The legalization of cannabis in the United States—the biggest change in policy for an illegal substance since Prohibition ended—has been an unqualified success for approximately no one. True, the drug is widely available for commercial purchase, many marijuana-related charges have been dropped, and stoner culture has become more aligned with designer smoking paraphernalia featured on Goop than the bumbling spaciness of Cheech and Chong. But a significant part of the market is still underground, medical research is scant, and the aboveground market is not exactly thriving. Longtime marijuana activists are unhappy. Entrepreneurs are unhappy. So are people who buy weed, as well as those who think weed should never have been legal in the first place.
The country is now poised to change the legal status of a new class of psychoactive drugs: psychedelics. They have shown early promise in treating mental-health issues, even though some enthusiasts are concerned that easing regulations without a better understanding of these drugs could put patients in a degree of danger. Oregon is now licensing centers that can administer psilocybin, and MDMA is moving toward FDA approval. In some ways, the fate of legalized pot could be read as a cautionary tale for how these drugs, too, could be left in a limbo that hardly anyone really likes. But as psychedelics enter the mainstream—becoming decriminalized, state-legal, or even FDA-approved—they will be dispensed and sold differently from marijuana. The process is unlikely to please everyone, but if advocates, manufacturers, and lawmakers can keep psychedelics from falling into the same traps that marijuana did, they have a chance of creating an industry that serves at least some Americans well.
Despite its wide availability, cannabis is still illegal under federal law. Since 1970, it’s been listed as a Schedule I drug, meaning the government believes it carries a high likelihood of abuse and no medical value. Starting in the 1970s, states began passing laws lowering penalties for cannabis possession and allowing it for medical purposes and, eventually, recreational use. In 2013, U.S. Deputy Attorney General James M. Cole issued a memo declaring that the Justice Department would not strictly enforce federal marijuana laws in states that legalized it.
Americans were eager to buy marijuana as states launched legalization programs, but in most states, cannabis hasn’t proved to be a great legal business. Because cannabis is still illegal at the federal level, many entrepreneurs don’t benefit from many of the tax breaks that other businesses do, meaning the industry essentially pays billions in extra taxes, according to an analysis by a cannabis-research firm. In most states, big corporations dominate the industry while small-business owners struggle to afford high licensing fees. One promise of legalization was its potential benefit to Black and Latino communities, who were disproportionately affected by the War on Drugs, but as of 2017, members of these communities accounted for single-digit percentages of state-sanctioned cannabis entrepreneurs. Because legal weed is sometimes more expensive than old-school dealer prices, plenty of people simply stick with the unregulated underground. In states like New York, the gap between what’s legal and what’s enforced has allowed illicit stores to pop up among the legitimate ones.
That’s all in places where recreational use is legal. In the 14 states where only medical use is allowed, dispensaries must make a different calculus: They serve patients in need, but others treat them only as a loophole to access the drug—and are likely to go elsewhere if recreational access becomes available. In the 12 states where even medical marijuana is illegal, the only cannabis products legally available are a handful of medications that have been approved by the FDA, all for a narrow set of indications, such as vomiting among chemotherapy patients, AIDS-related anorexia, and certain kinds of seizures. Active clinical trials to study cannabis are few and far between, which means that the drug currently has no clear pathways to be federally approved for other indications.
Psychedelics are much further behind in their journey to wider availability, but on the surface, they appear poised to mimic marijuana. The drugs are undergoing a sea change in public sentiment; Aaron Rodgers has a trip story, and so does Michael Bublé. Half of state governments have introduced psychedelics-related bills, some of them to form working groups that will dig into the science of psychedelics, and some to launch full-blown psilocybin industries. Assuming that reform moves at a comparable speed to cannabis, researchers have estimated that 25 states could legalize psychedelics in the next decade or so. Voters in Oregon and Colorado have already passed ballot initiatives that opened the way for psilocybin industries in their states.
But instead of following marijuana’s trajectory for reform—first decriminalization, then medical legitimacy, followed by recreational use—psychedelics are barreling down all those avenues at once. State-regulated psilocybin centers are shaping up to be less like cannabis dispensaries and more like a hybrid of a psychotherapy office, a medical clinic, and a spa. Rules in the psilocybin industry are much more restrictive than those for cannabis ever were, because many people believe unlocking the possible benefits of these drugs requires more careful support and perceive the risks of a bad trip as higher. Whereas Oregonians over 21 can pop into a dispensary, flash an ID, and take their bud (or gummies, or soda, or cookies) home, adults seeking psilocybin must undergo a comprehensive mental- and physical-health screening, then ingest their dose under the supervision of a trained and licensed facilitator. Meanwhile, researchers and start-ups are pushing psychedelics forward on the medical front. We might see the first MDMA approval to treat PTSD as soon as August.
This air of legitimacy—the idea that psychedelics could be more serious drugs than cannabis—gives drugs like MDMA and psilocybin certain advantages. Psychedelics research is booming in a way that marijuana research never really has. Few scientists have overcome the hurdles of studying cannabis; for instance, by most accounts, the government-grown weed that researchers have to use is less potent than what’s sold at dispensaries, and has been known to arrive in labs already moldy. And with the thriving black market, pharmaceutical companies have seemed uninterested in sponsoring cannabis clinical trials. But for psychedelics, which support much less illegal trade, start-ups and nonprofits are leaning hard into the clinical-trial route. Sue Sisley, a physician and marijuana researcher who previously developed clinical trials for marijuana, says psychedelics have moved toward legalization so quickly in large part because they’re following Big Pharma’s traditional drug-development playbook.
In some ways, the FDA-forward approach is a gamble for people hoping to create a psychedelics industry. For one thing, Ariel Clark, an Anishinaabe cannabis and psychedelics attorney, worries that this pathway could put the drugs firmly out of (legal) reach for the people who could most benefit from the protections that come with legalization, including the Indigenous communities that already use some psychedelics in traditional ceremonies. Currently, a single psilocybin session at an Oregon service center costs thousands; companies that receive FDA approval could possibly further inflate the prices of approved psychedelics and treatment. (That has already happened with ketamine.) Additionally, FDA approval of proprietary psychedelics might still leave growers paying the same high taxes that have caused small-cannabis-business owners to fold. “Farmers already have really low margins,” and taxes don’t help, says Hadas Alterman, a partner at Plant Medicine Law Group and a member of Oregon’s Psilocybin Advisory Board’s equity subcommittee.
But even in a scenario that leaves small-time entrepreneurs in the dust, some advocates argue that medicalization would be a net good. Medicalization might not lead the United States to a hallucinogenic utopia, but compared with underground use, it very well could increase access to psychedelics, improve patient safety, and build a functional (if inequitable) industry. Psychedelics manufacturers and people with the means to afford their pricey treatments might be perfectly happy with that outcome.
Psychedelics are still in uncharted territory in the U.S. Even though start-ups are investing millions on the assumption that they’ll be approved as medicines, and state-run programs are charging ahead with developing their own psychedelic industries, research on the drugs is still in early days, and their exact path to legalization remains murky. But at the very least, lawmakers have a great model of what not to do. “Folks sitting in government saw what happened with cannabis,” Clark told me. One can only assume that they don’t want to repeat the experience.
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Jane C. Hu
