Policies to expand access to psychedelics could be ‘short-sighted’

Jon Kostas sat in a room with doctors by his side as he received a pill that carried the potential to end his yearslong fight against alcoholism.

He ingested the capsule and waited for it to take effect after donning an eye mask and putting on headphones playing classical music. He reflected on his intention prior to taking the pill: “I just need to find some sort of inner peace. I felt like if I could calm down internally, I won’t want to drink.”

Kostas was a participant in a trial studying psilocybin-assisted therapy for alcohol use disorder at New York University’s Langone Center for Psychedelic Medicine that ran from 2014 through 2020. The eight-month experiment he participated in studied more than 90 men and women ages 25 to 60 who took either psilocybin or a placebo as part of psychotherapy sessions. 

Kostas received a dose of psilocybin, a psychedelic compound found in mushrooms that produces hallucinogenic and mind-altering effects, and he says it saved his life.

He stopped drinking after undergoing psychedelic-assisted therapy and is now the CEO of Apollo Pact, a patient-driven nonprofit that advocates for federal funding for research on psychedelic-assisted mental health therapies.

It’s success stories like Kostas’ that are driving states’ renewed interest in psychedelics as an option to address health concerns like depression and substance use disorders.

Before the NYU clinical trial, Kostas avoided experimenting with psychedelics “out of fear of having a bad experience and losing control and not being able to differentiate from reality or not,” he said.

“But I was at a point where I had already tried everything else—none of which worked.”

Ultimately, it remains unclear exactly how psychedelics actually work, said Peter Hendricks, a clinical psychologist and professor of psychiatry at the University of Alabama at Birmingham. But studies indicate psychedelic-assisted therapy can help mitigate the effects of addiction and other mental health conditions.

“When these substances are ingested, they can produce a sort of nonordinary, altered state of consciousness that is characterized by introspection and insight such that people see things from novel perspectives,” he said. “This new perspective can ultimately motivate behavior change.”

Earlier this month, California reintroduced a bill that would legalize psychedelic-assisted therapy for individuals 21 years and older to address the state’s growing substance use and mental health crises.

Rhode Island lawmakers also introduced a bill in January to decriminalize the personal cultivation and possession of psychedelics until July 1, 2026, as a way to expand access to the substance for individuals who may need it to treat a “serious or life-threatening mental or behavioral health disorder.”  

Hawaii is looking to make psilocybin available for therapeutic use, as policymakers introduced a bill last month that would establish a regulatory framework for qualified professionals to administer the substance. 

But some observers are concerned that states are being too hasty with the policies they’re introducing, given the research behind the substance’s effects are limited and the Federal Drug Administration has yet to approve psychedelics for market use. 

“With these arguments around legalization and decriminalization, we have to note people are extrapolating from very carefully controlled randomized control trials to use outside of these settings,” Hendricks said. “I think it's premature to conclude that psychedelics are uniformly safe and effective for a range of mental health conditions, and that seems to be the argument that's made often when legalization or decriminalization are mentioned.” 

If you have a cavity, Hendricks suggested, you go to a dentist who’s certified to treat you in a controlled setting, not to a stranger in their living room. Without the proper training to fill a cavity, someone could endanger your health. 

The same is true for psychedelics, he said, which “appear to be generally safe and effective when they are administered by qualified professionals in carefully controlled settings.” 

Only Colorado and Oregon have legalized the use of psychedelics, allowing the adult use of psilocybin under supervision at regulated centers to address mental and behavioral conditions. 

The benefits are tantalizing to imagine. Besides the value to patients, psychedelics could help governments and insurance companies save on long-term care, Hendricks said. If a patient ingested psychedelics today and quit smoking immediately, he said, that could reduce the need for heart surgery, chemotherapy or radiation 20 years later.

Kostas also sees upsides. Treating someone with an opioid use disorder could become less expensive since psilocybin-based treatments can be completed in just a few sessions, which could also be cost-saver, he said. Medical treatments with buprenorphine, methadone and naltrexone often require more frequent doses.

Clearly, more research is needed. 

Late last year, the Kentucky Opioid Addiction Abatement Advisory Commission proposed using $42 million of the state’s opioid settlement money to invest in research on ibogaine, a type of psychedelic, to combat opioid use disorders. The idea drew criticism from commission members and Gov. Andy Beshear over health and funding concerns and other issues, and even led to the resignation of the commission’s then-executive director Bryan Hubbard. 

Without more research, states’ recent push to broaden access to psychedelics to address mental health conditions is “a little short-sighted,” Hendricks said.

Decriminalization could create “legal loopholes” for organizations looking to commercialize the psychedelic market, he said, which could enable the development of unregulated psychedelic-assisted treatment markets. 

Plus, the legalization of personal use of psychedelics could create the opportunity for people to ingest these strong substances without proper supervision. In that case, someone may not receive the care they need if they have a poor experience while under the drug’s influence, he said.

Until psychedelics are approved at the federal level, a patchwork of legality will complicate payment for the use of the substances. Even if 40 states decriminalize the use and possession of psychedelics, for instance, a lack of federal approval means psychedelic-assisted therapy won’t be required to be covered by insurance. That could undermine the affordability and accessibility of psychedelic-assisted therapy, Kostas said. 

In Oregon, for instance, clients of psychedelic-assisted therapy could pay more than $2,000 for a treatment course. 

States should work to update regulatory processes and policies needed to ensure psychedelic-assisted therapy can be covered by insurance companies to avoid patients having to pay out of pocket, Hendricks said. By partnering with managed care organizations, officials and stakeholders could determine cost-effectiveness strategies to ensure psychedelic-assisted treatment remains accessible to patients. 

Policymakers should also consider the benefits of waiting for the FDA to approve psychedelics for market use, Hendricks said. The drug approval process may be expensive and bureaucratic, but it’s important that research be conducted on psychedelics’ long-term effects on large samples of individuals so governments know the drugs are a safe and effective option for medical treatment.

“We have to conduct more research with large samples to determine really for whom psychedelics appear to be effective, for whom they might not be effective, and for whom they might present a risk,” he said. 

Some states, including Arizona, Missouri and Indiana have recently introduced legislation to fund the research of psychedelics to treat extreme mental health conditions. 

Policymakers should think about creating options for psychedelic-assisted therapy in a medical setting, Kostas said, rather than legalizing the substances for general use. Plus, regulating treatment sites and the certification of clinicians who are qualified to administer psychedelic medication would ensure providers are adequately prepared for psychedelic-assisted therapy. 

“This therapy was the only thing that saved my life when nothing else did, and I want to be very cautious in getting this to other people in a responsible and effective way,” Kostas said.