Question 4: Legalizing psychedelic drugs

After decades in the medical shadows, psychedelic drugs are increasingly being used in clinical research, mental health treatment, and self-care.

Is it time for Massachusetts to legalize some psychedelics and set clear rules for therapeutic and personal use? This is the choice at the heart of Question 4 on the November ballot.

Question 4 would allow a group of naturally occurring psychedelic drugs — psilocybin, psilocyn, mescaline, DMT, and ibogaine — to be grown, shared, used at home, and offered by licensed professionals in a more clinical setting.

As part of our commitment to help voters understand state ballot questions, we have reviewed the details of this proposal, evaluated relevant research on psychedelics, spoken with advocates, and interviewed experts involved with similar efforts in other states. We found that:

• Psilocybin shows promise as a treatment for some serious mental health conditions, including anxiety among patients with terminal illnesses. Less is known about other psychedelics, but there is widening interest in their potential positive effects.
• Psychedelics are associated with some substantial harms. For instance, ibogaine can cause acute cardiac problems, while DMT (used in ayahuasca) may have lasting neurological effects. Risks seem more muted with psilocybin (found in "magic mushrooms") and mescaline (the active ingredient in peyote), but these drugs can still trigger significant adverse reactions, especially for those with pre-existing mental health issues.
• Unlike marijuana, psychedelics would not be available for purchase at retail shops. Interested adults will need to grow their own, find a person willing to share, or use at a licensed psychedelic therapy center.
• Treatment at psychedelic therapy centers would likely be expensive, encouraging more at-home and personal use, where the lack of guidance and oversight brings heightened risk.
• Colorado and Oregon have already legalized some psychedelics. However, Question 4 has a broader scope, including allowing a wider range of drugs to be offered in therapy centers.
• Federal authorities consider all of these drugs illegal, so passing Question 4 could put Massachusetts at risk of a future federal backlash.