As of mid‑2025, three U.S. states have legalized medical use of psilocybin, though federal law still classifies psilocybin as Schedule I:
Oregon
- First state to legalize therapeutic psilocybin in November 2020, via Measure 109.
- The Oregon Psilocybin Services Act allows supervised administration in licensed facilities for adults 21+, following a two-year implementation phase.
- Treatment protocols include preparation, administration, and integration sessions under licensed facilitators and facilities regulated by the Oregon Health Authority. READ MORE: Wikipedia, Wikipedia
Colorado
- In November 2022, Colorado voters approved therapeutic psilocybin access; clinics began licensing in late 2024.
- Regulations are being phased in, but psilocybin services are permitted in controlled, therapeutic settings. READ MORE ABOUT: Harris Sliwoski LLP
New Mexico
- On April 7, 2025, Governor Lujan Grisham signed SB‑219, the first state law legalizing medical psilocybin through legislation rather than ballot initiative.
- The law mandates licensed healthcare providers administer psilocybin in approved facilities, and establishes a research fund and university coordination for therapeutic protocols. READ MORE HERE: Foley & Lardner LLP
Local Decriminalization Efforts
- Washington, D.C.: Initiative 81 (2020) mandates de-prioritization of entheogenic fungi possession/use, effectively decriminalizing low-level personal use. READ MORE: Wikipedia
Other states like Minnesota, New Hampshire, Rhode Island, and Connecticut have introduced bills to decriminalize or regulate psilocybin, though no additional state has fully legalized medical access yet. MORE TO KNOW: Reason Foundation
Cannabis Legal Framework—A Direct Comparison
Cannabis, in contrast, is legal for medical use in 40 states and DC, and recreational use in 24 states plus DC. Medical cannabis patients are typically allowed possession, home cultivation, and access to higher-THC products.
Medical vs. Recreational Access to Cannabis
| Feature | Medical Cannabis | Recreational Cannabis |
|---|---|---|
| Legal in states | ~40 states + DC | ~25 jurisdictions |
| Cultivation | Often permitted | Varies: home grow limits |
| THC limits | Often higher | Lower product potency caps |
| Taxation | Lower or tax-exempt | Heavier excise taxes |
| Caregiver use | Allowed | Typically no caregiver provisions |
Legal infrastructure for cannabis is far more developed: established dispensaries, test labs, licensure regimes, and state-level tax and regulatory frameworks.
Medical Uses & Prescribed Indications
Cannabis
- Prescribed for a wide range of ailments: chronic pain, nausea (especially chemotherapy or HIV-related), seizure disorders (e.g. Epidiolex for pediatric epilepsy), PTSD, multiple sclerosis spasticity, and appetite loss.
- Medical cannabis card holders access dispensaries and choose from flower, tinctures, edibles, or vapes depending on state regulations.
Psilocybin Mushrooms
- Therapeutic use sanctioned in limited settings and states:
- Oregon, Colorado, New Mexico allow psilocybin-assisted therapy for treatment-resistant depression, anxiety, PTSD, addiction, existential or end-of-life distress.
- Patients must be screened and treated under supervision—no home-use or dispensary-style purchase permitted yet. Administration is clinical, not consumer-based.
Where Do Mushrooms Sell (If Legal)?
- Currently, licensed therapeutic centers in Oregon, Colorado, and soon New Mexico can legally provide psilocybin services—but mushrooms themselves are not sold retail like cannabis flower.
- Clients attend licensed facilities for preparation, dosing, and integration; no take-home product allowed outside of session protocols.
Local decriminalization (e.g., D.C.) does not permit legal sales—it merely deprioritizes enforcement for personal possession use.
Main Differences Between Mushrooms & Cannabis
- Regulatory Model
- Cannabis: Broad retail access, dispensary-based medical or recreational sales, with home cultivation allowed in many states.
- Psilocybin: Limited to supervised medical treatment in licensed clinical settings; no retail or home-use framework.
- Medical Use & Prescribing
- Cannabis: Can be recommended by clinicians for chronic conditions; patients self-administer at home.
- Psilocybin: Administered under guided therapy with pre- and post-session support; direct prescribing akin to prescription pills is not yet available.
- Legality & Acceptance
- Cannabis: Widely legal across states with mature markets and taxation/policy frameworks.
- Psilocybin: Legal in only a small number of states for medical use; broader legalization still pending and under strict clinical supervision.
- Public Access / Sales Model
- Cannabis: Retail licensed dispensaries, ready-to-sell formats, home use.
- Psilocybin: Therapeutic centers only; no direct retail or take-home formats.
Ethical & Safety Considerations
- Recent reports have exposed ethical lapses and abuse risks in unregulated psychedelic facilities (e.g. EAST Institute scandal in Atlanta)—highlighting the need for strong oversight and professional standards in psychedelic therapy.
- Cannabis decisions are backed by decades of regulatory experience and industry training. Psilocybin therapy is nascent and depends heavily on facilitator training, consent protocols, and integration frameworks.
Future Trends & Outlook
- Additional states are considering medical psilocybin legalization (e.g., Connecticut, Minnesota, Rhode Island), though timelines remain speculative. READ MORE: Source New Mexico
- Federal recognition is unlikely before clinical trial success (e.g. psilocybin for depression or PTSD) and likely advocacy pressure.
- Cannabis may yet serve as a legislative and regulatory model for emerging psilocybin frameworks—because cannabis infrastructure and medical card regimes are replicable baseline systems.
Summary
- Oregon, Colorado, and New Mexico currently permit licensed, supervised psilocybin-assisted therapy for adults—but retail or home-use marijuana-style access is not permitted.
- Cannabis, by contrast, is broadly legalized for medical and recreational use in many states; legal frameworks are robust and retail-based.
- Medical indications differ: cannabis treats chronic pain, nausea, seizures, mood and appetite issues; psilocybin is focused on mental health therapy in controlled settings (e.g. depression, PTSD, existential distress).
- Main difference: cannabis is accessible via dispensaries; psilocybin is confined to therapeutic centers with no retail purchase model.
- Oversight and ethical protocols bear more scrutiny for psilocybin; cannabis has a longer history of compliance and regulation.
In conclusion, while cannabis is widely available through regulated marketplaces, psilocybin remains tightly confined to therapeutic use in a handful of states—and its legal future hinges on more clinical validation, professional oversight, and legislative refinement.