Should some hallucinogenic drugs be legalized for use in Massachusetts? That is what Question 4 asks Bay State voters to decide.
If approved, the measure would allow five psychedelics — psilocybin, psilocyn, mescaline, dimethyltryptamine (also known as DMT, the psychoactive ingredient in the drug ayahuasca) and ibogaine — to be grown, shared, used at home and offered by licensed professionals in a clinical setting. It would also create a commission to regulate those substances.
Advocates say those drugs have shown promise in clinical research trials for folks battling everything from opioid use disorder to mental health conditions.
But the psychedelics are also associated with some substantial harms.
Psilocybin and mescaline may trigger adverse reactions for those with pre-existing mental health issues. Ibogaine can cause heart problems. DMT may have lasting neurological effects on people who take it.
Veterans have actively campaigned for legalization of these psychedelics as a critical mental health treatment option, particularly when other medications and therapies are ineffective.
Mike Botelho, a Somerville native and Gulf War veteran, is not actively campaign for Question 4. But he tells NBC10 Boston that psilocybin had a transformative effect on his mental health as he struggled with PTSD and other ailments following his military service.
"Once I tried it, I couldn't believe it. I had this moment of clarity, like that I must be onto something," Botelho said. "Really, it is like a moment of clarity when you when you do this, but it is something that sticks with you. It is not just the moment. The clarity stays with you."
Dr. Roxanne Sholevar is a psychiatrist working in private practice. She is in favor of Question 4, having worked on studies looking at psilocybin assisted therapy for patients with cancer.
Sholevar supports supervised use of psychedelics, where people who take them would be monitored by a trained facilitator. She believes legalization would help people feel more comfortable discussing their experiences with their doctors.
"Should something like this pass, it would offer two opportunities that I don't think are currently available," Sholevar told NBC10 Boston. "The first would be supervised public access use so that people could go and use a psychedelic compound in a space where they are monitored by trained facilitators. We will have an opportunity to define who those people are, what competencies they need to do the job correctly, and undergo screening to rule out medical issues that might make the use of psychedelics dangerous for them. Such a thing does not exist, so people are left to kind of decide on their own if they want to do it underground with unlicensed facilitators without screening, which is really dangerous."
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She says that public interest is another reason she is motivated.
"Now that psychedelics are becoming so much more popular, I have so many patients asking me, 'Where can I get it? How should I take it safely?'" she said. "But because these substances are illegal and have the significant criminal penalties, both patients and providers like myself are quite limited in how free we can be to not necessarily recommend, but to talk about what it means to do something like this. The good thing about Question 4 is that it brings these things above ground so they can be talked about in the light."
Dr. Nassir Ghaemi, president of the Massachusetts Psychiatric Society, is against the ballot measure.
"The psychiatrists and physicians in this state, the majority who oppose this question, don't oppose it because of possible medical benefits. We oppose it because it's for-profit legalization, which would harm the public health," Ghaemi said. "There could be medical and psychiatric benefits, which we would support. But we think, as with any drug, that should be proven with scientific studies. And then we would provide those medications safely to patients through the medical system."
Ghaemi says he worries that legalizing these drugs could have dangerous ramifications.
"One of my patients was a young lady in her early 20s who took ayahuasca," he said. "She got very severely depressed, psychotic, delusional hallucinations, hospitalized for six months. She became catatonic, which means she could not talk, move, eat, or drink, had to get a feeding tube, and eventually improved with electroshock treatment."
There will be no retail stores to buy mushrooms like there are for cannabis. Anyone older would be allowed to grow, possess, and use the substance. They could grow the substances in a 12-foot by 12-foot area at home, consume them without supervision, and give away small amounts to friends and family members ages 21 and older.
Personal use would begin in December. Rules allowing therapeutic centers to provide at least one drug would be in place by April 2026, and complete regulations for therapeutic centers to provide all named psychedelics would be ready by April 2028.
Click here to see more information about all five questions on the ballot in Massachusetts.
