Psychedelics enter the spotlight across Massachusetts on Election Day, as voters are set to weigh in on whether to allow people 21 and older to grow, possess and use certain natural psychedelic substances.

Question 4 is arguably the most competitive initiative on the Nov. 5 ballot, with latest statewide polling showing a deadlock at 46% each between “yes” and “no” voters. 

If supported by voters, the question would introduce not only decriminalization of psychedelics, but lay a regulatory foundation for monitored “trips” to be carried out by licensed professionals, possibly ushering a new chapter of psychedelic regulation in Massachusetts.

In addition to decriminalizing psychedelics, a “yes” vote on Question 4 would introduce regulation of certain substances and establish a host of other rules governing its future legal use; a “no” vote would keep current regulations in place.

Advocates cite the mental health benefits that have yet to be exploited, particularly for people who suffer from post-traumatic stress disorder, anxiety and depression. Even if not opposed to psychedelic substances, some “no” voters express concern over the expansive access voting “yes” would allow – while at the same time not adequately ensuring access for the people who need it most.

If voted in, “commercial activity” or retail sales of psychedelics will not be permitted as for marijuana and alcohol. In other words, there will not be “psychedelic dispensaries.” 

Instead, the measure would begin a process of regulating licensed locations where people can buy the substances and be supervised by trained personnel (under federal law, doctors and nurses would remain unable to supervise). The products sold at these locations would be subject to state sales tax as well as a 15% excise tax.

Home growing in spaces of up to 144 square feet, which must be secured from those under the age of 21, would be made legal. While substances produced in these spaces cannot be sold, they can be gifted to of age family or friends for unregulated consumption.

Those who have in the past been charged with offenses related to psychedelic possession or abuse will not have their records expunged, however.

Five types of the hallucinogenic fungi would be legally permitted under the measure: psilocybin and psilocin found in mushrooms, and dimethyltryptamine (DMT), ibogaine and mescaline found in plants.

Additionally, the proposed law calls for the formation of a five-member Natural Psychedelic Substances Commission that would administer the law governing the use and distribution of psychedelic substances, and for the creation of a 20-member advisory board to study and make recommendations to the commission on the regulation and taxation of these substances.

Psychedelics – often referred to as entheogenic plants or magic mushrooms – are often characterized by their hallucinogenic effects and spiritual experiences. Humans have ingested them for centuries, and some have even attributed them to the beginnings of human consciousness.

Pushes for legalization have come after new studies were published in 2023 by the U.S. Food and Drug Administration (FDA), laying out guidelines for research of hallucinogenic healing, although the drugs remain illegal at the federal level.

To date, seven municipalities in Massachusetts have decriminalized psychedelics, including Northampton and Easthampton, calling psychedelic offenses a “low priority” for enforcement. If Question 4 passes, Massachusetts would join Oregon and Colorado to legalize certain psychedelics.

Washington, D.C.-based nonprofit New Approach PAC has raised $6.1 million for its Massachusetts for Mental Health Options campaign in support of Question 4, according to the Massachusetts Office of Campaign and Political Finance. Large donations are coming from out-of-state donors.

New Approach also funded the psychedelic ballot questions in both Oregon and Colorado, and contributed $4.35 million in 2016 toward the ballot question that legalized marijuana in Massachusetts.

The opposing committee, Coalition for Safe Communities, has raised $100,000 in donations in the last week, but otherwise had not reported donations to the Office of Campaign and Political Finance. Chris Keohan, spokesperson for the coalition, said that “no” voters had not been motivated, assuming Question 4 would not pass, until recent polling that showed a split electorate. He said the money is funding commercials and digital advertisements, set to begin airing this week.

‘Vote yes’

Massachusetts for Mental Health Options, a group of medical professionals, advocates and military veterans, argues that plant-based medicinal choices are among the most effective forms of medical treatment available and that it is a matter of health care, which has led the organization to campaign in support of Question 4.

“The mental health crisis is everywhere around us, and our current treatment options are limited and are often not helpful to veterans with PTSD, first responders who have experienced trauma, and individuals battling anxiety and depression,” said Emily Oneschuk, campaign director for Massachusetts for Mental Health Options and a U.S. Navy veteran. She calls psychedelic care “nothing short of transformative.”

While many of those opposed to the measure have argued that the ballot question allows too much liberty surrounding psychedelic substances, state Rep. Lindsay Sabadosa, D-Northampton, and other state politicians, argue that since more than 5.5 million Americans use the substances regularly, the ballot measure would in fact place guardrails where there have not been any up to this point.

Sabadosa, who previously filed a bill seeking to decriminalize psychedelics, said she became active in the cause toward legalization after a constituent successfully used the substances to improve their mental health. Like Oneschuk, Sabadosa cites the need for those suffering from acute mental disorders, including depression, anxiety and PTSD, as deserving of this new step in medicine, and specifically mentions the benefits it would provide to veterans suffering from traumatic memories.

Steven Connor, director of the Central Hampshire Veterans Services’ District based in Northampton, has seen the positive impacts of hallucinogens on those suffering from PTSD. As a veteran who himself suffers from the effects of PTSD, he is open-minded toward psychedelic treatment, and said that many of his peers have greatly benefited from hallucinogenic care. Treatments using the substances “don’t work for everybody, like anything else,” but he said that for those suffering from acute PTSD symptoms, psychedelics are “another tool in the tool kit.”

Sabadosa said decriminalizing psychedelics would mean that “individuals will not need to hide their care from health care professionals,” citing this as one of the “most compelling” reasons to vote in favor of the ballot question.

“A ‘no’ vote tells the state Legislature that they are not interested in participating” in federal research and a newfound openness to legalizing the drugs, and instead prefer the “status quo,” she said.

‘Vote no’

Opponents to the measure cite extensive dangers with the way the question is written, and are concerned about the massive liberties – seen as genuine threats to public health and safety – introduced by the question. They are not arguing against legalizing psychedelics or challenging the medicinal benefits for the people who need help.

Among the liberties of most concern are a lack of professional oversight, the amount of space allowed for unregulated cultivation and the potential proximity of the substances to children.

The Massachusetts Psychiatric Society, which includes 15,000 psychiatric professionals in the state, worries that the regulations set forth in Question 4 are imprudent.

Dr. Nassir Ghaemi, president of the Massachusetts Psychiatric Society and a professor of psychiatry at Tufts University, said it is a “fantasy” to believe psychedelics would alleviate the mental health crisis. At best, he said, the substances have been proven to treat psychiatric disorders with the same efficacy as treatments currently available.

Ghaemi said MDMA, most commonly known as ecstasy, has been proven to assist with PTSD symptoms yet it is not among the drugs included in the legislation. He added that the legal limits of psilocybin that would be allowed are too low to induce anything other than offering participants a placebo effect. Meanwhile, ibogaine, which the question would allow, has a well-known history of causing heart issues.

“No” voters also say the 160 hours of professional training by staff in licensed psychedelic clinics that would be required in the new law is too low. Keohan said tattoo artists have more mandated requirements.

Ghaemi shared that in Oregon thus far, high school graduates have done online courses to enter the industry, and that here in Massachusetts, that would mean the licensed psychedelic industry would be led by “high school graduates supervised by a control commission,” and not even a licensed medical board.

Doctors are not allowed to distribute federally banned substances, and as a result, would be barred from positions supervising psychedelic trips.

Keohan describes the question as “poorly written,” noting that with an 18-24 month legislative period anticipated before licensed facilities would be opened, people would be left to their own devices for up to a year. That period “means 18-24 months of self-medicating” he said.

Opponents also warn that the costs for legal psychedelics would be steep, pointing to what’s happened in Oregon and Colorado after the substances were legalized. It has been reported in Oregon, for example, that the psychedelic industry is facing financial threats, as clinical settings are often priced between $1,000 and $3,000.

“These are for-profit facilities,” Keohan said.

Because of the prices, “The people in most desperate need (with cancer, schizophrenia, etc.), the people they talk about helping, are exponentially more likely for a bad trip.”

Speaking about the ability for home growing a bedroom’s worth of psychedelics, Keohan claims “there is no medicine involved there.”

“A grow kit is the size of a Ziploc bag,” he said, mentioning the almost inevitable outgrowth of a gray market. He also warns that a locked cultivation space would inevitably become as tempting to teens as a locked alcohol cabinet, posing health and safety risks to underage individuals.

Keohan also opposes the measure since, unlike marijuana, there is no opt-out clause for communities if they disagree with the measure. Marijuana retail and cultivation in the state requires community backing, for instance through host community agreements, and are subject to the demands of local voters. Keohan opposes the question because, he said, it forbids a host community agreement to even occur, and would entail statewide legalization.

If problems do arise, said Ghaemi, it would inevitably be the doctors and medical professionals who would be left with the responsibility and duty to address increases in vehicular fatalities, mental health complications and other adverse, unintended consequences.

Samuel Gelinas can be reached at sgelinas@gazettenet.com.