CO and OR have decriminalized and allow adult psilocybin use, NM allows medical use only.
In CO and OR, psilocybin use increased by 2% in the year following decriminalization.
Long term safety data is not available because psilocybin programs are new and varied.
Psilocybin is a naturally occurring compound found in certain mushrooms that influences mood and perception (Holze et al. 2024). Under the Controlled Substances Act, psilocybin is listed as a Schedule I drug. Drugs classified as Schedule I have high abuse potential and no accepted medical use (Controlled Substances Act). However, clinical psilocybin research shows low abuse potential and promising results for treating post-traumatic stress disorder (PTSD) and treatment-resistance depression (Siegel et al. 2023). For more information, see the Science Notes Medical Psilocybin Use, First Responder Mental Health, and Natural Medicines for Trauma, Palliative Care, and Hospice Care Patients.
Decriminalization reduces or removes criminal penalties for personal use or possession of a substance (Siegel et al. 2023). In 2020 OR decriminalized psilocybin and created a licensed system for adult use in supervised sessions (Oregon Health Authority 2022). CO did the same in 2022 (Code of Colorado Regulations 2024). In 2025 NM allowed psilocybin access through a regulated medical program for patients with qualifying conditions such as PTSD or treatment-resistant depression (New Mexico Health 2025). The NM Department of Health is currently developing this program.
After decriminalization, psilocybin use among adults increased by 2% in both CO and OR compared to 0.4% in the rest of the country (Monte 2024). In OR and CO, observed use was higher than predicted use without decriminalization (Black et al. 2026, Figure 1). Nationally, poison control calls about hallucinogenic mushrooms, including psilocybin, increased more than any other psychedelic category, rising from 593 (12% of all psychedelic calls) out of 4,858 in 2012 to 1,440 (32%) of 4,555 calls in 2022 (Simon et al. 2024).
Figure 1. Psilocybin use in OR and CO before and after decriminalization. Each panel shows yearly psilocybin use (yellow) and predicted use without decriminalization (blue) in OR (panel A) and CO (panel B). The dotted line marks when each state’s law passed. Actual use rose above predicted use following decriminalization, especially in OR (Black et al. 2026).
In 2024, 32% of the 2,124 adults who used psychedelics in the past year traveled outside their home state to do so, with 14% of all adults who used psychedelics going to CO and 9% to OR (Black et al. 2025). Among those who traveled within the U.S., 58% reported at least one emergency department or urgent care visit linked to psychedelic use in the past year, compared to 9% of non-travelers. It is unclear whether these medical visits occur during travel or after returning. Travelers were also more likely than non-travelers to report using psychedelics to treat medical or mental health conditions at 23% compared to 18% of non-travelers (Black et al. 2025).
Evaluating overall public health and safety remains difficult because each state psilocybin program sets its own operational standards and data collection protocols (Siegel et al. 2023, Belouin et al. 2022). There is no shared system for tracking safety issues (Siegel et al. 2023).
Oregon focuses strictly on psilocybin, tracking licensed facilitators, lab testing, and medical emergencies during supervised sessions (Siegel et al. 2023). Colorado covers multiple natural psychedelics, tracking hospital exposure calls, impaired driving cases, and community health trends alongside supervised session use data (Schonholz et al. 2024). Because of this, it is not possible to compare outcomes or determine whether safety concerns in one state are also occurring elsewhere (Belouin et al. 2022). Programs are also too new to show long-term results. OR service centers are the country’s oldest state-regulated program and began accepting clients in 2023 (Siegel et al. 2023). CO programs began in 2025 (Code of Colorado Regulations 2024).
Psilocybin remains federally illegal (Controlled Substances Act). However, in April 2026 federal agencies were directed to fast-track review for psilocybin once the Food and Drug Administration (FDA) has approved it (Executive Order 14401 2026). The FDA had previously designated psilocybin a “Breakthrough Therapy” to accelerate research and clinical trials (Schonholz et al. 2024, Belouin et al. 2022). Despite this, no psilocybin treatment has been approved.
References
21 U.S.C. § 801 et seq. https://uscode.house.gov/view.xhtml?path=/prelim@title21/chapter13&edition=prelim
Belouin SJ, Averill LA, Henningfield JE, Xenakis SN, Donato I, et al. (2022) Policy Considerations that Support Equitable Access to Responsible, Accountable, Safe, and Ethical Uses of Psychedelic Medicines. Neuropharmacology 219: 109214. https://doi.org/10.1016/j.neuropharm.2022.109214
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New Mexico Health (n.d) Medical Psilocybin Program Frequently Asked Questions. https://www.nmhealth.org/publication/view/guide/9603/
New Mexico Health (2026) Medical Psilocybin Program. Department of Medical Psilocybin Program. https://www.nmhealth.org/about/mcpp/mpp/
New Mexico Statutes Annotated § 30-31-6 (2025). https://nmonesource.com/nmos/nmsa/en/item/4371/index.do#30-31-6
Oregon Health Authority (2022) Public Health Division – Chapter 333 Psilocybin. Oregon Secretary of State. https://secure.sos.state.or.us/oard/displayDivisionRules.action?selectedDivision=7102
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Executive Order 14401 (2026) Accelerating Medical Treatments for Serious Mental Illness. Federal Register 91(76):21709-21717. https://www.whitehouse.gov/presidential-actions/2026/04/accelerating-medical-treatments-for-serious-mental-illness/
