The Osmind study relies on voluntary self-reports, making it “naturalistic” research that captures how these services perform outside the strict protocols of randomized trials (measuring outcomes through self-reported surveys is standard practice in real-world scientific research). The study tracked 88 participants and used standardized tools to measure changes: the PHQ-8 questionnaire for depression (a scale from 0 to 24, where higher scores indicate worse symptoms), the GAD-7 for anxiety, and the WHO-5 for overall well-being. Assessments occurred before the session, one day after, and a month later. No dosages were specified, but sessions followed state guidelines for supervised administration.

Results showed meaningful gains across the board. Depression scores on the PHQ-8 fell by an average of 4.6 points, shifting participants from moderate to mild severity, a change that meets the threshold for clinical significance. Anxiety dropped by 4.8 points (on the GAD-7 scale), and well-being rose by 10.7 points (on the WHO-5 index). No serious adverse events occurred during sessions, though 3 percent reported lingering issues, like heightened anxiety or family strain, a month later. These preliminary improvements suggest that psilocybin could offer rapid relief in a legal therapeutic setting, aligning with the compound’s reputation for fostering emotional resilience.

Direct comparisons to other psilocybin studies or clinical trials are tricky, as many rely on different scales, populations, and measures. Some studies report quantified outcomes (“effect size”) in the proportion of participants who had meaningful changes, while others report changes in a particular scale. As an example, in one randomized study, about two-thirds of participants continued to experience relief from major depressive disorder (MDD) remission five years after receiving treatment. That study only included participants diagnosed with major depression and measured outcomes with a different metric (the GRID-HAMD scale) than the Oregon study.

Nonetheless, Osmind’s review of real-world data reveals significant results on depression and anxiety, consistent with more medicalized clinical trials. Oregon’s approach to psychedelic treatment is a novel experiment, not just because it uses psychedelics, but because it created an entirely new mental health services framework. The state had to design training criteria for schools so that non-medical professionals could learn to administer a drug that is currently undergoing drug trials. By law, these “facilitators” did not need prior mental or medical training.

This new study shows promise for both the impact of psychedelics as a mental health treatment and for lowering the cost of licensed mental health services. Psychedelic therapy can be very expensive (over $15,000) when using a medical model, where two licensed therapists see a single patient for three extended sessions (based on countries where it is federally legal). In Oregon, professionals do not need to attend medical school and can administer group sessions, reducing the total cost per patient.

The Drug Enforcement Administration (DEA) has requested that Health and Human Services (HHS) review whether psilocybin should continue to be banned as a Schedule I drug (the DEA request was publicly confirmed by Kathryn Tucker, JD, who is involved with the case; it was also confirmed privately by legal counsel to Reason staff). A Schedule I designation reflects the government’s opinion that the substance has no medical value and is highly susceptible to abuse. Businesses that traffic in Schedule I substances, including Oregon psilocybin clinics, are considered federal criminal enterprises, are generally unable to access financial services, and are prohibited from claiming deductions on their federal income taxes using the “ordinary and necessary” standard that applies to other businesses. These federal penalties significantly increase the cost and risk faced by these businesses, and these additional financial burdens must be passed on to customers.

Data collected by Reason Foundation shows that states with legal psychedelic services do not display increased rates of criminal activity or hospitalizations. Taken together with this latest study, data from Oregon makes a strong case that psilocybin holds clear medical value and does not endanger public health, calling into question whether it should be considered a Schedule I drug.

The post New study details how legal psychedelic services can treat depression, anxiety appeared first on Reason Foundation.

The trial would seek approval of ibogaine as a treatment for opioid use disorder, depression, post-traumatic stress disorder, and other behavioral health conditions, especially those suffered by military veterans. If the FDA approves ibogaine to treat a medical condition, the legislation would allow licensed physicians to prescribe ibogaine administration for a patient under supervision.  

The post Proposed Model Policy: “Veterans Mental Health Innovations Act”  appeared first on Reason Foundation.

State-based research and clinical trials

• After years of advocacy by veterans’ organizations and researchers, a bipartisan coalition of state legislators in Texas voted to fund ibogaine research programs (Texas Senate Bill 2308). In 2025, Texas launched a multimillion-dollar endeavor that will allow any state that enacts the VMHI to join the effort on ibogaine clinical trials.
• The most effective way to ensure those in need benefit from ibogaine is to conduct clinical trials using ibogaine as an investigational new drug. Clinical trials are a costly and lengthy endeavor for any one entity, but through VMHI, multiple states will conduct their own local trials, advancing a single unified application to the Food and Drug Administration (FDA).
• Under the VMHI, each participating state selects and funds a research grantee of their choice to conduct ibogaine clinical trials locally with in-state participants.

Multistate collaboration and shared success

• A multistate consortium allows states with limited resources to take part in what could be nearly a billion-dollar endeavor. This public effort to conduct FDA-approved clinical trials will be in partnership with a private drug developer, which will assume financial risk and responsibility for advancing the treatment through the clinical trial process. 
• Under VHMI, states retain the long-term benefits of the research they fund. Instead of handing over value to pharmaceutical companies, the bill keeps the research and development process rooted locally and ensures states are compensated if an application is successful.

Federal government and the role of the FDA

• Ibogaine is deemed a Schedule I drug by the federal government. Engaging in FDA-approved research is the surest way to prove its medicinal and treatment value.
• Once ibogaine is approved by the FDA to treat a medical condition, the VMHI would allow licensed physicians to prescribe ibogaine administration for a patient under supervision.
• The VMHI leaves direct engagement with the FDA to the drug developer, eliminating the need for states to navigate the complex clinical trial application process.

The model legislation for the Veterans Mental Health Innovations Act is available below. The template is designed to be easily adapted by states, with the sections that need customization highlighted.

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The AGs argue that the 2018 federal Farm Bill, which legalized hemp with low levels of tetrahydrocannabinol (THC), unleashed a flood of intoxicating hemp products across state lines. Their proposed solution is for Congress to impose a nationwide prohibition. The irony is that nearly all of these AGs represent states that have already enacted laws governing these products, ranging from outright bans to treating them like alcohol or folding them into their existing frameworks for legal cannabis. Their request for a federal ban is a direct repudiation of the work done by their own democratically elected legislatures.  

This dynamic is perfectly illustrated by Minnesota Attorney General Keith Ellison. His state has regulated intoxicating hemp edibles and beverages since 2022—a year before establishing the state’s adult-use cannabis market—recently imposing new rules on hemp product testing. After facing backlash for signing a letter asking Congress to recriminalize products made legal under Minnesota law, his office clarified that he actually favors a carve-out for those states with “adequate regulatory schemes in place.” That nuance, absent from the AGs’ letter itself, only highlights the contradiction that these chief legal officers, sworn to uphold the laws of their states, are demanding a federal policy that would nullify them.  

Constitutionally, the framework for this issue is clear. Under the long-standing interpretation of the “Commerce Clause,” states retain the authority to regulate or ban any class of product they deem threatening to public health or safety, provided their laws do not discriminate against out-of-state producers. Congress does not interfere with this state-level power by authorizing interstate hemp commerce. However, it is up to states to implement their own rules. If attorneys general are concerned that their state laws are being violated, the responsibility of enforcement rests with them, not Congress.  

It is not surprising that attorneys general are struggling to enforce state-level restrictions on hemp. However, their frustration is the inevitable consequence of adopting overly restrictive and unenforceable regulatory regimes, rather than a loophole in federal law. As governments have learned repeatedly throughout history, prohibition—and even heavy-handed regulation—does not eliminate demand but pushes it toward unregulated alternatives. This is a lesson these officials should understand firsthand from their own states’ experiences regulating cannabis markets.  

It is therefore shocking that some of the signatories represent states like Arizona, California, and Colorado, which regulate hemp cannabinoid products under the same strict rules governing their legal marijuana markets. This raises the question of what these signatories believe a federal ban would accomplish, other than dismantling their own functional regulatory systems and handing the market back to illicit actors. 

Other states are pioneering more innovative models for hemp regulation that could effectively address the AGs’ concerns, if given time. Kentucky, a leading hemp producer, has created a sophisticated dual-track system for regulating hemp-derived products based on their potential to cause intoxication. The Kentucky Department of Public Health maintains an evolving list of cannabinoids categorized as “intoxicating” or “nonintoxicating.” Intoxicating products can be sold outside of the state’s medical marijuana dispensaries but are subject to strict manufacturing and quality controls, with a pathway for out-of-state products to enter Kentucky’s market legally. This approach fosters a compliant market capable of meeting consumer demand, demonstrating that there are many paths to ensuring public safety around adult products.  

The outcome of these state-level approaches is still unfolding. But building an effective regulatory regime that can balance public safety and market realities takes time and experimentation. What is certain is that granting the AGs’ request would bring this regulatory innovation to a screeching halt, preventing state legislatures from developing the very solutions needed to resolve the enforcement problems currently causing frustration.  

A federal hemp ban will prove no more successful than state-level prohibitions because neither eliminates demand. Just as overtaxed and overregulated marijuana markets once drove consumers to hemp, a federal hemp ban will only push them toward more harmful alternatives or back to illicit marijuana.  

The most effective solution to the problem of unregulated hemp products is a workable regulatory framework that businesses can comply with and that consumers will accept. State regimes that give adult consumers access to a variety of legal and reasonably priced state-authorized products would do far more to eliminate unregulated products than any ban. Fortunately, this work is already well underway in many states. Their attorneys general should support that effort rather than asking Congress to interfere.  

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These rules are often shaped by professional and regulatory organizations like the American Medical Association, whose influence on state and medical boards, as well as legislatures, affects who is authorized to prescribe and manage MOUD care. While rural areas frequently lack clinicians due to lower population densities, these restrictions make existing shortages worse by preventing qualified providers from offering care where it is most needed. 

Beyond these restrictions, outdated regulations on how and where patients can receive care, such as limits on telehealth and medication delivery, further compound access barriers. Reducing these unnecessarily restrictive occupational licensing and delivery barriers is a practical and evidence-based way to close these gaps and expand access to lifesaving care.

Nurse practitioners (NPs) are already a significant part of the solution. In 2016, Congress passed a law enabling some NPs to prescribe buprenorphine, one of three approved medications for opioid use disorder. However, in 22 states, NPs are not permitted to do so without a supervising physician. This limitation reduces access to MOUD, especially in areas where doctors are in short supply. In states that grant NPs autonomy in prescribing, the number of available MOUD prescribers roughly doubles and significantly increases local treatment access. A national analysis shows that expanding prescribing to NPs had a particularly significant impact in very rural areas, where NPs and physician assistants were responsible for 1.3 times more buprenorphine prescriptions than in urban areas. 

Additionally, the study found that areas where NPs were allowed to prescribe had roughly twice as many registered NPs compared to regions where NPs are barred from prescribing. This may be due in part to the fact that the lack of prescribing authority makes NPs seem less valuable to employers, who then instead opt for physicians. Because NPs are more likely than physicians to relocate to rural communities and to remain there long term, granting them prescribing power would be a meaningful step toward closing treatment gaps where they are most severe.

Pharmacists undergo the most extensive training in pharmacology of any healthcare professional. Idaho has successfully authorized pharmacists to prescribe medications for a range of conditions. Through House Bill 191, which passed in March of 2017, the state granted the Idaho Board of Pharmacy the authority to determine when pharmacists can prescribe medications independently using clinical judgment consistent with the standard practices of healthcare providers. This applied to minor or time-sensitive conditions that did not require a new diagnosis. Within the first year, pharmacists were able to treat over 20 common ailments, and the state reported no safety complaints, showing that pharmacist-led prescribing can safely expand access to care in underserved areas. 

At the national level, the 2021 Mainstreaming Addiction Treatment Act (MAT Act) eliminated the requirement for clinicians to register for and receive a waiver from the Drug Enforcement Administration (DEA) to prescribe buprenorphine for opioid use disorder. Any clinician who can prescribe DEA Schedule III drugs, such as buprenorphine, may now prescribe them in states that recognize pharmacists as prescribers. Within the first year of implementation, pharmacist-issued prescriptions increased eightfold, rising from about 0.1 percent to 0.8 percent of all buprenorphine dispensations nationwide. The increase was most pronounced in states that had already authorized pharmacist prescribers, such as Idaho, New Mexico, and Rhode Island. Still, 90 percent of states continue to restrict pharmacists from prescribing buprenorphine independently. Where pharmacists can prescribe independently, they primarily serve rural and medically underserved areas, increasing the number of filled buprenorphine prescriptions by 5 to 10 percent in counties that previously had no such prescribers. 

The Department of Veterans Affairs (VA) offers a clear example of how pharmacist prescribers can operate successfully as part of a coordinated healthcare team. Veterans experience disproportionately high rates of chronic pain and opioid dependence. Overdose deaths among veterans increased by more than 50 percent between 2010 and 2019, and as many as one in three service members prescribed opioids during active duty met the criteria for dependence. 

Building on the flexibility established under the MAT Act, the VA authorizes clinical pharmacist practitioners (CPPs) to initiate and manage buprenorphine treatment for opioid use disorder under collaborative practice agreements. In 2023, the first full year after the MAT Act’s passage, 110 CPPs prescribed buprenorphine to 1,090 veterans across 36 states, accounting for 4.8 percent of all veterans receiving buprenorphine in the VA system and 4.2 percent of total treatment episodes. Collectively, CPPs issued more than 5,200 prescriptions, over half delivered through telehealth, and served as the sole prescriber in 16 percent of cases. 

International approaches provide additional examples, with Canada, Australia, and the United Kingdom integrating pharmacists into the MOUD treatment infrastructure. 

Psychologists often serve as the first and most consistent point of contact for patients with addiction due to their role in addressing underlying mental or emotional health issues, and could serve as an important access point to medication for addiction treatment. The U.S. Department of Defense (DoD) demonstrated as early as 1991 that psychologists can be trained to safely prescribe medications. An independent review of the program found that the prescribing psychologists trained by DoD filled critical gaps in care, reduced patient wait times for treatment,  and safely managed medications with no reported adverse events linked to their prescribing. 

Today, just seven states allow psychologists with specialized training to prescribe medication. However, most of these states still prohibit them from prescribing the controlled substances that form the foundation of medication-assisted addiction therapy. In Illinois, for example, psychologists are barred from prescribing Schedule II drugs, including methadone—one of three FDA-approved drugs that serve as the foundation of medication-assisted addiction treatment. Granting psychologists this authority could create a crucial new pathway to treatment, especially for individuals managing co-occurring mental health and substance use challenges. 

These profession-specific reforms are a practical and low-cost way to expand access to treatment and care, but they are not the whole answer. These reforms must be paired with broader changes necessary to update America’s health delivery system. America needs to maintain telehealth access for addiction treatment and remove outdated licensing and delivery barriers that restrict how and where patients can receive care.

One of the most entrenched obstacles in expanding access to addiction treatment is the federal system governing methadone delivery. The current system, designed in the 1970s and changed little since, stipulates by law that methadone for opioid use disorder can only be dispensed through opioid treatment programs (OTPs) certified by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the DEA. OTP clinics operate under strict requirements, including daily observed dosing for new patients, regular drug testing, and frequent in-person counseling. 

Though intended to boost safety, these requirements often have the opposite effect by limiting the number of clinics patients can access. Clinics are concentrated in urban centers, forcing rural patients to travel daily, sometimes hours away for a single dose of medication—an impossible burden for many in rural areas. In many states, methadone access is severely limited—Wyoming has no opioid treatment programs at all, while West Virginia prohibits new clinics from opening, leaving some patients to cross state lines or travel hours each day to receive care.

During the COVID-19 pandemic, the United States implemented emergency waivers that allowed patients to take home several days’ worth of methadone instead of reporting daily to a clinic in person. The change proved safe and effective, improving patient retention without sacrificing safety outcomes or diverting the medication into the illicit market. 

These changes proved effective enough that SAMHSA made the COVID-19 flexibilities permanent. In its 2024 final rule, SAMHSA authorized prescribing up to 28 days of take-home methadone doses for stable patients and 14 days for less stable patients. It also permitted first-time prescribing of buprenorphine via telehealth, as well as expanded authorization for mobile medication units—mobile components of OTPs that can dispense medications at remote locations—to operate without requiring separate DEA registrations, improving access to care in rural and underserved communities.

Telehealth reform offers another opportunity to greatly increase access to care. Before COVID-19, clinicians were required to see patients in person before prescribing buprenorphine. The DEA temporarily waived this rule in March 2020, allowing treatment to begin through telehealth, including audio-only visits. A 2025 JAMA Network Open study analyzing more than 228,000 buprenorphine initiations from 2020 to 2022 found that about 10 percent occurred via telehealth, and roughly 20 percent of those would not have been possible under the DEA’s proposed post-pandemic rule requiring an in-person visit before or within 30 days of tele-initiation. Patients treated through telehealth had similar or better engagement and lower overdose rates than those treated in person, echoing earlier findings from JAMA Network Open and the Journal of General Internal Medicine. Telehealth tools have enabled clinicians to reach patients in rural communities, single parents unable to travel, and others who otherwise would have gone untreated.

The potential for telehealth to expand access to care, however, greatly depends on clinicians’ ability to practice across state lines. During the COVID-19 pandemic, many states temporarily permitted cross-state practice, allowing out-of-state healthcare providers in good standing elsewhere to deliver telehealth services when in-person visits were not possible. Those emergency measures demonstrate that interstate care can be safe and effective. Many states are making this flexibility permanent with universal recognition laws.” These laws permit licensed health professionals in good standing from other states to begin practicing immediately, whether they relocate to the state or provide care remotely. Twenty-eight states and Puerto Rico have already implemented such reforms. 

Research from the National Bureau of Economic Research shows that universal recognition improves physician distribution and increases access, particularly in underserved regions. Allowing addiction psychiatrists in Boston to treat patients in Nebraska or West Virginia without redundant licensing barriers could immediately relieve provider shortages in high-need areas.

These reforms form a coherent strategy for expanding access to evidence-based addiction care. Modernizing rules on methadone delivery, protecting access to telehealth, and enabling licensed healthcare providers to care for patients across state lines would allow trained clinicians, including pharmacists, psychologists, nurse practitioners, and physician assistants, to put their skills to work to treat opioid use disorder.

The path forward includes:

Leveraging underused professionals: Empower pharmacists, psychologists, and advanced practitioners to prescribe within their training, building on successful state and federal models such as Idaho’s pharmacist framework and the VA’s clinical pharmacist program, which achieved 87 percent retention among veterans treated for opioid use disorder.

Modernizing methadone delivery: Authorize office-based prescribing and pharmacy dispensing for stable patients under appropriate monitoring, following models proven in France, the U.K., and Canada.

Making telehealth permanent: Codify pandemic-era flexibilities for initiating buprenorphine virtually and reimburse telehealth visits for addiction care at parity with in-person treatment.

Promoting license portability: Expand universal recognition laws to allow qualified clinicians to serve patients across state lines without redundant requirements.

The opioid crisis is not a single-issue problem, and it cannot be solved by one profession alone. But we can drastically reduce the toll on individuals, families, and communities. By embracing practical, evidence-based reforms, we can strengthen the national response to the opioid epidemic. When more qualified people are empowered to provide care, more people survive.

The post Modernizing addiction regulations: How licensing, telehealth, and delivery reform can expand access to care appeared first on Reason Foundation.

• Ibogaine is a psychoactive alkaloid from the western Central African iboga shrub that can rapidly reduce, and sometimes eliminate, opioid withdrawal and craving symptoms within a single dose.
• Ibogaine is a potential breakthrough treatment for opioid use disorder (OUD) due to its unique ability to heal the neurochemical brain injury caused by opioid use and alleviate withdrawal symptoms.
• Opioid withdrawal syndrome (OWS) is the debilitating physical and neurological symptoms that are induced by the cessation of opioid consumption.
• Ibogaine has shown promising results in resolving OWS within 36 to 48 hours of administration under safe, clinically controlled conditions.

Ibogaine could reduce lifetime direct costs of OUD by nearly 90%

• A growing body of research suggests that ibogaine treatment for opioid use disorder (OUD) could be significantly more cost-effective than traditional medication-assisted treatments (MATs), such as methadone and buprenorphine (suboxone).
• Unlike MATs—which require long-term, or even lifelong, use—ibogaine offers a clear root-cause intervention, capable of disrupting OUD within a single dose. In one study, 30% achieved complete opioid abstinence after only one ibogaine session.
• Patients who discontinue MATs often relapse when opioid withdrawal and craving symptoms return. MAT success is therefore measured on program retention (or continuation) instead of abstinence.
• The comparative cost-analysis below predicts that ibogaine treatment for OUD could reduce the 20-year direct lifetime costs of MATs involving methadone and buprenorphine by 87% and 86%. Concurrently, this analysis reveals just how quickly per-patient costs for MATs exceed $100,000.

Cost-Effectiveness for OUD Treatment: Ibogaine vs. MATs

Download the full backgrounder here:

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• To commercialize a new drug, the Food and Drug Administration requires three ‘phases’ of testing to demonstrate that a molecule is both safe and effective for the treatment of a specified condition. Drug makers (“sponsors”) finance and run trials for which the study design must be pre-approved by the FDA.
• Upon successful completion of the final phase, the sponsor can submit a New Drug Application to the FDA. If if the FDA approves the application, the sponsor gains the right to market the drug as a treatment for the specified condition.

How long does it usually take, by phase?

• In all, it can take between 5 and 12 years to complete a drug trial. The timeline to drug approval can vary significantly depending on the type of treatment, according to a report from Health and Human Services (HHS). Initial discovery of a molecule and treatment in animals may take an indeterminate amount of time, but a molecule cannot enter trials in human beings until a sponsor has submitted an Investigational New Drug application to the FDA.
• Phase 1 is the first stage in which an investigational drug is permitted to be administered to a healthy sample of human beings, to determine proper dosing and potential toxicity levels, and averages 1.8 years.
• Phase 2, which includes placebo-controlled randomized trials in a small sample of human beings suffering from the specified condition, takes about 2.1 years.
• Phase 3 requires a drug to demonstrate effectiveness statistically greater than a placebo in two large-scale, well-designed clinical trials. The statistical significance thresholds often require a trial to include thousands of participants in each Phase 3 trial and to include double-blind control groups that receive a placebo. This phase frequently takes up to 4 years.

How is drug approval accelerated with a ‘Breakthrough’ designation?

• The FDA can award a “Breakthrough” designation for drugs that demonstrate exceptional preliminary results. The designation grants the sponsor a more efficient process that includes ongoing agency collaboration on trial design, “rolling” review of trial evidence in lieu of compiling years’ worth of evidence into a completed application, and priority review of a New Drug Application. These changes drastically reduce costs and uncertainty facing drug sponsors and can facilitate capital formation by the sponsor. One study found that a breakthrough designation can shorten the average time to approval to five years.

Have psychedelic drugs received Breakthrough status?

• Since 2017, a number of psychedelic drugs, including synthetic versions of MDMA (“ecstasy”), psilocybin (“magic mushrooms”), and lysergic acid diethylamide (LSD), have been granted breakthrough status by the FDA. Psychedelic drugs have a pattern of showing strong preliminary results in treating mental health issues.
• Non-FDA supervised clinical trials using ibogaine in foreign jurisdictions have also shown very strong results. If a drug sponsor used the same formulation of ibogaine used in these early clinical trials, it could argue that data already exists to show ibogaine offers a substantial improvement over existing therapies.

Are any manufacturers taking ibogaine-like drugs through the FDA process?

• Yes. Manufacturers Atai’s and DemRX’s ibogaine-like drug have already completed Phase I and may soon move on to Phase II. Another manufacturer, Gilgamesh, was awarded a $14 million grant from the National Institutes of Health to finance Phase I trials of its compound for the treatment of opioid disorder. State participation in an ibogaine research collaborative could steer funding toward a new drug or potentially support an existing clinical trial.

The post FAQ: Timeline for FDA ibogaine approval appeared first on Reason Foundation.

• According to the Department of Veterans Affairs (VA) annual report on suicide prevention, there are an average of 17.6 veteran suicides a day, indicating a significant gap between available mental healthcare and veterans’ needs. Some advocacy groups estimate the true number is closer to 44 Veterans a day when accounting for overdose deaths and other self-destructive behaviors linked to untreated trauma.
• VA has a backlog in mental healthcare services due to over 1.7 million veterans with only about 10,000 psychologists and psychiatrists to treat them.
• Veterans wait an indeterminable amount of time to secure an appointment and receive limited care if they are deemed “functionally stable.” Many current or former VA clinical psychologists report great pressure to cap individual therapy sessions to vets deemed “functionally stable.”
• VA works with veterans over 8-15 initial therapy sessions, then offloads the patient back to primary care as they are deemed “functionally stable.” However, many veterans only reach “functional stability” temporarily during the therapy sequence and decline once services are discontinued.

Current PTSD treatment = lifetime sentence of medication

• While selective serotonin reuptake inhibitors (SSRIs) are considered a common and safe treatment for post-traumatic stress disorder (PTSD)—and are routinely prescribed to veterans on a daily, perpetual basis—many experts and PTSD patients report that SSRIs have limited efficacy and effectiveness.
• Many veterans are prescribed multiple psychotropic drugs, receiving prescriptions for medication after medication that do not solve the underlying condition(s).
• This breakdown breeds mistrust and despair, as Veterans begin to wonder not only if they can recover, but if the system meant to help them is even capable of healing them.

One ibogaine treatment can replace a lifetime of medication

• Ibogaine is an extract of Tabernanthe iboga, a Central African shrub, and is a psychoactive compound that has long been used in spiritual practices and shows promising results in mental health treatments.
• Ibogaine’s Schedule I status in the U.S. has forced thousands of American Veterans to seek treatment abroad—most often in Mexico, where ibogaine is unregulated and available through private clinics.
• The profound results of ibogaine are seen in the study done by Stanford Medicine, showing an 88% decrease in PTSD symptoms, 87% in depression symptoms, and 81% in anxiety symptoms one month after an ibogaine treatment in a cohort of 30 special operations veterans with a history of traumatic brain injuries (TBI).
• Additional trial results published in Nature Medicine showed significant improvements in concentration, information processing, memory, and impulse control following ibogaine treatment.

Bottom line

Promising breakthrough treatments like ibogaine can provide military veterans with PTSD and other mental health conditions by eliminating the need to take medication every day and targeting the root conditions driving suicidal ideation, hyper-aggression, depression, or the many other conditions many veterans face.

Read the full Backgrounder:

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Current treatments for post-traumatic stress disorder (PTSD)—including cognitive behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs)—achieve only 30–40% remission rates, with many patients discontinuing treatment early, limited long-term efficacy, and significant side effects, particularly for those with treatment-resistant cases.

Association for Psychological Science (2021): “Approximately two-thirds of veterans with PTSD remain with the disorder following treatment. […] Treatments for veterans with PTSD show limited overall effectiveness in real-world settings.”

Promise of ibogaine

Psychological Healing occurs through the boosts in neurotrophic factors to promote neural regeneration and repair, profoundly revolutionizing the approach to treatment for addiction, traumatic brain injuries (TBI), and neurodegenerative diseases.

Research by Stanford University published in Nature Medicine in 2024 found that ibogaine treatment led to significant improvement in a cohort of 30 veterans. After one month of following treatment, these participants experienced average reductions of 88% of PTSD symptoms, 87% in depression symptoms, and 81% in anxiety symptoms relative to their initial conditions. The results held at 6 months. In a small-scale study, 75% of patients remained abstinent from opioids for an entire year following treatment.

Typical ibogaine treatment protocol

A standard ibogaine treatment protocol consists of a 5 to 10-day inpatient program conducted in a medically supervised environment. Participants undergo comprehensive medical evaluation, safety preparation, and therapeutic support prior to treatment, followed by a recommended 12 months of ongoing, structured integration and support services.

The post Ibogaine offers breakthrough treatment for mental health, addiction, and TBIs appeared first on Reason Foundation.

Opioid settlement funds have already been used for concerts, law enforcement equipment, and budget backfilling, among other purposes. These uses fall short of the settlements’ intent to remediate the crisis. With billions still to be spent over the next decade, it is crucial to establish better financial controls and reporting structures for the use of these funds to ensure they are deployed transparently, efficiently, and in compliance with their legal restrictions to advance evidence-based interventions proven to save lives.

The opioid epidemic has claimed more than 800,000 lives since 1999. As the crisis intensified, policymakers and the public sought to identify its causes. State and local governments filed thousands of lawsuits against opioid manufacturers, distributors, and retailers, accusing them of fueling the epidemic through misleading marketing and inadequate oversight. These lawsuits ultimately led to the national settlement agreements.  More than a dozen companies that manufactured, distributed, or aided in the prescription of painkillers, including McKinsey, Johnson & Johnson, Walgreens, CVS, and Walmart, reached settlements totaling approximately $50 billion, to be distributed to various state and local governments over nearly two decades.

The settlements stipulate that funds must be used to support opioid prevention, treatment, and recovery efforts. However, since receiving the funds, many jurisdictions have not provided the transparency, accountability, and prioritization of evidence-based strategies that genuinely address the needs of those most impacted by the crisis. Each state receives a designated portion of the national settlement based on factors such as opioid-related deaths, the volume of opioids shipped, and population size, with funds then subdivided between state agencies and local jurisdictions according to negotiated formulas.

To guide spending, the National Opioid Settlement Agreement includes Exhibit E, which stipulates a non-exhaustive list of approved uses centered on prevention, treatment, and recovery from opioid addiction, and harm reduction programs. States must allocate at least 70% of settlement funds toward these opioid remediation efforts, and some have gone further by committing to use 100% of their funds accordingly. The remaining 30% is allocated as follows: up to 15% for administrative costs and up to 15% for any other purpose.

Core priorities for the use of these funds include developing prevention efforts through supporting different evidence-based education programs; expanding training and increasing access to naloxone, a life-saving opioid overdose reversal medication; increasing education around and the availability of medication-assisted treatment (MAT) such as methadone and buprenorphine or other opioid-related treatment; supporting syringe service programs that reduce the spread of HIV and other infectious diseases through clean syringe distribution; and investing in wraparound services that offer coordinated, comprehensive care for individuals in recovery. Other allowable uses involve peer recovery support, workforce development, care for pregnant and postpartum individuals, and programs addressing the needs of those in the criminal justice system. The strategies listed are evidence-informed and designed to respond to the drivers and consequences of the crisis directly.

While the settlement agreement outlines preferred uses with an emphasis on remediation, the guidelines leave significant room for interpretation—creating wiggle room for states and localities to circumvent evidence-based treatment entirely.

This is what has happened in New Jersey, where state investigators uncovered how the Township of Irvington exploited the flexibility of the guidelines to fund events that had little connection to harm reduction, addiction treatment, or public health.

A report from the New Jersey Office of the State Comptroller revealed that over $632,000 was spent on two “Opioid Awareness” concerts in 2023 and 2024. As reported, thousands were spent on “generators, an ice maker, popcorn machine, cotton candy machine, four flavors of shaved ice, a hot food display stand, and catered food.” These events included celebrity performers and DJ sets. One township employee, Antoine Richardson, received $368,500 in unaccounted payments and steered nearly $470,000 in contracts to businesses linked to himself and his wife. The report concluded that Irvington’s actions violated the intent of the settlement and referred the matter to several state agencies for further review.

There have been issues elsewhere in how the funds have been spent. Scott County, Indiana, used over $250,000 to pay salaries for health and emergency services staff, effectively freeing up their local budget to buy a new ambulance and build a financial cushion for the health department. This is achieved through supplantation, where new dollars are used to fund existing programs, thereby making more general fund revenues available for governments to spend as they wish. This practice is not explicitly prohibited in Exhibit E of the settlement fund agreements. Still, it serves as a workaround that can undermine the intended goal of building service capacity through these funds. A similar example occurred in New York, where advocates noted that the state shifted millions from its addiction agency’s base budget and replaced it with opioid settlement dollars—substituting existing funding rather than using the settlement funds to enhance care. Blair County, Pennsylvania, directed $320,000 toward a long-standing drug court, using the funds in part to cover salary shortfalls for probation officers and aides due to limited state grants and probation fee revenue, rather than investing in new or expanded services.

Other states have directed the money toward law enforcement. Southington, Connecticut, used $18,000 to buy cellphone-unlocking technology for police. Ohio County, Ohio, spent nearly $43,000 on new K-9 and EMT equipment. Michigan counties, including Kalamazoo and St. Clair, purchased jail body scanners, infrastructure that experts argue should be funded through general law enforcement budgets. In West Virginia, $364 million, which is more than half of the state’s total opioid settlement spending for the year, went to police vehicles, jail bills, and salaries, while just 6% supported treatment and recovery. Jackson County took this further by using 90% of its $566,000 allocation to expand a first responder training center, including building a shooting range.

Although the opioid settlements stipulate that funds should be used for specific opioid remediation purposes, they contain no binding requirements, enforcement mechanisms, or clawback provisions if jurisdictions misuse the money. Oversight is left entirely to state and local discretion. Each state executed its own Memorandum of Agreement (MOA) defining how funds are distributed and what reporting, if any, is required.

As much of these funds currently remain unspent, it is incumbent on state and local governments to enact better financial controls and reporting mechanisms to ensure money is used consistently with its designated purpose—remediating the effects of the opioid epidemic.

Uncommitted settlement funds across states

According to the Johns Hopkins Opioid Settlement Expenditures Tracker*—developed by Johns Hopkins, Shatterproof, and KFF Health News—roughly one-third of the opioid settlement dollars tracked from 2022 to 2023 were allocated for specific uses.

The share of funds with reported uses varies significantly by state. Many states provide only limited information, leaving large portions of their initial allocations—sometimes more than 75%—without clear documentation of intended use. By contrast, a handful of states, such as Colorado, Washington, and Delaware, have published detailed reports showing how funds are being allocated.

Most settlement agreements do not require states or localities to publicly disclose how they spend the funds awarded to them. Twelve states had initially pledged to be “100% transparent,” meaning they would report on every dollar of settlement funds and how it is used. Only a few have followed through.

Among the handful of states that provide accessible and detailed descriptions of their uses of the funds is the state of Minnesota, which has a dashboard allowing anyone to track what will be done with the $117 million awarded. The dashboard breaks spending down by county, outlining who received the money, for what purpose, whether the grantee is using an evidence-based program, and the outcome of this spending.

Other dashboards include those maintained by the states of Michigan, New York, and North Carolina. New Jersey and Indiana, instead, publish annual reports outlining county-level spending.

Lessons from the tobacco settlement

The 1998 Tobacco Master Settlement Agreement (MSA) is the closest precedent to today’s opioid settlements, serving as an important cautionary tale. The MSA was a deal between four major tobacco companies and 46 states (plus D.C. and American territories). In exchange for releasing the companies from future Medicaid lawsuits related to smoking-related illnesses, the firms agreed to modify their marketing practices and make annual payments to the states in perpetuity, tied to cigarette sales.

Although the MSA was intended to offset public health costs and fund smoking prevention, it placed no restrictions on how states used the money. Most legislatures diverted payments into general budgets, infrastructure, or debt service rather than public health.

According to a United States Government Accountability Office Report, from Fiscal Years 2000 through 2005, the 46 states party to the MSA received $52.6 billion in tobacco settlement payments. However, only 30% of the funds were allocated to health care, and another 3.5% to tobacco prevention. The rest was split between covering budget shortfalls (22%), debt service on securitized funds (5.4%), infrastructure (6%), education (5.5%), tax reductions (1%), and others.

States are still receiving these settlements. According to the Kaiser Family Foundation, states received $6.8 billion from the MSA in 2024. 

Several states securitized the future tobacco settlement cash streams, which means selling the right to receive years of cash flows for a smaller upfront amount, while also passing to bondholders the risk that the companies settled with may not honor the agreed-upon future payment streams, or that tobacco sales would be lower than expected.

This practice is already under discussion for opioid settlements. Some municipalities, such as the Wisconsin Counties Association, have considered securitizing their opioid settlement funds, which would enable them to capture upfront the payment stream that extends through 2038 at a discount.

Securitization is problematic because it trades decades of future remediation dollars for a one-time cash infusion at a steep discount. Governments forfeit long-term funding streams that could sustain treatment and prevention infrastructure. The tobacco experience showed that securitization left many states with little or no settlement revenue in later years, even as smoking-related harms persisted.

Local officials may also be tempted to invest opioid bond proceeds, anticipating that market returns will surpass debt service costs—an approach akin to pension obligation bonds, which carries significant risks.

The outcomes of the tobacco settlement provide clear lessons for the use of opioid settlement funds: Absent binding guardrails and rigorous transparency, both state and local governments face strong incentives to divert or front-load funds in ways that undermine their intended purpose.

Policy recommendations for strengthening opioid settlement spending

When governments are entrusted with funds to address the opioid crisis, they take on a moral obligation to act accordingly. That means investing in what works: expanded access to medication-assisted treatment, naloxone distribution and education, syringe service programs, recovery housing models, and other approaches rooted in evidence and outlined in Exhibit E, including the development of potentially novel treatments.

Misallocating these dollars undercuts both public health outcomes and fiscal responsibility. When rehabilitation-eligible interventions are underfunded, communities miss out on life-saving programs like MAT and harm reduction. Instead, overdose deaths rise, and criminal justice systems bear the cost of repeated recidivism. By contrast, well-targeted settlement spending has the potential to save lives, strengthen communities, and ease the burden on public systems.

Below are recommendations to ensure that the awarded funds are used effectively.

1. Discourage supplantation through clear spending principles

Supplantation, or using settlement funds to replace existing public health dollars, weakens the impact of these resources. State budget officials and attorneys general should issue clear guidance encouraging local governments to deploy settlement funds as a supplemental expansion of care rather than an alternate method of financing existing services.

2. Prioritize external providers for efficiency

Governments should prioritize contracting with external providers rather than providing harm reduction services themselves. Building new publicly operated service programs tends to be costly and slow, while specialized providers are likely to deliver evidence-based care more efficiently and at lower cost.

Partnering with external providers also reduces the risk of budget supplantation, ensuring settlement dollars fund new services rather than displace existing expenditures. Service providers who receive these funds should be held accountable for their use and required to provide an independent auditor’s report detailing the use of these funds if they exceed a minimum threshold. For instance, recipients of federal grants in excess of $750,000 in any year must complete a federal single audit to account for the use of those funds.

3. Prohibit securitization

States should consider adopting explicit bans on securitizing opioid settlement revenues—that is, selling the right to future payments in exchange for upfront cash.

While securitization may appear to offer immediate budget relief, the tobacco settlement experience has shown that it strips away long-term remediation funding, often resulting in communities losing access to dollars even as their needs persist. Prohibiting securitization ensures that settlement payments remain available over time to sustain treatment, prevention, and recovery infrastructure, rather than being consumed in a single budget cycle.

4. Support voluntary frameworks for evidence-based spending

State governments can offer spending guidelines that prioritize effective, research-based strategies such as medication-assisted treatment, naloxone access, syringe service programs, and recovery housing. These frameworks should be developed with input from people with lived experience and members of the affected community to ensure they reflect real needs and can be adapted to local contexts. Highlighting these approaches helps localities focus on interventions that directly reduce harm and improve recovery outcomes.

5. Increase spending transparency

Local governments should regularly publish clear and accessible data showing how settlement funds are spent and what goals they aim to achieve. This can be achieved through either interactive dashboards, such as those used by the state of Minnesota, or yearly reports, as seen in the states of New Jersey and Indiana.

6. Allocate a portion of funds to innovative and emerging treatments

To drive long-term progress in addiction care, state and local governments should dedicate a portion of opioid settlement funds to support the research, development, and piloting of innovative treatment modalities. This includes exploring the therapeutic potential of ibogaine, a psychedelic alkaloid showing promise in interrupting opioid dependence, and GLP-1 receptor agonists, initially developed for diabetes and weight loss, which are being studied for their ability to reduce drug cravings and compulsive use. While more clinical trials are needed, strategic investment in these areas can help expand the future treatment toolkit beyond traditional approaches. Prioritizing innovation ensures that settlements can remediate current harms and foster breakthroughs that reshape addiction care for the next generation.

7. Invite independent spending reviews

Localities can partner with independent institutions to review how funds are allocated and whether spending aligns with the original purpose of the settlements. These reviews help identify areas for improvement and add an extra layer of accountability without requiring new laws or regulations.

8. Include community voices in spending decisions

People affected by addiction should have a role in shaping how funds are used. Community input ensures that spending decisions reflect local needs and improve outcomes for those most directly impacted.

The opioid settlements present a real opportunity to reshape how states support addiction care. Real impact comes from honest reporting, directing funds toward new and innovative treatment options, and strengthening what already exists on the ground. Many harm reduction and recovery programs already serve their communities, sometimes without formal recognition or support. These funds can help legitimize and expand their reach while empowering new groups to fill gaps where services do not yet exist. When used this way, the money can build sustainable systems that save lives and restore trust. The choices made now will determine whether these funds drive lasting progress or fade into missed potential.

*Correction: This piece has been updated to reflect that the data used from the Johns Hopkins Opioid Settlement Expenditures Tracker shows settlement funds received and committed in 2022–2023, not cumulative totals as previously described.

The post Best practices to prevent misuse of opioid settlement funds appeared first on Reason Foundation.

• DEA petition to reschedule psilocybin
• Reason testimony on ibogaine in Mississippi
• FDA releases MDMA decision
• Interview for a new book on psychedelics

DEA petition requests psilocybin rescheduling

The Drug Enforcement Administration (DEA) has requested that the Department of Health and Human Services (HHS) review the scheduling of psilocybin under the Controlled Substances Act. This means that the federal government could choose to change psilocybin from Schedule I (where all use is banned) to a lower schedule (where use may be allowed under certain guidelines).

Schedules III through V are for approved pharmaceuticals subject to varying levels of controlled access. Companies or individuals that traffic in these substances can access basic financial services and are not subject to special penalties on their federal income taxes, even if state laws allowing the sale of these substances differ from federal law. A key takeaway of the potential change is that psilocybin service centers in state-regulated markets, such as Oregon, would be able to deduct business expenses on their federal income taxes under the “ordinary and necessary” standard that applies to most businesses.

This request from the DEA follows a protracted legal battle by proponents, including Sunil Aggarwal, a Washington State-based doctor, who sought to treat a patient with psilocybin under “Right to Try,” a federal law that permits the use of drugs not approved by the Food and Drug Administration (FDA) under certain conditions. There is no word yet from HHS regarding when or how it will respond to the DEA’s request. Legally, the U.S. attorney general has the authority to change the status of a drug, provided that DEA and HHS have jointly considered a number of factors outlined in statute.

Reason testimony in the state roundup

Reason Foundation’s Geoff Lawrence traveled to Mississippi to testify during a hearing related to ibogaine. Lawrence discussed the medical benefits of ibogaine as a potential treatment for opioid addiction. He also discussed recent states that have approved millions of dollars in funding for clinical trials involving ibogaine, such as those in Texas and Arizona.

These public grants could contribute enough funding to take ibogaine through the initial phase of the Food and Drug Administration’s (FDA) drug approval process.

Read this and more about state-level policies in the state round-up here.

FDA releases rejection decision

The FDA has released details of its decision to reject a New Drug Application for MDMA. Last August, the FDA made headlines for rejecting the application of Lykos, a pharmaceutical company that had long been the frontrunner for medicalizing psychedelics with a patented version of MDMA for the treatment of post-traumatic stress disorder. The Multidisciplinary Association of Psychedelic Sciences (MAPS) published a critique of the decision, arguing that the FDA “moved the goal posts” on the clinical trial design.

According to MAPS, the FDA was fully aware of many of the limitations when it greenlit the organization’s clinical trial design. For instance, the FDA was ultimately concerned that too many participants ”broke” blinding because they were able to guess whether they received the drug or a placebo. Genuine blinding is a gold standard of clinical trials, but a challenge with mental health-related drugs that have acute effects (like potent psychedelics).

The FDA is now requiring more research. MAPS leadership had created a for-profit company, Lykos, to conduct the trials. Currently, it is unknown if and how Lykos will address these challenges in further research.

Book interview

Reason Magazine Editor-at-Large Nick Gillespie interviewed Joe Dolce about his new book, Modern Psychedelics: The Handbook for Mindful Exploration. Dolce argues that psychedelics have moved from an obscure interest of the counterculture to a mainstream treatment.

“No matter what happens, people are going to use these substances,” says Dolce, when asked about possible legalization policies. Gillespie noted that better public policies would help users make more informed decisions.

The post Psychedelics Policy Newsletter: DEA considers rescheduling psilocybin, FDA releases rejection decision, and more appeared first on Reason Foundation.

Kentucky

On Aug. 27, the Interim Joint Committee on Health Services discussed whether Kentucky should join a multi-state collaborative to conduct clinical trials of ibogaine as a treatment for certain neurological conditions, including opioid addiction. In 2023, the Kentucky Opioid Abatement Advisory Commission first broached the idea of directing a portion of the state’s opioid settlement funds toward ibogaine research to develop a novel, and potentially far more effective, treatment than what is currently available. That initiative was scrapped after a new state attorney general was elected. According to the Lexington Herald-Leader, Gov. Andy Beshear has expressed skepticism about the safety of ibogaine treatment. The legislature has not yet scheduled any further action on the issue (such as the introduction of a bill like in Texas to grant public funds for research).

Mississippi

Reason Foundation Research Director Geoff Lawrence testified at a state legislature Public Health Joint Committee hearing on Aug. 28, in which lawmakers learned about the possibilities of ibogaine as a potential treatment for a wide range of neurological conditions. Lawrence discussed the known benefits of ibogaine as a potential treatment for opioid use disorder, traumatic brain injury, and neurodegenerative disease, along with efforts in other states, including Texas, to fund FDA-supervised clinical trials (testimony begins around here at the 1:36 minute mark).

Massachusetts

House Bill 2506 from state Rep. Steve Owens (D-29) would allow limited personal possession and transfer of psilocybin for military veterans, law enforcement officers, and those with a ”qualifying condition,” which is defined by the bill as ”a medical condition for which at least two and a majority of relevant clinical studies suggest psilocybin therapy in a clinical environment is safe and tolerable and which is not a disqualifying condition.’ Individuals may not have a disqualifying condition, which is defined in the bill as “bipolar disorder, a schizophrenia spectrum disorder, a Cluster A personality disorder, a Cluster B personality disorder, or a medical condition for which at least two and a majority of relevant clinical studies suggest psilocybin therapy in a clinical environment is not safe.”

S1400, sponsored by state Sen. Cindy Friedman (D-Middlesex), would task the Department of Health with creating a pilot program for treatments with psychedelics. On Sept. 11, it received a favorable vote from the Joint Committee on Mental Health, Substance Use, and Recovery and has been referred to the Committee on Healthcare Financing.

Oregon

House Bill 3043 (introduced at the request of Gov. Tina Kotek’s office) states that a licensed medical practitioner may not be disciplined for using psilocybin under the state’s regulated program. The bill amends the state’s program to allow for reentry into medical professions for those who were once declared “impaired” by substance abuse. Specifically, a medical professional cannot be disciplined for legal psilocybin use if they used it “before entry into the impaired health professional program, if the licensee did not practice while impaired.”

Senate Bill 844 (introduced at the request of the governor’s office) requires the Oregon Health Authority to keep personally identifiable information confidential related to complaints against a psilocybin service center or licensee.

The post State psychedelics legalization and policy roundup — October 2025 appeared first on Reason Foundation.

Philadelphia Mayor Cherelle Parker signed a law that would restrict mobile health vans providing critical support, such as clean syringe access and naloxone for overdose emergencies, from operating in Kensington. The measure limits vans to just two pre-approved sites, caps each stop at 45 minutes, and requires providers to obtain a permit to operate. Groups that violate the rules face fines of up to $1,000—and if they incur three violations, they become permanently ineligible to obtain the required permits. 

Though the Philadelphia City Council has described the ordinance as a response to congestion and litter, many community complaints center on concerns about people who use drugs gathering near the vans. Regardless of the framing, these restrictions undermine the very purpose of making care mobile, which is to deliver care where it is most urgently needed.

Mobile health units exist mainly to serve people who use drugs, who often struggle to access traditional healthcare. But they also offer other kinds of support, like basic medical care and community outreach, to anybody, not just drug users, who would otherwise go without care. Between July 2022 and June 2023, Prevention Point Philadelphia’s mobile and stationary syringe services reached more than 30,000 people, provided 1,103 wound care visits, enrolled 357 new participants in medication-assisted treatment for drug addiction, and distributed over 95,000 doses of naloxone, the medication that reverses opioid overdoses. Demand for these services has surged, with the organization’s client numbers more than tripling over the past three years. 

Restricting vans to two fixed locations undermines their core strength: mobility. Outreach teams deploy based on real-time need. Much of Kensington falls within the 19134 zip code, where the Philadelphia Department of Public Health recorded 193 overdose deaths in 2022. A rigid permit system will leave many blocks without timely access to care. 

This policy also disrupts the trust and continuity that are the foundation of successful harm reduction services. Patients who might avoid hospitals or doctors’ offices because of past mistreatment—an exceptionally common experience for people who use drugs—might be willing to accept naloxone from a familiar outreach worker. That small act of trust may also allow the patient to receive wound care and, perhaps later, a discussion about treatment options. 

Philadelphia can address legitimate quality-of-life concerns without constraining lifesaving services. For example, it could establish rotating service zones for mobile vans to prevent clustering in one area, set voluntary sanitation and reporting standards, and offer grants to providers that meet sanitation standards. Programs like Project Reach already work alongside mobile harm-reduction providers to remove thousands of bags of trash and tens of thousands of discarded syringes from city streets each year, showing that public health and public space improvements can go hand in hand. 

The city can also better address the root causes of the problems mobile units seek to address by expanding low-threshold treatment programs and supportive housing. 

As a strategy, mobile outreach has demonstrated effectiveness in saving lives, building community trust, and improving neighborhood safety. Limiting these services to just two fixed locations—especially when Philadelphia is still losing nearly four residents a day to overdose—risks reversing the marked decrease in overdoses that the city has seen. Mayor Parker and city councilmembers should amend this new ordinance and collaborate with providers and the community to design a better approach that can preserve both neighborhood dignity and access to the types of flexible care on which our most vulnerable neighbors rely.

The post Restricting mobile health vans in Philadelphia will lead to more overdose deaths appeared first on Reason Foundation.

Despite $2.7 trillion in public spending to address the drug overdose crisis, the United States continues to experience alarmingly high death rates, strained emergency systems, and ineffective intervention pathways. Current strategies that are largely centered on enforcement and abstinence-only treatment are not meeting the scale or complexity of the drug problem. Public systems remain reactive rather than preventative, leaving taxpayers to fund a revolving door of crisis care that fails to produce meaningful or lasting outcomes.

This policy brief presents a case for integrating harm reduction into the federal response, not as a replacement for drug treatment, but as a pragmatic complement. Harm reduction includes proven tools like naloxone distribution, syringe service programs, fentanyl test strip access, and supervised consumption sites. These interventions reduce healthcare costs, lower disease transmission, and improve individual and community outcomes without requiring drug abstinence. They represent low-cost, high-impact strategies that support public health and public safety alike.

To assess the current drug policy landscape, the brief includes a 50-state matrix evaluating implementation of five core harm reduction policies, including: syringe service programs (SSPs), naloxone access, legality of fentanyl test strips, Good Samaritan laws, and supervised consumption sites (SCSs). While two states meet all five benchmarks, others fall short due to outdated paraphernalia laws, inconsistent naloxone access, and surveillance practices that discourage participation. These gaps reduce effectiveness, create preventable costs, and deter early intervention by eroding trust in care systems.

Key policy recommendations in this paper include decriminalizing essential health tools, strengthening “Good Samaritan” protection laws, limiting surveillance in service delivery, and funding flexible, community-led initiatives. These policy reforms do not expand federal authority or create new regulatory structures. They promote local autonomy and make room for innovation by empowering the organizations best positioned to serve people on the ground.

Harm reduction is a public health approach that prioritizes safety, dignity, and evidence-based care, aiming to build trust in healthcare systems and ensure public resources are used effectively. It’s a practical path forward that aligns with the core principles of reducing government waste, investing in what works, and protecting individual liberty.

Based on the existing evidence, Reason Foundation concludes that expanding access to harm reduction services may be one of the most cost-effective, community-driven uses of funds designated to reduce the harms of the opioid crisis.

Introduction

The United States is confronting a multifaceted drug crisis that carries not only a significant economic burden but a devastating human toll as well. Opioid overdoses alone are projected to claim between 543,000 and 842,000 lives between 2020 and 2032. Beyond the personal loss, these deaths strain emergency response systems, drive up healthcare costs, and contribute to lost productivity and long-term societal expense.

Although treatment options exist, access remains uneven, and relapse rates continue to hover between 40% and 60%. Despite these challenges, many policies continue to prioritize a one-size-fits-all rehabilitation model—often centered around abstinence—which is not sufficient to meet the diverse needs of individuals struggling with substance use disorders.

Traditional treatments for substance use disorders include psychological therapies such as cognitive behavioral therapy, motivational interviewing, contingency management, and family therapy. Medication-assisted treatments (MAT) like methadone, buprenorphine, and naltrexone also offer effective options, as do mutual support groups. However, psychological therapies have an average dropout rate of 30%, and medication-assisted treatments often suffer from limited accessibility and a lack of coordination with psychological or peer-based support systems.

This current system is inefficient, as it fails to reach or retain many of the individuals most in need at great financial cost. For example, among those who inject drugs, preventable infections like HIV and hepatitis C are common due to unsafe injection practices like sharing needles. The average lifetime medical cost of one HIV infection is over $261,000, while hepatitis C treatment can exceed $38,000 per case. Preventable hospitalizations due to abscesses, infections, or overdoses also drive up costs, with each non-fatal overdose costing thousands in emergency department use alone.

In addition to their limitations in efficacy and accessibility, these approaches can unintentionally reinforce harmful stereotypes about people who use drugs. Abstinence-centered rehabilitation often assumes complete sobriety as the only path to recovery. This misconception perpetuates the false notion that one-size-fits-all treatment is effective for everyone. It shapes public opinion of substance use disorder as a moral failing instead of a health issue. It also drives policy and healthcare decisions that discriminate against people who use drugs and restrict access to harm reduction and treatment programs. The persistent ethical condemnation of drug use exacerbates the challenges of treating substance use disorder and prevents people from receiving or even seeking the assistance they need.

Substance use exists on a spectrum. Research shows that most drug use is occasional, short-term, and not associated with addiction. A clinical diagnosis of substance use disorder requires meeting specific criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which classifies most drug use as “transient.” Unfortunately, treatment protocols often fail to reflect this definition, sidelining evidence-based approaches that could better align with actual patterns of use in communities.

Current research also supports the idea that addiction is not solely the result of individual behavior, but a complex condition influenced by biological, psychological, social, and environmental factors—including physical dependence. For many people with opioid use disorder, quitting abruptly can be dangerous. Unlike illnesses such as diabetes or cancer, which manifest with relatively uniform effects, the effects of addiction vary significantly from person to person. This complexity undermines the effectiveness of uniform treatment strategies. It also reinforces the importance of broadening public health responses to include harm reduction—a practical, compassionate approach that prioritizes health, safety, and human dignity without imposing immediate or total abstinence.

Harm reduction offers a pragmatic complement to existing treatment approaches. It prioritizes reducing the negative health consequences of drug use, particularly among individuals who are not yet ready or able to pursue abstinence. These programs include syringe service initiatives, naloxone distribution, and access to medication-assisted therapy—all of which have been shown to reduce emergency room visits, lower disease transmission, and improve long-term outcomes.

One illustrative example is Taiwan’s 2005 needle exchange program, launched during a surge in HIV among intravenous drug users. Despite the country’s strict anti-drug policies, the program reduced new HIV infections by 90% within four years—demonstrating the public health and fiscal power of targeted harm reduction policies. Similar evidence from cities like Vancouver and Lisbon supports this trend, showing how such approaches can relieve public health systems while improving the quality of life for individuals and families.

Despite the extensive data supporting harm reduction in mitigating drug-related harm, ongoing misinformation about drugs and those who use them continues to hinder widespread acceptance of these strategies in the United States.

However, other nations such as Portugal, Uruguay, the Netherlands, Canada, and Mexico have shifted towards more effective policies for mitigating the potential dangers of drug use. An international trend is emerging, with more nations adopting harm reduction approaches that uphold individual freedom and recognize the right of people to make informed decisions about drug use and treatment.

American policymakers should similarly refocus drug policies from the supply to the demand side and work primarily to reduce the harmful effects of drug use.

Full Policy Brief: Harm Reduction: An Evidence-Based Approach to the Drug War

The post Harm reduction: An evidence-based approach to the drug war appeared first on Reason Foundation.

The new constitutional framework

Both circuits applied the framework established in the Supreme Court’s 2022 New York State Rifle & Pistol Ass’n v. Bruen decision, which requires the government to demonstrate that firearm regulations are “consistent with this Nation’s historical tradition of firearm regulation.” This standard has proven particularly challenging for the federal prohibition on gun ownership by marijuana users under 18 U.S.C. § 922(g)(3), as courts struggle to find historical analogues that justify disarming an entire class of people based solely on their substance use.

The 10th Circuit’s decision in Harrison is noteworthy because it involved illegal recreational marijuana use rather than state-legalized medical use. The case involved a defendant who was pulled over for running a red light in Oklahoma. The defendant was sober, but police smelled marijuana, searched his car, and found a loaded revolver plus various marijuana products, which led to a federal charge of firearm possession by an unlawful drug user. Despite clearly illegal marijuana possession, the court concluded that the government must individually prove that non-intoxicated marijuana users “pose a risk of future danger” rather than simply assuming all marijuana users are categorically dangerous. The case was sent back to the District Court for the Western District of Oklahoma with new criteria for conviction and represents a dramatic departure from the previous approach of treating drug use as an automatic disqualifier for Second Amendment rights.

The 11th Circuit went even further in the Florida case, which involved two plaintiffs who were registered medical marijuana patients who were denied gun purchases and one more who was a gun owner who wanted to use medical marijuana but feared prosecution. All of the plaintiffs sued the federal government to challenge its prohibition. Although the District Court for the Northern District of Florida dismissed the case reflexively, the 11th Circuit sent it back on appeal, explicitly rejecting two of the government’s most common historical analogies. 

First, the court ruled that medical marijuana patients could not be compared to convicted felons because the plaintiffs had never been convicted of any crime—at most, two were committing a federal misdemeanor through marijuana possession. Crucially, the court noted that there is no historical tradition of categorically disarming misdemeanants, and that felony dispossessions require a judicial determination of guilt before stripping Second Amendment rights. (Note that  misdemeanors regarding violent acts like domestic violence can categorically disqualify gun ownership.)

Second, the court also rejected the “dangerous individuals” analogy, finding that the complaint contained no allegations about frequency of use, side effects, or impaired judgment. Instead, the medical marijuana patients in the case appeared to “use rational thought in making their decision to use marijuana and would stop their marijuana use if they were placed at risk of criminal prosecution.” This rational, controlled use was “a far cry from that of addicts and alcoholics whose actions are controlled by their need to use alcohol or drugs.” The court emphasized that these patients were participating in Florida’s highly regulated medical marijuana program, not engaging in illegal drug trafficking, and posed no “credible threat” to public safety.

Individualized assessments replace categorical bans

What emerges from these decisions is a requirement for individualized factual determinations rather than sweeping categorical prohibitions. As the 11th Circuit noted, while the government “very well may prove at a later stage of litigation, after development of a factual record, that Appellants can fairly be considered relevantly similar to felons or dangerous individuals,” such determinations cannot be made based on marijuana use alone. 

However, the Supreme Court has communicated that lower courts can uphold firearm regulations when individualized danger is present. In United States v. Rahimi, decided in 2024, the Supreme Court held that an individual who is a credible threat may have their firearms temporarily confiscated without a trial. This shift, following Bruen and Rahimi, does not give blanket protections to marijuana users, but it has led courts to assess whether specific individuals pose actual risks rather than relying on legislative assumptions. Although these rulings align with a recent decision from the Third Circuit, the Eighth Circuit has been much more nuanced, saying gun prohibitions for substance users are not “facially unconstitutional” and can be broadly applied to all felons. These inconsistencies between Circuit court jurisprudence may soon compel the Supreme Court to take up this issue.

The commandeering problem

These judicial developments occur against a backdrop of practical enforcement challenges that further complicate federal marijuana prohibition. The anti-commandeering doctrine, rooted in the 1997 Supreme Court decision Printz v. United States, prevents the federal government from compelling state and local officials to enforce federal law. This constitutional limitation creates significant enforcement gaps in areas where federal agencies lack sufficient resources.

Unlike pharmaceutical regulation, where the Food and Drug Administration (FDA) can effectively monitor a relatively small number of manufacturers and distributors, marijuana prohibition requires extensive state and local police powers to investigate, arrest, and prosecute individual users and small-scale distributors. Regarding firearms, many, if not the majority, of firearm transfers happen between private individuals without background checks or federal firearms licenses (FFLs), and are not monitored by the federal government. The federal government can say that gun transfers to marijuana users are illegal among private individuals, but it cannot force a state to enforce that law, and the federal government lacks the personnel and resources to enforce the prohibition without state cooperation.

In these cases, there was no commandeering challenge. But it is notable that in the 10th Circuit case, Oklahoma was attempting to enforce federal law on recreational possession when the state does not enforce federal law for medical marijuana use. Florida has a similar arrangement with its marijuana laws. As states have increasingly legalized medical and recreational marijuana, they have withdrawn this crucial enforcement support. The Rohrabacher-Farr Amendment, referenced in the 11th Circuit’s decision, also explicitly prohibits the Department of Justice from using federal funds to interfere with state medical marijuana programs, further constraining federal enforcement capabilities.

A changing legal landscape

The combination of heightened constitutional scrutiny and practical enforcement limitations is creating a perfect storm for federal marijuana prohibition. Courts are demanding individualized proof of danger before stripping citizens of gun rights, while states are refusing to provide the enforcement mechanisms necessary for effective prohibition. The result is a patchwork system where federal law remains technically supreme but practically unenforceable in many jurisdictions.

These developments suggest that categorical federal restrictions on marijuana users’ constitutional rights are becoming increasingly untenable. As more circuits require individualized assessments and more states legalize marijuana, the gap between federal prohibition and practical reality will likely continue to widen, potentially forcing either legislative reform or executive action to resolve these fundamental tensions. However, gun owners should understand that, as of now, their guns will likely be confiscated if they are caught possessing marijuana.

The post An evolving legal landscape for marijuana and firearms appeared first on Reason Foundation.

Protecting children is essential, but reducing their future to a single toxicology report ignores the complexity of what’s truly at stake. One test cannot distinguish between untreated substance use disorder, medication-assisted recovery, or prescribed pain management. Each of these scenarios presents distinct risks, whether related to infant health, the impact of unnecessary family separation, or the consequences of inadequate treatment access, and should be addressed through appropriate, individualized responses.

While many state laws require hospitals to detain infants after a positive toxicology screen, there is often no requirement to conduct follow-up testing to verify the results. This is despite the fact that toxicology screens produce false positive results up to 50% of the time, lack context, and often reflect past use—not current use. Yet, they are often treated as the sole basis for governments to seize a mother’s newborn child.

A study done by Health Economics, a peer-reviewed journal focusing on the economic aspects of health and healthcare, shows that punitive policies, like those that define prenatal substance exposure as child maltreatment in child welfare statutes or as grounds for the termination of parental rights, were associated with a 10-18% increase in infants born with opioid withdrawal syndrome. When healthcare providers serve as part of a punitive system, it undermines trust for both the providers and patients and discourages families from seeking the support they need to remain stable, healthy, and safe.

In a 2019 University of Arizona survey, 35% of people who use drugs said they avoided needed healthcare over fears of being mistreated by medical providers because of their drug use, something nearly all of them said they’d experienced before. When pregnant mothers avoid this care, both maternal and infant health outcomes suffer.

Decades of public health evidence show New Mexico’s new mandate is a superficial fix that undermines effective, long-term solutions. Other states are seeking more effective answers. Nine states have adopted the Sobriety Treatment and Recovery Teams (START) model, which serves families in the child welfare system where a parent has been diagnosed with a substance use disorder. Families are enrolled within two weeks of a child welfare report and paired with a child welfare caseworker and a family peer mentor to guide long-term recovery. These professionals work as a team to coordinate care.

START Services include rapid connection to treatment, intensive recovery support, parenting and life-skills coaching, targeted case management, and counseling for parents, children, and other family members—all while keeping the family involved in decision-making. Evidence shows that START not only reduces child maltreatment and foster care placements but also strengthens parenting capacity. In Ohio, parents in START reported significant improvements in appropriate expectations for their children, healthier family role boundaries, and greater support for children’s independence. In interviews, parents described being more present, engaging in daily activities with their children, maintaining steady employment, and managing stress more effectively.

Nationally, more than 75 percent of children in START remain safely with their parents or reunify by program completion, mothers are nearly twice as likely to achieve sobriety compared to those in traditional services, and the model has roughly halved taxpayer expense overall by reducing foster care costs.

Similarly, the Native American Connections’ Patina Wellness Center in Phoenix, Arizona, is a culturally grounded residential treatment facility for pregnant and parenting women with substance use disorders. It incorporates core principles of the START model, with Indigenous healing practices, placing strong emphasis on the parent–child relationship throughout recovery. Their model achieves remarkable engagement, with 92 percent of participants completing treatment. Crucially, the model fosters lasting recovery, with 67 percent of pregnant and parenting women remaining substance-free six months post-treatment, rising to 75 percent at the 12-month mark.

Lasting progress will come from legislation that embeds family-centered recovery initiatives into state law. Such a framework would protect maternal autonomy by requiring informed consent for drug testing, prohibiting automatic removal of newborns based solely on toxicology results, and ensuring access to services like medication-assisted treatment, peer mentoring, and parenting support. When tied to proven models—such as START, which prioritizes family preservation, or residential programs like the Patina Wellness Center—these protections translate into higher treatment engagement, fewer foster care placements, and long-term cost savings while upholding individuals’ fundamental rights and dignity. This should be the way forward for New Mexico.

The post Why New Mexico’s newborn state custody directive is a harmful misstep appeared first on Reason Foundation.

• The Trump administration’s psychedelics push
• Arizona’s ibogaine funding law
• Gov. Perry’s op-ed offering support for ibogaine

The Trump administration’s push for psychedelics

During a House Energy and Commerce Committee hearing, Secretary of Health and Human Services (HHS) Robert F. Kennedy Jr. said that he hopes that a psychedelic pharmaceutical is approved within the next 12 months. However, he did not specify which drug or how the Food and Drug Administration (FDA) would make this determination. “This line of therapeutics has tremendous advantage if given in a clinical setting, and we are working very hard to make sure that happens within 12 months,” RKF Jr. said.

“These are all very promising signs that the administration is aware of the potential of psychedelics and is trying to make overtures that they’re ready to approve them,” Reason Foundation’s Greg Ferenstein told the Associated Press.

HHS also made a key new hire who could help spur positive reforms. Mike Davis, who previously served as chief medical officer of the psychedelics research organization Usona Institute, is now the deputy director of the FDA’s Center for Drug Evaluation and Research, which evaluates drug applications and reviews standards for clinical trials.

Arizona funds ibogaine

The psychedelic compound ibogaine is a promising potential treatment for opioid addiction and brain disorders. Arizona lawmakers recently budgeted $5 million toward a public-private partnership that will perform clinical trials to determine the safety and efficacy of the treatment. Arizona becomes the second state, following Texas, to allocate funding for this purpose. “Arizona is showing the nation how to solve real problems by putting cutting-edge science first,” former U.S. Senator Krysten Sinema told Reason Foundation about the program. For more on Arizona and other developments, visit our most recent state psychedelics legalization and policy roundup.

Former Texas Gov. Rick Perry supports psychedelics

Former Texas Gov. Rick Perry penned an op-ed in The Washington Post about his commitment to advancing ibogaine as a treatment. Perry concludes the op-ed with a personal note:

“I traveled to see ibogaine clinics in Mexico myself. I met the doctors and researchers. I listened to the patients. I studied the clinical data. I don’t care if you’re a Republican or a Democrat. Every one of us knows someone who’s struggling, whether with addiction, trauma or mental health. This is the cause I will dedicate the rest of my life to fighting for, because too many lives hang in the balance to do anything less.”

Perry’s column links to recent Reason Foundation research by Madison Carlino examining the potential for psychedelics to allay the symptoms of neurodegenerative diseases like Alzheimer’s. Perry has co-founded a new nonprofit, Americans for Ibogaine, to pursue his advocacy.

The post Psychedelics Policy Newsletter: RFK Jr. gives hopeful approval timeline, Arizona advances ibogaine, and more appeared first on Reason Foundation.

Arizona

House Bill 2871 by state Rep. Justin Wilmeth (R-Phoenix), which would have allocated funding to ibogaine research, was folded into the state’s general appropriations bill and signed by the governor on June 27th. Reason Foundation has published an analysis on why Arizona’s joining Texas to fund ibogaine clinical trials marks an important step in the momentum to gain federal approval for the drug.

Senate Bill 1555 by state Sen. T.J. Shope (R-16) will legalize a pharmaceutical version of synthetic psilocybin at the state level if approved by the Food and Drug Administration (FDA). The bill passed on June 26th. The bill, as originally written, would have authorized a market for state-regulated psilocybin-assisted therapy, but was heavily amended.

Colorado

Colorado regulators are reportedly considering therapeutic use of iboga within the state’s regulated psychedelics program. Colorado would be the first state to offer legal iboga services. Under Proposition 122, a ballot initiative that created a regulated market for psilocybin therapy, the state can consider other botanical psychedelics. The Colorado Natural Medicines Advisory Board must first determine how to manage potential safety concerns and how licensees would be able to produce the compound.

Louisiana

Senate Resolution 186 from state Sen. Patrick McMath (R-11) would create a task force to study the use of psychedelics for veterans.

Massachusetts

H1858 (previously House Docket 188) from state Rep. Marc Lombardo (R-22nd Middlesex) would reduce the penalties for possession of psilocybin. It would impose a $100 fine for possession of less than one gram.

H1726 (previously House Docket 3895), from state Rep. Homar Gómez (D-2nd Hampshire), would direct courts to dismiss any arrest for possession of psilocybin by adults over 21 as long as their actions had no visible defects to the health or safety of another person.  

H1624 (previously House Docket 4243) from state Rep. Mike Connolly (D-26th Middlesex) would create a psychedelics task force to study equity in psychedelic access.

All three bills received a joint session hearing on July 15th, 2025, but show no indication yet of next steps.

Michigan

House Bill 4686 from state Rep. Mike McFall (D-14) would effectively legalize the possession of psilocybin for Michiganders diagnosed with post-traumatic stress disorder. The bill does not create an affirmative legalization of psilocybin but exempts possession for treatment of PTSD from state law relating to the prohibition of illicit substances.

Mississippi

Mississippi lawmakers will hold an informational hearing about ibogaine on August 28. Reason Foundation research director Geoffrey Lawrence is expected to testify. Bryan Hubbard, CEO of Americans for Ibogaine, is also set to testify.

Oregon

House Bill 3817 (multiple sponsors) would have authorized the Oregon Health Authority to study the use of ibogaine for a range of mental health issues, such as anxiety. It failed to pass before the legislature adjourned.

The post State psychedelics legalization and policy roundup — August 2025 appeared first on Reason Foundation.