“It is important to expect nothing, to take every experience, including the negative ones, as merely steps on the path, and to proceed.” - Ram Dass
Mental health. It’s been an ever present topic in the runup to, and certainly after, the November 5th election. Even putting elections aside, it’s no secret that the country and the world are experiencing an ever-deepening mental health crisis. The US Surgeon General issued only five Official Advisories in the past two years on what it deems important public health issues – all relate to mental health, with four addressing it directly.
In Massachusetts, mental health was literally on the ballot this November, but in a rather novel way. Ballot Question 4 was poised to make Massachusetts only the third state to legalize the use of certain natural or “plant-based” Schedule I psychedelics (particularly psilocybin or “magic mushrooms”), whose proper scheduling has only recently been seriously questioned. According to the DEA, Schedule I substances are those “drugs with no currently accepted medical use and a high potential for abuse.” This initiative followed in the footsteps of Oregon (2020) and Colorado (2022), who had also been pioneers in the marijuana legalization movement. And yet, despite the Commonwealth’s own recreational marijuana legalization, 20 years of positive clinical results for psychedelic treatment for mental health conditions such as PTSD, increased public awareness and normalization (helped by Harvard professor Michael Pollan’s 2018 book How to Change Your Mind), and bipartisan support from scientific and veteran communities, Question 4 failed to pass by 14 percentage points.
This seemed like a good time to breathe, listen, and think about why Question 4 failed, where the psychedelic movement sits today, where it’s heading, and how HBS and the private sector can conceptualize engaging in the space.
The Path to Today
Psychedelics and their use for spiritual, curative, and everyday purposes can be traced back over 16,500 years to the precursors of American indigenous societies. From the Great Lakes down to Brazil, archeologists and researchers (such as Harvard’s own Osiris Sinuhé González Romero of the Center for the Study of World Religions) have found extensive evidence of the sacred and utilitarian place these substances have occupied in communities, like the Tiwanaku in the Southern Andes and the Mixtecs in Mexico. The substances helped foster interpersonal communion, and deepened connections to nature and to generations long passed. Despite Christian colonization, these traditional uses have persisted in many of the communities that originated psychedelic practices millenia ago.
The recent history is summarized best by Richard Doblin’s 2019 article, “The Past and Future of Psychedelic Science: An Introduction to This Issue.” Doblin writes, “Modern psychedelic research began when Albert Hofmann first synthesized lysergic acid diethylamide (LSD-25) in 1938…After a burgeoning period of scientific and cultural exploration in the 1950s and '60s, psychedelic research was slowed to a near halt.” Notably, Harvard professors Timothy Leary and Ram Dass played prominent roles advancing psychedelic research in its heyday. Doblin continues, “Throughout the 1970s and '80s governmental interventions severely hampered global psychedelic research, despite evidence of the limited medical risks and therapeutic potential of psychedelics. After decades of persistent education and advocacy, rigorous research employing psychedelics as tools of discovery and healing are abundant today.” For instance, Dr. Roland Griffith’s studies at Johns Hopkins provide strong evidence supporting effective psilocybin treatment for psychological distress, as well as efficacy for treating alcohol and tobacco addiction. “The research,” Doblin summarizes, “includes clinical trials with MDMA-assisted therapy for the treatment of PTSD, alcoholism, and social anxiety, and psilocybin clinical studies for depression and addiction, as well as the ability of psychedelics to catalyze spiritual or mystical experiences and inspire creativity, and into the neuroscientific understanding the [of the] effects of psychedelic substances on our nervous system.”
With profound potential public health benefits and seeming growing public support on its side, this election cycle New Approach PAC (the organization that spearheaded both Oregon and Colorado’s measures) set its sights on Massachusetts with Question 4. The measure would have created regulations for residents 21 and older to seek therapeutic use from licensed providers, as well as the ability to grow and consume certain psychedelics in small quantities. New Approach emphasized that, unlike cannabis, retail sale would be strictly prohibited. Their website verbalized commitments to prioritizing safety, credibility, as well as inclusion of indigenous communities as stewards of the traditional use of these substances.
On the other hand, NPR reported that, “Opponents, including several large medical associations, argued these drugs can be harmful, especially for people at risk for schizophrenia or psychosis. They also feared the law would fuel a black market of home-grown psychedelics.” Proponents would counter that the risks pale in comparison to the potential benefits (especially when compared to legal substances with much higher likelihood of addiction, like alcohol), with certain studies pointing to positive outcomes for some with psychotic disorders, and that a black market already exists for the Schedule I substances.
Lessons From the Path
Psychedelic regulation is not new to Massachusetts. Eight municipalities have already decriminalized psilocybin and related substances, including our friends over in Cambridge. And, as another positive indicator, the Commonwealth legalized recreational marijuana in 2016. How could this historically-progressive bastion, birthplace of the American Revolution, cradle of the modern psychedelic movement, and home of the world’s largest library on altered states of mind (conveniently housed at Harvard) reject this legislation?
Many, including me, were more than a bit surprised. While phone banking for Yes On 4 ahead of the election, I found the campaign’s emphasis to be on Question 4’s benefits to society, and the profound positive impact on groups such as veterans, end of life patients, and others suffering from mental health conditions. Notably, the home growing and use provision was left out of the pitch, which instead focused on the more-controlled licensed therapeutic administration. Yet, home growing was very much what voters seemed to be focused on at the ballot box. Understanding this disconnect, it’s not entirely surprising that the measure failed, especially in a commonwealth that requires alcohol-serving establishments to close at 2:00 am and has flat out banned happy hour. Puritanical origins indeed abide. But is the explanation that simple?
I spoke with HKS student, Wharton MBA, Army veteran, and West Point alum, CJ LoConte (MPA ’26), who has recovered from PTSD and depression through psychedelics. While at Wharton, he started Truxtun, a psychedelic retreat facilitator, and in the past few months has served as a spokesperson for the Yes On 4 campaign. LoConte reflected that Question 4 was not a perfect fit for the state: “In Oregon it was a very regulated access model. Then in Colorado it was regulated access plus decriminalization statewide with the right to give it away. But in Massachusetts, [New Approach] added five psychedelics in addition to psilocybin and added home cultivation. It’s like they're trying to see how much they could get away with each time, and I think that went way too far. They overestimated the progressiveness of Massachusetts voters by a long shot.”
Paul Gillis-Smith, Program Lead in Psychedelics and Spirituality at Harvard Divinity School’s Center for the Study of World Religions, provided further political context: “We just saw in general a lower voter turnout than historically. I think for questions like this where you need a specific kind of turnout for the ‘YES,’ if you don’t have it, it affects you in a big way. I also feel that Mass is a more Puritanical state in general. This is the case for alcohol sale laws. These things have clung onto people with a sort of institutional stickiness.”
Besides cultural differences between Massachusetts and the Western US, there was also a problem with timing, with LoConte pointing out: “We knew about this over a year ago and only this summer did we really try to mobilize. We shot the commercials in August, and they didn't start rolling until October. By that point, way too late…I think it could have passed had the strategy been different and initiated earlier.” The movement is trying to take something that is still largely taboo, with ingrained skeptical public sentiment and an overall deficit in proper education and experience around it, and make it palatable for the majority of voters. This takes time.
One key lesson is the strategic need for local grassroots and community mobilization, as LoConte laid out, “Looking back, it's easy to point out the things we will do differently, looking at who you need to mobilize, such as the cannabis and psychedelic communities, as well as black and Latino communities, indigenous communities, along with ex-convict communities. We had that growing provision that just wasn’t mentioned much until three weeks before the election happened. In the end, it turned out that's all voters cared about… I think that it went too far, too fast for that person who's just looking at psychedelics for the first time.”
Gillis-Smith confirmed the importance of a more local-led, grassroots approach: “On the one hand, I understand using an established PAC for both cannabis medicalization and recreation, and plant medicine bills. It’s not a perfect track record, but they have had a number of successes. In the end there was a gap between this non-Massachusetts PAC running the campaign, and then the voters who didn't seem like the message was translated effectively.”
Given this disconnect, I asked Gillis-Smith how the campaign could have messaged differently: “Most of these plant based substances come from indigenous traditions, so why not communicate the ballot question along the terms of wanting to protect said traditions? The fact is that natural plant based substances have a better message than synthetics, which is why LSD is not in the mix. And the extent to which they did try to incorporate indigenous traditions fell a bit flat, primarily because the PAC was coming from outside Massachusetts and had a hard time finding indigenous voices in the state to speak for the bill.”
Gillis-Smith did point to a more persuasive overarching argument to be made for those on both sides: “The more general approach of personal use and cultivation is a great strategy. It de-prioritizes prosecution and allows people to do their own thing in a way that aligns with values like personal liberty, which is very persuasive to Americans in general. You even see Democrats moving more forcefully in that direction, case-in-point Tim Walz calling for the government to ‘mind its own damn business’ in speeches.”
It’s clear that the issues with Question 4 were multidimensional. There was a mismatch between organic voter sentiment and the strategy taken by New Approach, coming in from DC relatively late in the game. The strategy likely required longer-term engagement with local organizations and leaders in psychedelic and cannabis advocacy, along with proper inclusion of indigenous voices. Importantly, the emphasis on benefits for veteran communities and others suffering from mental health conditions proved effective, but this message was complicated by the personal use and cultivation provision, which didn’t have such a tangible tie to mental health impact.
The Path Ahead
While Question 4 failed in Massachusetts, on the national stage the psychedelic cause has begun to gain attention. RFK Jr., the highest-profile Trump nominee yet in the health space, has made statements on Instagram such as, “My mind is open to the idea of psychedelics for treatment. People ought to have the freedom and the liberty to experiment with these hallucinogens to overcome debilitating disorders.”
I asked Harvard Law Prof. I. Glenn Cohen, who teaches the Psychedelic Law course, to weigh in on the national policy outlook: “I like to point out that psychedelics is a more bipartisan issue than many others, bringing together a diverse coalition of individuals from Silicon Valley to veterans to Libertarians to spiritual communities. I do think some of [RFK Jr.’s] more anti-regulatory views expressed in other spaces, such as stem cell clinics and raw milk, suggest he may be open to a more permissive approach by the FDA overall on psychedelics. Elon Musk is also reported to be a user of psychedelics, so his involvement in the next administration may also be helpful in allowing space for reconsideration of current rules.”
In his article, “Branching Regulatory Paths and Dead Ends in Psychedelics,” Cohen lays out three main pathways for regulation: religious protection, connected with indigenous traditions; regulated medical use, where scientific firms such as Lykos Therapeutics (who recently tried to clear MDMA treatment through the FDA) operate; and “recreational,” which Cohen is careful to say is not a perfect term, as it includes not only “fun,” but also non-medical self care. The recreational pathway is also where Gillis-Smith’s broader decriminalization proposal, as is being implemented in Colorado, would have the most relevance. As a fourth alternative, Cohen mentions “supported use,” which encompasses the kind of licensed practitioner ecosystem for administered therapy that was passed in Oregon. Question 4, perhaps fatally, tried to sit between recreational and supported use, lending further credence to Cohen’s assertion that these pathways may not be able to be easily packaged together.
LoConte argued for the Massachusetts movement to lean on progress in other state ballot initiatives for guidance, and to continue to progress the issue on a more local level: “I would love to see a less-regulated supported use market and a decriminalization statute that is put in place for a few years to see how it works, but just for psilocybin, with the option of adding more psychedelics in the future. We’re seeing it's working in Colorado right now. The sky is not falling and actually DUI fatalities have gone down almost 25% since the ballot was passed. There needs to be more knowledge about how to do these things the right way. We need to go city to city to get decrim provisions and work with the state legislature to try to pass a more regulated access model in Massachusetts.”
Since, you know, this is technically a publication run by and for MBAs, I also asked Cohen to provide some insight into the implications for business: “If I were planning a business venture in this space, I would want to get a sense of the intersection of state, local, and federal law and how changes in federal approach might preempt state approaches or not, as well as how ‘sticky’ various regimes are…My second line answer is to understand the reality of network effects and start-up costs in this space. In Oregon, for example, there was a lot of enthusiasm for entrepreneurs to begin offering facilitator services, but my sense on the ground is that the reality of the costs of operating those services has been higher and the profit margins lower than anticipated.”
“My third line answer,” Cohen continued, “is specific to the FDA approval route. While the first group [Lykos] was unsuccessful in their initial attempt at getting their drug approved in this space (they may try again), they were until late in their journey a not for profit. The next companies in line look a lot more like traditional pharma. As I have written recently, the role of psychotherapy in the therapeutic model for psychedelics – and the FDA’s reluctance to regulate the psychotherapy piece – seems likely to drive these players to delivery models that are less therapy focused.”
Gillis-Smith was bullish on expansion of access, and maintained the importance of engagement with indigenous communities: “If psychedelics are rescheduled, it would permit broader use, making research easier. It would also afford greater access in non-research settings. It's already happening in grey and underground markets – people are taking mushrooms to replace alcohol in social settings like raves. In explicitly therapeutic use, or even ‘supportive’ use in Oregon or Colorado, you create a regulated market. This is one setting to strongly argue for indigenous reciprocity. For firms who are looking to marketize, and those who have done well with Schedule III medicines like ketamine, they may look to psilocybin in the near future. With the indigenous lineage from which our use of psilocybin comes, to what extent is this potential (and actual) marketization responsive to the histories, peoples, and cosmologies of indigenous psilocybin use?”
With regard to the link between business and government, LoConte mentioned that, “many of the big donors to PACs like New Approach are themselves in the business of, or are invested in, the psychedelic industry in many ways. A lot of people are incentivized financially to have psychedelics become more popularized and accessible.” Question 4, for example, had support from business leaders such as Blake Mycoskie of TOM’s and David Bronner of Dr. Bronner’s. Businesses could be in a unique position to capitalize on the nascent nature of the market – pioneers need to know not only how to navigate the current regulatory environment, but also how to work with governments, just like when alcohol and cannabis were legalized, to have lasting effects on American society at large.
A Call To Action
It seems all we can do now is assess, learn, and move forward. Yes, the movement was dealt two large setbacks this year: the FDA denying Lykos’s bid to clear therapeutic use of MDMA and the rejection of Question 4, but the fight persists. Both the alcohol and cannabis regulation movements were precipitated by strong growth in popular sentiment, like that we see around psychedelics today. The legal landscape eventually caught up, with significant implications for communities and businesses in the way regulations were shaped and executed.
The psychedelics case is distinct from these and, I would argue, more challenging to properly navigate because of the profound cultural, therapeutic, and spiritual aspects of human engagement with these substances. On one hand, as Ronald Siegel wrote in his book Intoxication, humans have a fundamental drive to seek substances that alter their mindset as a means of recreation, and will do so in spite of legal constraints. They also have a drive for healing and self betterment, not always found in such substances as alcohol and other hard drugs. Psychedelics can uniquely fulfill both needs.
Given its pedigree in the space, Harvard University has already been engaging deeply, creating The Study of Psychedelics in Society and Culture in 2023: “an interdisciplinary effort across the Faculty of Arts and Sciences, Harvard Law School, and Harvard Divinity School, [which] seeks to transform the psychedelics research landscape by producing cutting-edge scholarship and convening faculty, students, and experts to engage in discussion around their far-reaching implications.” Being the pattern recognition expert you likely are, you might have noticed one key graduate program missing from that list. Besides HBS Prof. Tiona Zuzul’s Strategy case on the psilocybin pharmaceutical company Compass Pathways’ path to commercialization, HBS has yet to meaningfully engage with the space, especially when it comes to consumer interaction with non-pharmaceutical substances, therapies, and experiences.
Given the disconnect between lagging regulation on one side and growing academic and cultural engagement on the other, HBS is in a unique position at this very moment to embrace a burgeoning industry with such high potential for positive human impact, thereby upholding its mission: to foster leadership that makes a difference in the world. This can take many forms: speaking engagements, research and grants, articles/podcasts, co-sponsored events with other Harvard programs, as well as conferences.
As Tennyson wrote in Ulysses, “Come, my friends, ‘t is not too late to seek a newer world.” This is the moment for HBS to reach across the river (and beyond) for more cross-disciplinary conversation, collaboration, and education around psychedelics to maximize societal impact, now more than ever, through hard work, with humility, for humanity.
Aaron Finder (MBA ’26) is originally from New York City. He graduated from Williams College with a degree in Economics and History, and studied Portuguese and Brazilian history at PUC Rio. Prior to HBS, Aaron worked in business development and marketing at beverage companies Anhesuer-Busch InBev and The Vita Coco Company.
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