Utah's 2024 law creating a tightly scoped pilot program to study psilocybin and MDMA therapy at approved research sites — framed as a veterans and mental health measure.
Utah Senate Bill 266 (2024) — referred to in law trackers as the SB 167 psychedelic pilot — created a narrow, time-limited program allowing two Utah hospital systems to administer psilocybin and MDMA as treatments for certain mental health conditions. Governor Spencer Cox allowed the bill to become law without his signature in March 2024, citing the Legislature's near-unanimous support. It took effect May 1, 2024.
The program is not a public access law. It is a structured clinical pilot designed to generate outcome data for the Legislature. No dispensary, no retreat center, and no private therapist's office qualifies.
The bill's sponsors — Senate Majority Whip Kirk Cullimore (R) and House Speaker Pro Tempore James Dunnigan (R) — framed it as a mental health and veterans care bill, not a drug reform measure. That framing proved decisive in a state where the Republican supermajority controls both chambers.
SB 266 is fewer than 300 words long. The Legislature left nearly every clinical protocol detail — dosing procedures, patient screening requirements, adverse-event reporting — to the two health systems to develop under their own institutional frameworks. In practice, the University of Utah Health and Intermountain Health are writing the clinical rules that other states will study if the pilot succeeds.
Qualifying patients must be adults with one of three specific clinical profiles: treatment-resistant depression or anxiety (defined as failing at least one prior treatment), a diagnosis of PTSD, or a serious illness for which the patient is already enrolled in hospice care.
Minors cannot participate. There is no self-referral: a licensed physician at one of the two approved health systems must review and approve each patient's case before treatment begins.
The conditions mirror those driving the strongest existing clinical evidence — the same populations studied in the MAPS MDMA-PTSD trials and the COMPASS Pathways and Usona Institute psilocybin depression trials. Utah legislators could point to peer-reviewed literature, not just advocacy, to defend each qualifying category.
Only two health systems in Utah are authorized to run the pilot: the University of Utah Health and Intermountain Health. These are the state's two largest hospital networks.
Treatment must take place inside a medical facility. Patients cannot take any substance home, which places Utah's model closer to a clinical infusion center than to Oregon's or Colorado's licensed facilitator model. A physician — not a lay facilitator — supervises each session.
Each hospital that sets up a program must report to the Legislature by July 1, 2026. The report must cover which substances were used, patient health outcomes, and any adverse effects. If no hospital launches a program before the 2027 sunset, there will be no data to report — meaning the pilot's success depends on whether the health systems choose to build out the clinical infrastructure.
Utah is one of the most conservative states in the US, with Republicans holding supermajorities in both legislative chambers. SB 266 passed with near-unanimous support. The framing strategy — centering veterans, hospice patients, and treatment-resistant cases — was the key.
Sponsor Kirk Cullimore explicitly avoided the language of drug reform. He drew on the same clinical evidence used by the FDA in granting Breakthrough Therapy Designation to both psilocybin (for depression) and MDMA (for PTSD). He positioned SB 266 as a tightly regulated medical study, not a step toward decriminalization.
The Libertas Institute, a Utah-based free-market think tank, supported the bill and helped build the conservative policy case. Its arguments focused on patient choice, the economic cost of untreated mental illness, and military veteran welfare — all themes that resonate in Utah's political culture. This coalition-building model is now being studied by advocates in other red states.
Utah and Nevada both took cautious, evidence-first approaches to psychedelic policy in recent years — but they took very different forms of caution. The table shows the key differences.
| Feature | Utah SB 266 (2024) | Nevada SB 242 (2025) |
|---|---|---|
| What it created | Active clinical pilot program | Legislative working group only |
| Can patients receive treatment now? | Yes, at approved health systems | No — no treatment pathway yet |
| Authorized substances | Psilocybin and MDMA | Psilocybin and MDMA (under study) |
| Who can administer? | Physicians at two hospital systems | N/A — study phase only |
| Report deadline | Hospitals report to Legislature by July 1, 2026 | Working group reports to 2027 Legislature |
| Program sunset | 2027 (unless renewed) | Working group dissolves after 2027 report |
| Political framing | Veterans, hospice, treatment-resistant cases | Evidence-based regulatory study |
When Utah fits better: if you want to understand what a minimally regulated, physician-only hospital pilot looks like in a red state — or if you are a qualifying patient trying to understand your current options. When Nevada fits better: if you are tracking how a working group shapes future legislation, or projecting what a 2027 Nevada law might look like. See the Nevada SB 242 explainer for the full working group details.
Both psilocybin and MDMA remain Schedule I controlled substances under federal law, which means they are still illegal at the federal level. Utah's SB 266 does not change that. Federal agents retain authority to enforce federal drug law, though the DEA has not moved against state psychedelic programs.
Because both substances are federally Schedule I, there is no commercial supply chain. The approved hospital systems must source any substances used in the pilot through DEA-registered research channels — the same channels used by FDA-approved clinical trials. This creates a significant practical barrier that the bill's text does not address. Supply logistics are one reason the health systems have moved slowly to stand up programs.
For a full picture of where psychedelics stand across the US, see our guide to what psychedelics are legal in the US and the legal status by state tool.
Utah SB 167 — officially Senate Bill 266 in the 2024 session — created a tightly scoped three-year pilot program allowing doctors at the University of Utah Health and Intermountain Health to administer psilocybin and MDMA to qualifying patients in a supervised clinical setting. Patients cannot take the substances home. The program runs from May 1, 2024 through 2027, after which the Legislature will review the data.
Psilocybin is not broadly legal in Utah. It remains a controlled substance under both Utah and federal law. The only lawful access is through the SB 266 pilot program, which restricts use to patients at two designated health systems — the University of Utah Health and Intermountain Health — under physician supervision.
Qualifying patients must be adults with a diagnosis of treatment-resistant depression or anxiety (after at least one prior treatment has failed), PTSD, or a serious illness for which they are receiving hospice care. Minors are excluded. A licensed physician at one of the two approved health systems must approve and oversee the treatment.
Only two health systems are authorized under the Utah pilot: the University of Utah Health and Intermountain Health. No other clinics, private practices, or hospitals may participate. Treatment must take place in a medical facility — not at a retreat center or therapist's office.
Utah's pilot (SB 266, 2024) allows actual treatment to begin immediately at two designated health systems. Nevada SB 242 (2025) created only a working group to study and recommend a framework to the 2027 Legislature. Utah took action; Nevada took notes. Both states framed their efforts as cautious and evidence-based, but Utah patients can receive treatment today.
The pilot program sunsets in 2027. Any hospital that sets up a psychedelic therapy program under the law must report to the Legislature by July 1, 2026. The report must detail which drugs were used, patient health outcomes, and any reported side effects. The Legislature will then decide whether to extend, expand, or end the program.
Utah's pilot is limited to two hospital systems. Our state-by-state tool shows you every jurisdiction with legal access — including Oregon and Colorado service centers that are open now.
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