For hundreds of years, psychedelic drugs have been praised for their medicinal benefits and mind-altering effects. Known also as hallucinogenic, these substances are deeply rooted in many cultures and practices. Plant-based psychedelics like peyote and ayahuasca play significant roles in religious and spiritual rituals among indigenous communities and are now also sought after by tourists for these experiences. Widely recognized psychedelics today include lysergic acid diethylamide (LSD), ketamine, psilocybin mushrooms, dimethyltryptamine (DMT), and MDMA. Many of these substances are now being reconsidered in modern medicine for their potential therapeutic uses.  

The potential therapeutic use of psychedelics first gained attention in the 1950s when researchers began exploring their effects on patients with psychiatric conditions through psychotherapy. However, this promising research abruptly ceased when psychedelics were prohibited in 1966. The classification of LSD and psilocybin as Schedule 1 drugs under President Nixon in 1970 further hindered scientific exploration, casting these substances as dangerous and devoid of medicinal value. This period significantly influenced public perception and slowed the advancement of psychedelic research. 

The potential for medicinal uses of psychedelics reemerged at the forefront of medical research in the mid-90s, including clinical studies that laid the psychopharmacological foundation for clinical studies involving psychedelic use in humans. Later trials evaluated psychedelics for obsessive compulsive disorder, post-traumatic stress disorder (PTSD), major depressive disorder, and substance use disorders. Many of these trials found positive results in patients, highlighting the potential for alternative treatments.  

As marijuana and CBD have gained mainstream attraction for their medicinal uses, research has pushed for further exploration of how certain drugs can improve quality of life. In 2019, the FDA granted approval of a ketamine-based treatment for depression. The use of ketamine and other hallucinogenics as treatment for patients struggling with their mental health has once again gained media attention based on both anecdotal and research-based positive results. Specifically, psychedelics as a treatment for individuals with PTSD has shown great promise.  

The mechanisms by which psychedelics enhance mental health remain largely speculative. Current hypotheses suggest that these substances may boost neuroplasticity—the brain's ability to form and reorganize synaptic connections—thereby improving cognitive and emotional patterns. Users often report profound shifts in self-perception and life outlook. However, these potential benefits come with significant risks, particularly when psychedelics are used without medical supervision. Adverse effects can include emotional disturbances such as mania or severe depression, underscoring the necessity for controlled, therapeutic use. 

The cost and accessibility of these emerging psychedelic treatments remain barriers to care for many patients. The road to coverage for psychedelic therapy is complicated, and the blurred lines of legality add to the challenge. Spravato, a nasal spray form of ketamine, is the only FDA approved psychedelic treatment for mental illness. The spray is covered by some insurers and could cost anywhere from $18,000-$45,000 out-of-pocket annually. Ketamine infusions are still considered off-label, and insurance coverage for this form of treatment is sparse.  

Hopefully, research of psychedelics in the field of mental health continues to flourish. The potential uses and mechanisms of these drugs are largely unknown, and research can reveal the efficacy and safety in different populations. Additionally, ethical and legal concerns about these drugs have been brought to the surface, emphasizing the need for open communication between clinicians, payors, and patients. 

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