This depends on which psychedelics you are referring to and where you are located.

Federal

In the United States, Ketamine is legal and FDA-approved for anesthesia. Nevertheless, FDA approval allows doctors to prescribe ketamine for off-label purposes, such as depression and anxiety. Ketamine requires a prescription and thus is used in a clinical setting.  Many of the professionals working in the space are using ketamine to work with patients suffering from a number of challenges ranging from depression and anxiety to chronic pain and cluster headaches.

Psychedelics, such as MDMA and psilocybin, are also used legally in FDA-approved clinical research or trials to treat patients in clinical settings. To receive these treatments with these substances, a person must qualify to participate in the clinical trials. 

In a narrow context, some terminal patients could work with their doctors to petition the FDA for compassionate use of investigational drugs, such as MDMA and psilocybin, under Public Law 115-176 (“Right to Try”).  

Some individuals and entities use certain psychedelics, such as ayahuasca, in ceremonial and religious settings to exercise their sincere faith that requires using psychedelics as a sacrament. These visionary churches rely on the Religious Freedom Restoration Act to protect their bona fide religious exercise. However, this type of use is not without risks and exposure to potential prosecution.

State

Cannabis, legal in many states, is psychoactive and with a high enough concentration of THC, it can produce a mild psychedelic effect. Cannabis remains illegal on the federal level. 

Additionally, in 2020 the state of Oregon voted to decriminalize psilocybin and all other drugs through Measure 110. This measure changed the sentencing laws regulating possession of controlled substances, up to a certain amount, from felonies to violations. In addition, voters of Oregon voted to legalize the therapeutic use of psilocybin, with other states likely to take similar action in the future. Advocates for psychedelics are hopeful that these breakthroughs will facilitate further revisions of misguided drug laws and policies.

Other than ketamine, all other psychedelic medicines in the United States remain Schedule I drugs, which are illegal to produce, possess, or use unless it is for research approved by the federal government; they are also illegal under state law with the exception of psilocybin in Oregon.In many cases, possession of paraphernalia associated with psychedelic intake could also be punishable by law.

Access to psychedelic medicine in the United States is limited for now. Access will expand after FDA approves certain psychedelics for mental health conditions, and if and when regulations change.  In the meantime, for those in the U.S. who wish to use psychedelics other than ketamine for healing, their only legal access points are (i) participation in an FDA-approved clinical trial; (ii) churches to exercise a religious faith that involves psychedelic sacraments; or (iii) application for compassionate use by terminal patients.  Alternatively, people could travel to a country where people can partake in psychedelic journeys without fear of prosecution:   For example, psilocybin mushrooms are legal in Jamaica because it was never criminalized, psilocybin truffles are legal in the Netherlands, and ayahuasca is legal in Peru.

Psychedelic medicine is an emerging therapeutic paradigm involving the use of psychedelic substances, both natural and synthetic, to help treat mental health conditions, including depression, anxiety, PTSD, and addiction. Psilocybin mushrooms, MDMA, ketamine, DMT, and ibogaine are some of the psychoactive substances being explored in the field of psychedelic medicine.

Therapies involving cannabis and psychoactive substances are not considered to be psychedelic medicine, even though they might be used to treat some of the same conditions. This includes kambo, which involves the application of the secretions of the Phyllomedusa bicolor frog, and Bufo which contains 5-MeO-DMT.

The model of medicalized psychedelics is oriented around the identification and synthesis of psychoactive compounds that can be used to treat specific disorders. One of the primary aims of medicalized psychedelics is the development of targeted delivery methods that support precise dosage and effective absorption. Unfortunately, this has not been able to be accurately measured when working with plant medicines and other organic substances.

Currently, ketamine is the only psychedelic medicine that is legally available through licensed practitioners in the United States. Psilocybin and MDMA-assisted therapy are expected to be legally available within 2-5 years. DMT is currently being trialed in the UK as a potential treatment for depression but remains illegal in most countries. 

Because of continued drug prohibition, many are turning to underground psychedelic facilitators and guides to find relief from difficult to treat conditions. Even more are self-medicating with psychedelics while working concurrently with qualified psychedelic integration therapists and coaches. 

Many report that the relief and healing they experience when combining psychedelics with psychotherapy is accelerated and long-lasting. However, self-medication and underground usage of psychedelics have their risks. For this reason, it is important to seek out safe, qualified, and experienced practitioners who are informed about the therapeutic benefits of psychedelics.

Psychedelic therapy involves the use of psychedelic substances to aid the therapeutic process, typically under the administration, guidance, and support of a licensed therapist. While psychedelic substances have been used for spiritual and medicinal purposes by different cultures around the world for thousands of years, the Western world’s exploration of psychedelic therapies began shortly after the discovery of LSD by Albert Hoffman in 1943. Throughout the 1950s and 60s, scientists in different countries conducted extensive research into the psychotherapeutic applications of psychedelics. During this time, thousands of peer-reviewed clinical research papers were published and several international conferences took place. 

Sadly, the flourishing of scientific research was brought to a halt by the 1970 Controlled Substances Act… until recently. In the last decade, renewed scientific interest in the therapeutic potential of psychedelics has given rise to “The Psychedelic Renaissance”.  The resurgence of clinical research into potential psilocybin and MDMA therapies has been facilitated by their recent designations by the FDA as “breakthrough therapies”. 

While we are still a few years away from mainstream access to legally administered MDMA and psilocybin therapies, ketamine treatment is currently legal when administered by registered practitioners. Ketamine, like many other psychedelics, has a high safety profile when used therapeutically by experienced and qualified providers. 

Currently, the expansion of psychedelic medicine and psychedelics-assisted therapies is driving the surge of interest in psychedelics around the world. With it comes the promise of increased access to healing for many people in our society, when used safely, responsibly, and with integrity.