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.