As Massachusetts prepares to vote on Question 4 next month, it finds itself at the forefront of a growing national conversation about the therapeutic potential and barriers to the widespread adoption of psychedelic substances.
If passed when voters head to the polls on November 5, Massachusetts’ Question 4 measure will allow adults in the state to legally use substances like psilocybin, DMT, mescaline, and ibogaine through licensed service centers. The initiative would also permit personal cultivation for non-commercial purposes, making Massachusetts the latest state to join a broader movement toward psychedelic reform.
Massachusetts has witnessed growing public support for psychedelics, with several cities, including Cambridge and Northampton, already decriminalizing psychedelic substances at the local level. Question 4 follows models established in Oregon and Colorado, where access to psychedelics is limited to regulated service centers under the supervision of trained facilitators. Advocates point to the mental health crisis as a driving factor for the initiative. “We have a mental health crisis, and the things we do have work for some people, but for others, they don’t,” said Taylor West of the Healing Advocacy Fund.
Research has shown that psychedelics offer significant promise in treating mental health conditions like PTSD, depression, and substance use disorders. The FDA has granted “breakthrough therapy” status to psilocybin and MDMA, expediting research efforts to assess their efficacy for treatment-resistant conditions. Studies indicate that a single psilocybin session, administered under the right conditions, can lead to long-lasting improvements in mental health, offering new hope for those who have not found relief through traditional therapies.
However, opposition to the initiative exists. The Massachusetts Coalition for Safe Communities has raised concerns about home-growing provisions, citing potential safety risks for children and the possibility of unregulated gifting markets that could undermine public health goals. Just last week, a middle school in Los Angeles saw more than a dozen students treated and some hospitalized for ingesting an unknown substance. “There was no evidence of any significant fentanyl-type drugs,” said Los Angeles City Fire Department Capt. Erik Scott. “What were described as gummy bears were ingested. That’s still being evaluated and is part of an active investigation, but the signs and symptoms were lethargy, increased heart rate, some anxiety-type symptoms, so nothing that was life-threatening at that point.”
A national movement with local nuances
Massachusetts is not alone in pursuing psychedelic reform. Other states are advancing similar measures. Colorado’s Proposition 122 legalized psilocybin and other plant-based psychedelics for therapeutic use, with the first service centers expected to open by late 2024. Colorado’s model allows adults to grow and share psychedelics but prohibits retail sales.
As the first state to implement regulated psilocybin therapy, Oregon’s system has become a reference point for other states, though it has faced criticism over high costs and accessibility issues.
While a statewide decriminalization effort failed in California, cities like Oakland and San Francisco have already decriminalized psychedelics. California activists continue to push for broader reforms, hoping to place a measure on the 2026 ballot.
In Arizona, the state legislature passed a bill supporting psychedelic therapy without requiring a medical diagnosis, though Governor Hobbs recently vetoed a related proposal aimed at expanding research efforts.
Several other states, including Michigan, Washington, and Maine, have decriminalized psychedelics at the local level or are exploring pilot programs for therapeutic use.
Challenges to scaling psychedelic access
Despite the enthusiasm around psychedelics, challenges remain. Service-center models, such as those in Oregon, have been criticized for high costs, with sessions priced between $700 and $3,000. The high-profile ketamine-related death of Friends star Matthew Perry last year also raised concerns about safety and risks of abuse. In comparison, cannabis — also once a Schedule I drug — has evolved into a billion-dollar industry with widespread retail access. Psychedelics, by contrast, are unlikely to follow the same commercial trajectory, given the emphasis on guided, therapeutic experiences.
James Davis, co-founder of Bay Staters for Natural Medicine, argues that regulatory frameworks must evolve to balance access with affordability, noting the challenges of a system that’s too expensive for people to access. He says his organization prefers decriminalization without strict commercial oversight. “This is one of those Y2K, dot-com bubble moments where people are just exuberant about a new thing that they see helping people, and they think it’s going to be profitable,” Davis told USA Today. “Maybe it’ll just help people. Maybe it’s not going to become a billion-dollar industry like cannabis.”
Lykos Therapeutics (formerly MAPS PBC), a leader in psychedelic research, faced a major setback in August when the FDA rejected its New Drug Application for midomafetamine (MDMA)-assisted therapy intended to treat post-traumatic stress disorder (PTSD). The FDA issued a Complete Response Letter requesting an additional Phase 3 trial to further assess the therapy’s safety and efficacy. This unexpected decision, despite promising results from earlier trials, has sparked disappointment among stakeholders, trial participants, and mental health advocates.
Amy Emerson, the CEO of Lykos, expressed frustration, stating that the delay represents a missed opportunity to provide new treatment options for millions suffering from PTSD, particularly veterans. Emerson emphasized that the company believes some of the FDA’s concerns could be addressed with post-approval monitoring or reference to existing scientific literature.
One of the core challenges highlighted by experts is balancing safety with efficacy. The FDA cited concerns about MDMA’s potential for abuse and the difficulty in standardizing therapeutic outcomes — issues that have complicated the drug’s path to approval. Psychiatrist John J. Miller noted the decision delays not only MDMA-assisted therapy but also potentially sets back progress on other psychedelic treatments, such as psilocybin, by years.
The FDA’s decision contrasts with recent developments abroad, such as Australia’s approval of MDMA-assisted therapy for PTSD under strict medical supervision. Lykos plans to meet with the FDA to negotiate next steps, while continuing to advocate for new mental health treatments amid an ongoing PTSD crisis in the U.S. and beyond. But further complicating the issue, psychedelics remain illegal at the federal level, making it more difficult not only for research efforts but for states to implement comprehensive regulatory frameworks.
Lawmakers are attempting to bridge this gap, though; Senators Cory Booker and Rand Paul have introduced the Breakthrough Therapies Act in 2022, which aims to ease federal restrictions on MDMA and psilocybin for therapeutic use. “Recent studies suggest that some Schedule I substances such as MDMA and psilocybin could represent an enormous advancement for the treatment of severe post-traumatic stress disorder, depression and addiction,” Senator Booker said in a statement. “This bill reduces these unreasonably burdensome rules and regulations that delay or prevent researchers from studying — and patients from accessing — this entire class of potential medicines.”
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