Psychedelic Drug Legislative Reform and Legalization in the US

Abstract

ImportancePsychedelic drugs are becoming accessible in the US through a patchwork of state legislative reforms. This shift necessitates consensus on treatment models, education and guidance for health care professionals, and planning for implementation and regulation.ObjectiveTo assess trends in psychedelics legislative reform and legalization in the US to provide guidance to health care professionals, policy makers, and the public.Evidence ReviewData were compiled from legislative databases (BillTrack50, LexisNexis, and Ballotpedia) from January 1, 2019, to September 28, 2022. Legislation was identified by searching for terms related to psychedelics (eg, psilocybin, MDMA, peyote, mescaline, ibogaine, LSD, ayahuasca, and DMT). Bills were coded by an attorney along 2 axes: which psychedelic drugs would be affected and in what ways (eg, decriminalization, funding for medical research, and right to try). To explore drivers and rates of legislative reform, data were compared with other state indices including 2020 presidential voting margins and marijuana legislative reform.FindingsTwenty-five states have considered 74 bills (69 legislative initiatives, 5 ballot measures); 10 bills were enacted, and 32 were still active. The number of psychedelic reform bills introduced during each calendar year increased steadily from 5 in 2019 to 6 in 2020, 27 in 2021, and 36 in 2022. Nearly all bills specified psilocybin (67 [90%]), and many also included MDMA (3,4-methylenedioxy-methamphetamine; 27 [36%]). While bills varied in their framework, most (43 [58%]) proposed decriminalization, of which few delineated medical oversight (10 of 43 [23%]) or training and/or licensure requirements (15 of 43 [35%]). In general, bills contained less regulatory guidance than the enacted Oregon Measure 109. While early legislative efforts occurred in liberal states, the margin between liberal and conservative states has decreased over time (although the difference was not significant), suggesting that psychedelic drug reform is becoming a bipartisan issue. In addition, an analytic model based on marijuana legalization projected that a majority of states will legalize psychedelics by 2034 to 2037.Conclusions and RelevanceLegislative reform for psychedelic drugs has been proceeding in a rapid, patchwork fashion in the US. Further consideration should be given to key health care issues such as establishing (1) standards for drugs procured outside the medical establishment, (2) licensure criteria for prescribers and therapists, (3) clinical and billing infrastructure, (4) potential contraindications, and (5) use in special populations like youths, older adults, and pregnant individuals.

Psilocybin history, action and reaction: A narrative clinical review

“…In 2019, Denver, Colorado, became the first city in the US to decriminalize psilocybin (Chavez and Prior, 2019). Similar legislation was passed in other US cities, such as Washington, DC; Seattle, Washington;Oakland and Santa Cruz, California;and Somerville, Bay State town, Cambridge, and Northampton, Massachusetts (City of Northampton, 2021;Council of the District of Columbia, 2020;Siegel et al, 2023). In 2020, Oregon and Colorado became the first US states to pass comprehensive psilocybin legislation, specifically Ballot Measure 109, which "directs the Oregon Health Authority to license and regulate the manufacturing, transportation, delivery, sale, and purchase of psilocybin products and the provision of psilocybin services," creating a regulatory framework for "psilocybin services" (Oregon Psilocybin Services, 2023) to be provided as part of medical care.…”

“…Proposition 122 decriminalized the personal use and possession (for adults aged 21 and older) of dimethyltryptamine (DMT), ibogaine, mescaline (Psychedelic Drug Legislative Refoexcluding peyote), psilocybin, and psilocyn. In many other state legislatures (Siegel et al, 2023), bills are pending that could determine the legality status of psychedelic mushrooms in the future. Given the changing legal status of hallucinogens, it is increasingly important to understand the health benefits and risks related to using psilocybin in different contexts (e.g., as part of medically supervised psilocybin-assisted therapy versus consumed for unmonitored medical purposes or recreationally).…”

Multidisciplinary argument for the decriminalization of drugs

“…They reinforced white supremacy and class domination, lent credence to policies of aggressive policing and mass incarceration, and relegated arguments for harm‐reduction strategies for addressing substance‐use disorders to the margins. However, as critiques of the WoD have gained traction among some politicians (Chiu et al., 2022), and some states and municipalities have enacted laws and policies legalizing or decriminalizing some street drugs (Hammond et al., 2020; Siegel et al., 2023), a small cadre of journalists is changing the way they cover the drug beat (Kavanagh, 2018; Murtha, 2016). They essay relying on the best available evidence from experts in science, medicine, and public health, whereas debunking claims rooted in racist and classist stereotypes or uncritical advocacy.…”

Predictors of Pharmacy Students' Attitudes About the Therapeutic Use of Psilocybin

“…However, findings from recent studies in humans and animals, including a large multi-site clinical trial with psilocybin for treatment-resistant depression, have attempted to establish the safety and medical efficacy of psychedelics, leading to an increased interest in therapeutic psilocybin in the United States [17,18]. In 2019, psilocybin use and possession were legalized in parts of Colorado, California, and Michigan [19].…”