Why States Are Considering Regulated Psilocybin-Assisted Therapy Policies

Legislatures across the country are evaluating structured, state-level approaches to alternative mental health treatments.

Currently, treatment options for veterans with post-traumatic stress disorder (PTSD) are limited. Trauma-focused therapy, the VA/DoD-recommended first-line treatment for PTSD, has an estimated dropout rate of 27.1%, and 50% of veterans who complete treatment still meet diagnostic criteria for PTSD. Second-line treatments involving FDA-recommended PTSD medications only achieve remission in about 20% to 30% of patients and often cause adverse side effects.

In response, researchers, federal agencies, and states are exploring options to expand access to alternative treatments for PTSD. Psilocybin, the compound found in certain mushroom species, is gaining traction as one of the most promising, including proposals in Iowa, New Hampshire, West Virginia, Washington, Missouri, New York, and Massachusetts to create regulated access programs for psilocybin-assisted therapy.

These regulated access programs do not legalize recreational psilocybin use. Instead, they respond to a growing body of research suggesting that psilocybin-assisted therapy may offer therapeutic benefits for PTSD, major depressive disorder (MDD), substance use disorder (SUD), and other neurological conditions when delivered in controlled, clinical settings.

Clinical research on psilocybin was extensive in the 1960s but was impeded in 1970 when it was classified as a Schedule I substance in the Controlled Substances Act. Schedule I substances are defined as “high abuse potential with no accepted medicinal use.”

However, researchers at Johns Hopkins Medicine and other academic institutions have questioned whether psilocybin fits this classification, citing research indicating that it is not addictive, has no known lethal overdose threshold, and is being studied for therapeutic applications across multiple conditions.

Research interest began to reemerge in the early 2000s, with multiple studies reporting significant reductions in depression and anxiety symptoms. One recent study reported a 58% remission rate for patients with MDD 12 months post-treatment, a condition that commonly co-occurs with PTSD. In addition to clinical research, observational data from nonprofit-led psilocybin retreats have drawn attention. One study examining veterans who attended a psilocybin retreat in Jamaica reported average improvements of 38% in depression symptoms, 30.4% in anxiety symptoms, and 24.8% in PTSD symptoms.

Federal agencies, academic institutions, and states have taken notice. The Department of Veterans Affairs recently announced plans for multi-year studies on psychedelic compounds across nine facilities, while institutions including Johns Hopkins Medicine, Mount Sinai Health System, and the University of Texas at Austin have established dedicated centers for psychedelic research. This growing body of research and institutional engagement has helped move psilocybin-assisted therapy from academic study into state policy action. In the past few years, Oregon, Colorado, Utah, and New Mexico have led by enacting legislation to provide access to psilocybin assisted therapy through regulated access programs.

Much like the legislation that is currently being considered across the states, these programs do not allow recreational psilocybin use. Instead, they provide a framework for providers to administer psilocybin-assisted therapy to patients in need. In Oregon, over 38,000 psilocybin products have been sold for medicinal use with fewer than 30 calls for emergency services, and a recent real-world study from the Oregon program found significant improvements in depression, anxiety, and general well-being.

Building on this momentum, the ALEC Veterans and Military Affairs Task Force recently approved The Therapeutic Psilocybin Act for Veterans and First Responders. The model policy establishes a state-supervised framework for regulated medical use of psilocybin to treat post-traumatic stress disorder (PTSD) and other qualifying conditions. It directs state health agencies to oversee the licensing of psilocybin cultivation, testing, and therapy facilities; register qualified medical and therapeutic providers; and enforce guardrails such as inventory controls, safety standards, and continuing education requirements. The Act also provides legal protections for patients and clinicians participating in approved treatment programs, expressly prohibits recreational use, and requires ongoing reporting to the legislature.

For veterans, first responders, and others struggling with treatment-resistant mental health conditions, this model policy offers a responsible way forward. It allows medical access for patients who have not found relief through traditional treatments while setting clear guardrails that prioritize patient safety, provider accountability, and legislative oversight. By providing a clear state-led framework, the Act allows lawmakers to lead on mental health policy while maintaining oversight, accountability, and public trust.