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US path to legal MDMA and psilocybin-assisted therapy

After decades of active prohibition of these substances that included legal banning and misinformation regarding their mind-altering effects—resulting in psychedelics being left out of scientific research for years—the tide is turning on government policy and public opinion.

In 2018, the U.S. Food and Drug Administration (FDA) named psilocybin a “breakthrough therapy” in treatment for severe depression, a designation the agency applies to drugs that in early trials demonstrate substantial improvement over existing treatments.   

In 2019, Imperial College London launched the Centre for Psychedelics Research and U.S. institutions Yale, UC Berkeley, and Mount Sinai Hospital have all followed suit, establishing psychedelic research divisions that conduct clinical trials. To date, close to a hundred US academic institutions have followed suit.​

Fast forward to 2023 and states like Oregon, Colorado have opted to push forward legalizing psilocybin and other natural medicines for the purpose of adult use in a treatment setting, stopping short of being able to deliver psychedelic-assisted therapy. Many more states are looking at legislative efforts that would review psychedelics therapy research and future implementation as well as decriminalization of psychedelics.  Some states are looking at adopting a model similar to Oregon and Colorado of legalizing adult use but the majority are leaning more towards the route of psychedelic-assisted therapy. The majority of these states are currently working through regulation efforts are taking the route of psychedelic-assisted therapy.  The difference between the two model is that the adult use in treatment setting cannot claim or include therapy work as psychedelics has not been approved by the FDA as therapy treatment drug federally.  The path to receiving FDA approval for wide therapy use federally in the US is through clinical trials. 

Clinical Trial with FDA Updates

Currently MAPS has completed its MDMA Phase 3B with promising results with the Phase 3C on its heel.  After which MAPS may ask the FDA to use their result to designate MDMA as a legal therapy drug under therapeutic administration settings.  Compass has been approved to begin its Phase 3 trial of over 1000 participants for psilocybin therapy. Compass’ route to FDA approval is yet unknown, but we’ll likely hear more on it later this year. With FDA approval of MDMA and psilocybin for therapy based on the results of these phase 3 clinical trials, states will be able to pass regulations they are currently working on into laws to allow for psychedelic-assisted therapy.

Read more about our psilocybin clinical trials.

Psychedelic-Assisted Therapy Legalization Efforts by State

Many states are looking to decriminalize psychedelics, allow for adult psychedelic therapy treatment services and/ or make allowances for special cases such as end of life for psychedelics. They are also working towards policies on psychedelic therapy for mental health in preparations for when MDMA and psilocybin receives FDA approval for therapy use.

US States working towards psychedelic therapy in alphabetical order


Senate Bill 519 would have decriminalized the personal possession of certain psychedelic substances, legalized life-saving public health interventions, and studied future approaches to increasing use of psychedelics, however did not receive support in various committees and will be reintroduced in 2023.


Colorado voters decided in favour of Proposition 122 in the November 2022 mid-term election, named the Natural Medicine Health Act of 2022 (NMHA), which will legalize a host of psychedelics in Colorado.  Similar to Oregon’s MB 109 in terms of creating accessibility but with added broader initiatives. Read more about Natural Medicine Health Act (NMHA) & Legalization of Psychedelics in Colorado.


On May 7, 2022, the Governor signed House Bill 5506 adjusting the state budget for the biennium, effective from July 1, 2022 to June 30, 2023.  This state budget bill specifically earmarked funds for psychedelic-assisted therapy programs administering psilocybin and MDMA treatments. Under the pilot program, veterans, retired first responders, and direct care health care worker can be qualified to receive MDMA-assisted or psilocybin-assisted therapy under the supervision of an approved federal Food and Drug Administration treatment site.


The bills, introduced as SB348 and HB193 (“Using Alternative Therapies to Treat Mental Health and Other Medical Conditions”), would require officials in the state to “conduct a study to evaluate the therapeutic efficacy of alternative therapies,” including MDMA, psilocybin, and ketamine, to treat conditions such as depression, anxiety, PTSD, bipolar disorder, chronic pain, and migraines.


On March 3, 2022, Georgia legislators amended and passed HR896, which would create the House Study Committee on Alternative Post-Traumatic Stress Disorder Treatment Resources for Veterans.   The committee will “undertake a study of the conditions, needs, issues, and problems” related to utilizing psilocybin-assisted therapy to treat veterans suffering from PTSD or depression and for other purposes, such as to treat people struggling with addiction. It will now move to the House Rules Committee for further consideration.


On January 21, 2022, Senate Bill 2575 was introduced proposing to remove “psilocybin and psilocyn from the list of Schedule I substances” and “establish designated treatment centers for the therapeutic administration of psilocybin and psilocyn.” If enacted, this bill would also require the governor to “establish and convene a psilocybin review panel to review and assess the effects of this Act.”


On January 12, 2023, HB0001 was introduced, the Illinois CURE (Compassionate Use and Research of Entheogens) Act. The Act would establish the Illinois Psilocybin Advisory Board within the Department of Public Health for the purpose of advising and making recommendations to the Department regarding the provision of psilocybin and psilocybin services.


HF480 was introduced February 11, 2021 and referred to Human Resources. The bill proposes decriminalizing certain schedule I controlled substances, including DMT, LSD, peyote, psilocybin, psilocyn, and MDMA, for use by certain patients diagnosed with a terminal illness or a life-threatening disease or condition.


On January 10, 2022, Kansas lawmaker introduced HB 2465, aimed at reducing the penalty for individuals cultivating or possessing small quantities of certain controlled substances.


On February 4, 2022, SB 709 was introduced and  establishes the Post–Traumatic Stress Disorder Alternative Therapies Fund as a special, nonlapsing fund, that is not subject to § 7–302 of the state finance and procurement article. The purpose of the fund is to support the department in studying the effectiveness of and improving access to alternative therapies for post–traumatic stress disorder in veterans. “Alternative therapies” includes psychedelics such as 3,4–methylenedioxymethamphetamine (MDMA), psilocybin, and ketamine. The bill will take effect July 1, 2022. 


Personal use and possession of entheogenic plants has been made the lowest law enforcement priority in the cities of Somerville, Cambridge, Northampton, and Easthampton. Statewide legislation has been introduced to decriminalize personal drug possession, and separately to study the legalization of entheogenic plants and fungi.


On February 1, 2022, a proposed ballot initiative would overhaul Michigan drug laws. If passed, this initiative would decriminalize possession of Schedule 1 and 2 substances. Additionally, the initiative identified psilocybin, psilocin, ibogaine, peyote, and dimethyltryptamine as “Natural Plants and Mushrooms,” which would be legal for anyone over 18 years old to cultivate, possess, use, or gift. A system of regulated sale and treatment would also be implemented. The initiative provides that entities designated by a hospital that have received a “Certificate of Need” from the Michigan Department of Health and Human Services may administer and sell “Natural Plants and Mushrooms” to patients possessing a “written recommendation” for services from a Michigan licensed physician.  The ballot in 2022 has been deferred to 2024 to allow more time to gather the requisite signatures. 


On January 1, 2022, HB 2429 was introduced which would expand Missouri’s Right to Try Act to no longer prohibit people with terminal or life-threatening illnesses from using substances such as MDMA, psilocybin mushrooms, LSD, DMT, mescaline or ibogaine with a doctor’s recommendation after exhausting all other approved treatment options, if they qualify as an “investigational drug.” The bill would also reduce penalties statewide for low-level possession of those drugs.



On March 1, 2022, HB 2850 was introduced which proposes to legalize certain “natural medicines” including: ibogaine, psilocybin and psilocin if derived from fungi, DMT and mescaline excluding peyote to treat a variety of medical conditions. The bill would also provide immunity to health care providers who recommend “natural medicines” to patients. The penalty for possession of “natural medicines” outside of the sanctioned medicinal uses would also be reduced.


Under a State Supreme Court case, the use of certain psychedelics may be protected under the New Hampshire state constitution if it properly qualifies as a religious practice.

As well, on January 5, 2022, HB1349-FN was introduced to the House and referred to the Criminal Justice and Public Safety committee. The act would have decriminalized the possession or use of a certain amount of psilocybin mushrooms by a person 18 years of age or older.


On June 23, 2022, Bill S2934 was introduced to the Senate and referred to Senate Health, Human Services and Senior Citizens Committees.  The “Psilocybin Behavioral Health Access and Services Act” would authorize production and use of psilocybin to promote health and wellness; decriminalizes, and expunges past offenses involving, psilocybin production, possession, use, and distribution.


Lawmakers in New York are considering several bills that would change the legal status of psychedelic drugs like psilocybin in New York.  Legislation has been introduced to create a medical psilocybin program, to provide $2 million for psilocybin treatment of veterans and first responders, and to establish a public psychedelic research institute and research program. Separate decriminalization bills also have been introduced. 


In January 2022, HB 3174 and HB 3414 two bills that would promote scientific research into psilocybin-assisted therapy and help foster new clinical trials. 


January 2023, Oregon Health Authority began licensing psilocybin business to provide psilocybin services to anyone over the age of 21.  The service would need to take place in a licensed facilitation center and with a licensed facilitator. Read more about Oregon Psilocybin Services.


On March 16, 2022, HB 2421 was introduced and referred to the Health committee. The Psilocybin Data Act provides for research and clinical studies of psilocybin and psilocybin-assisted therapy. The act provides a framework for research to discover innovative methods to optimize the public health benefits of psilocybin.


On March 2, 2022, HB7715 was introduced proposing to decriminalizing possession of psilocybin.  Additionally, HB7715 would allow “a practitioner in good faith and in the course of his or her professional practice” to “prescribe and dispense psilocybin as a therapeutic.” And the Director of Health would be empowered to promulgate necessary rules and regulations to allow practitioners to prescribe psilocybin as a therapeutic in accordance with this bill.


On June 18, 2021, HB1802 became law. It will be in effect from September 1, 2021 until it expires September 1, 2023. The bill calls for a study led by the Department of State Health Services to evaluate the therapeutic efficacy of alternative therapies including MDMA, psilocybin, and ketamine for the treatment of specific mental health and medical conditions including depression, anxiety, PTSD, bipolar disorder, chronic pain, and migraines. The department will evaluate and compare the efficacy of these novel treatments with current treatments, and prepare and submit a report by December 1, 2022. $1.4 million was allocated to directly fund a clinical trial of psilocybin to treat PTSD in veterans.


On March 22, 2022, Utah Governor signed 64 bills into law, including HB167, which created the Mental Illness Psychotherapy Drug Task Force.  The passage of this bill does not legalize or decriminalize any psychedelic compounds for medical or recreational use, but will position state law makers to be able to thoughtfully reconsider the role of certain scheduled compounds in mental health treatment. The legislation requires the task force to provide a written report of their findings to the Utah State Legislature’s Health and Human Services Interim Committee by October 31, 2022. 


Bill H.878, introduced by Vermont State Representatives would decriminalize “certain drugs commonly used for medicinal, spiritual, religious, or entheogenic purposes,” including psilocybin, peyote, ayahuasca, and kratom.


On January 11, 2023, HB 1513 was introduced, which would allow possession of psilocybin pursuant to a valid prescription by a health care practitioner in the course of professional practice for treatment of refractory depression or PTSD or to ameliorate end-of-life anxiety.


Senate Bill SB 5660 was introduced to move legalization of psilocybin in the same path as Oregon’s Measure Ballot 109 but did not received a vote.  ESSB 5693 is a state spending bill that had introduced spending on study to allow for psilocybin access for medical use in Washington.  The study must report findings before December 2023.

What is the utility of training for psychedelic therapy now?

As Oregon and Colorado begin delivering psilocybin assisted services in 2023 and 2024 respectively, there will be very few qualified psychedelic therapists and trained physicians to serve the tens of thousands of annual clients who are interested in or ideal candidates for treatment. In most cases, there will be more questions than answers, therapists and physicians who have taken psychedelic therapy and prescriber training will be best able to meet this new demand. You do not need to live in Oregon or Colorado to take this training or to offer psychedelic therapy services. With so few therapists and physicians who have had training and understand psychedelics, wherever you live, your expertise may be of value to those patients who will go to Colorado or Oregon for the treatment.

How can ATMA help you become a psychedelic therapist in 2023?

ATMA is pioneering a therapist-centred and therapist-driven business model by providing education, training, clinical trials, and business support services on the largest online community platform. Practitioners on the ATMA platform will have a guided path to integrating psychedelic-assisted therapies into their current practices.  We will be promoting and making our directory of trained psychedelic practitioners available to Oregon and Colorado for psychedelic psychotherapy support this year.  Find out more about us below.