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Where is Psychedelic-assisted Therapy Legal?

Psychedelics are being embraced in a growing number of places around the world. But where is psychedelic-assisted therapy actually accessible?

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DoubleBlind Mag is devoted to fair, rigorous reporting by leading experts and journalists in the field of psychedelics. Read more about our editorial process and fact-checking here.

An affinity for altered states of consciousness is a human universal. Around the world, and stretching back hundreds of thousands of years, people have sought ways to transcend ordinary waking consciousness and experiment with new modes of perception.

Psychedelics have always played a central role in this uniquely human pursuit. From Asia, to Africa, to the pre-colonial Americas, the anthropological record is filled with evidence of people using certain psychedelic plants, fungi, and even animals in complex ritualistic settings. For millennia, these were viewed by cultures around the world not only as allies and medicines but as institutions that were integral to the very warp and woof of a well-functioning society. 

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Fast-forward to today, and the situation is radically different. Indigenous cultures whose religions hinged on psychedelics have been pushed to the brink of extinction. Psychedelics have been staunchly outlawed in most countries around the world. For nearly half a century, these compounds have, for the most part, remained culturally taboo and scientifically off-limits. 

Now, slowly but surely, the pendulum is beginning to swing in the other direction. A growing body of scientific research is demonstrating that psychedelics like psilocybin and 3,4-methylenedioxymethamphetamine (MDMA) can provide significant and enduring therapeutic benefits for the very forms of mental illness that our current Westernized medical system has historically struggled to treat, such as Treatment-Resistant Depression (TRD), debilitating anxiety following a terminal diagnosis, and Post-Traumatic Stress Disorder (PTSD). 

This modern wave of research has ushered in what’s often been called the “Psychedelic Renaissance.” For the first time in a long time, public figures are speaking openly about how psychedelics have positively impacted their lives; psychedelic retreat centers are cropping up around the world; more psychedelic hopefuls are seeking out support from underground and above-ground guides, and lawmakers on both sides of the political aisle are beginning to support psychedelic research.

READ: How To Vet Your Psychedelic Guide

Still, the burgeoning psychedelic movement currently finds itself in a somewhat awkward position: While the cultural excitement around these medicines proliferates, the legal landscape is changing much more slowly. While several jurisdictions around the world have legalized or decriminalized psychedelics, there are currently very few places that offer legal psychedelic-assisted therapy—that is, therapy in which a subject takes a psychedelic in the presence (physical or virtual) of a licensed psychiatrist. 

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In the following sections, we’ll walk you through the legal status of psychedelic-assisted therapies around the world.

The legal status of psychedelic-assisted therapy in the United States is confusing and complicated. On the one hand, the “classic psychedelics” (mescaline, LSD, psilocybin, and DMT) are currently illegal at the federal level in the U.S. There are currently no forms of psychedelic-assisted therapies that the U.S. government has legally sanctioned. Yet, on the other hand, clinical trials, deprioritization, and limited forms of state-level adult use legalization have forged the first pathways for psychedelic therapy within the country.

READ: States Are Embracing Psychedelics, Paving the Way for FDA Approval

Since the passing of the Controlled Substances Act (CSA) by the Nixon administration in 1970, the classic psychedelics have been listed as Schedule 1 substances under the U.S. Drug Enforcement Agency’s (DEA) drug classification system, which means—according to the agency—that they have no recognized medical use and a high potential for abuse. (The DEA’s drug classification system includes five Schedules, Schedule 1 being the most tightly controlled and Schedule 5 being the least.)

In 2017, however, the U.S. Food and Drug Administration (FDA) granted MDMA-assisted therapy for the treatment of PTSD with “Breakthrough Therapy” status, meaning that early clinical results were promising enough to expedite the process of reviewing and approving the treatment. Psilocybin received the same designation for the treatment of TRD the following year. Breakthrough Therapy status has made it easier for some patients to access these MDMA- and psilocybin-assisted therapies through clinical trials—which are currently the only setting in which psychedelic-assisted psychotherapy can be legally administered in the United States. You can search for clinical trials here.

READ: Sexual Abuse in Psychedelic Therapy: Important Steps Being Taken to Support Survivors

A Note About Ketamine

As mentioned above, classical psychedelics are federally illegal in the United States. Yet, ketamine is scheduled differently and, therefore, more accessible for patients seeking psychedelic therapy. In the U.S., Ketamine is currently listed as a Schedule 3 drug under the CSA, meaning it’s considered to have “a moderate to low potential for physical and psychological dependence,” according to the DEA’s website. Though laws vary between states, it’s generally legal for healthcare clinics in the U.S. to dispense ketamine to patients, provided they possess a license from the DEA. 

Ketamine has been making headlines recently as an effective treatment for TRD and a host of other ailments, sparking a number of companies—including Mindbloom and Field Trip Health — to start providing ketamine-assisted therapy services in some major North American cities.

There’s debate surrounding whether ketamine, which is technically a dissociative anesthetic, can justifiably be classified as a “psychedelic.” Unlike classic psychedelics, ketamine does not interact with the brain’s serotonergic 5-H2A receptors. On the other hand, some argue that the experience of being under the influence of ketamine is similar enough to that of psychedelics that they should be grouped together. And like psilocybin, it’s been shown to be an effective treatment for some forms of mental illness, including TRD. A similar debate has long been swirling around MDMA.

READ: Biden Administration Prepares for Legalization of MDMA and Psilocybin Within Two Years

U.S. States With Legal Psychedelic Services

Access to psychedelic-assisted psychotherapy is limited by approval from the FDA. Only specific psychedelics have been granted Breakthrough Therapy status, and only for treating particular mental health conditions. Yet, recent policy changes in Oregon and Colorado have opened up another pathway to accessing one popular psychedelic: psilocybin. 

Both states legalized the “supported adult use” of psilocybin for individuals 21 and over. These non-medical models allow adults to engage in a supervised psilocybin session without a diagnosis. “Supported adult use” is distinct from “psychedelic-assisted psychotherapy,” although the terms are often used interchangeably. The term “psychedelic-assisted psychotherapy” refers explicitly to the experimental treatment model that falls under the jurisdiction of the FDA. In contrast, “supported adult use” is regulated at the state level, and facilitators are not required to have degrees in counseling, psychotherapy, social work, or related fields. Supported adult use remains illegal at the federal level.

Oregon

In November 2020, Oregon became the first state to legalize facilitated psilocybin services when it passed Oregon Measure 109, also known as the Psilocybin Mushroom Services Program Initiative. In that same election, the state also passed Measure 110—the Drug Addiction Treatment and Recovery Act—effectively decriminalizing non-commercial possession of small quantities of illicit drugs. (Measure 110 does not annul pre-existing charges for drug possession.)

Measure 109 led to the establishment of the Oregon Psilocybin Services Section, a subsidiary under the Oregon Health Authority (OHA) whose mandate is “to license and regulate the manufacturing, transportation, delivery, sale, and purchase of psilocybin products and the provision of psilocybin services,” according to the Oregon state government’s website. 

Oregon’s “psilocybin services,” according to a fact sheet from the OHA, “refers to preparation, administration, and integration sessions provided by a licensed facilitator.” But, unlike psychedelic-assisted psychotherapy, measure 109 is intended as a non-medical framework that allows adults over the age of 21 to take psilocybin in the presence of a licensed facilitator. This “supported adult use” model is available to all adults living in or visiting the state. Anyone with a high school degree and a passing background check can become a licensed facilitator. Prior professional education as a mental health professional is not a requirement to facilitate psilocybin sessions—a key difference from the psychedelic-assisted psychotherapy models approved for Federal clinical trials.  

Psilocybin services in Oregon will not require a medical referral or prescription, according to the OHA fact sheet. Measure 109 also mandates that all “psilocybin products consumed must be cultivated or produced by a licensed psilocybin manufacturer and may only be provided to a client at a licensed psilocybin service center during an administration session.” Under the OHA’s program, psilocybin services will only be available through state-licensed service centers. Growing, possessing, and consuming psilocybin outside those service centers remains illegal in Oregon.

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READ: It’s Your Last Chance to Comment on Oregon’s Psilocybin Program

Oregon’s state government will begin accepting applications from individuals and organizations seeking to become licensed psilocybin manufacturers, laboratory testers, service providers, and facilitators starting in January 2023. For the time being, it’s currently building what it describes as “the nation’s first regulatory framework for psilocybin services.”

The recent election has added some friction to the implementation of Measure 109. In November, more than twenty Oregon counties voted to opt out of (i.e., prohibit) the state’s psilocybin services program. Some of the counties’ bans are temporary; others are permanent. Still, according to attorney Vince Sliwoski, individual cities in Oregon can circumvent their county’s ban by going in a different direction. In other words: If a county opted out of Measure 109 this past November, a city within that same county could have voted to allow psilocybin services. The reverse is also true (i.e., a city can opt out even if its county opted in.)

Sliwoski does not have high hopes for the future of Oregon’s psilocybin services program. He told DoubleBlind that while he is not concerned about the federal government stepping in and shutting Oregon’s nascent psilocybin operation down, he does believe the state’s “model will be expensive and cumbersome from a user perspective. Many people simply won’t be able to afford ‘psilocybin services,’ while others won’t have the patience to go through the relatively intensive protocol for supervised use.”

In Sliwoski’s opinion, “For better access and affordability, you need broad decriminalization merged with a retail or storefront distribution model.” 

Colorado 

In November, Colorado became the second state to legalize facilitated psilocybin services when it passed Proposition 122, otherwise known as Measure 58 or the Natural Medicine Health Act. The NMHA decriminalized the use and possession of psilocybin, psilocin (another psychoactive compound found in some species of so-called “magic mushrooms”), DMT, ibogaine, and mescaline (not including peyote). The passing of Prop 102 has set in motion the long process that will be required for Colorado to develop its own framework—analogous but not identical to Oregon’s—for the production, distribution, and administration of the psychedelic compounds. 

The initiative does not call for psychedelic dispensaries but rather for the opening of “healing centers” staffed by trained facilitators in state-licensed locations:

“Adults 21 and older will be able to access research-backed psychedelic medicines under the guidance of a licensed facilitator at designated and licensed healing centers, approved healthcare facilities like palliative care, and in the comfort and safety of their own home,” Natural Medicine Colorado, an advocacy group behind the Prop 122 campaign, writes on its website.

READ: Why Everyone Cares So Much About Colorado’s Psilocybin Bill

Like Oregon’s Measure 109, Colorado’s proposition 122 legalized the supported adult use of psilocybin—a different model from the strictly medical psychedelic-assisted psychotherapy programs overseen by the FDA, which are therapy protocols used to treat specific mental health conditions. The state of Colorado will begin accepting applications for healing center and manufacturer licenses in September 2024. 

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Denver, Colorado’s capital, made history in 2019 when it became the first jurisdiction in the U.S. to decriminalize psilocybin-containing mushrooms, relegating them to lowest-priority status for local law enforcement. 
Another campaign in Colorado called Initiative 61, spearheaded by a group called Decriminalize Colorado, also aimed to fully decriminalize all psychedelics without establishing a state-sponsored regulatory framework. It did not receive the requisite number of signatures to be included in the November 2022 ballot.

California

At present, psychedelic-assisted therapies are not legally available in California—although activists in the state have been petitioning for adult access and decriminalization for several years. 

The California Psilocybin Initiative of 2022 attempted to legalize the retail sale of psilocybin mushrooms and create regulations for psilocybin-assisted therapies. The bill did not collect enough signatures to appear on the November 2022 ballot. California also came very close to decriminalizing many psychedelics earlier this year via Senate Bill 519, introduced by Senator Scott Wiener.

Senate Bill 519 sought to “make lawful the possession, obtaining, giving away, or transportation of” certain quantities of psychedelic compounds—such as psilocybin, LSD, mescaline, and MDMA—among California residents aged 21 and older. The bill described the ongoing War on Drugs as the source of “overwhelming financial and societal costs” and claimed its underlying policy “does not reflect a modern understanding of substance use nor does it accurately reflect the potential therapeutic benefits or harms of various substances.”

Though the California Senate passed the bill, it was ultimately abandoned in early August after the state’s Assembly Appropriations Committee removed the language about decriminalization and limited its effects to a scientific study. But Senator Wiener remains hopeful: “I am looking forward to reintroducing this legislation next year and continuing to make the case that it’s time to end the War on Drugs,” he wrote in a statement published on Twitter. “Psychedelic drugs, which are not addictive, have incredible promise when it comes to mental health and addiction treatment. We are not giving up.”

Though they remain illegal at the state level in California, the cities of Oakland, Santa Cruz, Arcata, and San Francisco have all deprioritized the criminalization of psychedelics, requesting that prosecution for psychedelics remain among the lowest priorities for law enforcement. Still, no state legislation has, as yet, specifically legalized psychedelic-assisted therapies in California. 

READ: Where Are Magic Mushrooms Legal? 

Other U.S. Jurisdictions:

Here are the other jurisdictions that have effectively decriminalized (or deprioritized the legal enforcement of) one or more psychedelic compounds in the U.S. as of December 2022:

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  • Washtenaw County, MI;
  • Detroit, MI;
  • Hazel Park, MI;
  • Easthampton, MA;
  • Northampton, MA;
  • Somerville, MA;
  • Port Townsend, WA;
  • Seattle, WA;
  • Washington, D.C.

Psychedelic-assisted therapies are not yet legally available in any of the jurisdictions above.

Is Psychedelic Therapy Legal in Canada?

Most psychedelics are currently illegal in Canada, though they’re less tightly controlled than in the United States; most of the compounds are categorized as Schedule 3 by the Canadian government’s Controlled Drugs and Substances Act (CDSA). As a result, no forms of legal psychedelic-assisted therapy are currently accessible to the average adult Canadian. 

That said, psychedelic-assisted therapies are not entirely off-limits in Canada. As of January 2022, Canadians suffering from life-threatening conditions unresponsive to traditional forms of treatment can apply to be treated with illegal psychedelics like psilocybin through Canada’s Special Access Program (SAP). Canadians can also volunteer to be research subjects in clinical trials investigating the therapeutic potential of psychedelics that have received a “Section 56 exemption” from the CDSA. According to the Canadian government’s website, this exemption allows practitioners and pharmacists to “prescribe, sell, or provide a controlled substance to patients” within the boundaries of specific terms and conditions.

Canadian non-profit TheraPsil filed a lawsuit against the Canadian government in August, aiming to win legal access to psilocybin-assisted therapy for seven patients without invoking the SAP or receiving a Section 56 exemption. The lawsuit is based on the premise that withholding psilocybin from the patients is an infringement of Section 7 of Canada’s federal Charter, which guarantees “the right to life, liberty, and security of the person.” If successful, TheraPsil’s lawsuit could force the Canadian government to create a legal framework for the regulation of psilocybin.

Are Psychedelic-assisted Therapies Legal in Mexico?

Most classical psychedelics are currently almost completely illegal in Mexico. The country’s government allows small quantities of LSD and MDMA—up to 0.015 and 40 milligrams, respectively—for personal consumption.

There are some exceptions, however. Ibogaine is unregulated in Mexico, making the country a popular destination for ibogaine retreats. In addition, Article 195 of the country’s Federal Penal Code exempts the use of psilocybin-containing mushrooms from prosecution if that use was conducted within a traditional ceremonial framework. (This is analogous to the DEA granting the Native American Church in the U.S. the right to use peyote, a Schedule 1 substance, for religious purposes.)

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Ayahuasca—a psychedelic brew made from Banisteriopsis Caapi (a species of vine) and Psychotria Viridis (a DMT-containing leaf) used by some indigenous societies in South America for millennia, particularly in the Amazon region—is also legal in Mexico. 

READ: How to Choose the Right Ayahuasca Retreat For You

Where Are Psychedelic Retreats Legal?

Like supported adult use, psychedelic retreats offer an alternative way to engage with mind-altering substances in a legal setting.

Psilocybin retreats are legal in the following countries:

  • The Netherlands 
  • Jamaica

Ayahuasca-based retreats are currently legal in the following countries:

  • Mexico
  • Costa Rica
  • Peru
  • Brazil (only in some cases for religious use)

A note from DoubleBlind: Psychedelic tourism can strongly impact local communities. We encourage those traveling to different countries to learn about and respect the histories, environment, and cultural traditions of the places they’re visiting. Further, we encourage you to prioritize your safety when using powerful substances and navigating unfamiliar spaces. 

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