Psychedelics Policy Is Changing. Now What?

Deanna Lee

You're listening to Policy Minded, a podcast by RAND. I'm Deanna Lee.

Earlier this year, President Trump signed an executive order aimed at accelerating research and expanding access to some psychedelic drugs for mental health treatment. Some state and local governments have also eased restrictions on psychedelics in recent years. Clearly, the policy landscape around psychedelics is shifting, but many unanswered questions remain. Some of the best evidence about these substances comes from RAND. Joining us today to discuss this evidence and what policymakers need to know is Beau Kilmer, who co-directs the RAND Drug Policy Research Center. Beau, welcome to the show.

Beau Kilmer

It's great to be with you, Deanna.

Deanna Lee

So we've got a lot to talk about when it comes to psychedelics. But first, I'd like our listeners to get to know you a little bit. So can you tell us about your background, what brought you to RAND, and why you wanted to study drug policy?

Beau Kilmer

I started as an intern at RAND 29 years ago, and I never really left. So even as I was finishing up my undergrad degree and grad school, I was primarily working with RAND researchers on drug policy. And so when I finished up with school, I knew this is where I wanted to be. I really liked the people. I liked the questions they were asking. I liked being able to do the research that actually would be used by decisionmakers to help inform their choices, especially on really controversial issues. And so, I got into drug policy because I was really interested in how other countries were addressing their issues around substance use and how it was different from what I was seeing in the United States. So early on, I was kind of focused on that. But over time, we've seen a lot of variation within the U.S. In terms of how different states are addressing their issues with various substances. So there's a lot to learn.

Deanna Lee

That's great. Let's talk about some of the work you have done more recently, not 29 years ago, with the Drug Policy Research Center. But before we get into it, let's talk about what exactly psychedelics are. What substances fall into this category?

Beau Kilmer

That's a great question because people have different definitions of what a psychedelic is. There's general agreement on what they call the classic psychedelics. So this is going to be LSD, psilocybin, or magic mushrooms, mescaline, and DMT. Those are kind of considered—they have different effects—but they are considered classics because they all kind of hit the same serotonin receptor. I mean, they affect other parts of the brain as well. But there's general agreement on the classics. But, other substances that sometimes get classified as psychedelics include MDMA, which is ecstasy, ketamine, ibogaine, and even some people consider Amanita muscaria mushrooms, which is a different type of magic mushroom, a psychedelic substance.

It's also important to note that, within indigenous communities, sometimes these substances can be referred to as spiritual medicines or sacraments. You have to be really careful. And so that's why a lot of the work we've been doing at RAND over the past couple of years has really tended to focus on specific substances, especially when it comes to public opinion, right? You ask somebody, should we legalize psychedelics? Well, if I feel this way about LSD and I feel a different way about psilocybin mushrooms. You know, how am I going to answer that question? So we try to get more specific, but I think it's important to acknowledge that people have different definitions. So being clear about that at the beginning of a policy conversation can be really helpful for making the debates more productive.

Deanna Lee

Absolutely. And thank you for the segue into public opinion, because you and your colleagues at RAND recently conducted a nationally representative survey of U.S. adults, and you asked about public opinion—in addition to asking about use, and we'll talk about that in a moment. Do Americans support the idea of legalizing psychedelics?

Beau Kilmer

It depends on which substance you're talking about. And so Gallup has asked this one question, I think since 1969: should the use of marijuana be legal or not? And you know, they've been asking it—you know started in '69, now they ask it every year—and you know the most recent numbers for what they call marijuana was 64% in 2025. So what we did is we asked the same question. Just to kind of see, you know, how they compared, and, sure enough, we got 64.5%. So we were right on. But then what we did is we took that question and we switched out marijuana. And so it was, should the use of psilocybin magic mushrooms be legal or not? Or we did it with LSD, we did with MDMA. What we found is that about 23% of the adult population supported the legal use of psilocybin mushrooms. For MDMA and LSD, it was closer to about 10%.

But what's interesting is if you go back to the Gallup data that I mentioned, and you kind of look at the trend over time, there was a period in the 80s and up through the mid-90s where public support for the legal use of marijuana was right around 23 to 25%. And then after that, it really began to ramp up. And that's when, in '96, when California passed this ballot initiative to create a medical cannabis market. So psilocybin is kind of where we were, where we are with psilocybin today is pretty similar to where we were with cannabis in the mid-90s. And so it's unclear to me whether or not psilosybin's gonna follow the same trajectory. But I do think you're gonna see more states liberalizing their approach to psilocybin and potentially other psychedelic substances.

Deanna Lee

You also conducted a survey asking U.S. adults about their use of psychedelics. What did that reveal?

Beau Kilmer

Yeah, so it was a probability-based, nationally representative sample. I think we ended up with over 10,000 people who took the survey. And, you know, we asked about their use of almost a dozen different substances that get sometimes classified as psychedelics. You know, the most popular was psilocybin. That wasn't surprising. We found that, in 2025, about 11 million adults reported using psilocybin at least once in the year. And then number two was MDMA or ecstasy. But what was interesting was that what ended up coming in at number three. And those are Amanita muscaria mushrooms, which a lot of people haven't heard of. But if you've seen a Super Mario video game or Alice in Wonderland, I mean, these are the mushrooms, the red mushroom caps with kind of the white spots on them. So a lot of people know them. You see them at holiday decorations. I have to say that was a bit surprising to see it so high up on the list

But you have to put it in perspective. Most of these substances are illegal under federal law—not Amanita muscaria mushrooms. They're not controlled at the federal level. I think only one state, Louisiana, actually prohibits them. And so not only can you find Amanita muscaria mushrooms in different parts of the country, they are all over the internet in gummies and candy bars, you name it. And so, you know, to the extent that they're not regulated at all, I guess it's not surprising that it would be kind of so high up on the list. But it's important to remember that even though Amanita muscaria mushrooms and psilocybin mushrooms sometimes both get classified as magic mushrooms, they are very different substances with very different effects and very different harm profiles.

Deanna Lee

Okay, interesting. Was there anything else from the survey that surprised you, other than the Amanita muscaria mushrooms?

Beau Kilmer

You know, we didn't just ask people about whether or not they had used a substance in their lifetime or in the past year or past month. We also included a number of questions about the number of days that people used and also whether they had microdosed on those days. And so, with microdosing, there's no standard definition of what a microdose is. But when we asked it in the survey, we asked people about, you know, you can kind of think about it as as a sub-threshold dose. It's a small amount, it's a fraction of a regular dose and where you're not intending to trip or hallucinate. Some people put it at maybe 5 to 10% of a regular dose. So anyway, so we asked about microdosing for psilocybin mushrooms, LSD, and MDMA. And we found that in 2025, about 10 million American adults had microdosed either psilocybin, LSD, or MDMA at least once in the past year. And before that, we really had no idea about kind of what that prevalence rate was.

But to kind of help put this in perspective, one of the things that we did, so we asked about the number of days that people used. So if you take everyone who used—let's focus on psilocybin—if you take anyone who had used psilosybin in all the days that they had used. And then you kind of add them up. You can kind of come up with the annual total number of psilocybin use days. And we found that, for 2025, that ended up being about 225 million. So there were roughly 225 million psilocybin use days kind of among American adults. Of that 225 million, about half of those psilosybin use days actually involve microdosing. And so it was a fair amount, but you have to kind of put this in perspective. So, whereas half the use days involved microdosing, given that the amount that's microdosed is so small, our best estimate was that if you looked at the total amount of psilocybin that was consumed in the U.S. In 2025, probably less than 10% of that was by those who were microdosing. So there are different ways you could kind of look at the market.

Deanna Lee

Sure. Interesting. Yeah, different ways to kind of slice up the data there. Let's talk a little bit about veterans. The Trump administration has pointed specifically to veterans as one group that could benefit from increased access to psychedelics. Do we have any data on veteran psychedelic use or policy preferences? That's something you're studying, correct?

Beau Kilmer

There have been some studies done. But in general, a lot of the studies that have been done with veterans and focused on psychedelics, they've often kind of grouped a number of substances together. You know, so they'll be asked about, you know, should the therapeutic use of psychedelics be legal? Or they'll lump together all of the different substances to come up with a prevalence rate. And so, the study that we'll be publishing soon, makes a few different contributions. First of all, it's a large sample. We ended up, as part of the work that we did, we ended up over-sampling veterans so we could have a large number of them. But we also then—as opposed to asking, "Do you use psychedelics or how do you feel about psychedelics?"—we asked about specific substances. And I think that's gonna be really useful because, as I alluded to before, how you feel about LSD could be very different from how you feel about psilocybin. And so yes, I'm really excited to kind of get that through the publication process and share it with the world.

Deanna Lee

Absolutely. We'll be looking forward to reading it. I'm curious about some of the findings we've discussed so far about use and public opinion. How might this kind of data help inform the development of effective policies?

Beau Kilmer

If you're doing any type of policy analysis, you've got to just have some baseline information so you can then begin to make realistic projections. And I got to tell you, I don't do a lot of survey work, but when I was starting to do the policy analysis on this in 2023, 2024, thinking through about what the potential consequences could be for different policy options, I realized that a lot of the information that we need just didn't exist. You know, we spent a lot of money on a lot of big surveys and we still didn't know about the past year prevalence rate of psilocybin, which was getting all this attention. We had no idea how many people were getting arrested for psychedelic offenses. And so a lot of what we did in that report that came out that was published in 2024 was really just trying to provide the baseline information to help kind of ground some of these discussions. And obviously, you know, I wasn't planning on doing a survey, I didn't really budget for it. So it was pretty small. And it largely focused on psilocybin.

But once that was out, and it got a fair amount of attention, and I think people found it helpful, we were able to kind of mobilize that interest to get additional funding to a much bigger survey where we could ask about more substances, get more detailed information, and we are also able to oversample veterans.

And what I'm really excited about is, so not only do we have this kind of really nice kind of cross-sectional snapshot of here's what we know about psychedelic use and policy preferences in 2025, what we're able to do is we're now gonna be able to, for those individuals who said that they had used or they were using these substances, we're gonna be able follow them over time. So there's gonna be a longitudinal component as well with a nationally representative sample of people who use these substances. So that's something we're going to be working on throughout the summer. Developing that survey and testing it, and I'm really excited to do that because I think that's going to provide some really rich information because how you feel about a psychedelic experience, you know the next day or even the next month could be very different from how you feel about it 6, 12 months later. So we're really excited to kind of learn more about the patterns over time and also, how people feel about their experiences. And so we'll be getting more information about that in the coming months.

Deanna Lee

Let's talk a little bit about the policy landscape more broadly right now. I mentioned the executive order at the top of the show, but federal law still prohibits the supply and possession of most psychedelic substances. So what does that executive order actually do? And what does it not do?

Beau Kilmer

Well, stepping back, most of these substances are illegal under federal law. They're schedule one, schedule one drugs, meaning that the federal government doesn't recognize that there is a medical value to them. But that's not stopping localities and states from kind of moving ahead. I mean, this is what happened with cannabis. Cannabis is illegal under federal law, and you saw states, you know—they began with medical and then they kind of moved to adult use. We're starting to see states moving in this direction now. In 2020, the voters in Oregon passed a ballot initiative that allows for supervised psilocybin use. So, I mean, you'd have to go to a licensed facility, work with a licensed facilitator, but then you can get access to the psilocybin. And you have to use it there. You can't just access it and then kind of take it home. You have to use it at the facility. So that was passed in 2020 and I think launched a couple of years ago. And I think so far they've had over 15,000 people go through the program. Although I think about half of them are from out of state.

In 2022, Colorado passed a similar ballot initiative, allowing for supervised psilocybin use. Down the road, they may allow it for other substances. And that's kind of just gotten off the ground. But there's an interesting twist with Colorado. In Colorado, they also allow adults to grow or forage and use or give away psilocybin and a few other plant-based substances or psychedelics. And so that's kind of very different from what you see in Oregon. It's the kind of the supervision plus model. And then in 2025, the legislature in New Mexico passed a bill that was signed into law to allow supervised psilocybin use just for those who have certain medical conditions—so, a bit more restrictive.

And the thing is, there are I think eight other states which have created working groups or kind of blue ribbon commissions to look at policy options for various psychedelics at the state level. And in 2026 alone, there've been bills related to psychedelics introduced in more than 30 states. Now, granted, a lot of those bills would fund clinical research or the trigger laws, which say, if the federal government changes this particular law, then we're going to change this at the state level. But there are some states where there are active bills that would actually allow for retail psilocybin sales. Now, I have no idea if those have any chance of passing, but I do think you're going to see more states moving in this direction over time.

Deanna Lee

Are there any clear policy lessons from some of these changes that we've seen take place in the states that you just mentioned?

Beau Kilmer

It's very early. I do think that one of the things that they've been confronting in both Oregon and especially now in Colorado, it's just the cost. Because individuals, you just don't walk into a licensed facility and have the experience and then walk out, right? There's typically, there's prep sessions where you talk to the facilitator to find out if this makes sense for you. Then they'll actually supervise an experience. Then there could be an integration session afterwards. In fact, just last week I was on a panel with someone from Colorado who knows the program quite well and he said some people are paying between $2,500 to $3,200 for this experience. Put that in perspective: you can go to other places in Denver and for $25, $50, I mean, get a bag of mushrooms.

And one of the interesting things is, we're starting to hear more about people using AI chatbots as they're trip sitters, and it raises really interesting questions. What happens when ChatGPT hallucinates while you're hallucinating? And so I think it's going to be really important to begin thinking about what type of guardrails we build into this because not everyone can afford $3,000 even if it's $1,000 in Oregon. That's expensive. And so that's something that we're going to be paying really close attention to, and hopefully getting more data about that with additional surveys.

Deanna Lee

Really interesting, and the sort of integration with AI is something I have never thought about. So, you know, I'm sure there's going to be much more to come there in terms of, you know how these two kind of emerging spaces come together. You also mentioned cannabis earlier and obviously we've seen cannabis policy evolve over the past 20 or 25 years. Are there meaningful lessons there? Is what has happened with cannabis and legalization some kind of a model for psychedelics that's useful at all?

Beau Kilmer

I don't know if it's a model, but I think you're right about there being potential lessons. I mean, one thing we saw with cannabis is, early on, so California passed medical cannabis in '96, and then other states jumped on. And for a while there, in the late '90s, early 2000s, there were some federal crackdowns. But over time, the feds were more likely to sit on the sidelines. And in fact, there was a budget rider that was passed at the federal level beginning in 2014, which essentially prohibited the Department of Justice from using government funds to crack down on state medical cannabis markets. It was only specific to medical. It didn't apply to adult use.

But for the most part, you know, the federal government really hasn't gotten involved … especially over the past 15 years. And look what's happened: you've seen this ... an increasing number of states adopting these for-profit commercial models, you've got advertising all over the place, the proliferation of products. Now, some people might say, that's good. Some people might say that's not good. I'll leave the judgment up to the listeners. But that is a potential lesson. If the federal government just kind of sits on the sidelines and lets the states do whatever they want, you could end up with this very hyper-commercial market. And the question is, do you want a hyper-commercial market for psychedelics like you have for cannabis? I mean, these are very different substances.

And also, I think one of the lessons is—I mean, think about back in '96 when people were talking about, you know, for you listeners who are old enough—I mean think about when people were voting on medical cannabis in California, I mean you're thinking about people, you know smoking flower, maybe eating a homemade edible, maybe making a tea. Fast forward 30 years to 2026 and look at when you go into the shops—all the different products, different levels of potency. And so I think when I think about potential lessons or insights from cannabis is that, right now we spend a lot of time talking about psilocybin mushrooms and obviously there are a number of different strains. But if you were to unleash a commercial market on this, what would the products look like in 10, 15, 20 years? They may look very different with very different harm profiles. And so I think you need to be really thoughtful about—if you're going to unleash a commercial industry in this space—what it could lead to.

I think one of the things that we've learned with cannabis legalization is that If you're, you know, if you're prohibiting cannabis and you want to do something different, you don't necessarily need to jump all the way to the for-profit commercial model. In fact, if you go outside of the United States, there's much more interest in some of these middle-ground approaches, and maybe just allowing grow-and-give or limiting supply to collectives or nonprofit co-ops. And even in Canada, you've got government stores. But within the United States, it's a pretty commercial model.

But, when we talk about various psychedelics at the state level, I mean, these are very early days. So states can begin to think about, there are alternative models out there in terms of providing access to individuals if you want. I mean there are pros and cons with all of these things. But just as there is with cannabis, there are these other options you could consider.

Deanna Lee

Absolutely. It's not a binary choice between the commercial market and all-out prohibition.

Beau Kilmer

Exactly.

Deanna Lee

So, given all of those policy options and, you know, potential trade-offs with them, if policymakers are making decisions about psychedelics in the coming months and years, what do you think they should keep in mind?

Beau Kilmer

Well, it depends on the level of government and the type of policy. It's one thing if we're talking about state policymakers or state legislators thinking about, you know, relaxing certain laws about different psychedelics or creating a commercial regime. It's another thing if you're talking about funding clinical research. Because, as I said, you know, of the bills that have been introduced in 2026, a lot of them have focused on providing more funding there. And I'm thrilled. I think there's a lot more we have to learn about the effects of these substances for treating different mental health conditions, but I do hope that for those that are considering funding this research that they provide enough to allow for some of these longer-term studies. I mean, I think that's one of the issues, and it's not necessarily specific to psychedelics. I mean sometimes, you know, they're not looking ... they don't have the funds to actually look two, three, four, five years out. And I think that information can be really helpful in terms of thinking about, well, how long do the effects of these substances last?

So I'm thrilled that at the federal level and a number of states are having these conversations about doing more clinical research. But I just hope that they provide the resources, because it's expensive to follow people. To follow them and do the testing; it's not cheap. And so I hope that they provide their resources for that so we can learn more about the longer-term outcomes.

Deanna Lee

And what's the biggest potential risk of moving too quickly on psychedelics policy? And then maybe on the flip side, is there a risk to moving too slowly as well?

Beau Kilmer

Well, once again it depends on the level of government and what type of policy. I mean, I think one thing that I've heard as I've been doing more work in this space—in the psychedelic space—is that there's a real concern that if some of these states, if they move too far ahead and they get this wrong, and it creates a backlash, there's real concern that that could potentially have a chilling effect on some of the clinical research that's going on. And this isn't that idle fear; this is what we saw happen in the '70s. We had a fair amount of research on psychedelics happening in the 1950s and the 1960s, but then there was this backlash to LSD and Timothy Leary—and with that backlash came, what, 20, 25 years where we didn't do much research on this. So I think there's a real concern there that, as I said, if some of the states go too far ahead and commercialize, then it could backlash.

Recall what I said earlier, especially if you allow for commercialization, who knows what the market's gonna look like and the products are gonna look in 10 years. But obviously I think there's been a fair amount of research on these substances, and we're learning a lot, but there's still so much more to be done. And so if the funds were unlimited, I would love to be supporting much more work in this space. But obviously, even in the research space, there are trade-offs. But I mean, some of the clinical trials coming out on this are quite encouraging. But that said, none of these substances have been approved by the FDA yet. I mean the one exception is ketamine. But most of these—when we talk about psilocybin and LSD and MDMA—they haven't been approved by the FDA.

And so that's why, in April, when President Trump signed the executive order, it got a fair amount of attention. Now, put this in perspective, this is an executive order. So it's not as if something was signed into law. But within that particular order, you can kind of think about there being three different buckets. Obviously, one of the things that the executive order, or the president hopes to do, is to expedite and fund more clinical research to try to figure out which psychedelic substance might to help a different, uh, different mental health conditions. The second part of this executive order was to make it easier for people to access psychedelics as part of a kind of a compassionate use program. So we've got this federal Right to Try Act, which is for individuals with life-threatening conditions who've tried other treatments that haven't been successful, and they may not have access to a clinical trial. And so part of it would be to make some of these substances more accessible under that particular act. And then the third part of the executive order was to accelerate the time to review these substances and figure out whether or not they should be rescheduled, and then potentially changing their schedule.

And so I put those into those kind of three general categories. And as I said, it's just an executive order. But you know, that was signed on April 18th, and I believe it was maybe April 24th—so just I think within a week—you saw that the FDA actually issued three of what they call priority vouchers to some companies to help expedite the potential review for some of these substances. So some action has been taken and it's gonna be really interesting to see how this plays out.

Deanna Lee

And rescheduling the drugs, if that were to happen, that would certainly open a lot of other doors for research and potential use in treatment and things like that, correct?

Beau Kilmer

Potentially, I mean, we see this in the cannabis space, it's one thing to reschedule, it's another thing to have a drug approved by the FDA, right? I mean, so that's what the week after President Trump signed the executive order, his acting attorney general put out an order with respect to cannabis. And essentially, it reclassified products that are produced and sold as part of state legal medical markets. But that's different than having the FDA approve cannabis for treating certain conditions. You have to be careful there.

But, in general, you can do research on Schedule I drugs. But there are a lot of hoops you need to jump through. And with, so if something's schedule three, there's still a lot of administrative paperwork, but there are fewer barriers there. But the larger question I have is, if we can reduce the barriers to research, but it really depends on, is there going to be money available for this? And if so, who's gonna pay for it? The executive order did call for, I think it was $50 million. I mean, we'll see if that actually happens. That's the thing to think about this. Yeah, I mean, on the margins—going from schedule I to schedule III—whether or not we're talking about cannabis or we're taking about other substances, yeah, it potentially could reduce barriers. But the bigger question is who's gonna pay for that research?

Deanna Lee

Absolutely. Well, we've covered a lot of ground. Before we go, what's the one takeaway you want our listeners to have when it comes to psychedelics?

Beau Kilmer

When you're discussing policy options or what the research says in terms of treating different mental health conditions, be specific about the substance. Because as I said, people have different definitions of psychedelics, and I think just being on the same page with, "Hey, we're talking about psilocybin or we're talking about LSD," I think—especially in the policy space—can make it easier to have a more productive conversation about this.

Deanna Lee

Excellent point. Okay, I think that's all the time we have for today. We'll certainly look forward to the forthcoming study that we discussed and all of the other research that we discussed today will be linked in the show notes on our website, rand.org/policyminded. Beau, thank you so much for being here today.

Beau Kilmer

Deanna, it was great to chat with you.

Deanna Lee

And thanks to our listeners. Today's episode was recorded and edited by Emily Ashenfelter. It was produced by me, Deanna Lee. RAND's Director of Digital Communications is Pete Wilmoth. RAND is a nonprofit institution that helps improve policy and decisionmaking through research and analysis.