Two legal paths to psilocybin, different speeds
Oregon's program has served 16,000 people. The VA trial enrolled its first veteran weeks ago.
THE DISPATCH
In 2026, a patient can walk into a licensed service center in Oregon or Colorado and receive supervised psilocybin without a prescription, diagnosis, or referral.¹ ² In June 2026, the VA enrolled its first veteran into a federally sponsored, multi-site trial evaluating psilocybin for treatment-resistant depression, the first study of its kind inside the VA system.³ Two legal routes to the same compound are now open in the United States, and they move at very different speeds. The institutions are in. The question now is whether access will keep pace with the evidence.
In this issue:
→ What's actually available to patients today in Oregon and Colorado, and what it doesn't include
→ Why 16,000 people served in one state hasn't yet translated into insurance-covered, VA-connected access
→ A new ibogaine research pilot in Colorado, the VA's first enrolled veteran, and where Oregon's three-year safety record stands
THE SCIENCE
Two distinct legal pathways to therapeutic psilocybin now exist in the United States, and they are not the same thing. Oregon's Psilocybin Services Program, established under Measure 109 and serving clients since summer 2023, allows adults 21 and older to receive supervised psilocybin sessions at licensed service centers without a prescription, diagnosis, or referral.¹ As of early 2026, 23 of the state's 35 licensed service centers are operating, supported by nearly 400 licensed facilitators, and have served approximately 16,000 clients.¹ Colorado's Natural Medicine Health Act, passed in 2022 and issuing its first healing center licenses since April 2025, runs a parallel model with one structural difference: facilitators can be licensed either as general facilitators, or, for those already trained as medical or mental health providers, as clinical facilitators.²
Neither program is a clinical pathway in the sense this newsletter usually covers. Both operate outside insurance, outside a diagnosis-and-treatment framework, and outside FDA authority, because they rely on natural psilocybin under state law rather than the synthetic psilocybin (COMP360) moving through federal trials.⁴ A patient with treatment-resistant depression or PTSD can access supervised psilocybin in Oregon or Colorado today, but pays out of pocket, and the session doesn't connect to their broader medical record, their VA care team, or any insurance-backed follow-up. For the veterans this newsletter's clinician readers treat most often, that gap matters because the population most likely to benefit is also among the least likely to have several thousand dollars in discretionary income for an out-of-pocket session.
The VA's own answer to that gap began enrolling patients on June 1, 2026. A new multi-site, double-blind randomized controlled trial, sponsored by the VA Office of Research and Development, started evaluating psilocybin for treatment-resistant depression, with and without co-occurring PTSD, across nine VA facilities including Portland, Oregon, the same state where the adult-use program has already served 16,000 people.³ The study is expected to run for multiple years before its results could support any change in VA treatment policy.
The distance between what's already legal to access and what's actually reimbursed and clinically integrated is the story worth sitting with this week.
THE STORY
Since summer 2023, Oregon's licensed psilocybin service centers have served close to 16,000 clients with an adverse event rate of roughly 0.15 percent, none requiring hospitalization.¹ That's a real, multi-year safety record, generated entirely outside a clinical trial setting.
That data hasn't yet translated into anything a VA provider can act on. A veteran enrolled in VA care today cannot have a psilocybin session at an Oregon service center covered, referred, or documented as part of their treatment plan. The VA's own research track, evaluating the same compound, enrolled its first participant in June 2026, a new and separate pathway moving on its own federal timeline rather than an extension of what Oregon and Colorado have already built.³
Nine VA facilities are now actively recruiting for that trial. It's the first time this compound has entered the VA's own research infrastructure directly, not adjacent to it, and that's the piece of this story actually moving forward.
Rose Hill Life Sciences is a psychedelic research organization – specializing in the production and research of Psilocybe cubensis operating at the intersection of science and therapeutic integration.
ON OUR RADAR
① Colorado's New Ibogaine Research Pilot On May 12, 2026, the Colorado legislature passed House Bill 26-1325, establishing the state's first ibogaine research pilot program within its Behavioral Health Administration, authorizing up to five research sites integrated into the state's existing Natural Medicine regulatory structure.⁵ Separately, state law set a June 1, 2026 deadline for regulators to decide whether ibogaine, DMT, and mescaline should join psilocybin in Colorado's broader therapeutic program. We could not independently confirm the outcome of that specific decision as of this writing and will follow up once confirmed.⁶
② VA Enrolls First Veteran in Psilocybin RCT The VA Office of Research and Development's multi-site trial evaluating psilocybin for treatment-resistant depression in veterans, with and without co-occurring PTSD, enrolled its first participant on June 1, 2026, across nine VA facilities nationwide.³ The design uses two dosing sessions one month apart: the first under blinded, randomized dosing, the second an open 25 mg dose for all participants.³
③ Oregon's Three-Year Track Record As of early 2026, Oregon's psilocybin service center program, operating since summer 2023, has served nearly 16,000 clients through 23 of its 35 licensed centers, generating $1.7 million in program revenue with an adverse event rate of roughly 0.15 percent and no reported hospitalizations.¹ It remains the largest real-world safety dataset for supervised psilocybin use outside a clinical trial anywhere in the country.
YOU ASKED
Q: “A patient asked me why they can legally get psilocybin therapy at a wellness center in Oregon, but their VA doctor can’t prescribe or refer them anywhere. What do I tell them?”
Tell them the honest answer: those are two different legal systems, not two speeds of the same one. Oregon’s program operates under state adult-use law, entirely outside FDA approval, insurance, and the VA’s own clinical authority, so a VA provider legally cannot refer, document, or coordinate care around a session that happens there. What is changing is that the VA has now opened its own trial testing the same compound, using its own protocols, at nine of its own facilities, which is the pathway that could eventually let a VA provider prescribe, refer, and bill for it directly. Until that trial produces results the VA can act on, state-legal access and VA-connected care remain two separate tracks that happen to point at the same compound.
This week's takeaway: supervised, legal psilocybin access already exists in Oregon and Colorado, and it hasn't yet translated into anything a VA provider can prescribe, refer to, or bill for. The VA's own trial, evaluating the same compound at nine of its facilities, enrolled its first veteran this year, the start of the pathway that could close that gap.
A question worth sitting with: if a state-run program has already produced three years of real-world safety data, what should that dataset be allowed to count for in a VA or FDA decision, and what should it not?
There is a growing need to educate clinicians about psilocybin and its potential therapeutic applications, including appropriate patient selection, safety considerations, and clinical integration; a useful primer for primary care clinicians is provided by Tabaac et al., who offer an evidence-informed overview of psilocybin for physicians seeking to better understand this emerging field (Tabaac BJ, Shinozuka K, Arenas A, et al. Psychedelic Therapy: A Primer for Primary Care Clinicians—Psilocybin. Am J Ther. 2024;31(2). doi:10.1097/MJT.0000000000001724; PMID:38518269).
Read the VA trial directly: ClinicalTrials.gov — Psilocybin Intervention for Veterans Overcoming Treatment-Resistant Depression (NCT07226232)
If a patient has asked you about psilocybin and you weren't sure where to point them, this is the source. Forward it to one colleague fielding the same question.
— Burton Tabaac
MD, Neurologist and Psychedelic Researcher
Advancing the development of novel psychedelic-based therapeutics
FOOTNOTES
¹ Oregon Health Authority / OregonPsychedelics.org. "Oregon Psilocybin Services Licenses and Permits 2026." https://oregonpsychedelics.org/psilocybin-licenses | Oregon Health Authority, Oregon Psilocybin Services: https://www.oregon.gov/oha/ph/preventionwellness/pages/oregon-psilocybin-services.aspx
² Vicente LLP. "The Ultimate Guide to Colorado's Natural Medicine Health Act (SB23-290 Psychedelics Law)." https://vicentellp.com/insights/ultimate-guide-to-sb23290-colorado-natural-medicine-psychedelics-regulation-and-legalization-bill/
³ ClinicalTrials.gov. "Psilocybin Intervention for Veterans Overcoming Treatment-Resistant Depression." NCT07226232. https://clinicaltrials.gov/study/NCT07226232
⁴ Compass Pathways. "Compass Pathways Successfully Achieves Primary Endpoint in Second Phase 3 Trial Evaluating COMP360 Psilocybin for Treatment-Resistant Depression." February 17, 2026. https://ir.compasspathways.com/News--Events-/news/news-details/2026/Compass-Pathways-Successfully-Achieves-Primary-Endpoint-in-Second-Phase-3-Trial-Evaluating-COMP360-Psilocybin-for-Treatment-Resistant-Depression/default.aspx
⁵ Vicente LLP. "Colorado Legislature Passes Landmark Ibogaine Research Bill, Expanding the State's Natural Medicine Framework." May 2026. https://vicentellp.com/press/colorado-legislature-passes-landmark-ibogaine-research-bill,-expanding-the-states-natural-medicine-framework/
⁶ Axios Denver. "Psychedelic therapy program considers expanding options." February 3, 2026. https://www.axios.com/local/denver/2026/02/03/psychedelic-therapy-expands-natural-medicine-options
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