Psychedelic Policy and Market Considerations

Following his session "Psychedelics Preconference: Psychedelic Horizons" at Psych Congress 2024 in Boston, Massachusetts, Beau Kilmer, PhD, MPP, co-director of the RAND Drug Policy Research Center, answered some questions on the policy and regulatory side of psychedelic-assisted therapy. Dr Kilmer discusses the psychedelic market in the United States, policy on both state and local levels, and the role of the federal government in regulation.

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Answers have been lightly edited for clarity. 

Psych Congress Network: What is the size of the psychedelics markets in the US?

Beau Kilmer, PhD: There are multiple ways to estimate the size of drug markets, including the total amount of substance consumed or the amount of money spent. Because these outcomes are not readily available for the various psychedelics, my colleagues and I focused on another measure: the total number of use days. In 2022, the total number of use days in the past month for cannabis was on the order of 650 million whereas the comparable figure for what the National Survey on Drug Use and Health defines as “hallucinogens” was closer to 7 million. It is not a surprise that the figure for cannabis is much higher than it is for psychedelics, but thinking about this in terms of use days provides more insight into the relative size of these markets.
 
PCN: What is happening with psychedelics policy at the state and local levels?

Dr Kilmer: Since 2019, more than two dozen localities have deprioritized the enforcement of some state laws regarding psychedelics, generally making it a low or the lowest priority for local law enforcement officials. Also, a series of state laws have been passed to support clinical research on psychedelics or create task forces to explore policy changes. Despite the federal prohibition, a few states have also legalized some forms of supply under state law.

Voters in Oregon and Colorado passed ballot initiatives to legalize the administration of psilocybin in state-licensed supervision facilities (not for retail sales as is the case in states that have legalized cannabis). The Colorado initiative also legalized possessing, growing, and sharing of psilocybin, psilocin, DMT, ibogaine, and mescaline (excluding peyote) under state law—this is sometimes referred to as the “grow-and-give” model. Discussions about changing laws about psychedelics are happening in other states. For example, an initiative somewhat similar to Colorado’s will be on the ballot in Massachusetts next week, and there is a bill in New York that would allow retail psilocybin sales and require individuals to obtain a user permit to possess or purchase psilocybin. To obtain a permit, people ages 18 and older would have to undergo a health screening, participate in an in-person or online educational course, and successfully complete a test.
 
PCN: When it comes to the supply of psychedelics for nonclinical purposes, what can the federal government do?

Dr Kilmer: Now is the time for U.S. federal policymakers to decide whether they want psilocybin and other psychedelic substances to follow in the footsteps of the for-profit cannabis model. The federal government has multiple options when it comes to the supply of psychedelics outside the traditional FDA process, but it does not have unlimited time. Federal decisionmakers are in a somewhat similar position to where they were in 2012 after voters in Colorado and Washington passed cannabis legalization but with an important difference: The cannabis initiatives allowed for commercialized retail sales, while the initiatives for state-legal access to supervised psilocybin services passed in Colorado and Oregon are much more restrictive.

Now is the time for federal policymakers to decide what they want these supply models to look like and to start taking action. Or, if they prefer a patchwork of state policies—possibly including those that allow for commercial supply and promotion—they can do nothing and just watch the industry grow. If that happens, it can be difficult to make major changes to supply or regulations, but that will depend on the size and political power of the industry that has taken root.

Beau Kilmer, PhD, MPP: (he/him) is codirector of the RAND Drug Policy Research Center, a senior policy researcher at RAND, and a professor of policy analysis at the Pardee RAND Graduate School. His research lies at the intersection of public health and public safety, with special emphasis on substance use, illegal markets, crime control, and public policy. Some of his current projects include assessing the consequences of cannabis legalization (with a special focus on social equity); measuring the effect of 24/7 Sobriety programs on impaired driving, domestic violence, and mortality; analyzing changes in illegal fentanyl markets; and considering the implications of legalizing psychedelics.