Rhode Island lawmakers are advancing a bill to decriminalize psilocybin mushrooms and create rules for using them in medical treatment. It could see Rhode Island become the latest state, after Oregon and Colorado, to take steps like these. But creating a medical option for the drug doesn’t ensure that anyone who wants treatment can get it.
On June 12, the Rhode Island House of Representatives approved House Bill 5923A in an overwhelming vote of 54-11. Two of the nine Republicans broke ranks to join Democrats in support, while four Democrats joined the other Republicans in opposition. The bill now heads to the Senate, where it must also pass a full vote before reaching the governor’s desk.
“Adults in our state deserve the freedom to decide for themselves and have access to every treatment possible, rather than have our state criminalize a natural, non-addictive, effective remedy,” said Rep. Brandon Potter (D), the bill’s sponsor in the House, in a press release. Senator Meghan Kallman (D) is sponsoring the Senate version.
The bill first decriminalizes psilocybin possession of up to 28 grams (about 1 ounce). It also allows individuals to share psilocybin with others, without payment, and to grow the mushrooms at home.
Secondly, it begins the process for offering psilocybin as a medical treatment. If the Food and Drug Administration (FDA) approves psilocybin as a treatment for mental health disorders, Rhode Island will create rules around producing, prescribing and selling the drug to patients.
This is more than just wishful thinking. Right now, clinical trials studying psilocybin for depression are entering the final stages. COMPASS Pathways, based in the UK, has now begun Phase 3 trials of psilocybin for treatment-resistant depression. The research is ongoing for the next few years, and the company predicts it will be able to apply for FDA review of the drug in 2025. Meanwhile, a separate research group, the Usona Institute, is in Phase 2 of investigating psilocybin for major depressive disorder.
In theory, a very limited number of people could begin receiving psilocybin treatment in Rhode Island this year if the bill passes.
If signed into law, the Rhode Island bill would take effect on July 1. But all of its provisions would “sunset” after July 1, 2025. The state’s attorney general and health director would be required to file a report to the House and Senate investigating how many psilocybin arrests were made after enactment, as well as the results of medical psilocybin treatment.
Despite the progress of trials, it is highly unlikely that the FDA will actually approve psilocybin before the sunset clause kicks in. But the agency has a second option that could make treatment a reality in Rhode Island and elsewhere: expanded access. For people suffering a life-threatening illness, the FDA can choose to allow patients to receive a drug that isn’t yet approved, but which has some evidence behind it. So in theory, a very limited number of people could begin receiving psilocybin treatment in Rhode Island this year if the bill passes—under strict circumstances. If so, Rhode Island’s health department will provide psilocybin for eligible patients.
The bill has some serious limitations. Of course, decriminalization will prevent some arrests and jail time, but people could still be harshly penalized if they’re above the legal possession limits. Decriminalization will at least allow people to grow and use mushrooms freely, but ideally, the bill would also include protections for group and community psilocybin use.
Further shortcomings concern equal access to psilocybin therapy. Even if the FDA approved psilocybin tomorrow, treatment would still be restricted to patients with a doctor’s prescription. That shuts out anyone who is uninsured and can’t afford to see a doctor out-of-pocket—and even for those with access to doctors, it’s not guaranteed that insurers would cover the full cost of this therapy yet. Because psilocybin therapy for depression involves many hours of therapists’ time, it’s likely to cost in the range of several thousand dollars.
Both Oregon and Colorado have voted in favor of legalizing psilocybin or other psychedelics for healing purposes (and Colorado decriminalized possession of these drugs, while Oregon has decriminalized low-level possession of all drugs). The major difference with Rhode Island is that those states opted for a supervised but non-medical approach, where clients can visit a service center and use psilocybin while being monitored for any adverse effects. No medical diagnosis is required, and the trained staff facilitating use don’t need to be doctors or nurses. It’s a model that theoretically allows broader access—although in Oregon, which is furthest in rolling it out, associated red tape ensures that costs are high enough to exclude many people.
Rhode Island has been a national leader in other areas of drug policy reform. In 2021, it became the first state to approve a pilot safe consumption sites program program to prevent overdose deaths. Last year it also legalized adult-use cannabis, and the state government has already expunged over 23,000 marijuana possession convictions.
Photograph via Washington Senate Democrats