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CJ LoConte, a Duxbury native and Army veteran, said he experienced suicidal ideation upon return from his deployment in the Middle East in 2019. After going the traditional route of care, he experienced a “complete 180” after being treated with psilocybin.

Backers of Question 4 on the Nov. 5 state ballot say they have taken lessons from their experiences and from other states on the use of psychedelics as a mental health treatment that would make Massachusetts a national model. 

Key 2024 election dates

Nov. 5 general election

The general election is Nov. 5, with a new set of deadlines.
Oct. 19 to Nov. 1: Early voting from 8 a.m. to 4 p.m. at the Main Public Library, 613 Pleasant St.
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Opponents disagree with how the question is written and worry that the state can’t count on the Legislature to fix it if voters give their approval.

“I think the worst part is that I did what I was told to do, right?” said LoConte, a spokesperson for Yes on 4. “I went to the VA, I sought the help, I did the things, I followed the orders, and when the help doesn’t work, you start to think that you’re the problem.”

LoConte said he has heard similar stories from other veterans. His own experience with his mental health, and the experiences he has seen with other soldiers and veterans, has fueled his advocacy. 

“I think that it’s just incredibly, incredibly important that Massachusetts sets the example for the rest of the East Coast, and hopefully sets the example for the rest of the country, after learning from Oregon, Colorado and how to push these policies forward the right way,” LoConte said, “in a way that [is] equitable, affordable, accessible to the people who need it the most.”

The principal concerns of opponents involve supervision of psychedelic treatment and the inability of communities to opt out of having a treatment center within their borders.

“The way ballot questions work in Massachusetts, this is what’s been filed, and that’s what voters have to vote on,” said Chris Keohan, spokesperson for the Coalition for Safe Communities. “We can’t just hope that the Legislature tries to fix some of these issues. Once it’s voted on, it becomes law. So, because of the way it’s written, we had to come out and oppose it.”

Opponents’ main concerns are that the question does not require a licensed medical professional to be on site at the treatment centers, nor does it allow for a community opt-out. The proposal also allows for home growth space for psychedelic plants and fungi to be 12 by 12 feet, Keohan said. 

“This allows for 144 square feet of grow in your home, which is an astronomical amount of space to be able to grow,” Keohan said. “It’s actually the equivalent of the average bedroom here in Massachusetts.”

Because the plants and fungi can be grown at home, opponents think the ballot proposal may encourage a “gray market” of unauthorized sales, Keohan said. 

“The amount that you’re able to grow, they believe, will lead to a gray or even an expansion of the black market here in Massachusetts,” Keohan said. 

New Approach PAC, a Washington D.C. political action committee, is the principal funder of Yes on 4. It has also done work in both Colorado and Oregon to legalize psychedelics.

The question would authorize the legalization of five substances: psilocybin, psilocyn, mescaline, DMT and Ibogaine. If passed, it would allow legal use by anyone 21 and older. 

The question also allows for people to grow their own plants and fungi in a limited space. A commission would be established to regulate the use of these substances. Treatment centers for psychedelics would open so people can use the substances with supervision, according to a report by the Center for State Policy Analysis at Tufts. 

Personal use of psychedelics would be legalized in December, the report says, while rules allowing at least one drug at therapeutic centers would be in place by April 2026, with complete regulations by April 2028 for therapeutic centers to provide all five psychedelics.

Even though psychedelics have shown some promise in short-term studies, there is no definitive answer that they will work as medications long-term, and there are also questions about side effects, said Dr. Anthony J. Rothschild, professor of psychiatry at the UMass Chan Medical School and editor-in-chief of the Journal of Clinical Psychopharmacology. 

“It showed promise that these medications might affect treatment-resistant depression,” Rothschild said. “But even in that study, there were side effects; some people experienced suicidal thoughts and other adverse events.”

Rothschild is currently involved in a Stage 3 study of psilocybin run by Compass Pathways. The Stage 2 study, which he was not involved with, found promising results, but in short-term participants. The Stage 3 testing is in process right now, and those studies measure the long-term effects of psilocybin in participants. 

It will take two Stage 3 positive studies for the FDA to consider psilocybin for approval, Rothschild said. 

He expressed reservations about the ballot question’s home-grow provisions.

“The idea of somebody growing a mushroom plant in their backyard and then taking it without medical supervision, without knowing who should or shouldn’t take it, is really dangerous,” Rothschild said.

The Massachusetts Psychiatric Society also opposes Question 4, Rothschild said.

If passed, Massachusetts would be the third state to legalize certain psychedelics. Oregon does not allow home growth, and it only legalized psilocybin as a substance that people can take at treatment centers. Colorado was the second state to legalize certain psychedelics, and it has a home-growth component, according to the Tufts study.

The law in Colorado is about integrating psychedelic care into the existing health care system, said Joshua Kappel, co-author of Proposition 122 and founding partner at Vicente LLP, a cannabis law firm. 

“The structure that’s being proposed in Massachusetts is like a modality of care that our current medical and mental health professionals can use, another tool in their toolbox,” Kappel said. 

Kappel also worked with the Healing Advocacy Fund to source best practices to create a safe program. Compared to cannabis law, psychedelic law does not have a retail component, Kappel said. 

“There’s licensed mental and medical health professionals involved,” Kappel said. “Psychedelic care isn’t a product we’re selling, but it’s a modality of care that is really beneficial for some and not for everyone.”

In Oregon, psychedelic clinics are already open and taking clients. Dr. Eric Lee, a physician and owner and founder of Space Psychedelic Clinic in Portland, provides “psychedelic facilitation” with psilocybin. There are three phases of the treatment plan: preparation, guided facilitation (using the psilocybin), and integration, Lee said.

“It takes about two or three weeks, and they are working with me and the facilitator to get ready for their session,” Lee said. “The session itself is about six hours, and then afterwards, the process [is] integration, or using the principles that you put together in your session, [and] that never really stops.”

Lee opened the clinic in March 2023, and before that he worked as a doctor. 

“I am endlessly interested in the research behind psychedelics, so I always try to apply those principles to what we do at Space,” Lee said. “And when I talk to the clients [who] are interested in coming in, I talk to them through that lens, through the scientific medicine-based lens.”

Not every facility in Oregon is run by a medical professional, and others can charge thousands of dollars, Lee said. “It’s been a lifelong research passion, and as new information comes out, it is just a joy to incorporate it into what I do with the clients,” Lee said.