A plain-English reference for where each state stands on therapeutic access, decriminalization, and active legislation. Federal law sits on top of everything below — read that section first.
Schedule III. Legal with a valid prescription. Spravato (esketamine nasal spray) is FDA-approved for treatment-resistant depression under a REMS program that requires in-office administration. Off-label IV and IM ketamine for depression, PTSD, and other conditions is prescribed widely but is not FDA-approved for those indications.
Schedule I. No FDA approval. Compass Pathways (COMP360) Phase 3 program is reading out through 2025-2026; Usona IPR001 Phase 3 is ongoing. State-level therapeutic programs are live in Oregon (Measure 109, 2023) and Colorado (Prop 122, 2024-2025).
Schedule I. FDA declined Lykos Therapeutics' first NDA in August 2024 and requested an additional Phase 3 trial. No approved clinical use; access is primarily via trials.
Schedule I. MindMed's MM120 (LSD-D-tartrate) received FDA Breakthrough Therapy Designation for generalized anxiety disorder and is in a Phase 3 program.
Schedule I. No FDA approval; significant cardiac safety profile. State appropriations for research exist in Texas (SB 2308, ~$50M, 2025) and were proposed in Kentucky and Arizona.
Schedule I. Beckley Psytech / atai's BPL-003 (synthetic 5-MeO-DMT) is in Phase 2b for treatment-resistant depression.
Schedule I. Federally exempt under 42 U.S.C. § 1996a and 21 CFR 1307.31 for bona fide ceremonial use by Indians practicing traditional Indian religions (Native American Church).
Schedule I (as DMT). Federal RFRA exemptions exist for the União do Vegetal (Gonzales v. UDV, 2006) and Santo Daime.
Measure 109 psilocybin services (2023). Licensed facilitators administer psilocybin at licensed service centers; no physician referral required; clients must be 21+.
Measure 110 (2020) decriminalized all drug possession; partially rolled back by HB 4002 (2024) which restored misdemeanor personal-use possession.
Natural Medicine Health Act (Prop 122, 2022). Psilocybin healing centers began licensing in 2024; Division of Professions and Occupations supervises facilitators. DMT, mescaline, and ibogaine scheduled for 2026 advisory-board review.
Personal use/possession/gifting of psilocybin, psilocyn, DMT, ibogaine, and mescaline (non-peyote) is decriminalized for adults 21+.
Denver.
Peyote explicitly excluded from the decriminalization statute in deference to NAC concerns.
SB 2308 (2025) appropriated substantial funding for ibogaine research at Texas A&M in partnership with former Kentucky official W. Bryan Hubbard. Texas IMPACT ibogaine trial is one of the larger active US ibogaine research programs.
Texas remains the only US state where wild peyote harvest is permitted under federal distributor licensing.
HB 54 (2024) authorized a pilot program studying psilocybin and MDMA for mental health indications in partnership with designated healthcare systems.
HB 2759 (2024) appropriated $5M for psilocybin research at Arizona universities; separate ibogaine interest via veterans-focused legislation.
No state-level decriminalization. SB 58 (2023) passed the legislature but was vetoed by Governor Newsom. SB 1012 (2024) failed. SB 751 (2025) advancing.
Oakland, Santa Cruz, San Francisco, Berkeley, Arcata, Eureka.
Seattle, Port Townsend, Olympia.
Question 4 (Massachusetts Natural Psychedelic Substances Initiative) failed at the November 2024 ballot (57-43).
Somerville, Cambridge, Northampton, Easthampton, Salem, Amherst, Provincetown.
Ann Arbor, Detroit, Hazel Park, Ferndale, Ypsilanti.
Minneapolis.
Burlington.
Initiative 81 (2020) made enforcement of entheogenic-plant-and-fungi laws among the lowest law-enforcement priorities.
The 2024 proposal to direct $42M of opioid-settlement funds toward ibogaine research at the Kentucky Opioid Abatement Advisory Commission was ultimately not funded; advocacy continues.