The scientific literature is limited in its understanding of the consequences of using
psychedelics and preventing and mitigating adverse events.
Summary
Although the clinical research and associated media reports on these substances continue to grow, what receives less attention is the changing policy landscape for some psychedelics in the United States.
Despite the federal prohibition on supply and possession — outside approved clinical research, the Food and Drug Administration's Expanded Access program, and some religious exemptions — some state and local governments are loosening their approaches to some psychedelics.
Some states are implementing or considering approaches that legalize some forms of supply to adults for any reason.
It seems likely that more jurisdictions will consider and implement alternative policies to prohibiting the nonclinical supply of some psychedelics, possibly including retail sales.
The primary goal of this mixed-methods report is to present new data and analysis to help inform policymakers participating in these discussions in the United States, but much of this report should also be useful to decisionmakers in other countries.
These insights should also be useful to anyone who is interested in learning more about these substances and the public policy issues surrounding them.
Key Findings
Unlike people who use cannabis and many other drugs, infrequent users of psychedelics account for most of the total days of use.
Psychedelics Market Impact
The total number of use days for psychedelics — a proxy for the size of the market — is two orders of magnitude smaller than it is for cannabis.
Within the class of drugs generally classified as psychedelics, psilocybin has the highest past-year and past-month prevalence rates among U.S. adults. Of those ages 18 and older, 3.1 percent — or approximately 8 million people — used psilocybin in 2023.
Among those reporting the use of psilocybin in the past year, nearly half reported microdosing the last time they used it.
The economic implications of legalizing psychedelics include potential tax revenues and the impact on illegal markets. Unlike cannabis, the market for psychedelics is relatively small (Chapter 2), but the potential for product innovation and commercialization exists
Scientific literature is limited in its understanding of the consequences of using psychedelics and preventing and mitigating adverse events.
Health Implications
Clinical trials suggest psychedelics could help treat mental health conditions like PTSD, depression, and anxiety
Indigenous practices also highlight their spiritual and personal growth benefits
Policy changes should account for the impact on Indigenous communities and ensure their practices and access to these substances are preserved and respected.
The exploitation of Indigenous knowledge and resources, as seen with peyote and iboga, must be addressed
Adverse events can occur, including psychological distress and physical risks, particularly with substances like ibogaine
Studies also indicate that misuse of these substances can lead to prolonged difficulties
Policy + Regulatory
Most of the policy changes at the state and local levels focus on supporting research and deprioritizing the enforcement of certain laws about psychedelics, but a few states have legalized some forms of supply and others are considering it (Colorado, Oregon).
There are many supply policy options between prohibition and legalizing production and sales by for-profit companies.
The role of price as a regulatory tool may matter less for psychedelics compared with many other drugs
The importance of supervised use is emphasized to mitigate risks (Chapter 4). Oregon’s model of supervised psilocybin services is one example
Ensuring product quality through testing and proper labeling is crucial to avoid contamination and ensure accurate dosing
Recommendations
Those participating in psychedelics policy debates and analysis should be specific about the changes being considered, implemented, or evaluated.
Meaningful policy discussions should include Indigenous Peoples who are community authorized to speak on these matters.
Policymakers need to be thoughtful about the role of supervision and facilitators when considering changes to psychedelics policies.
It is critical to improve the data infrastructure on psychedelics to better support policy analyses.
Now is the time for U.S. federal policymakers to decide whether they want psilocybin and other psychedelic substances to follow in the footsteps of the for-profit cannabis model.
The scientific literature is limited in its understanding of the consequences of using
psychedelics and preventing and mitigating adverse events.
Guidelines for preventing and mitigating adverse events related to use in non Indigenous settings are beginning to take shape. These include public education about the effects and potential risks, standards for informed consent, and expanded training for first responders and health care professionals. We have much to learn about these guidelines and hope they will be subject to rigorous evaluation.
There are concerns that use of psychedelics could worsen health outcomes for some individuals, especially if the use is not supervised or if individuals are not properly screened.
Although the safety profile of psychedelics may be better than many other controlled substances, it is still important for policymakers to understand the nonzero potential risks of psychedelics.
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