,” or “Ecstacy”. It’s a synthetic drug with hallucinogenic and stimulant effects known to amplify feelings of energy, pleasure, emotional warmth, and distorted sensory and time perception.

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.

Where it’s legal for therapeutic use

As stated above, MDMA is only legal in the United States in the context of clinical trials approved by the FDA, or in the context of case-by-case circumstances in which its use was deemed medically essential.

Where It’s Illegal

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.