ARTICLE

MICRODOSING PSYCHEDELICS UNDER LOCAL, STATE,

AND FEDERAL LAW

MASON MARKS,* I. GLENN COHEN,**

JONATHAN PEREZ-REYZIN*** & DAVID ANGELATOS****

ABSTRACT
Microdosing psychedelic substances (“microdosing”) is a growing trend that
has gained significant media and scientific attention. The practice typically
involves consuming low doses of psychedelics, such as psilocybin or lysergic
acid diethylamide (“LSD”), two or three times per week, over the course of
weeks or months. Many claim that microdosing improves attention, creativity,
or mood. Some say it reduces pain as well as symptoms of anxiety, depression,
and migraine or cluster headaches. Others fear it has not been proven safe or
effective by randomized controlled trials. Nevertheless, the microdosing trend is
growing against the backdrop of a broader psychedelic renaissance
characterized by increasing interest in researching, legalizing, consuming, and
commercializing psychedelics. This Article is the first to address the legal status
of microdosing under local, state, and federal law. It analyzes the national trend
toward psychedelic legal reform and how it affects the legal status of people who
microdose.

*
Assistant Professor, Florida Bar Health Law Section; Professor, Florida State University
College of Law; Senior Fellow, Project Lead, Project on Psychedelics Law and Regulation
(“POPLAR”), the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics
at Harvard Law School; Affiliated Fellow, Information Society Project at Yale Law School.
**
Deputy Dean, James A. Attwood and Leslie Williams Professor of Law, Harvard Law
School; Faculty Director, Investigator, POPLAR, the Petrie-Flom Center for Health Law
Policy, Biotechnology, and Bioethics at Harvard Law School.
***
Affiliated Fellow, POPLAR, the Petrie-Flom Center for Health Law Policy,
Biotechnology, and Bioethics at Harvard Law School; J.D. Candidate, Yale Law School.
****
Senior Counsel, New York City Law Department; former Fellow, POPLAR, the
Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law
School.
The authors wish to thank Carmel Shachar, James Fadiman, John Rapp, and Vincent
Sliwoski for helpful discussions. Marks and Cohen receive funding from POPLAR, which
itself is funded by a grant from the Saisei Foundation, a nonprofit organization based in
Austin, Texas. Marks has served as a volunteer member of the Oregon Psilocybin Advisory
Board. He previously served on the advisory boards of nonprofit organizations in the
psychedelic space.
573
574 BOSTON UNIVERSITY LAW REVIEW [Vol. 103:573

Since 2019, over a dozen U.S. cities have decriminalized psychedelics,

making their possession in each city a low priority for law enforcement. The
following year, during the 2020 presidential election, the psychedelic
renaissance reached a turning point. Through ballot initiatives, the District of
Columbia partially decriminalized psychedelics, and Oregon became both the
first state to decriminalize psychedelics and the first to legalize the production,
sale, and supervised adult use of psilocybin. In 2022, Colorado became the
second state to partially decriminalize psychedelics and create a legal market
for their supervised administration. Related legislation has been proposed in
about a dozen other states, including California, New York, Massachusetts,
Illinois, and New Hampshire. However, despite the growing popularity of
microdosing, these jurisdictions have largely overlooked the practice and thus
raised numerous equity and public health concerns. This Article analyzes
available scientific evidence for microdosing, summarizes its risks and benefits,
and analyzes how existing and proposed legislation affect the practice. It
concludes with recommendations for the safe and equitable integration of
microdosing into existing, proposed, and future psychedelics regulation. As
more jurisdictions decriminalize or legalize psychedelics, they can use the
Article as a resource and guide.
2023] MICRODOSING PSYCHEDELICS 575

CONTENTS
INTRODUCTION ............................................................................................... 576
I. LAW AND THE PSYCHEDELIC RENAISSANCE ....................................... 579
A. Federal Law................................................................................. 579
B. State Law ..................................................................................... 583
1. The Oregon Psilocybin Services Act..................................... 587
2. The Oregon Drug Decriminalization and Addiction
Treatment Act ........................................................................ 588
3. Proposed Legislation in Other States Following
Oregon’s Historic Votes ........................................................ 590
C. Local Ordinances and Resolutions .............................................. 593
1. Denver Decriminalization Ordinance .................................... 593
2. Oakland Decriminalization Resolution ................................. 594
D. Foreign Jurisdictions................................................................... 595
II. THE ART AND SCIENCE OF MICRODOSING .......................................... 599
A. Microdosing Defined ................................................................... 599
B. History of Microdosing................................................................ 606
C. Why People Microdose ................................................................ 611
D. Scientific Evidence on Microdosing Safety and Efficacy ............ 612
1. Potential Benefits .................................................................. 614
2. Potential Risks ....................................................................... 618
III. DESIGNING LEGAL FRAMEWORKS TO PROMOTE EQUITY AND
PUBLIC HEALTH .................................................................................. 622
A. Microdosing Safety ...................................................................... 623
1. Microdosing as a Gentle Introduction to Standard
Dosing ................................................................................... 623
2. Safer and More Consistent Products and Services ................ 624
3. Decreased Risk of Abuse and Exploitation ........................... 625
B. Microdosing Economics and Psychedelic Equity........................ 626
C. Making Oregon’s System Safer and More Equitable .................. 629
IV. LEGAL AND REGULATORY RECOMMENDATIONS ................................ 636
A. Decriminalization Frameworks ................................................... 636
B. Supported Adult-Use Frameworks .............................................. 637
C. Retail Models ............................................................................... 639
D. Medical Frameworks ................................................................... 640
CONCLUSION ................................................................................................... 641
576 BOSTON UNIVERSITY LAW REVIEW [Vol. 103:573

INTRODUCTION
Psychedelics are a diverse class of substances known to promote feelings of
openness and connection.1 Some naturally occurring psychedelics, derived from
plants and fungi, have been used by Indigenous communities for millennia in
healing and religious ceremonies.2 Others were first synthesized by chemists in
the early twentieth century.3 Though studied by Western scientists during the
1950s and 1960s, Congress effectively banned most uses for psychedelics when
it passed the Drug Abuse Control Amendments of 1965 and the Controlled
Substances Act of 1970.4 Research largely came to a halt, and psychedelic use
went underground.5
Fifty years later, we are witnessing a resurgence of interest in the spiritual,
recreational, and therapeutic use of psychedelics.6 Since the early 1990s, some
researchers have gained permission to conduct small or modestly sized clinical
trials, and in the past few years, these efforts have multiplied.7 There is now
significant interest in commercializing psychedelics, and hundreds of millions

1
See Mason Marks, Psychedelic Medicine for Mental Illness and Substance Use
Disorders: Overcoming Social and Legal Obstacles, 21 N.Y.U. J. LEGIS. & PUB. POL’Y 69,
80-86 (2018) [hereinafter Marks, Psychedelic Medicine for Mental Illness] (defining
psychedelic substances and discussing several examples).
2
See Jamilah R. George, Timothy I. Michaels, Jae Sevelius & Monnica T. Williams, The
Psychedelic Renaissance and the Limitations of a White-Dominant Medical Framework: A
Call for Indigenous and Ethnic Minority Inclusion, 4 J. PSYCHEDELIC STUD. 4, 4-6 (2020)
(describing ceremonial and therapeutic use of psychedelics by Indigenous peoples of Africa,
North America, Central America, and South America).
3
See Albert Hofmann, The Discovery of LSD and Subsequent Investigations on Naturally
Occurring Hallucinogens, in DISCOVERIES IN BIOLOGICAL PSYCHIATRY 91, 91 (Frank J. Ayd,
Jr. & Barry Blackwell eds., 1970); Roland W. Freudenmann, Florian Öxler & Sabine
Bernschneider-Reif, The Origin of MDMA (Ecstasy) Revisited: The True Story Reconstructed
from the Original Documents, 101 ADDICTION 1241, 1242 (2006); Georges Mion, History of
Anaesthesia: The Ketamine Story—Past, Present and Future, 34 EUR. J. ANAESTHESIOLOGY
571, 572 (2017).
4
See Franz X. Vollenweider & Michael Kometer, Opinion, The Neurobiology of
Psychedelic Drugs: Implications for the Treatment of Mood Disorders, 11 NATURE REVS.
NEUROSCIENCE 642, 642 (2010); Shaunacy Ferro, Why Doctors Can’t Give You LSD (But
Maybe They Should), POPULAR SCI. (Apr. 16, 2013, 10:00 PM), http://www.popsci.com
/science/article/2013-04/new-science-lsd-therapy [https://perma.cc/V9CK-QQ54].
5
See Ferro, supra note 4 (explaining that once LSD was placed in Schedule I, research
became severely restricted and funding was difficult to receive).
6
See Donna Lu, ‘Psychedelics Renaissance’: New Wave of Research Puts
Hallucinogenics Forward To Treat Mental Health, GUARDIAN (Sept. 25, 2021, 4:00 PM),
https://www.theguardian.com/society/2021/sep/26/psychedelics-renaissance-new-wave-of-
research-puts-hallucinogenics-forward-to-treat-mental-health [https://perma.cc/B2PB-
LXF6].
7
See David Nutt, Psychedelic Drugs—A New Era in Psychiatry?, 21 DIALOGUES CLINICAL
NEUROSCIENCE 139, 141 (2019).
2023] MICRODOSING PSYCHEDELICS 577

of dollars are flowing into emerging psychedelic markets.8 The Food and Drug
Administration (“FDA”) designated three psychedelic “breakthrough
therap[ies]” for treating drug-resistant depression or post-traumatic stress
disorder (“PTSD”), which means they may offer substantial improvements
relative to existing therapies.9 Meanwhile, since 2019, at least fifteen U.S. cities
have essentially decriminalized various psychedelics, making their possession
low on the list of the cities’ law enforcement priorities.10 In 2020, Oregon voters
legalized the adult use of psilocybin, a psychedelic produced by many species
of fungi, when they approved Measure 109, and partially decriminalized
possession by approving Measure 110.11 In 2022, Colorado voters enacted
comparable legislation by approving Proposition 122.12 About a dozen other
states have proposed or enacted related bills to promote psychedelic
decriminalization, supported adult use, medical use, clinical research, or policy
analysis.13 What may initially have been regarded as a West Coast phenomenon
has grown into a wave of psychedelic policy reform that has washed over the
nation.
Despite significant medical and commercial interest in psychedelics and
accelerating legal reform, very few legal scholars have addressed the
psychedelic renaissance, a relatively recent phenomenon that remains heavily
stigmatized. In 2019, one of us analyzed the social and legal obstacles to using
psychedelics as mental health therapies and the importance of increasing access
to address the worsening American mental health crisis.14 In 2022, two of us

8
See Shayla Love, Is It Possible To Create an Ethical Psychedelics Company?, VICE:
MOTHERBOARD (Apr. 6, 2021, 10:30 AM), https://www.vice.com/en/article/m7amw4/is-it-
possible-to-create-an-ethical-psychedelics-company [https://perma.cc/3MKC-CXYP].
9
See Erin E. Kepplinger, FDA’s Expedited Approval Mechanisms for New Drug Products,
34 BIOTECHNOLOGY L. REP. 15, 22 (2015).
10
See Psychedelic Legalization & Decriminalization Tracker, PSYCHEDELIC ALPHA,
https://psychedelicalpha.com/data/psychedelic-laws (last updated Feb. 5, 2023).
11
See Oregon Measure 109 Election Results: Legalize Psilocybin, N.Y. TIMES,
https://www.nytimes.com/interactive/2020/11/03/us/elections/results-oregon-measure-109-
legalize-psilocybin.html (last visited Feb. 10, 2023); Oregon Measure 110 Election Results:
Decriminalize Some Drugs and Provide Treatment, N.Y. TIMES, https://www.nytimes.com
/interactive/2020/11/03/us/elections/results-oregon-measure-110-decriminalize-some-drugs-
and-provide-treatment.html (last visited Feb. 10, 2023).
12
Colorado Proposition 122 Election Results: Decriminalize and Regulate Certain
Psychedelics, N.Y. TIMES, https://www.nytimes.com/interactive/2022/11/08/us/elections
/results-colorado-proposition-122-decriminalize-and-regulate-certain-psychedelics.html (last
visited Feb. 10, 2023).
13
Mason Marks, The Varieties of Psychedelic Law, 226 NEUROPHARMACOLOGY
(forthcoming Mar. 2023) (manuscript at 1, 4) [hereinafter Marks, Varieties of Psychedelic
Law], https://reader.elsevier.com/reader/sd/pii/S0028390822004580?token=95BF755D6617
EC5A88BA3AEB16499A6ADDAC3D12B4BACF7B40C29A4C473EA29A84120349B08
40547531C53B1AE185A35&originRegion=us-east-1&originCreation=20230211211606
[https://perma.cc/U8PY-ZPT6] (describing five varieties of psychedelic law in United States).
14
See generally Marks, Psychedelic Medicine for Mental Illness, supra note 1 (describing
social and legal obstacles); Mason M. Marks, Controlled Substance Regulation for the
578 BOSTON UNIVERSITY LAW REVIEW [Vol. 103:573

analyzed ongoing legal and ethical disputes over patenting psychedelic

substances and related technologies.15 Other legal scholars have framed the
psychedelic renaissance in terms of social justice or explained the legality of
doctors prescribing psychedelics off-label once they become FDA approved.16
However, no legal scholars have addressed the legality of microdosing
psychedelics (“microdosing”) or its role in the mental health crisis and evolving
psychedelic renaissance.
Microdosing is a growing national phenomenon in which people consume
small amounts of psychedelic substances such as psilocybin or lysergic acid
diethylamide (“LSD”) on a schedule lasting weeks or months. People report
microdosing to improve cognitive performance or enhance physical or mental
health.17
This Article analyzes the ethical, legal, and social implications of
microdosing. It describes the available evidence regarding its risks and benefits
and explains how existing psychedelics legislation and regulation have largely
overlooked the practice. The Article analyzes how microdosing is currently
affected by local, state, and federal law. It concludes with recommendations for
safely and equitably integrating microdosing into existing regulatory
frameworks and charts a path for addressing the practice in proposed and future
psychedelics legislation.
Compared to traditional approaches to wellness and mental healthcare, and
the growing practice of administering or consuming larger doses of psychedelics
(“standard dosing”), microdosing can potentially save significant time, money,
and healthcare resources. It may also be safer. Although microdosing is not yet
well understood from a scientific perspective, there is experimental evidence to
support its safety and benefits, and despite legitimate concerns, there is little
reason to believe that it poses significant risks to individuals or public health,
especially when done in moderation. As jurisdictions at all levels of government
contemplate psychedelics legal reform, they should consider how new
legislation will impact microdosing.

COVID-19 Mental Health Crisis, 72 ADMIN. L. REV. 649, 717-18 (2020) [hereinafter Marks,
Controlled Substance Regulation] (arguing for increased access to psychedelics to address
worsening mental health crisis).
15
See generally Mason Marks & I. Glenn Cohen, Patents on Psychedelics: The Next Legal
Battlefront of Drug Development, 135 HARV. L. REV. F. 212 (2022).
16
See Matt Lamkin, Legitimate Medicine in the Age of Consumerism, 53 U.C. DAVIS L.
REV. 385, 389 (2019) (analyzing legality of prescribing psychedelics off-label once they are
FDA approved); Dustin Marlan, Beyond Cannabis: Psychedelic Decriminalization and Social
Justice, 23 LEWIS & CLARK L. REV. 851, 884-92 (2019) (arguing for decriminalization of
psychedelics as means of achieving social justice).
17
Ben D. Rifkin, María J. Maraver & Lorenza S. Colzato, Microdosing Psychedelics as
Cognitive and Emotional Enhancers, 7 PSYCH. CONSCIOUSNESS: THEORY RSCH. & PRAC. 316,
316-17 (2020); see also Lindsay P. Cameron, Angela Nazarian & David E. Olson, Psychedelic
Microdosing: Prevalence and Subjective Effects, 52 J. PSYCHOACTIVE DRUGS 113, 113 (2020)
(finding these results in anonymous online survey of 2,347 respondents).
2023] MICRODOSING PSYCHEDELICS 579

The Article proceeds in four parts. Part I describes the legal reforms that have
allowed the psychedelic renaissance to accelerate as well as the national mental
health crisis and past injustices associated with the war on drugs that propel the
renaissance forward. Part II defines microdosing, describes its history and why
people do it, and explains its role within the psychedelic renaissance and
ongoing attempts to mitigate the mental health crisis. Part III summarizes the
evidence for supporting microdosing, which is derived from population-based
and experimental studies. Part III also describes concerns regarding microdosing
and the evidence to support and refute them. Part IV addresses how microdosing
is regulated under existing local, state, and federal law and makes
recommendations for better integrating the practice into current, proposed, and
future legislation.

I. LAW AND THE PSYCHEDELIC RENAISSANCE

The psychedelic renaissance is characterized by increasing interest in
researching, legalizing, consuming, and commercializing psychedelics. It
includes the proliferation of psychedelic research centers at leading universities,
the influx of hundreds of millions of dollars of venture capital into psychedelic
companies, the increased patenting of psychedelic substances and related
technologies, and the rapid expansion of psychedelic legal reforms at state and
local levels.18 This Part provides an overview of the legal reforms underlying
the renaissance.

A. Federal Law
This Section describes federal drug laws and their impact on microdosing.
Part IV returns to these topics while making recommendations for safer and
more equitable microdosing regulation.

18
See Marks & Cohen, supra note 15, at 216 (discussing increased patenting of
psychedelic substances); Ryan Basen, Academic Centers Start To Take Psychedelics
Seriously, MEDPAGE TODAY (Nov. 24, 2021), https://www.medpagetoday.com/special-
reports/exclusives/95865 (discussing proliferation of academic research centers); Emmy M.
Cho, Harvard Law School Launches First-Ever Research Initiative on Psychedelics and the
Law, HARV. CRIMSON (July 2, 2021), https://www.thecrimson.com/article/2021/7/2/law-
school-psychedelics-research-initiative/ [https://perma.cc/SX4H-F5KG] (discussing launch
of one such academic research center at Harvard Law School); Sam Shead, Peter Thiel Backs
Berlin Start-Up Making Psychedelics in $125 Million Round, CNBC: HEALTHY RETURNS
(Nov. 23, 2020, 10:40 AM), https://www.cnbc.com/2020/11/23/peter-thiel-backs-
psychedelics-startup-atai.html [https://perma.cc/NF38-MJ3F] (discussing influx of hundreds
of millions of dollars in venture capital); Psychedelic Legalization & Decriminalization
Tracker, supra note 10.
580 BOSTON UNIVERSITY LAW REVIEW [Vol. 103:573

Prior to the 1960s, psychedelics were unregulated in the United States.19

Swiss chemist Albert Hoffman first synthesized LSD in 1936.20 In contrast,
about 200 species of naturally occurring fungi produce psilocybin,21 and
Hoffman was the first to isolate it in 1958.22 Five years later, Hoffman and Franz
Troxler became the first to synthesize it.23
During the 1950s and 1960s, researchers studied psilocybin and LSD as
therapeutic aids, and they published their discoveries in hundreds of peer-
reviewed articles.24 However, in the 1960s, the psychedelics became associated
with the countercultural movement and opposition to the Vietnam War.25 During
that time, Timothy Leary and Ram Dass (formerly known as Richard Alpert)
founded the Harvard Psilocybin Project.26 But their experiments were widely
criticized and eventually the university shut them down.27 After being expelled
from Harvard, Leary and Dass popularized psychedelics’ use and acquired a cult
following.28
In the late 1960s, President Nixon submitted a new federal drug law to
consolidate a patchwork of existing regulations.29 In 1970, Congress passed
Nixon’s legislation as the federal Controlled Substance Act (“CSA”), which
created a five-tiered schedule called the controlled substances list.30 Most
commonly used psychedelics were placed in Schedule I, which is the most
heavily restricted category.31 According to the CSA and the Drug Enforcement

19
See Marlan, supra note 16, at 865-69.
20
Trina Calderon, Flashback: LSD Creator Albert Hofmann Drops Acid for the First
Time, ROLLING STONE (Apr. 19, 2018), https://www.rollingstone.com/culture/culture-
news/flashback-lsd-creator-albert-hofmann-drops-acid-for-the-first-time-629085/.
21
Gaurav Dubey, Are There Different Kinds of Psychedelic Fungi? A Guide to the Many
Unique Species of Magic Mushrooms, MICRODOSE (Aug. 30, 2021), https://microdose.buzz
/news/are-there-different-kinds-of-psychedelic-fungi-a-guide-to-the-many-unique-species-
of-magic-mushrooms/ [https://perma.cc/8Z3A-9734].
22
Psilocybin, AM. CHEM. SOC’Y (Oct. 2, 2017), https://www.acs.org/content/acs/en
/molecule-of-the-week/archive/p/psilocybin.html [https://perma.cc/8M5A-QDD6].
23
Id.
24
See Vollenweider & Kometer, supra note 4, at 642; Ferro, supra note 4.
25
MICHAEL POLLAN, HOW TO CHANGE YOUR MIND: WHAT THE NEW SCIENCE OF
PSYCHEDELICS TEACHES US ABOUT CONSCIOUSNESS, DYING, ADDICTION, DEPRESSION, AND
TRANSCENDENCE 205-18 (2018); Marlan, supra note 16, at 869.
26
DON LATTIN, THE HARVARD PSYCHEDELIC CLUB: HOW TIMOTHY LEARY, RAM DASS,
HUSTON SMITH, AND ANDREW WEIL KILLED THE FIFTIES AND USHERED IN A NEW AGE FOR
AMERICA 37-51 (2010).
27
POLLAN, supra note 25, at 185-218.
28
Id.; LATTIN, supra note 26, at 107-18.
29
See David T. Courtwright, The Controlled Substances Act: How a “Big Tent” Reform
Became a Punitive Drug Law, 76 DRUG & ALCOHOL DEPENDENCE 9, 11 (2004).
30
Drug Scheduling, U.S. DRUG ENF’T ADMIN., https://www.dea.gov/drug-information
/drug-scheduling [https://perma.cc/E682-YERD] (last visited Feb. 10, 2023).
31
See 21 U.S.C. §§ 801, 812.
2023] MICRODOSING PSYCHEDELICS 581

Administration (“DEA”), they have no currently accepted medical use and a

high potential for abuse.32
Following passage of the CSA, research on psychedelics came to an abrupt
halt, and there was little or no progress for decades.33 That started to change in
the early 1990s, when a small group of researchers gained permission from the
DEA to conduct small clinical studies.34 Since then, these studies have
proliferated, and in the past few years, the pace of research has dramatically
increased.35 However, significant barriers to research remain. The DEA requires
manufacturers to hold Schedule I licenses before producing psychedelics, and
researchers must be registered with the agency before studying them.36
Moreover, the DEA significantly limits the total amount of each substance that
can be produced each year.37 Outside of clinical trials, possession and use of
psychedelics remain federal crimes.38 Consequently, microdosing outside the
research context is illegal at the federal level, and people who engage in the
practice risk arrest and prosecution.
Some experts have argued for federal rescheduling of psilocybin and other
psychedelics because the available science does not support their categorization
in Schedule I.39 Rescheduling can occur through three different pathways. First,
anyone can submit a rescheduling petition to the DEA.40 However, these
petitions are rarely successful.41 Second, if the DEA rejects a petition, a
petitioner can sue the DEA and ask the court to compel rescheduling, which is
also unlikely to succeed.42 Third, Congress can amend the CSA to reschedule
psychedelics or remove them from the list of controlled substances completely.43
If the DEA decides to reschedule a controlled substance, it must seek guidance
from the FDA, which conducts a scientific evaluation to estimate the public
health risk associated with the proposed change.44 In making its

32
Drug Scheduling, supra note 30.
33
POLLAN, supra note 25, at 216-18.
34
Id. at 60-63.
35
Id. at 78.
36
Marks, Psychedelic Medicine for Mental Illness, supra note 1, at 87-106.
37
Id.
38
21 U.S.C. § 844(a).
39
See Mason Marks & Carmel Shachar, Comment, Drug Scheduling Limits Access to
Essential Medicines and Should Be Reformed, NATURE MED. (Jan. 27, 2023),
https://www.nature.com/articles/s41591-022-02169-4 [https://perma.cc/5DZ2-NT7R]
(explaining why Schedule I status of common psychedelics is incompatible with growing
body of evidence and describing efforts to reschedule psilocybin).
40
Marks, Controlled Substance Regulation, supra note 14, at 672-79.
41
See id. at 673.
42
See id. at 688-91.
43
Id. at 679-88.
44
21 U.S.C. § 811(c).
582 BOSTON UNIVERSITY LAW REVIEW [Vol. 103:573

recommendations, the FDA performs an eight-factor scientific analysis required

by the CSA.45
The FDA also regulates psychedelics when they are evaluated in clinical trials
or administered as medical therapies.46 The federal Food, Drug, and Cosmetics
Act (“FDCA”) restricts the marketing of medical products that have not been
FDA approved.47 Because psychedelics have not yet met the requirements for
FDA approval, their medical use violates the FDCA, regardless of the dose.
However, under the investigational new drug process, the pharmaceutical
company Compass Pathways Limited has legally completed the largest Phase 2
clinical trial of psilocybin therapy, and most experts believe that FDA-approved
psilocybin therapy is only a few years away.48
If the FDA approves psilocybin therapy, then, at least in theory, psilocybin
microdoses could be prescribed off-label, or for nonapproved purposes, to treat
a variety of medical conditions.49 However, even if that occurs, the FDA retains
the ability to impose restrictions on the use of psychedelics after they become
approved. These conditions, called Risk Evaluation and Mitigation Strategy
(“REMS”), are imposed on therapies that the FDA believes pose special risks.50
For instance, an injectable drug called Zyprexa Relprevv is used to treat
schizophrenia in adults.51 However, it can cause serious reactions upon injection
characterized by severe sleepiness, confusion, and coma within three hours of

45
Id.
46
Id. § 505.
47
Id. § 355(a).
48
Press Release, COMPASS Pathways, COMPASS Pathways Announces Positive
Topline Results from Groundbreaking Phase IIb Trial of Investigational COMP360
Psilocybin Therapy for Treatment-Resistant Depression (Nov. 9, 2021), https://ir.compass
pathways.com/news-releases/news-release-details/compass-pathways-announces-positive-
topline-results [https://perma.cc/9NQ3-8WCQ]; Letter from Miriam E. Delphin-Rittmon,
Assistant Sec’y for Mental Health & Substance Use, Substance Abuse & Mental Health Servs.
Admin., to Madeleine Dean, Rep., U.S. House of Reps. (May 13, 2022), https://s3.document
cloud.org/documents/22121426/exhibit-3-response-to-rep-dean-et-al.pdf [https://perma.cc
/FZ8G-7ZA4].
49
See Lamkin, supra note 16, at 390-91 (describing off-label prescribing of psychedelics
after FDA approval).
50
REMS are “required risk management plan[s] that use[] risk minimization strategies
beyond professional labeling to ensure that the benefits of the drug outweigh the risks.”
ELAINE LIPPMANN, U.S. FOOD & DRUG ADMIN., RISK EVALUATION AND MITIGATION
STRATEGIES (REMS) 3 (2017), https://www.fda.gov/media/105565/download
[https://perma.cc/C3B5-VL4K]. REMS programs may include restrictions on distribution or
require enhanced communication to patients or healthcare providers. See 21 U.S.C. § 355-
1(c), (e)-(f). Each approved REMS program must also include a timetable for the
manufacturer’s provision of reports to the FDA to assess the effectiveness of REMS
requirements. Id. § 355-1(c)-(d).
51
See Risk Evaluation and Mitigation Strategies | REMS, U.S. FOOD & DRUG ADMIN.,
https://www.fda.gov/drugs/drug-safety-and-availability/risk-evaluation-and-mitigation-
strategies-rems [https://perma.cc/8KKZ-A9Z9] (last updated Dec. 17, 2021).
2023] MICRODOSING PSYCHEDELICS 583

treatment.52 Consequently, the FDA implemented REMS that require Zyprexa

Relprevv to be administered only in healthcare facilities that can monitor
patients for three hours after they receive the injection.53 The agency will
undoubtedly impose REMS on psilocybin-assisted therapy and therapies
involving other psychedelics such as 3,4-methylenedioxymethamphetamine
(“MDMA”), which is being tested in clinical trials for treating PTSD. According
to the Multidisciplinary Association for Psychedelic Studies (“MAPS”), which
is conducting the trials with MDMA, the FDA will likely implement REMS that
require health professionals who offer MDMA-assisted therapy through a
MAPS protocol to complete an MDMA therapy training program offered by
MAPS.54 Other possible REMS include limits on the dose of a psychedelic and
the number of doses administered, restrictions on who can administer the
substance and the type of facilities and settings in which it may be administered,
and requirements regarding distribution, storage, and patient surveillance for
adverse events after the therapy becomes FDA approved.55 When the FDA
issues final REMS on psilocybin therapy, these restrictions could make
microdosing impractical or impossible in healthcare settings. The implications
of this probable outcome are discussed further below.56

B. State Law
This Section describes proposed and recently enacted state-level psychedelics
laws and their impact on microdosing. Part IV returns to these topics while
making recommendations for safer and more equitable microdosing regulation.
Existing state psychedelic laws can be divided into five general categories,
including decriminalization, supported adult use, medical use, clinical research,
and policy analysis.57 Laws in the first category decrease or eliminate criminal
penalties associated with producing, possessing, selling, or consuming
psychedelics.58 The approaches are not uniform among jurisdictions that

52
Id.
53
Id.
54
See Therapy Training Program Application Requirements, MAPS PUB. BENEFIT CORP.,
https://mapspublicbenefit.com/training/program-application-requirements/ [https://perma.cc
/F6MJ-WJPE] (last visited Feb. 10, 2023).
55
Matthew W. Johnson, Roland R. Griffiths, Peter S. Hendricks & Jack E. Henningfield,
The Abuse Potential of Medical Psilocybin According to the 8 Factors of the Controlled
Substances Act, 142 NEUROPHARMACOLOGY 143, 144 (2018).
56
See infra Section IV.D.
57
Marks, Varieties of Psychedelic Law, supra note 13 (manuscript at 1).
58
See, e.g., Drug Addiction Treatment and Recovery Act, ch. 2, § 11, 2021 Or. Laws 1, 5-
6 (codified as amended at OR. REV. STAT. § 475.752 (2022)) (partially decriminalizing
psychedelics and other controlled substances by reducing possession of small amounts to civil
infraction); S. 519, 2021-2022 Reg. Sess. (Cal. 2021) (eliminating criminal penalties for
possession of certain psychedelics and sharing or giving them away without compensation);
H.R. 1392-FN, 2022 Sess. (N.H. 2022) (proposing reducing possession of small amounts of
584 BOSTON UNIVERSITY LAW REVIEW [Vol. 103:573

decriminalize, and decriminalization efforts fall along a spectrum from partial

to full decriminalization.59 Portugal took a decriminalization approach to drug
policy in 2001 when it partially decriminalized the possession of most drugs,
including psychedelics.60 In the United States, Oregon’s Measure 110, which
voters passed by ballot initiative on November 3, 2020, was the first enacted
state law of this kind.61 More recently, other states such as California,
Washington, Vermont, and New Hampshire have proposed similar types of
decriminalization bills.62 On November 3, 2022, Colorado voters passed
Proposition 122, the Natural Medicine Health Act.63 Proposition 122 partially
decriminalized the personal cultivation, possession, consumption, and sharing
of five psychedelic compounds and the plants and fungi that contain them.64
However, Proposition 122 did not decriminalize sales, and it limits possession
of psychedelics to amounts “necessary to share” with others in specific contexts,
such as “spiritual guidance” and “beneficial community-based use and
healing.”65 To date, no state laws have fully decriminalized psychedelics, and
though some may allow for microdosing, none have specifically addressed it.
A second type of bill involves creating a legal framework for the supported
adult use of psychedelics, which entails their controlled administration by

psychedelics to civil infraction); H.R. 1349-FN, 2022 Sess. (N.H. 2022) (proposing
decriminalization of psilocybin mushrooms in New Hampshire).
59
See infra Sections I.B.2, I.B.3, I.C.
60
Naina Bajekal, Want To Win the War on Drugs? Portugal Might Have the Answer, TIME
(Aug. 1, 2018, 6:09 AM), https://time.com/longform/portugal-drug-use-decriminalization/.
61
See OR. REV. STAT. § 475.752(3); MICHAEL LANTZ & BRIAN NIEUBUURT, LEGIS. POL’Y
& RSCH. OFF., MEASURE 110 (2020): BACKGROUND BRIEF 1 (2020), https://www.oregon
legislature.gov/lpro/Publications/Background-Brief-Measure-110-(2020).pdf
[https://perma.cc/6LVL-Q8YF].
62
See Ben Adlin, Washington Senate Replaces Drug Decriminalization Bill with Revised
Measure To Reinstate Penalties, MARIJUANA MOMENT (Apr. 16, 2021),
https://www.marijuanamoment.net/washington-senate-replaces-drug-decriminalization-bill-
with-revised-measure-to-reinstate-penalties/ [https://perma.cc/KA2A-BPTQ]; Kyle Jaeger,
Vermont Lawmakers File Drug Decriminalization Bill with Hopes of Promoting Harm
Reduction, MARIJUANA MOMENT (Jan. 14, 2022), https://www.marijuanamoment.net
/vermont-lawmakers-file-drug-decriminalization-bill-with-hopes-of-promoting-harm-
reduction/ [https://perma.cc/R6S2-ARRZ]; Kyle Jaeger, New Hampshire Lawmakers File
Psilocybin and Broader Drug Decriminalization Bills for 2022, MARIJUANA MOMENT (Dec.
29, 2021), https://www.marijuanamoment.net/new-hampshire-lawmakers-file-psilocybin-
and-broader-drug-decriminalization-bills-for-2022/ [https://perma.cc/3G5K-FBYY]; Hannah
Wiley, Bill To Decriminalize Psychedelics in California Gutted by Lawmakers, L.A. TIMES
(Aug. 12, 2022, 7:32 PM), https://www.latimes.com/california/story/2022-08-12/bill-to-
decriminalize-psychedelics-in-california-gutted-by.
63
Colorado Proposition 122 Election Results: Decriminalize and Regulate Certain
Psychedelics, supra note 12.
64
2022 Colo. Legis. Serv. Init. Pet. 122 (West) (creating regulatory framework for
supervised administration of psilocybin).
65
Id.
2023] MICRODOSING PSYCHEDELICS 585

trained facilitators who support clients during the experience.66 Supported adult
use is legal in the Netherlands, where companies like the Synthesis Institute and
Red Light Holland offer the service.67 They are part of a thriving psychedelic
tourism industry in which people travel to countries like the Netherlands,
Jamaica, and Peru for supported adult-use experiences with psilocybin,
ibogaine, or ayahuasca.68 In the United States, Oregon’s Measure 109 will allow
the supported adult use of psilocybin in 2023. Further, lawmakers in other states,
such as Washington and Florida, have proposed similar bills with subtle
variations on Oregon’s legislation.69
A third type of psychedelic law focuses on the supervised medical use of these
substances.70 Lawmakers in New York and Pennsylvania have proposed this
variety of legislation, which puts licensed healthcare providers in control and
limits use to the treatment of medical conditions that are often specified by the
law.71
Colorado’s Proposition 122 may fall somewhere between supported-adult-use
and medical-use legislation. It will allow people over twenty-one years of age to
access psilocybin at licensed “healing centers.”72 Unlike Oregon’s Measure 109,
which prohibits the state from requiring a medical diagnosis or doctor’s
prescription, Colorado’s Proposition 122 lacks these limitations and has the
potential to become a medical-use law during its eighteen-month

66
Marks, Varieties of Psychedelic Law, supra note 13 (manuscript at 5); see also Mason
Marks, Warning: Oregon Legalized Supported Adult Use of Psilocybin, Not Psychedelic
Therapy, CHACRUNA (Dec. 14, 2021) [hereinafter Marks, Warning: Oregon Legalized
Supported Adult Use of Psilocybin], https://chacruna.net/oregon-legalized-psilocybin-
supported-adult-use/ [https://perma.cc/NST5-GW8M].
67
About, SYNTHESIS INST., https://www.synthesisinstitute.com/about?hsLang=en
[https://perma.cc/Q8BJ-EZTN] (last visited Feb. 10, 2023); Products, RED LIGHT HOLLAND,
https://redlight.co/products/ [https://perma.cc/QL2X-QG6H] (last visited Feb. 10, 2023).
68
Debra Kamin, The Rise of Psychedelic Retreats, N.Y. TIMES (Dec. 1, 2021),
https://www.nytimes.com/2021/11/25/travel/psychedelic-retreat-ayahuasca.html.
69
See H.R. 549, 2021 Sess. (Fla. 2021); Assemb. A08569A, 2021-2022 Reg. Sess. (N.Y.
2022); S. 5660, 67th Leg., Reg. Sess. (Wash. 2022).
70
Marks, Varieties of Psychedelic Law, supra note 13 (manuscript at 5).
71
Id. (manuscript at 5-6).
72
2022 Colo. Legis. Serv. Init. Pet. 122 (West).
586 BOSTON UNIVERSITY LAW REVIEW [Vol. 103:573

implementation period.73 Proposition 122 also has characteristics of a fourth

variety of psychedelics legislation that focuses on clinical research.74
A third type of state psychedelics legislation focuses solely on clinical
research.75 Lawmakers in Florida, Pennsylvania, and Texas have enacted or filed
this type of legislation.76 Though research on microdosing could be conducted
under this regulatory model, which would be an important step toward better
understanding the practice, research-oriented legislation would be less likely to
increase safe and equitable access to microdosing.
At least so far, no psychedelic laws have specifically addressed microdosing.
However, the flexibility of Oregon’s framework allows for it. Moreover, the
governing agency, the Oregon Health Authority (“OHA”), has finalized rules
that allow for limited approaches to microdosing.77
Some approaches to microdosing might also be possible under laws that
promote psychedelic decriminalization, medical use, and clinical research.
However, as discussed below, those laws could just as easily impede or prohibit
the practice. The following discussion introduces Oregon’s Measure 109 and
Measure 110 and describes how they affect microdosing. Part IV makes

73
See Oregon Psilocybin Services Act, ch. 1, 2021 Or. Laws 1, 9-10 (codified as amended
at OR. REV. STAT. § 475A.325(4) (2022)); Marks, Varieties of Psychedelic Law, supra note
13 (manuscript at 6) (explaining how governing agencies can shift laws from one category,
such as supported adult use, into another, such as medical use and how Colordo’s governing
agency could shift Colorado’s law into medical-use category during its eighteen-month
implementation period); Kyle Jaeger, Colorado Voters Approve Psychedelics Legalization
Ballot Initiative, MARIJUANA MOMENT (Nov. 9, 2022), https://www.marijuanamoment.net
/colorado-voters-approve-psychedelics-legalization-ballot-initiative/ [https://perma.cc/2JB6-
T7C2] (stating Proposition 122 creates option for regulators to add DMT, ibogaine, and
mescaline to Colorado’s supported adult-use framework in 2026).
74
See Mason Marks, Seeking Psychedelics? Check the Data Privacy Clause, WIRED (Nov.
2, 2022, 9:00 AM), https://www.wired.com/story/colorado-psychedelics-health-privacy-
surveillance/ (explaining Proposition 122 requires governing state agency, Department of
Regulatory Agencies, to collect outcomes data from Colorado healing centers, which act’s
drafters hope to utilize for medical research); see also Marks, Varieties of Psychedelic Law,
supra note 13 (manuscript at 6) (describing characteristics of clinical research category of
psychedelic legislation and how elements of Proposition 122 fit this description).
75
Marks, Varieties of Psychedelic Law, supra note 13 (manuscript at 6).
76
Act of June 18, 2021, ch. 983, 2021 Tex. Gen. Laws (authorizing study of psilocybin
therapy for veterans with PTSD); H.R. 193, 2022 Sess. (Fla. 2022) (proposing research and
clinical studies of psilocybin); H.R. 1959, 2021 Reg. Sess. (Pa. 2021) (same).
77
See Letter from André Ourso, Adm’r, Ctr. for Health Prot., and Angie Allbee, Section
Manager, Or. Psilocybin Servs., to Members of the Pub. (Dec. 27, 2022),
https://www.oregon.gov/oha/PH/PREVENTIONWELLNESS/Documents/December-2022-
Letter-to-Public.pdf [https://perma.cc/88PB-SB8S] (announcing finalization of rules
governing psilocybin use in Oregon); see also OR. ADMIN. R. 333-333-5250(1)(a) (2022)
(permitting clients who consume 2.5 milligrams or fewer of psilocybin to leave psilocybin
service center after thirty minutes, allowing them to microdose without having to be
supervised for extended periods required of clients who consume higher doses).
2023] MICRODOSING PSYCHEDELICS 587

recommendations for the interpretation, implementation, and modification of

each law to promote safe and equitable access to microdosing.

1. The Oregon Psilocybin Services Act

On November 3, 2020, Oregon voters passed the Oregon Psilocybin Services
Act, also known as Measure 109, with nearly fifty-six percent of Oregonians
voting in favor of the measure.78 Psilocybin services entail the supported adult
use of psilocybin in a controlled setting.79 They are typically delivered in three
stages comprising preparation, administration, and integration sessions.80
During preparation sessions, potential clients meet with licensed facilitators to
assess clients’ goals and explain what clients should expect during a psilocybin
experience.81 Facilitators establish ground rules for the psychedelic session,
identify significant health or safety risks clients may face, and obtain informed
consent for psilocybin services.82 The administration session, which can last
thirty minutes to six hours under current rules,83 is the stage in which clients
consume psilocybin under a facilitator’s supervision. The optional integration
session is a stage in which clients contemplate their psychedelic experiences
with a facilitator’s support and attempt to integrate the lessons learned into their
lives.84 This session may take many forms, including creative writing and other
forms of artistic expression.
Passage of Measure 109 triggered a two-year development period and
required Governor Kate Brown to assemble a body called the Oregon Psilocybin
Advisory Board (“Oregon Board”), which was formed on March 16, 2021, and
first convened on March 31, 2021.85 The Oregon Board makes recommendations

78
See Ballot Measures: Measure 109, OR. LIVE, https://gov.oregonlive.com/election/2020
/general/measures/ [https://perma.cc/EV6S-SS2H] (last visited Feb. 10, 2023). See generally
Oregon Psilocybin Services Act, ch. 1, 2021 Or. Laws 1 (codified as amended at OR. REV.
STAT. §§ 475A.200-.722 (2022)).
79
Marks, Warning: Oregon Legalized Supported Adult Use of Psilocybin, supra note 66.
80
Oregon Psilocybin Services Information, PSILOCYBIN ASSISTED THERAPY ASS’N,
https://pata-us.org/or-psilocybin-services [https://perma.cc/XPG2-3MKQ] (last visited Feb.
10, 2023) (explaining that under Oregon’s Measure 109, integration sessions are optional).
81
Id.
82
Id.
83
See OR. ADMIN. R. 333-333-5250 (2022); cf. Adrienne Santos-Longhurst, How Long Do
Shrooms Stay in Your System?, HEALTHLINE (May 25, 2022),
https://www.healthline.com/health/how-long-do-shrooms-stay-in-your-system
[https://perma.cc/Y6CE-T9PF] (“Shroom trips typically last between 3 and 6 hours, though
some people may feel effects a lot longer.”).
84
See David Bronner, Why We Support the 2020 Ballot Measure That Would Legalize &
Regulate Psilocybin Therapy in Oregon, DR. BRONNER’S (Sept. 21, 2019),
https://www.drbronner.com/all-one-blog/2019/09/psi-2020/ [https://perma.cc/4S78-RPUD].
85
Lizzy Acker, Governor Appoints Board To Oversee Oregon’s New Psychedelic
Mushroom Program, OR. LIVE (Mar. 16, 2021, 6:53 PM), https://www.oregonlive.com
/pacific-northwest-news/2021/03/governor-appoints-board-to-oversee-oregons-new-
psychedelic-mushroom-program.html [https://perma.cc/CBT5-TSZN].
588 BOSTON UNIVERSITY LAW REVIEW [Vol. 103:573

to the state’s public health agency, the OHA, regarding rules for administering
the emerging psilocybin industry.86 Under Measure 109, the Oregon Board’s
recommendations were due on June 30, 2022.87
After convening in March 2021, the Oregon Board quickly formed five
subcommittees focused on psilocybin research, health equity, training, products,
and professional licensure.88 Measure 109 required the Oregon Board to
assemble and publish a summary of available research on the safety and efficacy
of using psilocybin to treat a variety of mental health conditions.89 The Research
Subcommittee published the Oregon Board’s Rapid Evidence Review and
Recommendations on July 30, 2021.90 This report primarily summarized data
from clinical trials designed to evaluate the safety and efficacy of psilocybin for
treating depression, PTSD, substance-use conditions, and anxiety.91 It
mentioned microdosing only once and cited none of the surveys or clinical trials
that evaluated its safety or efficacy.92 We now turn to Oregon’s Measure 110,
the first state law to partially decriminalize psychedelics.

2. The Oregon Drug Decriminalization and Addiction Treatment Act

On November 3, 2020, Oregon voters passed Measure 110, a citizen-initiated
ballot measure that partially decriminalized many controlled substances,
including the most common psychedelics, and established a treatment-and-
recovery program for people with substance-use conditions.93 Section 11
amends Oregon’s Uniform Controlled Substances Act by removing criminal
penalties for the possession of specified quantities of psychedelics and other
controlled substances such as cocaine and heroin.94

86
OR. REV. STAT. § 475A.230 (2022).
87
Oregon Psilocybin Services—Oregon Psilocybin Advisory Board, OR. HEALTH AUTH.,
https://www.oregon.gov/oha/ph/preventionwellness/pages/psilocybin-advisory-board-
meetings.aspx [https://perma.cc/HSU5-MC7U] (last visited Feb. 10, 2023).
88
Or. Psilocybin Advisory Bd., Meeting Minutes (Apr. 28, 2021) (on file with the Boston
University Law Review).
89
Id.
90
See generally ATHEIR I ABBAS, ANGELA CARTER, THOMAS JEANNE, RACHEL KNOX, P.
TODD KORTHUIS, ALI HAMADE, CHRISTOPHER STAUFFER & JESSIE UEHLING, OREGON
PSILOCYBIN ADVISORY BOARD RAPID EVIDENCE REVIEW AND RECOMMENDATIONS (2021),
https://www.oregon.gov/oha/PH/PREVENTIONWELLNESS/Documents/Psilocybin%20ev
idence%20report%20to%20OHA%206-30-21_Submitted.pdf [https://perma.cc/S3KC-
DXCN].
91
Id. at 4-5.
92
Id. at 10 (stating microdosing might require further study).
93
LANTZ & NIEUBUURT, supra note 61, at 1.
94
Drug Addiction Treatment and Recovery Act, ch. 2, § 11(3), (7), 2021 Or. Laws 1, 6
(codified as amended at OR. REV. STAT. § 475.752 (2022)).
2023] MICRODOSING PSYCHEDELICS 589

With respect to psilocybin and LSD, Measure 110 creates possession limits
of less than twelve grams and less than forty “user units,” respectively.95 Though
grams are an easily understood unit of measurement, neither Measure 110 nor
Oregon’s Uniform Controlled Substances Act defines “user units.”96 However,
context from Oregon legislation and case law suggests that “user unit” refers to
a typical standard dose.97
Under Measure 110, possessing fewer than twelve grams of psilocybin or
forty user units of LSD carries no risk of arrest or prosecution.98 Instead, as
noncriminal Class E violations—a category created by Measure 110—the
maximum punishments are a $100 fine or completion of a health assessment
with an addiction treatment professional.99 Individuals found in possession of
psychedelics may choose between these options.100 Additionally, individuals
who possess more than the allowed limits of LSD or psilocybin are no longer
guilty of Class B felonies, because Measure 110 reduces those offenses to Class
A misdemeanors punishable by up to 364 days of imprisonment and a fine up to
$6,250.101 This means that, under Oregon law, a person could possess dozens of
microdoses of psilocybin or LSD without risking state criminal penalties.
However, one must still assume the risk of receiving a fine for a civil infraction.
Further, possessing microdoses remains a crime under the federal CSA.102
However, federal law enforcement will likely lack the resources and motivation
to enforce relevant provisions of the federal CSA against those who choose to

95
Id. Note also that, in both cases, Oregon law does not refer to these units or weights of
LSD or psilocybin specifically, but rather to “mixture[s] or substance[s] containing a
detectable amount of psilocybin[,] . . . psilocin,” or LSD. Id. § 11(7)(b)(A)-(B).
96
See id.; OR. REV. STAT. §§ 475.005, .035, .055, .065.
97
See OR. REV. STAT. § 475.814(2)(b)(B) (including “user units” in list with “pills,
tablets[, and] capsules” in state-controlled substances legislation provision regarding
hydrocodone); State v. Robertson, 412 P.3d 223, 224 (Or. Ct. App. 2018) (stating twenty-
seven grams of methamphetamine is 138 “user units”); State v. Slovik, 71 P.3d 159, 162 n.7
(Or. Ct. App. 2003) (referring to “user units” as “dosage units”); SACRAMENTO CNTY. PROB.
DEP’T, METHAMPHETAMINE TRENDS IN THE PROBATION DEPT. 4 (2020), https://dhs.sac
county.gov/BHS/Documents/SUPT/Methamphetamine/Coalition-2020/MA-ADS-2020-02-
13-Methamphetamine-Trends-in-the-Sacramento-County-Probation-Department.pdf
[https://perma.cc/G2EM-BRZX] (stating average dose of methamphetamine is one-fifth of
one gram). A “tab”—that is, a small square of absorbent paper—is often viewed as a standard
dose of LSD. Kimberly Holland, How Long Does Acid Last? What To Expect, HEALTHLINE
(July 24, 2022), https://www.healthline.com/health/how-long-does-acid-last
[https://perma.cc/JR4T-ZPAB]. One tab can contain thirty to one-hundred micrograms. How
Can We Reduce the Harms Associated with Using LSD?, DRUG POL’Y ALL.,
https://drugpolicy.org/drug-facts/reduce-harms-lsd [https://perma.cc/5KK5-2PS7] (last
visited Feb. 10, 2023).
98
OR. REV. STAT. § 475.752(7)(a).
99
Id. §§ 153.018(2), .019(2), .062(1).
100
LANTZ & NIEUBUURT, supra note 61, at 1.
101
OR. REV. STAT. §§ 161.615, .635; see also LANTZ & NIEUBUURT, supra note 61, at 1.
102
21 U.S.C. §§ 801-802, 812, 844.
590 BOSTON UNIVERSITY LAW REVIEW [Vol. 103:573

microdose, and state and local law enforcement would not enforce the federal
CSA on their behalf.103
In the wake of Oregon’s historic 2020 ballot measures, many other states have
drafted or enacted related legislation, which we address in the following Section.

3. Proposed Legislation in Other States Following Oregon’s Historic

Votes
The following discussion describes other proposed state psychedelics laws
and explains how they differ from Oregon’s Measure 109 and Measure 110.
Though many states are producing psychedelics legislation, this discussion
focuses on bills introduced in New Hampshire, California, and Washington.
In 2022, New Hampshire legislators refiled two psychedelics-related
decriminalization bills, which were ultimately unsuccessful. The first, New
Hampshire House Bill 1349, would have decriminalized the possession and use
of psilocybin mushrooms and other fungi containing “hallucinogenic
alkaloids,”104 such as Amanita muscaria, which contains a psychoactive
compound called muscimol.105 If enacted, any person aged eighteen or older
who knowingly possessed twelve grams or fewer of psychedelic fungi would
have been guilty only of a civil violation—not a criminal offense—carrying a
penalty of a $100 fine for a first or second offense and a fine of up to $300 for
subsequent offenses.106 In addition, the bill would have instructed courts to
waive the fine for any single civil violation “within a 3-year period upon proof
that person has completed a substance abuse assessment by a licensed drug and
alcohol counselor within 60 days of the conviction.”107
If New Hampshire had enacted House Bill 1349, people could have possessed
dozens of microdoses of psilocybin without risking state or local criminal
penalties. Like law enforcement officers in Oregon, New Hampshire state and
local police would not have enforced the federal CSA.108 However, the
possession or use of microdoses of psilocybin or LSD would have remained
felonies under federal law.109
The second proposed psychedelics-related New Hampshire bill was House
Bill 1392, which sought to decriminalize all “nonviolent drug offenses and [to]
eliminate[] the prohibitions and penalties for the possession, use, or sale of drug

103
See Robert A. Mikos, The Evolving Federal Response to State Marijuana Reforms, 26
WIDENER L. REV. 1, 10-13 (2020) (discussing softer federal response to state marijuana reform
since 2008).
104
H.R. 1349-FN, 2022 Sess. (N.H. 2022).
105
Povl Krogsgaard-Larsen, Lotte Brehm & Kjeld Schaumburg, Muscimol, a
Psychoactive Constituent of Amanita Muscaria, as a Medicinal Chemical Model Structure,
35B ACTA CHEMICA SCANDINAVICA 311, 311-12 (1981).
106
N.H. H.R. 1349-FN § 3.
107
Id. § 3.IV(a).
108
See Mikos, supra note 103, at 10-14 (discussing federal response to state marijuana
reform).
109
Id.
2023] MICRODOSING PSYCHEDELICS 591

paraphernalia.”110 The bill specified that where a person knowingly possesses

cocaine, heroin, methamphetamine, LSD, or phencyclidine (“PCP”) they would
be penalized with a fine of forty dollars per gram.111 Where a person knowingly
possessed any other substance prohibited by New Hampshire’s controlled
substance laws, such as psilocybin, they would be penalized with a fine of
twenty dollars per gram.112 Violating House Bill 1392 would not have resulted
in arrest or prosecution.113 If New Hampshire had enacted HB 1392, people
could have possessed microdoses of psilocybin, LSD, and other psychedelics
without risking state or local criminal penalties.
Like Oregon’s Measure 110 and New Hampshire’s House Bills 1349 and
1392, California’s Senate Bill 519 would have removed criminal penalties
associated with possessing certain psychedelic substances.114 However, the
original draft of Senate Bill 519 went further: it would have removed all
penalties associated with possessing certain psychedelics as well as penalties
associated with cultivating and sharing them without compensation.115
Consequently, for a certain range of criminalized activities, the original version
would have been a form of full decriminalization, at least with respect to state
law.
If California had maintained and enacted the original draft of Senate Bill 519,
state and local law would have allowed people twenty-one years of age or older
to cultivate, obtain, possess, share, or consume certain quantities of
psychedelics.116 The allowed substances would have included “psilocybin,
psilocyn, dimethyltryptamine (DMT), ibogaine, mescaline, lysergic acid
diethylamide (LSD), and 3,4-methylenedioxymethamphetamine (MDMA).”117
Possession limits for psilocybin and LSD would have been “[t]wo grams of
psilocybin or four ounces of a plant or fungi containing psilocybin” and one
hundredth of a gram of LSD, which equals ten milligrams or 10,000
micrograms.118
Senate Bill 519 would not have allowed commercial distribution or sale of
psychedelic substances.119 However, though the bill would have created no
regulatory framework for supported adult use of psychedelics, it would have
allowed facilitators to charge “reasonable fees for counseling, spiritual guidance,
or related services” provided in conjunction with supported adult use.120

110
H.R. 1392-FN, 2022 Sess. (N.H. 2022).
111
Id. § 2.
112
Id.
113
See id.
114
S. 519, 2021-2022 Reg. Sess. (Cal. 2021).
115
See id. at 12, 15-16, 18-19, 21.
116
Id. at 18.
117
Id.
118
Id. at 20.
119
Id. at 12.
120
Id. at 2.
592 BOSTON UNIVERSITY LAW REVIEW [Vol. 103:573

Additionally, Senate Bill 519 would have taken several other steps to broaden
legal protection for those who consume psychedelics. For instance, it would
have repealed California’s prohibition on relevant drug paraphernalia.121 The
bill also makes clear that if federal law were “to permit physician[s],
pharmacist[s], or other authorized healing arts licensee[s]” to “prescribe,
furnish, or dispense” one of the listed psychedelic substances, such conduct
would simultaneously become decriminalized under California state law.122
Finally, Senate Bill 519 would have required the State Department of Public
Health to convene a working group to conduct research and make
recommendations to the legislature regarding “public education, public health,
and harm reduction, and possible regulatory systems that California could adopt
to promote safe and equitable access to” the decriminalized psychedelic
substances, including for facilitated group use.123
Though Senate Bill 519 would have allowed Californians to possess, share,
and consume psychedelic microdoses for personal use, its text did not explicitly
mention microdosing. Consequently, if Senate Bill 519 had passed, it would
have remained unclear whether microdosing would be considered by the state
working group and included in its recommendations. Moreover, if in the future
federal law allows healthcare providers to prescribe psychedelics, it is uncertain
whether microdosing would be decriminalized under Senate Bill 519. These
issues are discussed further in Part IV. Although the bill advanced from the
California Senate to the State Assembly, it ultimately stalled in the Assembly
Appropriations Committee in August 2021.124 When this committee
reconsidered the bill in 2022, it gutted the proposal, turning it into a policy
analysis bill instead of a psychedelic decriminalization bill.125 The bill’s
sponsor, California State Senator Scott Wiener, vowed to reintroduce it the
following year.126 In December 2022, he filed a revised version titled SB 58.127
Over a dozen other states have proposed legislation that decriminalizes or
legalizes psychedelic use.128 Yet Oregon and Colorado remain the only states to

121
Id. at 20.
122
Id. at 2, 10.
123
Id. at 24.
124
The Future of the Psychedelic Decriminalization Bill in California, Its Potential Impact
on Patient Care, PHARMACY TIMES (Oct. 4, 2021), https://www.pharmacytimes.com/view
/the-future-of-the-psychedelic-decriminalization-bill-in-california-its-potential-impact-on-
patient-care [https://perma.cc/V4RV-SYZG].
125
See Wiley, supra note 62.
126
Id.
127
Senator Wiener Reintroduces Legislation To Decriminalize Psychedelics, SCOTT
WIENER REPRESENTING SENATE DISCT. 11, https://sd11.senate.ca.gov/news/20221219-
senator-wiener-reintroduces-legislation-decriminalize-psychedelics [https://perma.cc/D2CK-
6YNF] (last visited Feb. 10, 2023).
128
See Michael Ollove, More States May Legalize Psychedelic Mushrooms, PEW (July 15,
2022), https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2022/07/15/more-
states-may-legalize-psychedelic-mushrooms [https://perma.cc/2NRP-9DNG].
2023] MICRODOSING PSYCHEDELICS 593

have enacted laws that create regulated psychedelic markets.129 On January 4,

2022, two Washington senators prefiled Senate Bill 5660, which was modeled
largely after Oregon’s Measure 109.130 Though the Washington bill does not
mention microdosing, it contains several improvements that could make the
practice more accessible compared to Measure 109.131 However, following a
hearing with the Senate Health and Long Term Care Committee, Senate Bill
5660 failed to advance for consideration by the full Senate.132 Its sponsors
subsequently proposed a state working group, housed within the Washington
Health Care Authority, to research psilocybin services and make
recommendations to improve Senate Bill 5660 prior to its reintroduction.133 The
bill’s primary sponsor, Washington State Senator Jesse Salomon reintroduced
the bill as SB 5263 in January 2023.

C. Local Ordinances and Resolutions

Though Oregon and Colorado are the only states to have decriminalized
psychedelics, at least fifteen U.S. cities have decriminalized them or
deprioritized the enforcement of related criminal penalties, including Denver,
Colorado; Oakland, Berkeley, San Francisco, Santa Cruz, and Arcata City,
California; Detroit and Ann Arbor, Michigan; Cambridge, Somerville,
Northampton, and Easthampton, Massachusetts; Seattle and Port Townsend,
Washington; and the District of Columbia.134 The following Sections describe
the policies implemented by two of the first cities to decriminalize and how those
policies affect microdosing.

1. Denver Decriminalization Ordinance

On May 7, 2019, Denver voters passed a city ordinance by ballot initiative,
which effectively decriminalized the personal possession and use of psilocybin
mushrooms by prohibiting the city from spending resources to arrest or
prosecute people for possession or use of psilocybin mushrooms.135 Called the
Denver Psilocybin Mushroom Decriminalization Initiative, the ordinance
decriminalized psilocybin-producing mushrooms by prohibiting the city from

129
Psychedelic Legalization & Decriminalization Tracker, supra note 10.
130
Marks, Warning: Oregon Legalized Supported Adult Use of Psilocybin, supra note 66.
131
Id. (describing how Washington Senate Bill 5660 allows for home administration of
psilocybin when clients are medically unable to travel to service center).
132
Rich Smith, Washington Bill To Legalize Psilocybin Mushroom Treatment Centers
Won’t Pass, STRANGER (Feb. 2, 2022, 1:55 PM), https://www.thestranger.com/slog/2022/02
/02/65940566/bill-to-regulate-psilocybin-mushrooms-in-washington-wont-pass
[https://perma.cc/E2D8-7EYK].
133
Id.
134
Psychedelic Legalization & Decriminalization Tracker, supra note 10.
135
Marks, Varieties of Psychedelic Law, supra note 13 (manuscript at 4); Nicole Chavez
& Ryan Prior, Denver Becomes the First City To Decriminalize Hallucinogenic Mushrooms,
CNN (May 9, 2019, 4:25 PM), https://www.cnn.com/2019/05/08/us/denver-magic-
mushrooms-approved-trnd/index.html [https://perma.cc/US75-J9ZV].
594 BOSTON UNIVERSITY LAW REVIEW [Vol. 103:573

spending resources to impose criminal penalties for this conduct and by making
personal possession by individuals twenty-one years or older the city’s “lowest
law enforcement priority.”136 Denver is the only U.S. city to have passed an
ordinance, which carries the force of law.137 By comparison, all other cities that
have decriminalized psychedelics have passed resolutions, which are mere
statements of city policy that are more easily ignored or reversed than
ordinances.138
The Denver ordinance includes “propagation”—that is, the production of a
new plant or fungus139—in its definition of “personal possession.”140 However,
it excludes “the sale of psilocybin mushrooms for remuneration” from the
definition, specifying that such conduct remains subject to prosecution under
existing state laws.141 The provision does not include a cap on how much
psilocybin an individual can possess before being subject to prosecution, though
possession of large amounts could be interpreted by law enforcement and
prosecutors as possession for a commercial purpose.142 Thus, in Denver, people
can possess microdoses of psilocybin without risking criminal or other penalties
under state and local law. The city ordinance also suggests people do not risk
arrest or prosecution for cultivating their own psilocybin mushrooms, sharing
them, or giving them away without compensation.

2. Oakland Decriminalization Resolution

On June 4, 2019, the City of Oakland, California effectively decriminalized
entheogenic plants, which includes mushrooms containing psychoactive
substances, by City Council resolution.143 Like Denver’s ordinance, Oakland’s
resolution aims to decriminalize by defunding law enforcement activities related
to the possession and use of the relevant substances by adults.144 Also like
Denver’s ordinance, Oakland’s resolution states that investigations and arrests

136
DENVER, COLO., REV. ORDINANCES tit. 1, ch. 28, art. IX (2019).
137
See 5 EUGENE MCQUILLIN, THE LAW OF MUNICIPAL CORPORATIONS § 15:2, at 122-
25(3d ed. 2022) (discussing differences between ordinances and resolutions).
138
Id.
139
Propagate, MERRIAM-WEBSTER, https://www.merriam-webster.com/dictionary
/propagating [https://perma.cc/P8B2-ENX6] (last visited Feb. 10, 2023).
140
See DENVER, COLO., REV. ORDINANCEStit.1, ch. 28, art. IX, § 28-301.
141
Id.
142
Id.
143
Merrit Kennedy, Oakland City Council Effectively Decriminalizes Psychedelic
Mushrooms, NPR (June 5, 2019, 4:57 PM), https://www.npr.org/2019/06/05/730061916
/oakland-city-council-effectively-decriminalizes-psychedelic-mushrooms [https://perma.cc
/8CNX-FGX5].
144
Oakland City Council, Res. No. 87731 (June 4, 2019), https://oakland.legistar.com
/View.ashx?M=F&ID=7321042&GUID=2661C980-0A36-45A2-A687-545A5F9C9D85
[https://perma.cc/2DPR-83QD] (barring City of Oakland from using funds “to assist in the
enforcement of laws imposing criminal penalties for the use and possession of Entheogenic
Plants by adults”).
2023] MICRODOSING PSYCHEDELICS 595

related to the possession of the relevant substances “shall be amongst the lowest
law enforcement priority for the City of Oakland.”145 However, because it is a
resolution instead of an ordinance, Oakland’s resolution merely reflects City
Council policy and does not carry the force of law. Though Oakland police and
prosecutors may be unlikely to violate the policy, they technically could do so,
and the city’s resolution could be changed more easily than an ordinance.
Despite being a resolution, Oakland’s measure goes further than Denver’s by
addressing a longer list of psychedelic substances and by stating that the
investigation of and arrest for growing, buying, and distributing the listed
substances is also among the city’s lowest law enforcement priorities.146 Thus,
in Oakland, arguably a person could possess microdoses of psilocybin and other
psychedelics without risking arrest or prosecution so long as local police and
prosecutors abide by the resolution.147

D. Foreign Jurisdictions
Despite an international treaty that heavily restricts psychedelics,148 legal
prohibitions are softening around the world. Many foreign jurisdictions,
including Canada, Portugal, Jamaica, and the Netherlands, have moved away
from criminalizing psychedelics toward public-health-oriented approaches.149
The Canadian approach to psychedelics is most like that of the U.S. federal
government. In Canada, the Controlled Drugs and Substances Act prohibits the
production, sale, and possession of psychedelic substances.150 MDMA and
ketamine are listed on Canada’s Schedule I, which carries the most severe
criminal penalties.151 The other psychedelics, including psilocybin and LSD, are
listed on Schedule III.152 Despite these restrictions, the Canadian Minister of
Health has discretion to grant exemptions for scientific or other purposes in the

145
Id.
146
Id.
147
Wayne A. Logan, After the Cheering Stopped: Decriminalization and Legalism’s
Limits, 24 CORNELL J.L. & PUB. POL’Y 319, 327-30 (2014) (discussing police evasion and
disregard of cannabis decriminalization measures); see also Marisa Demarco, State Police
Ignore Decriminalization Law in Albuquerque, KUNM (May 31, 2019, 5:42 PM),
https://www.kunm.org/local-news/2019-05-31/state-police-ignore-decriminalization-law-in-
albuquerque [https://perma.cc/2M7X-56KM] (explaining how state police began making
arrests for cannabis possession in parts of Albuquerque after city decriminalized that conduct
and Albuquerque police stopped making arrests for it).
148
See generally Convention on Psychotropic Substances, Feb. 21, 1971, 1019 U.N.T.S.
175.
149
See Psilocybin Laws: A Country-by-Country Magic Mushrooms Legal Guide,
PSILOCYBIN, https://psilocybin.net/laws/ [https://perma.cc/9JKU-5L3R] (last visited Feb. 10,
2023).
150
Hilary Ball, What Is the Future of the “Psychedelic Renaissance” in Canada?, MCGILL
J. OF L. & HEALTH (Nov. 1, 2021), https://mjlh.mcgill.ca/2021/11/01/what-is-the-future-of-
the-psychedelic-renaissance-in-canada/ [https://perma.cc/YM6Z-Z4ZY].
151
Id.
152
Id.
596 BOSTON UNIVERSITY LAW REVIEW [Vol. 103:573

public interest, and the number of exemptions regarding psychedelics has been
growing.153 For example, the Minister of Health granted religious exemptions
for ayahuasca import and administration, starting in 2017, and medical
exemptions for palliative psilocybin therapy for people with life-threatening
cancer diagnoses, starting in 2020.154 Health Canada has said it will consider
requests for medical exemptions for psychedelic-assisted therapy on a case-by-
case basis for a “serious or life-threatening condition” when conventional
treatments have failed, are not suitable for the patient, or are not available in
Canada.155 In addition, doctors in Canada, like those in the United States, can
already prescribe and administer ketamine-assisted therapy off-label for a
variety of mental health conditions, because the Canadian government has
approved the medical use of ketamine as an anesthetic.156 Consequently, private
ketamine clinics are opening throughout Canada.157 Finally, Vancouver and
Toronto—two of Canada’s largest cities—decriminalized the personal
possession of controlled substances, including psychedelics.158
For now, the jurisdiction that best mirrors U.S. state and local efforts to
decriminalize substances is Portugal, a pioneer of this approach. Faced with an
intractable substance use and HIV crisis that impacted all segments of society,
Portugal became the first country to partially decriminalize personal possession
of all drugs in 2001.159 The country also increased the social services, medical
services, and treatment opportunities available to people who use substances.160

153
Id.
154
Id.
155
Fakiha Baig, Canada Approving Psychedelics for Therapy Is a Positive Step, Experts
Say, GLOB. NEWS (Jan. 15, 2022, 9:10 PM), https://globalnews.ca/news/8514429
/psychedelic-drugs-therapy-canada/ [https://perma.cc/F4PK-W2ZV].
156
See Rani Sheen, Would You Try a Ketamine-Enhanced Therapy Session?, KIT (Oct. 30,
2020), https://thekit.ca/health/ketamine-therapy-canada/ [https://perma.cc/5XMY-5VPL];
Julian Uzielli, Ketamine-Assisted Therapy Lifted Me out of Depression. But It Remains
Costly—And Controversial, CBC: RADIO (Sept. 5, 2021), https://www.cbc.ca/radio
/docproject/ketamine-assisted-therapy-lifted-me-out-of-depression-but-it-remains-costly-
and-controversial-1.6068333 [https://perma.cc/WQU9-42G4].
157
See Sheen, supra note 156.
158
See Rachel Browne, Vancouver Just Voted To Decriminalize All Drugs, VICE: WORLD
NEWS (Nov. 25, 2020, 10:59 PM), https://www.vice.com/en/article/z3v4gw/vancouver-just-
voted-to-decriminalize-all-drugs [https://perma.cc/H6SQ-4CJY]; Rachel Gilmore, Is the
‘War on Drugs’ Over? Canada Is Seeing a ‘Shift’ in Its Approach to Drugs, Experts Say,
GLOB. NEWS (Dec. 8, 2021, 5:21 PM), https://globalnews.ca/news/8428115/drug-laws-
canada-mandatory-minimums-war-on-drugs-over/ [https://perma.cc/79FM-WUGD];
Kirthana Sasitharan, Toronto Board of Health Votes To Decriminalize Possession of Small
Amounts of Illegal Drugs, CBC: NEWS (Dec. 7, 2021, 5:00 AM), https://www.cbc.ca
/news/canada/toronto/toronto-board-of-health-votes-yes-process-decriminalization-small-
drug-posession-illegal-1.6275501 [https://perma.cc/R2KC-BRAZ].
159
Bajekal, supra note 60.
160
Austin Frakt, Pointers from Portugal on Addiction and the Drug War, N.Y. TIMES: THE
UPSHOT (Oct. 6, 2020), https://www.nytimes.com/2020/10/05/upshot/portugal-drug-
legalization-treatment.html.
2023] MICRODOSING PSYCHEDELICS 597

Nevertheless, substance manufacture and sale remain criminal offenses.161 In

Portugal, possessing less than a ten-day supply of any substance results in a
hearing before a local commission that includes a doctor, a lawyer, and a social
worker. These professionals attempt to learn about the individual’s relationship
with substances and inform them of available medical services.162 The panel can
refer individuals to drug treatment programs, impose fines, or require
community service.163 Although psychedelics and people who use them were
not among the primary concerns that prompted Portuguese drug policy reform,
they benefit from this less punitive form of substance regulation.164
Other countries have taken more idiosyncratic approaches to psychedelics law
and regulation. For example, unlike Portugal, Canada, the United States, and
most countries around the world, Jamaica never outlawed psilocybin.165
Accordingly, Jamaicans can legally grow, sell, and consume psilocybin
mushrooms.166 Western tourists frequently travel to Jamaica for legal psilocybin
retreats.167 Recently, Jamaica took steps to alter the substance’s unregulated
status—not by criminalizing it but by seeking to maximize the substance’s
potential through both government collaboration with industry and investors and
promulgation of health and safety regulations.168 In 2021, the Jamaican Minister
of Agriculture and Fisheries announced that the government had put interim
protocols in place to facilitate the cultivation and processing of psilocybin
mushrooms.169
The Dutch approach to psychedelics law and regulation may be the most
idiosyncratic. The Netherlands is famous for its “coffee shops,” where locals and
tourists have long been able to openly buy and consume cannabis.170 The country
is becoming increasingly famous for its “smartshops,” which often sell

161
Bajekal, supra note 60.
162
Id.
163
Frakt, supra note 160.
164
See Linnae Ponté, Decriminalization and Harm Reduction in Portugal: An Interview
with Dr. João Goulão, MULTIDISCIPLINARY ASS’N PSYCHEDELIC STUD., Spring 2015, at 18,
19.
165
Nickieta Sterling, Protocols in Place for ‘Magic Mushrooms,’ JAM. INFO. SERV. (July
18, 2021), https://jis.gov.jm/protocols-in-place-for-magic-mushrooms/ [https://perma.cc
/3XQE-9DZJ].
166
Id.
167
Id.
168
Id.
169
Id.
170
See Holly Ellyatt, Amsterdam’s Coffeeshops, Already Hit by Covid, Fear a Clampdown
on Tourists, CNBC: EUR. ECON. (Sept. 9, 2021, 2:33 AM), https://www.cnbc.com/2021/09/09
/amsterdams-coffeeshops-reel-from-low-tourist-numbers-this-summer.html
[https://perma.cc/L4LZ-RJ79].
598 BOSTON UNIVERSITY LAW REVIEW [Vol. 103:573

psilocybin “truffles.”171 However, despite being sold over the counter, cannabis
and psilocybin truffles have distinct legal statuses in the Netherlands.
Although Dutch law enforcement tolerates the possession, consumption, and
retail sale of cannabis, it and other “soft drugs” are technically illegal.172 The
Dutch “Opium Act”—the country’s drug prohibition legislation—distinguishes
between hard and soft drugs.173 Hard drugs include heroin, cocaine, various
synthetic psychedelics (such as LSD), and extracts of certain naturally occurring
psychedelics, such as psilocybin, mescaline, and dimethyltryptamine
(“DMT”).174 Soft drugs include not only cannabis but plants and fungi
containing psychedelic substances, including psilocybin, 5-MeO-DMT, and
ibogaine.175 Despite technically prohibiting soft drugs, the Netherlands has long
followed a policy of toleration where the government does not prosecute the
possession of small quantities of cannabis (five or fewer grams) or its sale by
coffee shops holding the relevant government license.176 The Dutch
government’s website indicates that its policy of toleration extends to other soft
drugs as well, including psychedelics, which locals and tourists can purchase
online and in smart shops.177
Unlike soft drugs, psilocybin mushrooms—the fruiting bodies that break
through the soil when fungi reproduce—have been prohibited since 2008.178
However, sclerotia (“truffles”), which represent a dormant stage of the fungal
life cycle, are available for purchase in smart shops.179
Truffles and the commerce surrounding them remain largely unregulated in
the Netherlands.180 The lack of regulation has led some psychedelic facilitators

171
See Amsterdam Smartshops, AMSTERDAM.INFO, https://www.amsterdam.info
/smartshops/ [https://perma.cc/5TKN-8ZH5] (last visited Feb. 10, 2023).
172
See Difference Between Hard and Soft Drugs, GOV’T OF THE NETH.,
https://www.government.nl/topics/drugs/difference-between-hard-and-soft-drugs
[https://perma.cc/S6DD- 3Y7R] (last visited Feb. 10, 2023).
173
See id.
174
See Opiumwet van 12 mei 2021, Stb. 2021, https://wetten.overheid.nl/BWBR0001941
/2021-10-28#BijlageII [https://perma.cc/LN8T-WFKD]; Are Psychedelics Legal in the
Netherlands?, DRUG SCI. (Aug. 23, 2021), https://www.drugscience.org.uk/are-psychedelics-
legal-in-the-netherlands/ [https://perma.cc/Q2T3-LLKR]; Amsterdam Drugs Laws,
AMSTERDAM.INFO, https://www.amsterdam.info/drugs/ [https://perma.cc/LCX5-LKQU] (last
visited Feb. 10, 2023).
175
Opiumwet van 12 mei 2021, Stb. 2021; Are Psychedelics Legal in the Netherlands?,
supra note 174.
176
See Difference Between Hard and Soft Drugs, supra note 172 (stating this policy on
government website); Amsterdam Smartshops, supra note 171 (noting coffee shop licensing
requirement).
177
Difference Between Hard and Soft Drugs, supra note 172.
178
See id.; Alberto Cantizani López, Truffle Therapy in the Netherlands Is Running Ahead
of the Science, OPEN FOUND. (May 7, 2021), https://open-foundation.org/truffle-therapy-in-
the-netherlands-is-running-ahead-of-the-science/ [https://perma.cc/W48S-PNYC].
179
See López, supra note 178; Difference Between Hard and Soft Drugs, supra note 172.
180
López, supra note 178; Difference Between Hard and Soft Drugs, supra note 172.
2023] MICRODOSING PSYCHEDELICS 599

to found a professional association called the “Guild of Guides” to develop

ethical standards and promote best practices.181 Among the few laws regulating
Dutch commerce in psilocybin truffles is an effective ban on advertising them
as medical treatments.182 Once medical claims are made, the Dutch Health and
Youth Care Inspectorate (“IGJ”) may assert that truffles fall under the Dutch
Medicines Act, which would subject them to extensive regulations.183 The IGJ
may impose fines for violations.184 Despite this risk, truffle sellers and retreat
companies are increasingly making medical claims.185

II. THE ART AND SCIENCE OF MICRODOSING

Part I analyzed local, state, and federal laws that pertain to microdosing.
Part II further defines microdosing and explains why people engage in the
practice.

A. Microdosing Defined
The modern trend of microdosing is relatively new,186 and there has been little
standardization of the practice.187 Nevertheless, generalizations can be drawn
from the growing literature on the topic. At its core, microdosing is the practice
of consuming very small doses of psychedelic substances, usually on a schedule
consisting of “on days,” during which people consume a microdose, interspersed
with “off days,” during which they do not.188
In his influential writing on microdosing, James Fadiman refers to “sub-
perceptual” doses in the range of one-tenth to one-twentieth of a standard
dose.189 The idea behind this term is that microdoses are below the “perceptual
threshold,” meaning that people who consume subperceptual doses do not

181
López, supra note 178; Difference Between Hard and Soft Drugs, supra note 172;
Professional Association for Facilitators of Psychedelic Experiences, GUILD OF GUIDES,
https://www.guildofguides.nl [https://perma.cc/TG5G-Z7XJ] (last visited Feb. 10, 2023).
182
López, supra note 178; Difference Between Hard and Soft Drugs, supra note 172.
183
López, supra note 178; Difference Between Hard and Soft Drugs, supra note 172.
184
Monitoring the Quality and Safety of Medicines, GOV’T OF THE NETH.,
https://www.government.nl/topics/medicines/monitoring-the-quality-and-safety-of-
medicines [https://perma.cc/4AD7-EMSH] (last visited Feb. 10, 2023).
185
See López, supra note 178; Difference Between Hard and Soft Drugs, supra note 172.
186
See infra Section II.B (discussing history of microdosing).
187
See Kim P.C. Kuypers, Livia Ng, David Erritzoe, Gitte M. Knudsen, Charles D.
Nichols, David E. Nichols, Luca Pani, Anaïs Soula & David Nutt, Microdosing Psychedelics:
More Questions than Answers? An Overview and Suggestions for Future Research, 33 J.
PSYCHOPHARMACOLOGY 1039, 1039 (2019) (“[T]here is no agreed scientific consensus on
what microdosing entails.”).
188
See infra notes 189-220 and accompanying text.
189
JAMES FADIMAN, THE PSYCHEDELIC EXPLORER’S GUIDE: SAFE, THERAPEUTIC, AND
SACRED JOURNEYS 198 (2011) [hereinafter FADIMAN, THE PSYCHEDELIC EXPLORER’S GUIDE];
see also Kuypers et al., supra note 187, at 1040 (“[Fadiman’s book] is often referred to as a
protocol for those practising microdosing.”).
600 BOSTON UNIVERSITY LAW REVIEW [Vol. 103:573

perceive any effect.190 Several researchers, writers, and other commentators

have adopted this description,191 though Fadiman himself acknowledges that it
could be something of a misnomer because one can “almost always” tell that
one has taken a microdose.”192 Other authors have used the term “sub-threshold”
dose, though it too appears to reference the perceptual threshold, at which people
feel some kind of mental or physical effect.193 Some refer to microdoses as “sub-
hallucinogenic” rather than “sub-perceptual.”194 This term is also something of
a misnomer because many psychedelic experiences do not involve
hallucinations.195 Semantic issues aside, though microdoses may be considered
psychoactive—because they may alter one’s neurochemistry and may facilitate
behavioral change—they do not typically produce psychedelic effects such as
changes in visual, auditory, spatial, or temporal perception.196 Microdoses may
have subtle physical effects—for instance, people have reported increased
perspiration197—however, they do not typically impair one’s ability to function
normally at home or at work.198

190
See Kuypers et al., supra note 187, at 1040 (defining microdosing psychedelics as “use
of a low dose below the perceptual threshold that does not impair ‘normal’ functioning of an
individual”).
191
See, e.g., Nadia R.P.W. Hutten, Natasha L. Mason, Patrick C. Dolder & Kim P.C.
Kuypers, Motives and Side-Effects of Microdosing with Psychedelics Among Users, 22 INT’L
J. NEUROPSYCHOPHARMACOLOGY 426, 426 (2019) [hereinafter Hutten et al., Motives and Side-
Effects]; Rifkin et al., supra note 17, at 316; Daniel Rosenbaum, Cory Weissman, Thomas
Anderson, Rotem Petranker, Le-Anh Dinh-Williams, Katrina Hui & Emma Hapke,
Microdosing Psychedelics: Demographics, Practices, and Psychiatric Comorbidities, 34 J.
PSYCHOPHARMACOLOGY 612, 612 (2020).
192
James Fadiman & Sophia Korb, Might Microdosing Psychedelics Be Safe and
Beneficial? An Initial Exploration, 51 J. PSYCHOACTIVE DRUGS 118, 118 (2019).
193
See, e.g., Kuypers et al., supra note 187, at 1040.
194
See, e.g., Thomas Anderson, Rotem Petranker, Adam Christopher, Daniel Rosenbaum,
Cory Weissman, Le-Anh Dinh-Williams, Katrina Hui & Emma Hapke, Psychedelic
Microdosing Benefits and Challenges: An Empirical Codebook, HARM REDUCTION J., July
2019, at 1, 1; Cameron et al., supra note 17, at 114.
195
See Katrin H. Preller & Franz X. Vollenweider, Phenomenology, Structure, and
Dynamic of Psychedelic States, in 36 BEHAVIORAL NEUROBIOLOGY OF PSYCHEDELIC DRUGS
221, 223 (Adam L. Halberstadt, Franz X. Vollenweider & David E. Nichols eds., 2018) (“At
the present time, the term hallucinogen is the most common designator in the scientific
literature, although it is somewhat of a misnomer because true hallucinations rarely occur at
low-to-medium doses.”).
196
See Fadiman & Korb, supra note 192, at 118 (stating Fadiman’s intention in using term
subperceptual “was to say that microdosing did not cause visual or perceptual changes usually
associated with psychedelics” like visual distortions and internal visions); Petter Grahl
Johnstad, Powerful Substances in Tiny Amounts: An Interview Study of Psychedelic
Microdosing, 35 NORDIC STUD. ON ALCOHOL & DRUGS 39, 44 (2018) (distinguishing
microdose from minidose); Kuypers et al., supra note 187, at 1040 (stating microdose “can
be seen as being somewhat below a very low dose”).
197
Cameron et al., supra note 17, at 118.
198
Rifkin et al., supra note 17, at 316.
2023] MICRODOSING PSYCHEDELICS 601

Microdosing psychedelics also differs from standard dosing because rather

than having a single psychedelic experience or a series of experiences separated
by weeks or months, as is typical of standard dosing, people who microdose
usually do so periodically—at predefined intervals—over the course of weeks
or months.199 For example, Fadiman popularized the “one-day-on, two-days-
off” schedule in his 2011 book The Psychedelic Explorer’s Guide: Safe,
Therapeutic, and Sacred Journeys.200 This dosing schedule appears to be one of
the most common.201 Another popular schedule involves alternating between on
days and off days.202 A third popular schedule is the “Stamets Stack,” which
refers to American mycologist Paul Stamets, who patented the protocol, and the
process of “stacking” or combining nonpsychoactive substances with a
psychedelic microdose to boost the effects.203 The Stamets Stack involves
consuming 100 to 200 milligrams of dried psilocybin mushrooms, 500 to 1000
milligrams of nonpsychedelic Lion’s Mane mushroom extract powder, and 50
to 200 milligrams of niacin (vitamin B3) on four consecutive days followed by
three off days. This pattern is repeated over four consecutive weeks followed by
a two- to four-week “reset” period, during which the individual abstains from
microdosing.204 Despite the popularity of the Stamets Stack and other

199
See Cameron et al., supra note 17, at 114 (defining microdosing as “practice of taking
chronic, sub-hallucinogenic doses of psychedelic compounds on an intermittent schedule”);
Kuypers et al., supra note 187, at 1040 (including “multiple dosing sessions” as definitional
component of microdosing); Rifkin et al., supra note 17, at 316 (defining microdosing as
“semiregular administration of small, subhallucinogenic doses of psychedelics to enhance
performance during regular daily life”). But see Katrin H. Preller, Commentary, The Effects
of Low Doses of Lysergic Acid Diethylamide in Healthy Humans: Demystifying the
Microdosing of Psychedelics, 86 BIOLOGICAL PSYCHIATRY 736, 736 (2019) (“[M]any
recreational microdosers seem to be taking a low dose a few times a year and do not follow a
regular dosing schedule.”).
200
FADIMAN, THE PSYCHEDELIC EXPLORER’S GUIDE, supra note 189, at 199-202, 210-11
(describing and discussing case report of man who used that protocol); see also Rosenbaum
et al., supra note 191, at 617 (stating popularity of this protocol may have its basis in
Fadiman’s 2011 book). Note that Fadiman now recommends a one-day-on, three-days-off
schedule. James Fadiman, Microdose Research: Without Approvals, Control Groups,
Double-Blinds, Staff or Funding by Dr James Fadiman, PSYCHEDELIC PRESS (Nov. 16, 2017)
[hereinafter Fadiman, Microdose Research], https://psychedelicpress.co.uk/blogs
/psychedelic-press-blog/microdose-research-james-fadiman. This schedule is also popular.
Rosenbaum et al., supra note 191, at 616 (finding twenty percent of respondents who
microdosed did so every fourth day, while thirty-six percent did so every third day).
201
See, e.g., Kuypers et al., supra note 187, at 1041 (finding, in search of microdosing
protocols that included books, online fora, and surveys, that this was among three most
common protocols); Rosenbaum et al., supra note 191, at 613, 617 (finding this result in
anonymous online survey of 909 respondents recruited primarily from Reddit).
202
See Kuypers et al., supra note 187, at 1041.
203
Stamets Stack (Stacking Lion’s Mane and Psilocybin Mushrooms), MICRODOSING INST.,
https://microdosinginstitute.com/microdosing-101/substances/lions-mane-stacking/
[https://perma.cc/7XW9-SY64] (last visited Feb. 10, 2023).
204
Id.
602 BOSTON UNIVERSITY LAW REVIEW [Vol. 103:573

microdosing protocols, one recent survey found that approximately half of 1,116
respondents followed microdosing schedules of their own design.205
Most microdosing protocols share several common features. For example,
they usually include off days, because people who microdose attempt to avoid
developing a tolerance to the psychedelic they are consuming.206 Tolerance
refers to a person’s diminished response to a substance after repeated
ingestion.207 When developing a tolerance to a substance, individuals must take
higher doses to achieve the same effects.208 Scientific research regarding
standard doses of psilocybin and LSD suggest that people can develop tolerances
to those substances, however, many relevant studies are decades old.209 In
addition, there are conflicting reports from people who microdose regarding
whether the practice leads to tolerance.210 Further research could shed additional
light on this phenomenon.
Microdosing schedules share other common features. Regardless of the
protocol, people typically integrate microdosing into their daily routines.211

205
Hutten et al., Motives and Side-Effects, supra note 191, at 430.
206
See Johnstad, supra note 196, at 44 (“[R]espondents typically dosed one to three times
per week, although some reported dosing on a daily basis.”); Rifkin et al., supra note 17, at
316 (“Generally, microdoses of psychedelics are recommended to be administered only
‘semiregularly’—not on consecutive days—but approximately every third day, to prevent the
development of tolerance.”).
207
Shalini S. Lynch, Tolerance and Resistance to Drugs, MERCK MANUAL (Sept. 2022),
https://www.merckmanuals.com/home/drugs/factors-affecting-response-to-drugs/tolerance-
and-resistance-to-drugs [https://perma.cc/U963-8ZZY].
208
Id.
209
See Rosenbaum et al., supra note 191, at 617 (first citing Harris Isbell, A.B. Wolbach,
A. Wikler & E.J. Miner, Cross Tolerance Between LSD and Psilocybin, 2
PSYCHOPHARMACOLOGIA 147, 155-57 (1961); then citing Harris Isbell, R.E. Belleville, H.F.
Fraser, Abraham Wikler & C.R. Logan, Studies on Lysergic Acid Diethylamide (LSD-25), 76
A.M.A. ARCHIVES NEUROLOGY & PSYCHIATRY 468, 475-77 (1956); and then citing Louis S.
Cholden, Albert Kurland & Charles Savage, Clinical Reactions and Tolerance to LSD in
Chronic Schizophrenia, 122 J. NERVOUS & MENTAL DISEASE 211, 211 (1955)); see also T.
Buchborn, G. Grecksch, D.C. Dieterich & V. Höllt, Tolerance to Lysergic Acid Diethylamide:
Overview, Correlates, and Clinical Implications, in 2 NEUROPATHOLOGY OF DRUG
ADDICTIONS AND SUBSTANCE MISUSE 846, 846 (2016) (“Tolerance to LSD was first described
systematically in the mid-1950s . . . yet, . . . there are hitherto virtually no reviews specifically
dedicated to this topic.”).
210
See Hutten et al., Motives and Side-Effects, supra note 191, at 427 (stating people who
microdose have reported “tolerance to the desired effects after daily use”); Johnstad, supra
note 196, at 44 (“There were conflicting reports on tolerance build up from daily microdosing
and about the impact of microdose tolerance on full doses. Some frequent microdose users
experienced a build up of tolerance, while others found no such effect . . . .”).
211
See Johnstad, supra note 196, at 45 (“Besides the effects on health issues, respondents
commonly reported what they regarded as a positive influence from microdosing on energy,
mood, and cognition. This allowed them to function better in everyday life even when they
had no specific health issues.”); Rosenbaum et al., supra note 191, at 620 (“Psychedelic
microdosing, on the other hand, appears more akin to conventional pharmacotherapy: regular
2023] MICRODOSING PSYCHEDELICS 603

Many even engage in the practice to improve occupational or academic

performance.212 Notably, people who microdose often report experiencing
benefits during off days and for extended periods after completing a microdosing
cycle.213 Fadiman and coauthor Sophia Korb write that people often report
noticing sustained mood enhancement after about two weeks of microdosing.214
Despite these common practices and experiences, there appears to be little
uniformity in the duration of a microdosing cycle.215 Though cycles are often
limited to weeks or months, survey participants have reported following
protocols ranging from one week to two years.216 Fadiman and Korb suggest that
after an initial month of microdosing on an intermittent schedule, individuals
should decide whether they prefer microdosing once a week or once a month
thereafter.217 Others claim that microdosing cycles tend to be counted in weeks
or months rather than years.218
Survey data indicates that the most common psychedelic substances for
microdosing are psilocybin and LSD.219 However, some have reported using

consumption of a substance for some intended benefit(s) without significant or disruptive life-
interfering acute effects.”).
212
See Fadiman & Korb, supra note 192, at 120 (stating people who have positive
experiences microdosing tend to report “hav[ing] an easier time getting their work done on
time and leaving the office in a timely way”); Hutten et al., Motives and Side-Effects, supra
note 191, at 430 (“One-half of the microdosers (47.6%) indicated to have microdosed while
working, of which studying and computer/office work were the most prevalent daily
occupations.”); Megan Webb, Heith Copes & Peter S. Hendricks, Narrative Identity,
Rationality, and Microdosing Classic Psychedelics, 70 INT’L J. DRUG POL’Y 33, 34 (2019)
(finding, in “semi-structured interviews with 30 people who had microdosed,” that many did
so as “means to become better people and workers”).
213
See Webb et al., supra note 212, at 37 (“It was common for participants to talk about
the long-term mood enhancement of microdosing. While the effects were not immediate and
dramatic, they all discussed the presence of a subtle, but positive, enhancement in their mood
over time.”).
214
Fadiman & Korb, supra note 192, at 120.
215
See Kuypers et al., supra note 187, at 1041.
216
See Id. at 1041 (finding, in review of various microdosing protocols, that “[d]osing
periods ranged from 1 week to 2 years”).
217
Fadiman & Korb, supra note 192, at 120.
218
See Toby Lea, Nicole Amada, Henrik Jungaberle, Henrike Schecke & Michael Klein,
Microdosing Psychedelics: Motivations, Subjective Effects and Harm Reduction, 75 INT’L J.
DRUG POL’Y 1, 3 (2020) (“Most participants had been microdosing for 6 months or less
(65.0%).”); see also Johnstad, supra note 196, at 44 (“For experienced microdosers, the
practice was usually regarded as a cyclic activity, with microdosing periods lasting from a
few weeks to a few months.”).
219
See Anderson et al., supra note 194, at 3; Hutten et al., Motives and Side-Effects, supra
note 191, at 430; Kuypers et al., supra note 187, at 1039; see also Fadiman, Microdose
Research, supra note 200 (“Most people microdose with LSD or psilocybin mushrooms.”).
604 BOSTON UNIVERSITY LAW REVIEW [Vol. 103:573

other psychedelics, including DMT and mescaline,220 as well as other

psychoactive substances, such as cannabis.221 Microdosing is also a process used
to assess pharmacokinetics—how drugs are absorbed, broken down, and
eliminated by the body—during drug development.222 Regulatory guidelines in
the United States and Europe allow human studies using microdoses—defined
as one hundredth of the expected pharmacological dose—very early in the drug
development process.223 In this Article, we refer to doses administered in this
range and context as “microdosing trials.” Such low doses are unlikely to cause
major side effects, which allows them to be administered to humans before
conducting expensive preclinical toxicology studies using animals.224
Consequently, before investing in costly animal studies, drug companies can use
microdosing trials to screen out drugs that show suboptimal human
pharmacokinetics.225 Because microdosing trials occur before Phase 1 trials,
some refer to them as “Phase 0” studies.226
During routine medical care, some healthcare providers implement a variation
on microdosing called off-label low-dose prescribing.227 For instance, at doses
of approximately fifty milligrams, a drug called naltrexone can be used to treat
alcohol dependence.228 It can also be injected monthly as a treatment for opioid

220
See Hutten et al., Motives and Side-Effects, supra note 191, at 430 tbl.3 (enumerating
other substances that survey respondents had used, such as 5-MeO-DMT, ayahuasca, DMT,
MDMA, mescaline, etc.).
221
See Sara Davidson, Why Microdosing Is Taking over Medical Marijuana, ROLLING
STONE (Apr. 20, 2017), https://www.rollingstone.com/culture/culture-features/why-
microdosing-is-taking-over-medical-marijuana-114462/.
222
Kuypers et al., supra note 187, at 1040. Pharmacokinetics is the branch of
pharmacology concerned with how the body interacts with a drug, including the drug’s
movement into, through, and out of the body. Jennifer Le, Overview of Pharmacokinetics,
MERCK MANUAL (Sept. 2022), https://www.merckmanuals.com/professional/clinical-
pharmacology/pharmacokinetics/overview-of-pharmacokinetics [https://perma.cc/XHL8-
SAL4].
223
Tushar Tewari & Shoibal Mukherjee, Microdosing: Concept, Application and
Relevance, 1 PERSPS. CLINICAL RSCH. 61, 61 (2010).
224
Id.
225
Id.
226
Id.
227
What You Need To Know About Low Dose Naltrexone, WEILL CORNELL MED. (Sept. 2,
2020), https://weillcornell.org/news/what-you-need-to-know-about-low-dose-naltrexone
[https://perma.cc/6YBU-BFXQ].
228
Alex Smith, In Tiny Doses, an Addiction Medication Moonlights as a Treatment for
Chronic Pain, NPR (Sept. 23, 2019, 4:02 PM), https://www.npr.org/sections/health-
shots/2019/09/23/741783834/in-tiny-doses-an-addiction-medication-moonlights-as-a-
treatment-for-chronic-pain [https://perma.cc/CD6S-P3GL]. In this context, doctors frequently
prescribe a fifty-milligram dose once daily, though they will sometimes prescribe a higher
dose (100-150 mg) to be taken every two to three days under a healthcare professional’s
supervision. Naltrexone HCL—Uses, Side Effects, and More, WEBMD, https://www.web
md.com/drugs/2/drug-7399/naltrexone-oral/details [https://perma.cc/C9FM-7B3C] (last
visited Feb. 10, 2023).
2023] MICRODOSING PSYCHEDELICS 605

dependence.229 However, doctors also prescribe low-dose naltrexone to treat

persistent pain, which is an off-label use because naltrexone is not FDA
approved for that purpose.230 In this context, naltrexone is administered in a
microdose that is less than one tenth the size of doses administered for treating
alcohol dependence.231 Similarly, providers sometimes prescribe microdoses of
the antipsychotic medication quetiapine and the antidepressant mirtazapine as
off-label treatments for insomnia.232
The use of microdoses in drug development and off-label prescribing
illustrates how microdosing is not a monolithic practice. Doses of varying sizes
administered in different contexts can be considered microdoses. In the
psychedelic context, microdoses should not exceed the threshold beyond which
individuals experience psychedelic effects, such as noticeable perceptual
changes or significant physical effects. For this reason, one should think of
microdoses as a narrow range of doses at the end of a continuum. Psychedelic
microdoses usually constitute about one twentieth to one tenth of a standard
dose,233 or five to ten times the doses used in microdosing trials.234
Beyond this approximate range, doses begin to produce psychedelic effects,
and should not be considered microdoses. For example, people with cluster
headaches, a severe pain-related condition, report that doses of up to one gram
of dried psilocybin mushrooms—about half of a standard dose—are most

229
See Smith, supra note 228; What You Need To Know About Low Dose Naltrexone,
supra note 227; Naltrexone HCL—Uses, Side Effects, and More, supra note 228.
230
Smith, supra note 228. In this context, doctors prescribe the small doses to be taken
once daily. John Knab & Jaklyn Drew McCauley, The Use of Low Dose Naltrexone in the
Management of Chronic Pain, PRAC. PAIN MGMT. (May 29, 2020), https://www.practical
painmanagement.com/treatments/pharmacological/non-opioids/use-low-dose-naltrexone-
management-chronic-pain [https://perma.cc/9X9Y-VPSK].
231
See What You Need To Know About Low Dose Naltrexone, supra note 227 (explaining
that, for chronic pain, some patients report relief at doses below five milligrams, and doctors
might prescribe doses ranging from 0.01 milligrams to eight milligrams); see also Smith,
supra note 228 (stating low doses of Naltrexone help patients with complex chronic pain).
232
Jeanine Kamphuis, Katja Taxis, Catharina C.M. Schuiling-Veninga, Richard
Bruggeman & Marike Lancel, Off-Label Prescriptions of Low-Dose Quetiapine and
Mirtazapine for Insomnia in the Netherlands, 35 J. CLINICAL PSYCHOPHARMACOLOGY 468,
468 (2015).
233
See Rifkin et al., supra note 17, at 316. Note that, in pharmacology, a microdose is
defined as “a dose of drug that is 1% of the pharmacologically active dose, up to a maximum
of 100 µg.” Kuypers et al., supra note 187, at 1040. Note also that several sources approximate
that a microdose of psychedelics is one-tenth of a standard dose, rather than providing the
one-tenth-to-one-twentieth range. Hutten et al., Motives and Side-Effects, supra note 191, at
426; Johnstad, supra note 196, at 44; Rosenbaum et al., supra note 191, at 612.
234
See Lea et al., supra note 218, at 3 (“Among participants who were microdosing with
LSD/1P-LSD . . . the mean microdose was 13 micrograms . . . .”); see also Anya K. Bershad,
Scott T. Schepers, Michael P. Bremmer, Royce Lee & Harriet de Wit, Acute Subjective and
Behavioral Effects of Microdoses of Lysergic Acid Diethylamide in Healthy Human
Volunteers, 86 BIOLOGICAL PSYCHIATRY 792, 792-97 (2019) (using LSD doses up to twenty-
six micrograms as “microdoses” in placebo-controlled study on microdosing).
606 BOSTON UNIVERSITY LAW REVIEW [Vol. 103:573

effective at alleviating their symptoms.235 Doses of this size are more accurately
called “small” or “minidoses,” rather than microdoses. In most psychedelic
clinical trials, participants consume standard doses.236 For instance, in
psilocybin studies, a standard dose may be within the range of twenty to forty
milligrams.237
Outside the lab and clinical context, people often consume psilocybin,
whether microdoses, standard doses, or otherwise, using fresh or dried
mushrooms or other fungal material. Psilocybin-producing fungi can be
cultivated as mushrooms, which are the reproductive structures of the
organisms, and they can also be cultivated as sclerotia, which are small, dense
root-like structures that constitute the dormant phase of the fungi.238 The
psilocybin content of naturally occurring fungi varies widely,239 which makes it
difficult to standardize the dose of psilocybin consumed. Because psilocybin
content can vary significantly from batch to batch, or even mushroom to
mushroom, it is difficult to maintain a consistent dose throughout a microdosing
cycle. These variables become important when contemplating regulation
because the availability of isolated psilocybin, which can be more accurately and
consistently dosed, may allow for safer and more effective microdosing.
Regardless, because all doses of psychedelic substances can be said to sit
along a continuum, and different circumstances call for different doses and
dosing schedules, understanding the distinctions between various doses and
schedules is essential for crafting effective legislation, which will be discussed
further in Part IV.

B. History of Microdosing
Although the modern trend of microdosing is relatively new, the practice itself
is not. This history includes Indigenous microdosing and experimentation with
microdoses by Swiss chemist Albert Hofmann, the scientist credited with first
synthesizing LSD and extracting natural psilocybin from fungi.240 However, like

235
Busting Protocol—The Dosing Method, CLUSTERBUSTERS, https://clusterbusters.org
/resource/the-dosing-method/ [https://perma.cc/GYC2-BCKQ] (last visited Feb. 10, 2023).
236
See, e.g., sources cited supra note 209.
237
Nicholas Levich, Psychedelic Dosage Guide: How Much of Each Substance To Take,
PSYCHEDELIC PASSAGE (July 20, 2020), https://www.psychedelicpassage.com/psychedelic-
dosage-guide-how-much-of-each-substance-to-take/ [https://perma.cc/E2ES-8QQS].
238
ABBAS ET AL., supra note 90, at 13.
239
Theresa M. Carbonaro, Matthew P. Bradstreet, Frederick S. Barrett, Katherine A.
MacLean, Robert Jesse, Matthew W. Johnson & Roland R. Griffiths, Survey Study of
Challenging Experiences After Ingesting Psilocybin Mushrooms: Acute and Enduring
Positive and Negative Consequences, 30 J. PSYCHOPHARMACOLOGY 1268, 1277 (2016)
(describing wide variation in psilocybin content with and across species of fungi).
240
Stephie Grob Plante, LSD Microdoses Make People Feel Sharper, and Scientists Want
To Know How, VERGE (Apr. 24, 2017, 8:00 AM), https://www.theverge.com/2017/4/24
/15403644/microdosing-lsd-acid-productivity-benefits-brain-studies [https://perma.cc
/D5PN-PJYX].
2023] MICRODOSING PSYCHEDELICS 607

the science of microdosing, the history of microdosing is poorly understood

when compared to the history of standard psychedelic dosing.
Some sources trace the history of microdosing to Franciscan friar Bernardino
de Sahagún’s Historia General de las Cosas de la Nueva España, a sixteenth-
century source that documents the Aztec consumption of psilocybin mushrooms,
which they called “teonanacatl.”241 Documenting life among the Aztecs for a
Spanish audience during Spain’s conquest of the Americas, Sahagún reports that
one use of teonanacatl was the treatment for fevers and rheumatism, which
required only two or three mushrooms.242 This dosage may be classified as
smaller than a standard dose because modern descendants of the Aztecs—such
as members of the Mazatec Tribe—reportedly consume six to twelve
mushrooms as a standard dose.243 However, Sahagún reports that consumption
of two or three mushrooms produced visions and a faintness of the heart.244 This
suggests that the doses Sahagún describes most likely constituted standard
doses.245
Other sources note that, although there is evidence of Indigenous
microdosing, the earliest occurrence of the practice is unknown.246 Existing
evidence of Indigenous microdosing appears to include reports that the Mazatec
have used psilocybin microdosing to “support the healing of physical conditions
and emotional states such as sadness, anger, envy, isolation and agitation.”247
There is also evidence of microdosing among practitioners of the Bwiti religion
in Gabon, West Central Africa.248 Adherents consume ibogaine, a psychedelic
produced by the Iboga shrub, in both large ceremonial doses and in
microdoses.249

241
Kuypers et al., supra note 187, at 1039; Richard Evans Schultes, Teonanacatl: The
Narcotic Mushroom of the Aztecs, 42 AM. ANTHROPOLOGIST 429, 429 (1940) (providing
historical records to describe Aztec uses of psychedelic substances).
242
Kuypers et al., supra note 187, at 1039.
243
Schultes, supra note 241, at 435-36.
244
Kuypers et al., supra note 187, at 1039.
245
Id.
246
Vince Polito & Richard J. Stevenson, A Systematic Study of Microdosing Psychedelics,
PLOS ONE, Feb. 2019, at 1, 2 (stating Indigenous groups have used psychedelic substances
at “lower doses as an aphrodisiac, to reduce hunger, inspire courage, nullify pain, and to treat
ailments such as gout and syphilis”); see also Fadiman & Korb, supra note 192, at 118 (“Even
though it is likely that Indigenous people have used microdoses historically and currently,
such evidence rarely appears in the anthropological literature.”).
247
Joseph M. Rootman, Pamela Kryskow, Kalin Harvey, Paul Stamets, Eesmyal Santos-
Brault, Kim P.C. Kuypers, Vince Polito, Francoise Bourzat & Zach Walsh, Adults Who
Microdose Psychedelics Report Health Related Motivations and Lower Levels of Anxiety and
Depression Compared to Non-microdosers, SCI. REPS., Nov. 2021, at 1, 1.
248
Michael Winkelman, Psychedelics as Medicines for Substance Abuse Rehabilitation:
Evaluating Treatments with LSD, Peyote, Ibogaine and Ayahuasca, 7 CURRENT DRUG ABUSE
REVS. 101, 105 (2014).
249
Id. (noting practice of iboga consumption in West Central Africa to enhance hunting
skills).
608 BOSTON UNIVERSITY LAW REVIEW [Vol. 103:573

Microdosing is not a new practice in Western society, either. For example,

years after Hofmann synthesized LSD, he accidentally consumed a dose and
famously experienced its effects while riding a bicycle. He then began
experimenting with low doses of the substance.250 Hofmann also expressed
regret that his employer, Sandoz, had declined his suggestion to look more
closely at the effects of very low doses of LSD.251
Despite this history, microdosing, as practiced today, is a relatively new trend
that traces its roots to James Fadiman’s 2011 book, which contains several case
reports from people who report having microdosed.252 The practice was also
popularized by Ayelet Waldman in her autobiographical book, A Really Good
Day: How Microdosing Made a Mega Difference in My Mood, My Marriage,
and My Life.253 Though people have likely microdosed for centuries in Mexico
and elsewhere throughout the world, Fadiman and Waldman brought this mode
of psychedelics consumption to a larger audience, garnering the media attention
that has perpetuated the trend, and ultimately triggering an explosion of
scientific research into microdosing since 2018.254 This scientific research and
increased public interest in microdosing has prompted discussion by legislators
and regulators.255
In many cases, media coverage of microdosing has focused on Silicon
Valley.256 Since 2011, dozens of articles have discussed how technology
professionals have been experimenting with microdosing to gain an edge in their
competitive professional environment.257 These articles have focused on the use

250
Calderon, supra note 20; Plante, supra note 240.
251
Fadiman & Korb, supra note 192, at 118-19.
252
See FADIMAN, THE PSYCHEDELIC EXPLORER’S GUIDE, supra note 189, at 199-210
(publishing these case reports).
253
See generally AYELET WALDMAN, A REALLY GOOD DAY: HOW MICRODOSING MADE A
MEGA DIFFERENCE IN MY MOOD, MY MARRIAGE, AND MY LIFE (2017).
254
See Rosenbaum et al., supra note 191, at 617 (discussing influence of Fadiman’s 2011
book); see also Martin Andersson & Anette Kjellgren, Twenty Percent Better with 20
Micrograms? A Qualitative Study of Psychedelic Microdosing Self-Rapports and Discussions
on YouTube, HARM REDUCTION J., Nov. 2019, at 1, 1 (“The origins of psychedelic
microdosing are often attributed to James Fadiman and his 2011 book ‘The psychedelics
explorer guide.’”); Kuypers et al., supra note 187, at 1040; infra notes 293-94 and
accompanying text (identifying explosion in research since 2018).
255
See infra Section III.B (citing discussions regarding microdosing by Oregon Board).
256
See, e.g., Emma Hogan, Turn on, Tune in, Drop by the Office, ECONOMIST (Aug. 1,
2017), https://www.economist.com/1843/2017/08/01/turn-on-tune-in-drop-by-the-office;
Dominique Mosbergen, Microdosing LSD Is a Growing Silicon Valley Trend. But Does It
Actually Work?, HUFFPOST (Sept. 3, 2018, 9:11 AM), https://www.huffpost.com/entry
/microdosing-lsd-placebo-study_n_5b8d1e48e4b0511db3daaaff [https://perma.cc/Y9ZY-
QEU6].
257
See, e.g., Andrew Leonard, How LSD Microdosing Became the Hot New Business Trip,
ROLLING STONE (Nov. 20, 2015), https://www.rollingstone.com/culture/culture-news/how-
lsd-microdosing-became-the-hot-new-business-trip-64961/; Olivia Solon, Under Pressure,
Silicon Valley Workers Turn to LSD Microdosing, WIRED (Aug. 24, 2016, 8:28 AM),
2023] MICRODOSING PSYCHEDELICS 609

of microdosing as a “productivity hack”258 that helps tech workers improve their

focus, energy, and creativity,259 as well as boost mood,260 and perhaps “stay
young and relevant.”261
Despite the media’s focus on Silicon Valley,262 however, the microdosing
trend is not limited to the West Coast, the tech sector, or even the relatively
educated or wealthy. At least one survey has found that tech professionals are
not overrepresented in the populations that microdose, and on average, people
who microdose tend to be less educated and less wealthy.263 Media reports
acknowledge this observation, at least implicitly, by often using “Silicon
Valley” or “productivity hack” in headlines before describing how the practice
of microdosing has spread to many other locales and contexts, including self-
treatment for symptoms of depression, anxiety, pain, and addiction.264
With a large and growing market for microdosing products, several
businesses have entered the field. Red Light Holland and Earth Resonance have
leveraged the legality of psilocybin “truffles” in the Netherlands to sell
microdosing kits containing consistent doses of truffles appropriate for
microdosing.265 In the Netherlands, Red Light Holland also offers expert

https://www.wired.co.uk/article/lsd-microdosing-drugs-silicon-valley [https://perma.cc
/WD34-TVHX].
258
See, e.g., Chris Gayomali, Forget Coffee, Silicon Valley’s New Productivity Hack Is
‘Microdoses’ of LSD, GQ (Nov. 23, 2015), https://www.gq.com/story/forget-coffee-silicon-
valleys-new-productivity-hack-is-microdoses-of-lsd [https://perma.cc/248Z-QE73]; Hayden
Vernon, Silicon Valley’s Extreme New Productivity Hack: LSD, GQ (Nov. 16, 2019),
https://www.gq-magazine.co.uk/lifestyle/article/microdosing-lsd [https://perma.cc/KS55-
WTUC].
259
See Vernon, supra note 258; see also Barbara Sahakian, Camilla D’Angelo & George
Savulich, Is Silicon Valley onto Something with Its LSD Microdosing?, NEWSWEEK (Feb. 15,
2017, 7:55 AM), https://www.newsweek.com/lsd-creativity-silicon-valley-brain-activity-
557055 [https://perma.cc/2ZL2-LXVN]; Solon, supra note 257.
260
See Vernon, supra note 258.
261
See, e.g., Jack Kelly, Silicon Valley Is Micro-Dosing ‘Magic Mushrooms’ To Boost
Their Careers, FORBES (Jan. 17, 2020, 11:11 AM), https://www.forbes.com/sites/jackkelly
/2020/01/17/silicon-valley-is-micro-dosing-magic-mushrooms-to-boost-their-
careers/?sh=30ba8895822a.
262
See Webb et al., supra note 212, at 37 (“While there is no large-scale epidemiological
study to show patterns of microdosing, media reports suggest that the practice is primarily
found among White, middle- and upper-class professionals, especially in technology
industries.”).
263
See Cameron et al., supra note 17, at 116 (finding individuals who reported
microdosing tended to have less education and earn less than $50,000 per year).
264
See, e.g., Sahakian et al., supra note 259; Solon, supra note 257; Vernon, supra note
258.
265
See Tim Smith, The Startups That Microdose Magic Mushrooms, SIFTED (Mar. 26,
2021), https://sifted.eu/articles/startups-microdosing/ [https://perma.cc/7M6K-7QCN];
Products, RED LIGHT HOLLAND, https://redlight.co/products/ [https://perma.cc/9Z68-BFTH]
(last visited Feb. 10, 2023).
610 BOSTON UNIVERSITY LAW REVIEW [Vol. 103:573

consultations in English or Dutch regarding microdosing.266 In the United States,

businesses have begun selling mock microdosing products in order to capitalize
on the microdosing trend without violating local, state, and federal laws
prohibiting psychedelic substances.267 These companies include Psychedelic
Water, which sells a beverage containing a mixture of herbal substances
including damiana leaf, kava root, and green tea extract, which the company
claims can produce feelings of calmness and euphoria.268 Another example is
Gwella, which sells gummy products intended to stimulate the effects of
microdosing and optimize performance.269 They contain mushrooms and
botanicals that are legal to produce and sell, such as cordyceps, a species of
fungus with medicinal uses in China and Tibet.270
In Canada, a company called Microdelics skirts the country’s national
prohibition by selling microdosing kits containing 1P-LSD, a derivative and
functional analogue of LSD that occupies a legal gray area.271 Medicinal
Mushroom Dispensary, another Canadian company, sells microdoses of
psilocybin online and plans to open a retail location in Vancouver, despite
prohibition, on the expectation that Canadian law enforcement will use its
resources elsewhere.272 Other Canadian and American businesses are exploring
the medical applications of microdosing in the hopes that they can legally offer
those products in the future.273

266
Products, supra note 265.
267
See infra notes 268-70 and accompanying text.
268
Alisha Mughal, Makers of the First Legal Psychedelic Beverage To Launch
Microdosing Product in 2022, SOME GOOD CLEAN FUN (Oct. 28, 2021), https://www.some
goodcleanfun.com/blog/makers-of-the-first-legal-psychedelic-beverage-to-launch-
microdosing-product-in-2022nbsp [https://perma.cc/256V-BAU6].
269
Gwella Introduces Mojo: The World’s First Legal Microdose Product,
GLOBENEWSWIRE (May 27, 2021, 8:00 AM), https://www.globenewswire.com/news-
release/2021/05/27/2237360/0/en/Gwella-Introduces-Mojo-The-World-s-First-Legal-
Microdose-Product.html [https://perma.cc/T7GB-L3RR].
270
Id.
271
Danielle Simone Brand, You Can Now Buy a Microdosing Kit Online, DOUBLEBLIND
(May 20, 2021), https://doubleblindmag.com/lsd-microdosing-kit/ [https://perma.cc/LN5W-
YXTS].
272
Elianna Lev, Could Magic Mushrooms Be the Next Drug Legalized in Canada?,
YAHOO! NEWS (July 26, 2019), https://finance.yahoo.com/news/could-magic-mushrooms-be-
the-next-drug-canada-legalizes-171728039.html [https://perma.cc/C3SH-A5JY].
273
Press Release, MindMed, MindMed Expands Psychedelic Microdosing Division, Adds
Groundbreaking Study Evaluating LSD Microdosing Through Next-Gen Digital Clinical
Markers (Jan. 12, 2021), https://mindmed.co/news/press-release/mindmed-expands-
psychedelic-microdosing-division-adds-groundbreaking-study-evaluating-lsd-microdosing-
through-next-gen-digital-clinical-markers/ [https://perma.cc/R4CJ-M2Y6]; Natan Ponieman,
This Canadian Company Is Launching a Psilocybin Microdosing Study, BENZINGA (Aug. 18,
2021, 3:17 PM), https://www.benzinga.com/markets/cannabis/21/08/22563207/this-
canadian-company-is-launching-a-psilocybin-microdosing-study [https://perma.cc/42WA-
5K8D] (“Diamond Therapeutics Inc., a biotech company in the psychedelics sector has
2023] MICRODOSING PSYCHEDELICS 611

C. Why People Microdose

Survey data indicate that people microdose for many reasons. The potential
benefits of microdosing include improving cognitive function (e.g., focus,
productivity, or problem-solving ability), promoting creativity, and enhancing
mental and physical well-being.274 Because many people microdose to improve
focus, energy, or creativity,275 the practice is often framed as a means of
increasing occupational or academic performance.276 Others report microdosing
as a means of enhancing their mood.277 In this context, the most frequently
sought benefits are the alleviation of symptoms of depression or anxiety.278
People also report microdosing to mitigate pain, especially symptoms related to
cluster headaches, and migraines.279 Finally, people have reported microdosing
to address various substance use conditions.280 Relatedly, Fadiman and Korb
write that a substantial number of participants report substituting microdoses for
the stimulants regularly prescribed for attention deficit and hyperactivity
disorder (“ADHD”) such as Ritalin or Adderall.281 During the COVID-19

received authorization from Health Canada to launch a clinical trial to study the effects of low
doses of psilocybin in healthy volunteers.”).
274
See Kuypers et al., supra note 187, at 1050; see also Webb et al., supra note 212, at 33
(“The purpose of microdosing is not to achieve unitive experience or ego dissolution from
these substances; rather, people microdose classic psychedelics for a range of salubrious
outcomes, including improving mood, heightening creativity, and reducing anxiety.”).
275
See Hutten et al., Motives and Side-Effects, supra note 191, at 427 (“The most
frequently reported motives and effects of microdosing are stimulating productivity, for
example, increasing focus, energy levels, and creativity and inducing positive mood.”);
Kuypers et al., supra note 187, at 1040 (“[M]icrodosing became prominent due to the belief
it improved cognition . . . .”). But see Lea et al., supra note 218, at 6 (“The most common
motivation for microdosing was an alternative treatment for mental health (40%), either as a
replacement or adjunct to conventional treatments, followed by personal development and
general wellbeing (31%), and enhancement of cognitive function (18%).”).
276
See sources cited supra notes 256-64 (discussing practice of microdosing while at
work).
277
See Hutten et al., Motives and Side-Effects, supra note 191, at 430 (finding following
intended uses in survey of 1,116 respondents: “performance enhancement (37%), mood
enhancement (29%), out of curiosity (15%), and for self-medication (14%)”).
278
See id. at 427 (“Another commonly reported motivation and subsequent outcome is the
alleviation of psychological symptoms including depressive mood and anxiety and/or
physiological symptoms such as pain.”); Preller, supra note 199, at 736 (“Anecdotal reports
describe the use of small doses of LSD to alleviate symptoms of anxiety and
depression . . . .”).
279
Kuypers et al., supra note 187, at 1040.
280
See Toby Lea, Nicole Amada, Henrik Jungaberle, Henrike Schecke, Norbert
Scherbaum & Michael Klein, Perceived Outcomes of Psychedelic Microdosing as Self-
Managed Therapies for Mental and Substance Use Disorders, 237 PSYCHOPHARMACOLOGY
1521, 1522 (2020).
281
Fadiman & Korb, supra note 192, at 121.
612 BOSTON UNIVERSITY LAW REVIEW [Vol. 103:573

pandemic, national rates of stimulant consumption increased significantly.282

Though not empirically proven, replacing the use of stimulants such as Ritalin
or Adderall with periodic microdoses could reduce the risk of addiction and
other harms associated with these prescription medicines.283 The following
discussion evaluates the scientific evidence for the efficacy of microdosing as
well as the evidence for its associated risks.

D. Scientific Evidence on Microdosing Safety and Efficacy

Self-reported data provide support for the benefits listed above, including
improvements to cognition (e.g., focus, productivity, or problem-solving
ability), creativity, and mental and physical wellness.284 Based on surveys, many
people who microdose report the practice can effectively treat the same mental
and physical conditions often treated by standard psychedelic doses.285 Some
find microdosing to be more effective than conventional therapies for mental
health conditions, such as generalized anxiety disorder and ADHD, and physical
conditions associated with pain.286 Furthermore, although some people who
microdose report unwanted side effects such as anxiety, and physical discomfort
such as headache or muscle pain, few report that these adverse effects occur
frequently,287 and when they do occur, they are typically mild.288 Many side
effects appear to result from the difficulty of obtaining accurate or consistent
doses.289 Some people who microdose report consuming a higher dose than
intended and experiencing undesired effects such as perceptual changes,

282
See Ashley Abramson, Substance Use During the Pandemic, MONITOR ON PSYCH., Mar.
2021, at 22, 23.
283
Susan York Morris, Adderall vs. Ritalin: What’s the Difference?, HEALTHLINE (Jan. 28,
2019), https://www.healthline.com/health/adhd/adderall-vs-ritalin [https://perma.cc/4DEE-
5PGL] (discussing side effects of Ritalin and Adderall).
284
See Anderson et al., supra note 194, at 4 (categorizing self-reported benefits and
challenges of microdosing).
285
See Nadia R.P.W. Hutten, Natasha L. Mason, Patrick C. Dolder & Kim P.C. Kuypers,
Self-Rated Effectiveness of Microdosing with Psychedelics for Mental and Physical Health
Problems Among Microdosers, FRONTIERS PSYCHIATRY, Sept. 2019, at 1, 7 (noting although
microdoses were less effective than larger doses for treating anxiety and depression,
researchers found no statistically significant difference in effectiveness with respect to other
mental or physical disorders).
286
Id. at 5.
287
Lea et al., supra note 218, at 6.
288
Kim P.C. Kuypers, Microdosing Psychedelics as a Promising New
Pharmacotherapeutic, in MODERN CNS DRUG DISCOVERY 257, 271 (Rudy Schreiber ed.,
2021); see also Hutten et al., Motives and Side-Effects, supra note 191, at 433 (finding
occurrence of negative psychological or physical side effects did not predict microdosing
cessation individually (although occurrence of both did predict cessation), that microdosing
side effects were predominantly acute rather than long term, and that “main reason for users
to have stopped microdosing was not due to negative side effects but rather because they
deemed it to not be effective”).
289
Hutten et al., Motives and Side-Effects, supra note 191, at 433.
2023] MICRODOSING PSYCHEDELICS 613

confusion, or anxiety, which are more frequently encountered with standard

doses.290 Insofar as the legal prohibition of psychedelics obstructs access to
accurate and consistent microdoses, many challenges stem from the current legal
status of psychedelics rather than from the substances themselves.291
Survey-based evidence for the safety and efficacy of microdosing is
informative, and placebo-controlled trials are starting to catch up. One meta-
analysis conducted in 2021 aimed to review “all scientific research to date on
the effects of microdoses of psychedelics.”292 The author identified forty-four
relevant peer-reviewed publications, eight of which were modern, placebo-
controlled trials.293 Of the forty-four total studies, thirty were published in 2018
or later, reflecting rapidly expanding scientific interest in microdosing.294 On the
whole, the placebo-controlled studies have yielded mixed results—providing
evidence for some of the benefits reported by surveys, failing to find evidence
for others, and leaving some benefits reported in survey data unexplored.295
Overall, placebo-controlled studies have mostly been inconclusive with respect
to confirming the results of survey-based studies.296 Nevertheless, the available
evidence for the safety and effectiveness of microdosing is encouraging and
establishes the need for further research.297 The existing evidence is analyzed
below.
Notably, although psilocybin is often used for microdosing, consuming
microdoses of LSD has been more extensively studied.298 However, because the
effects of LSD and psilocybin are similar, many studies combine subjects who
microdose LSD and psilocybin. One such study, which in part investigated the
differences between those who microdose psilocybin and LSD, found no
significant differences with respect to the reported benefits and side effects of

290
See Hutten et al., Motives and Side-Effects, supra note 191, at 427 (reporting
respondents mentioned “unwanted ‘trips’ . . . when using higher doses than intended”);
Johnstad, supra note 196, at 46 (“While there were no reports of accidentally taking a full
dose when attempting to microdose, several respondents had unintentionally verged into the
terrain of a mini-dose that led to uncomfortable situations . . . .”); Rosenbaum et al., supra
note 191, at 618 (finding in anonymous online survey of 909 respondents recruited primarily
from Reddit many respondents cited “guesswork” associated with dosing to be significant
drawback).
291
Anderson et al., supra note 194, at 5.
292
Vince Polito & Paul Liknaitzky, The Emerging Science of Microdosing: A Systematic
Review of Research on Low Dose Psychedelics (1955-2021) and Recommendations for the
Field, NEUROSCIENCE & BIOBEHAVIORAL REVS., Aug. 2022, at 1, 2.
293
Id. at 4-6.
294
Id.
295
See id. at 10, 12.
296
See Kuypers, supra note 288, at 270.
297
Id. at 272.
298
See Balázs Szigeti, Laura Kartner, Allan Blemings, Fernando Rosas, Amanda Feilding,
David J. Nutt, Robin L. Carhart-Harris & David Erritzoe, Self-Blinding Citizen Science To
Explore Psychedelic Microdosing, ELIFE, Mar. 2021, at 1, 2 (noting that, as of publication, all
recent double-blind, placebo-controlled microdosing studies had been conducted using LSD).
614 BOSTON UNIVERSITY LAW REVIEW [Vol. 103:573

microdosing.299 However, those who reported microdosing psilocybin rated the

importance of the benefits higher than those who microdosed LSD.300 Given the
dearth of microdosing research on psilocybin specifically, and the overall
similarity of reported effects, studies on LSD and studies in which participants
used both LSD and psilocybin are included in this analysis. However, due to its
rising popularity, special attention is paid to psilocybin.

1. Potential Benefits
Anecdotal reports have long claimed that microdosing has positive effects as
both a cognitive enhancer and a natural remedy for mental health conditions.301
Observational and survey-based research has largely supported these claims.302
Moreover, placebo-controlled research has supported anecdotal claims
regarding additional effects and benefits, including decreases in pain perception,
increases in certain dimensions of creativity, and changes to time perception.303
On the other hand, placebo-controlled research has largely failed to find support
for other claimed benefits, including benefits to other aspects of cognition like
working memory and attention, improved mental wellbeing, and enhanced
sociability.304 Some benefits reported in survey-based studies have not yet been
investigated by placebo-controlled research, including, most significantly,
benefits to populations with confirmed medical diagnoses.305 Below, the benefits
observed in survey-based research are examined first, followed by a discussion
of the extent to which these self-reported benefits have been confirmed in
placebo-controlled research.
Recent observational research has lent some credibility to anecdotal reports
that “microdosing may improve well-being, creativity, and cognition.”306 One
such study was a large cross-sectional survey that compared people who
currently and formerly microdosed to individuals who had never microdosed
and found that “experience with microdosing is associated with lower
dysfunctional attitudes and negative emotionality and higher wisdom, open-
mindedness, and creativity” compared to people who lack microdosing
experience.307 Another study, which was longitudinal (i.e., tracked participants

299
Anderson et al., supra note 194, at 5.
300
Id. at 4. Anderson explains, “Microdosing respondents reported up to three benefits and
three drawbacks of microdosing psychedelics. They also gave each outcome a rating of
subjective importance on a sliding scale from 0 to 100.” Id.
301
Lea et al., supra note 218, at 2.
302
See infra notes 306-12 and accompanying text.
303
See infra notes 313-20 and accompanying text.
304
See infra notes 326-30 and accompanying text.
305
Polito & Liknaitzky, supra note 292, at 7, 10, 12-13.
306
Szigeti et al., supra note 298, at 1.
307
Thomas Anderson, Rotem Petranker, Daniel Rosenbaum, Cory R. Weissman, Le-Anh
Dinh-Williams, Katrina Hui, Emma Hapke & Norman A.S. Farb, Microdosing Psychedelics:
Personality, Mental Health, and Creativity Differences in Microdosers, 236
PSYCHOPHARMACOLOGY 731, 737 (2019).
2023] MICRODOSING PSYCHEDELICS 615

for some time before and after they microdosed) rather than cross-sectional (i.e.,
collected data at one point in time without before and after measurements),
investigated a group of people who microdosed over the course of six weeks,
collecting both daily and longer-term measures.308 The study found “an increase
across all psychological functions measured on dosing days” as compared to
nondosing days, as well as a decrease in depression and stress ratings over the
course of the study.309 However, the study did not “identify any [long-term]
changes on measures of mindfulness, mystical experience, positive personality
traits, creativity, sense of agency or overall quality of life.”310 Broadly speaking,
different survey-based studies report effects that are generally positive, but not
always consistent, with respect to indicators of participants’ cognitive
processing, creativity, mood, mental health (e.g., depression and anxiety
symptoms), self-efficacy (i.e., belief in one’s ability to execute behaviors to
achieve specific results),311 and sociability, as well as reduced physical pain and
reduced use of other substances.312
The remainder of this Section addresses placebo-controlled trials. Overall,
these studies have yielded mixed results. They can confirm certain limited
findings of less rigorous studies, including the conclusion that psychedelic
microdoses alter cognitive processing, for instance, with respect to the
perception of time313 and pain.314 Although altered time perception is neither
strictly beneficial nor harmful, this result suggests that further inquiry into time
perception may be warranted, especially given the potential of psychedelics to
increase one’s sense of being “in the present.”315 Focusing one’s attention on the
present is a common goal of meditation that has been shown to promote physical

308
See Polito & Stevenson, supra note 246, at 1 (describing longer-term measures as
“battery of psychometric measures tapping mood, attention, wellbeing, mystical experiences,
personality, creativity, and sense of agency, at baseline and at completion of the study”).
309
Id. at 13.
310
Id. at 15.
311
See Michael P. Carey & Andrew D. Forsyth, Teaching Tip Sheet: Self-Efficacy, AM.
PSYCH. ASS’N (2009), https://www.apa.org/pi/aids/resources/education/self-efficacy
[https://perma.cc/VE92-5Y24].
312
See Polito & Liknaitzky, supra note 292, at 7, 10, 12-14.
313
Jiří Wackermann, Marc Wittmann, Felix Hasler & Franz X. Vollenweider, Effects of
Varied Doses of Psilocybin on Time Interval Reproduction in Human Subjects, 435
NEUROSCIENCE LETTERS 51, 51 (2008); see also Steliana Yanakieva, Naya Polychroni,
Neiloufar Family, Luke T.J. Williams, David P. Luke & Devin B. Terhune, The Effects of
Microdose LSD on Time Perception: A Randomised, Double-Blind, Placebo-Controlled
Trial, 236 PSYCHOPHARMACOLOGY 1159, 1159 (2019) (finding similar effects of LSD
microdoses).
314
See Johannes G. Ramaekers, Nadia Hutten, Natasha L. Mason, Patrick Dolder, Eef L.
Theunissen, Friederike Holze, Matthias E. Liechti, Amanda Feilding & Kim P.C. Kuypers, A
Low Dose of Lysergic Acid Diethylamide Decreases Pain Perception in Healthy Volunteers,
35 J. PSYCHOPHARMACOLOGY 398, 398 (2021).
315
Kuypers, supra note 288, at 269.
616 BOSTON UNIVERSITY LAW REVIEW [Vol. 103:573

and mental wellbeing.316 Though somewhat speculative, it is possible that

changes in time perception help mediate some of the reported benefits of
microdosing. People with symptoms of depression and anxiety often become
stuck worrying about the future or the past, and microdosing may help them
refocus their attention.
The reduced perception of pain associated with microdosing warrants further
study. Some pain medicine experts hypothesize that psychedelics help disrupt
pathways that convey pain sensations throughout the body.317 Like shaking a
snow globe, psychedelic experiences might help disrupt these well-worn paths
to reduce the perception of painful stimuli, or at the very least, help people form
a less distressing relationship with pain.
A recent set of psilocybin-specific controlled studies reports limited positive
effects on creativity, finding that subjects who microdosed produced higher
quality original answers than subjects who did not, although no effect was found
on other measures of creative thinking.318 Similarly, a different study found that
microdosing psilocybin increased feelings of awe in response to aesthetic
stimuli.319 Finally, placebo-controlled studies have consistently found that
people who microdose report subjective alterations to their conscious state.320 A
qualitative examination of anecdotal reports characterized these subjective
alterations as an overall “heightened sense of presence and perceptual clarity,”321
and several studies have attempted to quantitatively explore this altered
consciousness using a five-dimensional altered states of consciousness scale.322
One study measured the effects of different microdoses of LSD and found that
the largest dose (twenty micrograms) produced significant changes in four of the
five dimensions of altered consciousness compared to placebo.323 The affected
variables included oceanic boundlessness, anxious ego dissolution, visionary

316
See Yi-Yuan Tang, Britta K. Hölzel & Michael I. Posner, The Neuroscience of
Mindfulness Meditation, 16 NATURE REVS. NEUROSCIENCE 213, 215 (2015).
317
See Ramaekers et al., supra note 314, at 403.
318
See Luisa Prochazkova, Michiel van Elk, Josephine Marschall, Ben D. Rifkin, Neil R.
Schon, Donatella Fiacchino, George Fejer, Martin Kuchar & Bernhard Hommel, Microdosing
Psychedelics and Its Effect on Creativity: Lessons Learned from Three Double-Blind Placebo
Controlled Longitudinal Trials 2 (June 17, 2021) (unpublished manuscript),
https://psyarxiv.com/emcxw/ [https://perma.cc/2AXJ-66YG].
319
See Michiel van Elk, George Fejer, Pascal Lempe, Luisa Prochazckova, Martin Kuchar,
Katerina Hajkova & Josephine Marschall, Effects of Psilocybin Microdosing on Awe and
Aesthetic Experiences: A Preregistered Field and Lab-Based Study, 239
PSYCHOPHARMACOLOGY 1705, 1705 (2022).
320
See Polito & Liknaitzky, supra note 292, at 2.
321
Andersson & Kjellgren, supra note 254, at 4.
322
See Polito & Liknaitzky, supra note 292, at 12-13.
323
See Nadia R.P.W. Hutten, Natasha L. Mason, Patrick C. Dolder, Eef L. Theunissen,
Friederike Holze, Matthias E. Liechti, Amanda Feilding, Johannes G. Ramaekers & Kim P.C.
Kuypers, Mood and Cognition After Administration of Low LSD Doses in Healthy Volunteers:
A Placebo Controlled Dose-Effect Finding Study, 41 EUR. NEUROPSYCHOPHARMACOLOGY 81,
84, 87, 89 (2020) [hereinafter Hutten et al., Mood and Cognition].
2023] MICRODOSING PSYCHEDELICS 617

restructuralization, and reduction of vigilance (with no significant change to the

auditory alterations dimension).324 The smallest dose (five micrograms) did not
produce any significant changes, but a moderate dose (ten micrograms) only
produced significant changes in the anxious ego dissolution dimension.325
Alterations to consciousness are neither clearly a benefit nor an adverse event.
At least so far, controlled studies have not confirmed many benefits of
microdosing that are reported in surveys and observational studies, including
enhanced cognition,326 increased sociability,327 elevated mood,328 and
improvements in various measures of anxiety and depression.329 Notably,
several controlled studies have suggested that the purported positive effects of
microdosing may largely be attributable to expectancy bias (i.e., the placebo
effect).330 Nevertheless, it is important to note that conclusive evidence for the
benefits of microdosing should not be required to legalize or decriminalize the
practice. Proving or disproving the reported benefits of microdosing is essential
for advancing scientific understanding of the practice and developing FDA
approved therapies that utilize it. However, proof is not required for reducing

324
See id. at 84. The study explains oceanic boundlessness is “the experience of unity,
spiritual experience, blissful state, and insightfulness.” Id. Anxious ego dissolution is
“disembodiment, impaired control and cognition, and anxiety.” Id. Visionary
restructuralization is “complex imagery, elemental imagery, audio-visual synesthesia, and
changed meaning of percepts.” Id. The source does not further define auditory alterations or
reduction of vigilance. Id.
325
See id. at 87 tbl.3.
326
Federico Cavanna, Stephanie Muller, Laura Alethia de la Fuente, Federico Zamberlan,
Matías Palmucci, Lucie Janeckova, Martin Kuchar, Carla Pallavicini & Enzo Tagliazucchi,
Microevidence for Microdosing with Psilocybin Mushrooms: A Double-Blind Placebo-
Controlled Study of Subjective Effects, Behavior, Creativity, Perception, Cognition, and
Brain Activity 24 (Dec. 7, 2021) (unpublished manuscript), https://www.biorxiv.org/content
/10.1101/2021.11.30.470657v1.full.pdf [https://perma.cc/8PDW-FXXU].
327
See Bershad et al., supra note 234, at 797-99 (finding no significant difference between
people who microdose and placebo group in measuring feelings of social rejection or
friendliness).
328
See id. at 792. But see Anya K. Bershad, Katrin H. Preller, Royce Lee, Sarah Keedy,
Jamie Wren-Jarvis, Michael P. Bremmer & Harriet de Wit, Preliminary Report on the Effects
of a Low Dose of LSD on Resting-State Amygdala Functional Connectivity, 5 BIOLOGICAL
PSYCHIATRY: COGNITIVE NEUROSCIENCE & NEUROIMAGING 461, 461 (2020) (finding “weak
and variable” effect of microdosing on mood based on twelve-microgram dose of LSD);
Hutten et al., Mood and Cognition, supra note 323, at 89 (finding no group-level differences
in mood but positive mood increase at individual level).
329
See Josephine Marschall, George Fejer, Pascal Lempe, Luisa Prochazkova, Martin
Kuchar, Katerina Hajkova & Michiel van Elk, Psilocybin Microdosing Does Not Affect
Emotion-Related Symptoms and Processing: A Preregistered Field and Lab-Based Study, 36
J. PSYCHOPHARMACOLOGY 97, 97 (2022).
330
See, e.g., Cavanna et al., supra note 326, at 1 (finding microdosing psilocybin had either
null effects or trend toward cognitive impairment on all measures except for acute subjective
effects); Szigeti et al., supra note 298, at 1 (finding in large self-blinded study that anecdotal
benefits of microdosing could be explained by placebo effect).
618 BOSTON UNIVERSITY LAW REVIEW [Vol. 103:573

criminal penalties or creating regulatory frameworks. In the context of supported

adult-use frameworks, for example, consumers should be free to draw their own
conclusions and to make their own decisions regarding whether to microdose.
The adult-use context differs significantly from the healthcare context, where
efficacy should be established before a treatment is approved and can be
prescribed by physicians. In the medical context, introducing ineffective
therapies into clinical practice is a poor allocation of resources that can
negatively affect outcomes. By comparison, in adult-use markets, if people are
fully informed of the risks and benefits of microdosing, they can decide for
themselves whether to spend time and money on the practice. Moreover, if the
risks of microdosing are low, it may be worthwhile regardless of whether it is
proven more effective than placebo.
One notable limitation of existing research is the lack of controlled studies on
longer-term microdosing. However, one study concluded earlier this year.331 It
is possible that changes to mood or mental health, for example, require more
than a few weeks of microdosing, as is typically the case with commonly used
antidepressants.332 The lack of trials involving longer-term microdosing could
help explain some of the differences between the survey-based and placebo-
controlled studies. Additionally, most placebo-controlled studies have been
conducted on subjects without existing mental health diagnoses, so it remains to
be seen whether effects are different for subjects with documented mental health
diagnoses such as depression or PTSD.333 Given these and other limitations of
existing controlled studies, it is likely premature to conclude that the anecdotal
evidence supporting the benefits of microdosing are due only to expectancy
bias.334

2. Potential Risks
In some respects, the adverse effects of microdosing have not been fully
evaluated. However, what evidence does exist has led Dutch psychologist and
neuroscientist Kim P.C. Kuypers to suggest that “[a]ll in all, the negative effects
linked with low doses of psychedelics seem rather mild.”335 Furthermore, the
only placebo-controlled study specifically designed to evaluate the safety of
microdosing found that “administration of low dose LSD carried no safety risk

331
Robin J. Murphy, Rachael L. Sumner, William Evans, David Menkes, Ingo Lambrecht,
Rhys Ponton, Frederick Sundram, Nicholas Hoeh, Sanya Ram, Lisa Reynolds & Suresh
Muthukumaraswamy, MDLSD: Study Protocol for a Randomised, Double-Masked, Placebo-
Controlled Trial of Repeated Microdoses of LSD in Healthy Volunteers, TRIALS, Apr. 2021,
at 1, 13.
332
Polito & Liknaitzky, supra note 292, at 14.
333
See, e.g., Szigeti et al., supra note 298, at 14 (noting use of nonclinical population as
study limitation).
334
Polito & Liknaitzky, supra note 292, at 15-16.
335
Kuypers, supra note 288, at 271.
2023] MICRODOSING PSYCHEDELICS 619

and was well tolerated during the limited 21-day period studied.”336 The existing
evidence thus suggests a favorable safety profile for short-term microdosing, but
further research is needed to evaluate microdosing that occurs over longer
periods.337
One notable survey-based study attempted to create a taxonomy of self-
reported benefits and side effects.338 The most commonly reported categories of
challenges and side effects were related to the illegal status of microdosing,
which requires people to obtain illicit products of unknown identity and purity,
causing possible physiological discomfort (e.g., visual distortion, insomnia, and
headaches), increased anxiety, and impaired focus, energy, and mood.339 Less
commonly reported challenges included social and cognitive disturbances.340
Survey-based studies have not always agreed regarding the prevalence of side
effects, with estimates ranging from twenty percent of people experiencing side
effects341 to more than fifty percent.342 However, side effects appear to be largely
limited to the day the microdose was taken, rather than long-term,343 and they
appear to occur infrequently, even among people who report them.344
Overall, placebo-controlled clinical studies have found microdosing to be
well tolerated.345 Nevertheless, the side effects observed include mildly
increased anxiety and mild dissociation (a feeling of disconnection from oneself
and the external world),346 minor unpleasant physical symptoms such as
headaches,347 and decreases in self-rated concentration with minidoses.348 These
minor undesired effects comport well with the most common self-reported side
effects from surveys discussed above.349

336
Neiloufar Family, Emeline L. Maillet, Luke T.J. Williams, Erwin Krediet, Robin L.
Carhart-Harris, Tim M. Williams, Charles D. Nichols, Daniel J. Goble & Shlomi Raz, Safety,
Tolerability, Pharmacokinetics, and Pharmacodynamics of Low Dose Lysergic Acid
Diethylamide (LSD) in Healthy Older Volunteers, 237 PSYCHOPHARMACOLOGY 841, 848
(2020).
337
See Polito & Liknaitzky, supra note 292, at 16.
338
See Anderson et al., supra note 194, at 1-2.
339
Id. at 5.
340
Id.
341
Hutten et al., Motives and Side-Effects, supra note 191, at 433.
342
See Lea et al., supra note 218, at 6 tbls.3, 7.
343
See Hutten et al., Motives and Side-Effects, supra note 191, at 433 (“[O]nly a small
proportion of the microdosers (1-3%) in the present study indicated that the negative effects
lasted for days after dosing.”).
344
Lea et al., supra note 218, at 7.
345
Kuypers, supra note 288, at 271.
346
Ramaekers et al., supra note 314, at 403.
347
See, e.g., Family et al., supra note 336, at 848 (finding low doses of LSD to have
favorable overall safety profile, but people who microdose still reported more headaches than
members of placebo group).
348
Hutten et al., Mood and Cognition, supra note 323, at 89.
349
See supra notes 338-44 and accompanying text.
620 BOSTON UNIVERSITY LAW REVIEW [Vol. 103:573

One interesting trend among existing trials is the observation of bidirectional

effects.350 In other words, microdosing may sometimes produce benefits
reflected by a particular measure, and at other times produce side effects
reflected by the same measure—for example, microdosing has been reported to
both increase or decrease anxiety and improve or impair focus.351 Why
microdosing has such bidirectional effects is a question that requires further
study. Expectancy bias may account for some of these bidirectional effects in
individual users.352 However, some bidirectional effects may be related to
dosage, the environments in which people microdose, or differences in
individual psychology or physiology.353
Crucially, among the most commonly reported difficulties of microdosing are
those associated with its illegality. These challenges are primarily related to
accurate and consistent dosing, the availability of products, and the cost of
microdosing.354 If people lack a legal means of obtaining products for
microdosing, then they might obtain illicit products of unknown identity and
purity from friends or strangers, which can be dangerous. One meta-analysis,
which in part analyzed the side effects reported in survey-based studies,
expressed concern about the relative frequency of some side effects.355 However,
the authors noted that the prevalence of these effects may be partially explained
by incorrect dosing.356 If side effects are caused by ingestion of a larger dose
than intended, as has been suggested by some controlled research,357 then the
availability of accurate and precise doses could largely mitigate this risk, and
legal access to microdoses may serve as a form of harm reduction.
In the context of microdosing, consuming more than the intended dose of a
psychedelic is unlikely to cause direct physical or psychological harm; the risk
is primarily related to the impact of the dose on one’s ability to work and perform
other activities of daily life while microdosing. Accordingly, one must use
caution and ensure that one’s physical and cognitive abilities are not affected
before driving or engaging in other potentially dangerous activities. It may be
more prudent to avoid dangerous activities entirely while microdosing.
Though their concerns have not been substantiated, some researchers
hypothesize that long-term microdosing could cause valvular dysfunction due to
psilocybin’s repeated activation of serotonin receptors in the heart.358 Though it

350
See Polito & Liknaitzky, supra note 292, at 14-15.
351
Anderson et al., supra note 194, at 6.
352
Id.
353
See Polito & Liknaitzky, supra note 292, at 14-15.
354
Anderson et al., supra note 194, at 5.
355
Genís Ona & José Carlos Bouso, Potential Safety, Benefits, and Influence of the
Placebo Effect in Microdosing Psychedelic Drugs: A Systematic Review, 119 NEUROSCIENCE
& BIOBEHAVIORAL REVS. 194, 200 (2020).
356
Id.
357
See Hutten et al., Mood and Cognition, supra note 323, at 89 (noting reduced
concentration was only found in participants who took largest of three LSD doses).
358
Id.
2023] MICRODOSING PSYCHEDELICS 621

did not involve psilocybin, one meta-analysis conducted on drug-associated

heart valve disease found a significant relationship between this condition and
the consumption of certain drugs that stimulate the serotonin 5-HT2B receptor.359
Although psilocin (a psychoactive produced when the body breaks down
psilocybin) has been shown to bind to 5-HT2B receptors,360 “psilocybin testing
in preclinical studies has not revealed any signals of [heart valve diseases].”361
However, human studies designed to test the valve injury hypothesis have not
yet been conducted.362
In a response to theoretical concerns regarding valvular dysfunction and
microdosing, Fadiman and Korb argue that these concerns are excessive given
the established safety profile of psychedelics and the lack of reported heart valve
problems among those who microdose.363 Further, they noted that the FDA-
approved drug that led to these concerns, a weight loss drug called Fen-Phen,
was administered in doses that “far exceed the doses used in microdosing,
seemingly resulting in several orders of magnitude more activity at the
receptors.”364 Moreover, while Fen-Phen was administered daily for extended
periods, people usually microdose intermittently, with several days between
doses, and for limited periods ranging from weeks to months.365 Fadiman and
Korb argue that researchers must “be careful not to create such fears [regarding
microdosing and valve dysfunction] before we have evidence.”366 In the
meantime, reasonable precautions can be taken such as limiting the frequency
of dosing and the duration of microdosing cycles.
Although more research on the risks and benefits of psychedelic microdosing
is necessary, existing scientific evidence suggests many potential benefits and
that adverse effects are largely transient and mild.367 Especially in supportive
and controlled settings, where effects can be monitored over time, microdosing
may be a valuable addition to both therapeutic and supported adult-use
frameworks.

359
Jacqueline H. Fortier, Beatrice Pizzarotti, Richard E. Shaw, Robert J. Levy, Giovanni
Ferrari & Juan Grau, Drug-Associated Valvular Heart Diseases and Serotonin-Related
Pathways: A Meta-Analysis, 105 HEART 1140, 1140-48 (2019).
360
Kuypers et al., supra note 187, at 1045.
361
Id. at 1043.
362
See id. (“It remains to be seen whether repeated low-dose psilocybin administration in
preclinical studies might produce valvular hyperplasia, and whether or not this would translate
to the human user population.”).
363
James Fadiman & Sophia Korb, Commentary, 33 J. PSYCHOPHARMACOLOGY 1054,
1054 (2019).
364
Id.
365
Id.
366
Id.
367
See supra notes 345-48 and accompanying text.
622 BOSTON UNIVERSITY LAW REVIEW [Vol. 103:573

III. DESIGNING LEGAL FRAMEWORKS TO PROMOTE EQUITY AND PUBLIC

HEALTH
As local, state, and federal governments legalize or decriminalize psilocybin
and other psychedelics, they should consider how proposed legislation and
administrative rules may impact microdosing, with a particular eye toward
concerns regarding equity and public health. Although most of the reported
benefits of the practice have yet to be confirmed by randomized controlled trials,
there is little reason to believe that microdosing carries significant risks if used
sparingly or for limited periods.368 Indeed, for many people who microdose, the
greatest challenges may be posed not by adverse health effects per se, but by
access to safe and affordable products, reliable education and support, and
accurate and consistent dosing.369 Thoughtful legalization and regulation can
help address these concerns.
The following discussion addresses equity and public health concerns
associated with legal prohibitions on microdosing. Prohibition raises equity
concerns because many people may be unable to afford standard dosing offered
through supported adult-use frameworks like Oregon’s and the medical
frameworks of other states. Many believe that the complex rules created to
implement Measure 109 could drive prices beyond the reach of some historically
marginalized communities, including racial minorities and people with
disabilities.370 Microdosing can help bring prices down because smaller doses of
psilocybin are required, and the length of administration sessions can be
shortened. However, the practice can only produce these benefits if regulators
adopt rules that allow microdosing. If the practice is prohibited, then some
marginalized communities, which often lack equal access to mental healthcare
resources, may also lack a legal means of benefitting from psychedelics.
Finally, though decriminalization and legalization can minimize the risks
associated with microdosing, overly permissive rules could create additional
risks unless they are accompanied by education for stakeholders such as
healthcare providers, first responders, psychedelic facilitators, and the public.
Without adequate education, people may microdose incorrectly or too
frequently, which could have unknown risks. In jurisdictions that have only
partially decriminalized psychedelics, police could arrest, institutionalize, or
otherwise harm people for possessing or consuming low doses, and the most
marginalized communities could be disproportionately impacted. The following
discussion analyzes these concerns.

368
See supra Section II.D.
369
See supra notes 339, 354-57 and accompanying text.
370
See Oregon Psilocybin Services—Public Listening Sessions, OR. HEALTH AUTH.,
https://www.oregon.gov/oha/PH/PREVENTIONWELLNESS/Pages/Psilocybin-Public-
Listening-Sessions.aspx [https://perma.cc/37PL-S7JT] (last visited Feb. 10, 2023).
2023] MICRODOSING PSYCHEDELICS 623

A. Microdosing Safety

1. Microdosing as a Gentle Introduction to Standard Dosing

Standard dosing of psychedelics can cause temporary challenging
experiences characterized by a variety of mild side effects such as anxiety,
headache, and nausea.371 In rare instances, people may experience more severe
or prolonged adverse effects, including depressed mood or protracted perceptual
disturbances.372 Though severe adverse effects appear to be rare, the possibility
of their occurrence, and the high likelihood of experiencing at least some degree
of mental or physical discomfort, may cause people to experience anxiety before
consuming a standard dose.373 Accordingly, microdosing could serve as a gentle
introduction to psychedelics for people who have little experience with these
substances.
In this respect, microdosing serves an important safety function by allowing
people to build confidence before progressing to higher doses. Some individuals
may be more sensitive to psychedelics. Moreover, some are allergic to
substances found in mushrooms and may not be aware of it.374 For these reasons,
in some cases, it may be preferable for first time users to consume microdoses
instead of standard doses. If they respond well to a microdose, then the dose can
be increased hours later or on subsequent days.
Microdosing may also be an appealing alternative to standard dosing for
people who wish to experience some of the benefits of psychedelics without
experiencing the emotional and perceptual changes that are associated with
consuming standard doses. If jurisdictions prohibit microdosing or make it too
expensive or burdensome, those individuals must either seek illicit sources of

371
See Robin Carhart-Harris, Bruna Giribaldi, Rosalind Watts, Michelle Baker‑Jones,
Ashleigh Murphy‑Beiner, Roberta Murphy, Jonny Martell, Allan Blemings, David Erritzoe
& David J. Nutt, Trial of Psilocybin Versus Escitalopram for Depression, 384 NEW ENG. J.
MED. 1402, 1410 (2021).
372
See Press Release, supra note 48 (finding in Phase 2 trial of psilocybin therapy for
treatment-resistant depression that some participants reported treatment-emergent suicidal
behavior, intentional self-injury, and suicidal ideation); see also John H. Halpern, Arturo G.
Lerner & Torsten Passie, A Review of Hallucinogen Persisting Perception Disorder (HPPD)
and an Exploratory Study of Subjects Claiming Symptoms of HPPD, in 36 BEHAVIORAL
NEUROBIOLOGY OF PSYCHEDELIC DRUGS, supra note 195, at 333 (discussing hallucinogen
persisting perception disorder—a rare condition that occurs less frequently with psilocybin
than with LSD and less frequently with supported use than unsupported use—that involves
reexperiencing of some perceptual distortions after intoxication, as well as attendant
functional impairment or anxiety).
373
See JEFFREY GUSS, ROBERT KRAUSE & JORDAN SLOSHOWER, YALE MANUAL FOR
PSILOCYBIN-ASSISTED THERAPY OF DEPRESSION, at II.9 (2020), https://psyarxiv.com/u6v9y/
[https://perma.cc/N9F4-9GQQ] (listing “[e]mpathizing with . . . anxiety about being in the
study” as part of preparation session).
374
Test ID: MUSH, MAYO CLINIC LAB’YS, https://www.mayocliniclabs.com/test-
catalog/overview/82626#Clinical-and-Interpretive [https://perma.cc/4LXF-DZ72] (last
visited Feb. 10, 2023) (discussing mushroom allergies).
624 BOSTON UNIVERSITY LAW REVIEW [Vol. 103:573

psychedelics for microdosing and expose themselves to the associated legal and
safety risks, or they must forgo the potential benefits altogether.

2. Safer and More Consistent Products and Services

One of the greatest potential benefits of legalizing and regulating
psychedelics, as Oregon has elected to do, is the availability of accurate and
consistent doses that are correctly labeled, unadulterated with other substances,
and uncontaminated by pesticides and other toxins.375 Accurate and consistent
dosing reduces the risk of consuming higher doses than intended when
microdosing, as well as when consuming minidoses, standard doses, or high
doses. Proper labeling conveys accurate information to consumers regarding
common allergens, such as peanuts, and other additives that may be present in
psychedelic products. In Oregon, the OHA’s final rules required psilocybin
product labels to list potential food allergens, but the rules did not require labels
to include information about pesticides, substrates, or other chemicals.376
Testing products for contaminants and adulterants can reduce the risk of physical
and psychological harm.377
Accurate and consistent dosing is particularly important in the context of
microdosing, where people risk consuming higher doses than intended before
returning to work or engaging in potentially dangerous activities such as driving
or operating heavy machinery.378 The legalization and permissive regulation of
microdosing reduces this risk by increasing the likelihood of consuming
consistent microdoses that do not exceed the intended dose and cause unintended
psychedelic effects.379 Psychedelic substances obtained from illicit sources may
have variable and unpredictable potency.380 However, the psilocybin content of

375
See Jean-Gabriel Fernandez, Why Legal Marijuana Is Safer, SHEPHERD EXPRESS (Dec.
10, 2019, 3:16 PM), https://shepherdexpress.com/cannabis/cannabis/why-legal-marijuana-is-
safer/ [https://perma.cc/7MQS-JESR]; Oregon Psilocybin Services, OR. HEALTH AUTH.,
https://www.oregon.gov/oha/PH/PREVENTIONWELLNESS/Pages/Oregon-Psilocybin-
Services.aspx [https://perma.cc/V54Q-EQUP] (last visited Feb. 10, 2023) (explaining Oregon
Psilocybin Services Section will “license and regulate the manufacturing, transportation,
delivery, sale, and purchase of psilocybin products”).
376
See OR. ADMIN. R. 333-333-2400, -2410 (2022); Oregon Psilocybin Services—Oregon
Psilocybin Advisory Board, supra note 87.
377
See generally FRED FISHEL & PAUL ANDRE, MU EXTENSION, UNIV. OF MO.-COLUMBIA,
PESTICIDE POISONING SYMPTOMS AND FIRST AID (2002),
https://extension.missouri.edu/media/wysiwyg/Extensiondata/Pub/pdf/agguides/agengin/g01
915.pdf [https://perma.cc/23ZS-MSMM] (discussing pesticide poisoning); Dusty Rose
Miller, Potentiating Psilocybin: MAOIs and the Entourage Effect, PSYCHEDELIC TIMES (Mar.
13, 2020), https://psychedelictimes.com/potentiating-psilocybin-entourage-effect/
[https://perma.cc/2RY7-9DZR] (discussing monoamine oxidase inhibitors and other
substances that can potentiate psilocybin).
378
See supra Section II.D.2.
379
See Fernandez, supra note 375.
380
See, e.g., How Can We Reduce the Harms Associated with Using Psilocybin
Mushrooms?, DRUG POL’Y ALL., https://drugpolicy.org/drug-facts/reduce-harms-psilocybin-
2023] MICRODOSING PSYCHEDELICS 625

mushrooms produced and sold through adult-use frameworks will also vary
considerably because psilocybin content varies significantly from species to
species, batch to batch, and even mushroom to mushroom.381
Under many emerging legal frameworks, such as Oregon’s supported adult-
use model, extracts of psilocybin, for which the concentration of the substance
can be more consistently controlled, can be administered as alternatives to whole
mushrooms. Other alternatives, such as dried and homogenized mushrooms, or
truffles, may also result in more consistent doses. These options have been
discussed by the Oregon Board and are permitted in the final rules published by
the OHA.382
Creating burdensome rules that make microdosing too expensive or
burdensome, or banning the practice entirely, may push people to microdose
without guidance, using illicit substances of unknown purity and origin.383 Some
may consume substances that are contaminated or adulterated, which can cause
physical or psychological injury.384 Dosage may be unpredictable and highly
variable, and those who microdose could accidentally consume higher doses
than intended, putting people at risk for unanticipated mental or physical
impairment and subsequent injury to themselves or others.385 Some might seek
the guidance of underground suppliers and microdosing coaches who could
exploit them physically, emotionally, or financially.386 The following Section
discusses this risk and how legalization can reduce it. By reducing or eliminating
the risk of adulteration and inaccurate dosing, legalization will help those who
microdose ensure that they do not exceed their intended dose, which could result
in unanticipated perceptual, emotional, or physical effects while at work or in
other dangerous or inappropriate settings.

3. Decreased Risk of Abuse and Exploitation

In the context of standard dosing, serious allegations have recently been made
regarding emotional, physical, and sexual abuse by psychedelic facilitators.387
Though the risk of abuse could be lessened when microdoses are administered,

mushrooms [https://perma.cc/33CP-7LL4] (last visited Feb. 10, 2023) (discussing variability

in potency of psilocybin mushrooms); Mushrooms, DANCESAFE, https://dancesafe.org/magic-
mushrooms/ [https://perma.cc/3B65-PGNH] (last visited Feb. 10, 2023).
381
See sources cited supra note 380.
382
See OR. ADMIN. R. 333-333-1010 (2022).
383
See infra Section III.B.
384
See Sarah Saleemi, Steven J. Pennybaker, Missi Wooldridge & Matthew W. Johnson,
Who Is ‘Molly’? MDMA Adulterants by Product Name and the Impact of Harm-Reduction
Services at Raves, 31 J. PSYCHOPHARMACOLOGY 1056, 1056 (2017).
385
See sources cited supra note 380.
386
See infra Section III.A.3.
387
See, e.g., Katie MacBride, “Aharon Said It Was Healing.,” INVERSE (Nov. 16, 2021),
https://www.inverse.com/mind-body/grossbard-bourzat-psychedelic-assisted-therapy-abuse
[https://perma.cc/CAF5-3UCG] (reporting on allegations of abuse made against underground
facilitator Aharon Grossbard and his wife Françoise Bourzat).
626 BOSTON UNIVERSITY LAW REVIEW [Vol. 103:573

significant asymmetries of power exist between underground psychedelic

facilitators and their clients, and these power dynamics could be exploited even
in the context of microdosing.388 Decriminalizing or legalizing microdosing
brings it out of the shadows and promotes safer practices. Because people may
be less fearful of being stigmatized, arrested, or prosecuted, they may be more
likely to report instances of abuse, which could act as a deterrent.389 Under
prohibition, people may be hesitant to report cases of abuse or the sale of
adulterated or contaminated psychedelic products.390 If microdosing is
decriminalized or regulated, and people are harmed by consuming contaminated
or adulterated products, they may be more likely to report those products and
prevent future harm. Because psychedelic substances obtained from
underground sources can be contaminated or adulterated, legalizing or
decriminalizing psychedelic microdosing should be framed as an important
harm-reduction measure that promotes public health.391 After attending a
meeting of the Oregon Board’s Research Subcommittee, Dr. Fadiman told a
journalist, “There is going to be microdosing throughout Oregon regardless of
what this committee does. . . . The question is, can it also help people use it more
safely and more effectively?”392

B. Microdosing Economics and Psychedelic Equity

As psychedelics are increasingly commercialized, and more states legalize
these substances and related services, many are concerned that psychedelic
products and services will become too expensive.393 When states legalized
cannabis, the cost of obtaining licenses and opening businesses skyrocketed in
many states.394 Punitive tax regulations also increased the costs, and the same
will be true of businesses that provide psychedelics and related services.395
Under Section 280E of the Internal Revenue Code, companies that handle illicit

388
See id.
389
See id.
390
See Fernandez, supra note 375.
391
See Saleemi et al., supra note 384, at 1056, 1058 (discussing frequent adulteration of
MDMA obtained from underground sources).
392
Tess Riski, Oregon Voters Legalized Psilocybin Use. But What About Microdosing?,
WILLAMETTE WEEK (Jan. 26, 2022, 9:20 AM), https://www.wweek.com/news/2022/01/26
/oregon-voters-legalized-psilocybin-use-but-what-about-microdosing/ [https://perma.cc
/EM3U-9UW6].
393
Alexander Lekhtman, How Will Oregon Implement Legal Psilocybin Therapy?, FILTER
(Mar. 17, 2021), https://filtermag.org/oregon-legal-psilocybin-therapy/ [https://perma.cc
/62RT-XRWP].
394
Angela Dills, Sietse Goffard, Jeffrey Miron & Erin Partin, The Effect of State
Marijuana Legalizations: 2021 Update, CATO INST. (Feb. 2, 2021), https://www.cato.org
/policy-analysis/effect-state-marijuana-legalizations-2021-update [https://perma.cc/9FUM-
VZZT].
395
Id.
2023] MICRODOSING PSYCHEDELICS 627

substances like cannabis or psilocybin cannot deduct their business expenses.396

Consequently, these costs are passed on to consumers.397
Decriminalizing psychedelics could be an effective means of reducing the
cost of microdosing and standard dosing because people can access psychedelics
by producing them at home or obtaining them from other noncommercial
cultivators, avoiding Section 280E and burdensome state regulation. In contrast,
psychedelics sold under state legalization frameworks can significantly increase
the cost of both microdosing and standard dosing because products and related
services are subject to Section 280E and complex administrative rules.398 In
these circumstances, deliberate steps should be taken to reduce the cost of
psychedelics and related services. Otherwise, people will be denied access or
encouraged to receive them from underground sources.
In Oregon-based market research, people who expressed interest in legal
microdosing under Measure 109 demonstrated that they are price conscious.399
People who reported interest in attending six-hour microdosing workshops
indicated that they would be “happy to pay” about $60 overall and would be
willing to pay a maximum of about $100.400 These prices are likely unrealistic
because they would have to include the cost of products, overhead associated
with operating a psilocybin service center, and compensation for six hours of a
facilitator’s time. This research illustrates the importance of reducing the costs
of microdosing products and services.
Although economies of scale could reduce the cost of legal psilocybin
services, legislators and regulators also play an important role by setting tax rates
and licensing fees, which influence the prices of controlled substances such as
cannabis and psychedelics.401 Legal cannabis markets—which can serve as
useful comparators—have been most successful at replacing underground
cannabis markets in states with lower taxes on cannabis sales.402 Psychedelic
microdoses need not be overly expensive even in legally sanctioned markets.
For instance, in the Netherlands, Red Light Holland sells a kit containing fifteen

396
Katherine P. Franck, Cannabis Reform: High on the Banking Agenda, 24 N.C.
BANKING INST. 163, 184 (2020).
397
Id. at 167-72.
398
See id. at 170, 184.
399
See RED LIGHT OR., RED LIGHT OREGON: MARKET RESEARCH AND MICRODOSING
SAFETY REPORT FOR MEASURE 109, at 12, 14 (2021), https://redlightoregon.com/wp-
content/uploads/2021/10/Survey-Report-1-1.pdf [https://perma.cc/MB7M-NMJ2].
400
Id.
401
See Dills et al., supra note 394.
402
See Natalie Fertig, ‘Talk About Clusterf—’: Why Legal Weed Didn’t Kill Oregon’s
Black Market, POLITICO (Jan. 21, 2022, 4:45 PM), https://www.politico.com/news/magazine
/2022/01/14/oregon-marijuana-legalization-black-market-enforcement-527012
[https://perma.cc/WJ8V-E2MM] (noting Oregon’s low taxes have made legal market account
for eighty to eighty-five percent of state’s demand, but underground marijuana operations are
still flourishing by exporting marijuana to high-tax jurisdictions like Los Angeles).
628 BOSTON UNIVERSITY LAW REVIEW [Vol. 103:573

microdoses of psilocybin truffles for twenty-fives euros,403 which is less

expensive than current prices in underground U.S. markets.404 Nevertheless, in
the United States, tax reform will be necessary to significantly reduce the prices
of psychedelic substances once they are legalized.405 Still, there are limits to how
much these prices can be reduced in supported adult-use frameworks. In such
systems, which require facilitators to sit with clients for up to six hours after
administering standard doses, paying for a facilitator’s time accounts for much
of the associated cost.406 Frequently, psychedelic services require the presence
of more than one facilitator or staff member,407 raising prices further.
However, because microdoses do not produce the physical and perceptual
disturbances that are characteristic of standard doses, the duration of
administration sessions can be shortened, significantly reducing the cost of
services.
If a facilitator charges $100 per hour for facilitation services, a five-hour
administration session would cost $500, before accounting for the cost of
psilocybin and other business expenses. Reducing the duration of an
administration session to one hour, would significantly reduce costs associated
with the facilitator’s services from $500 to $100. The OHA’s rules allow for
administration sessions lasting as few as thirty minutes if clients consume 2.5
milligrams or less of psilocybin.408
Critics of allowing microdosing under supported adult-use frameworks might
claim that people who microdose typically follow schedules of alternating “on
days” interspersed with periods of several “off days” over the course of weeks
or months.409 Consequently, whereas clients consuming standard doses might
attend administration sessions spaced several (often three) weeks apart,
microdosing clients would complete multiple microdosing sessions during the
same period. Due to the necessity of paying for a facilitator’s time, the cost of
microdosing could approach the cost of a single five-hour standard dosing

403
Have You Tried Microdosing?, IMICRODOSE, imicrodose.nl [https://perma.cc/A62J-
9H3B] (last visited Feb. 10, 2023).
404
Amelia Williams, How Much Do Shrooms Cost?, LEAFLY (Jan. 31, 2023),
https://www.leafly.com/news/lifestyle/how-much-do-shrooms-cost [https://perma.cc/RRH3-
XN3J].
405
See Franck, supra note 396, at 170 (outlining dynamic in which high banking costs for
cannabis firms are passed on to cannabis consumers).
406
See Santos-Longhurst, supra note 83.
407
See Press Release, Multidisciplinary Ass’n for Psychedelic Stud., MAPS Wins Appeal
and Authorization To Study MDMA in Healthy Volunteer Therapists (May 12, 2021),
https://maps.org/news/media/maps-wins-appeal-and-authorization-to-study-mdma-in-
healthy-volunteer-therapists/ [https://perma.cc/LE2H-SK98] (indicating MAPS uses two-
facilitator team to support MDMA therapy).
408
See OR. ADMIN. R. 333-333-5250(1)(a), (2) (2022) (providing that “[f]or clients
consuming less than 2.5 mg of psilocybin analyte . . . . the minimum duration shall be 30
minutes,” unless administration session is client’s first or client is consuming whole dried
fungi, in which case minimum administration time is one hour).
409
See Kuypers et al., supra note 187, at 1041.
2023] MICRODOSING PSYCHEDELICS 629

session.410 However, many people report microdosing for only a few weeks
before experiencing benefits, and the limited duration may therefore yield cost
savings compared to standard dosing.411 Moreover, if products with consistent
psilocybin content are used, then the duration of administration sessions could
be further reduced after a client completes an initial session to determine
tolerability.412 If an initial microdose is well tolerated, then subsequent
administration sessions could be reduced to fifteen minutes because the client’s
response to the selected dose would have been established, and there would be
little or no reason to prolong the administration session. We now move from a
discussion of general principles to an analysis of a specific dilemma faced by
the Oregon Board and the OHA.

C. Making Oregon’s System Safer and More Equitable

The OHA published final rules for Oregon’s psilocybin services program on
December 27, 2022. These rules allow for limited approaches to microdosing.
However, this outcome was far from certain. Though the text of Oregon’s
Measure 109 does not mention microdosing, it also lacks any mention of
standard dosing, or any other type of dosing for that matter.413 The Measure only
requires the OHA to specify the “maximum concentration of psilocybin that is
permitted in a single serving of a psilocybin product” and the “number of
servings that are permitted in a psilocybin product package.”414 It requires no
minimum dose nor minimum duration for administration sessions. Regarding
the length of administration sessions, Measure 109 provides little guidance. It
merely requires the Oregon Board to make recommendations regarding the
“public health and safety standards and industry best practices for holding and
completing an administration session, including . . . [t]he circumstances under
which an administration session is considered complete.”415 The Oregon Board
must also recommend “requirements, specifications and guidelines for holding
and verifying the completion of . . . an administration session.”416 These
mandates provide significant latitude for the Oregon Board to make
recommendations regarding the conduct and completion of psilocybin
administration sessions.
Tom Eckert, a chief petitioner and codrafter of Measure 109, who formerly
served as chair of the Oregon Board and its training subcommittee before
resigning, has stated that he does not support microdosing under Measure 109

410
See sources cited supra note 199.
411
See Fadiman & Korb, supra note 192, at 120.
412
Id.
413
OR. REV. STAT. § 475A.210-722 (2022).
414
Id. § 475A.642(1).
415
Id. § 475A.230(8).
416
Id. § 475A.230(3)(a).
630 BOSTON UNIVERSITY LAW REVIEW [Vol. 103:573

because it is not within the spirit of the measure.417 However, according to Dave
Kopilak, an attorney and codrafter of the measure, the text of Measure 109
clearly allows for microdosing, and the OHA has statutory authority to adopt
rules that allow it.418 Moreover, when the drafters were contemplating whether
to implement dosing limits, they intentionally left the text open-ended to allow
for flexibility.419 According to Kopilak, it is therefore up to the OHA to draft
rules that either make microdosing accessible or impede access.420 A textualist
might doubt whether the intent of Measure 109’s drafters is of any consequence,
particularly when the text is clear and the statute was enacted by ballot initiative
instead of through an act of the legislature.
Throughout the Oregon Board’s first year of operation, Board members and
the public raised the topic of microdosing at various meetings and public
listening sessions.421 The first in-depth discussion of microdosing occurred at a
meeting of the Oregon Board’s Licensing Subcommittee on December 2,
2021.422 At this meeting, the subcommittee passed a recommendation that would
allow facilitators to adjust the duration of psilocybin administration sessions to
suit the needs and goals of each client.423 The subcommittee recommended that
there be no minimum or maximum duration for administration sessions and that
facilitators be allowed to decide when an administration session ends based on
a variety of factors, including the dose and type of psilocybin products
administered, the client’s goals, whether the client has trustworthy transportation
home, and the degree to which the administered psilocybin products are
affecting the client’s physical and cognitive function.424 The subcommittee
made this recommendation to allow for shorter administration sessions that are
better suited to microdosing.425 Members who approved the recommendation
believed that shorter sessions and lower doses could reduce the cost of

417
See WATCH | Webinar | Oregon Psilocybin Update & What’s To Come, GREEN LIGHT
L. GRP. (Jan. 25, 2022), https://greenlightlawgroup.com/blog/watch-webinar-oregon-
psilocybin-update-whats-to-come [https://perma.cc/GEY8-CQM8].
418
Emerge L. Grp., Deep Dive into Oregon Psilocybin Services Act—Microdosing,
YOUTUBE, at 25:40 (Apr. 9, 2022), https://www.youtube.com/watch?v=wSMrwfXbCjE&ab_
channel=EmergeLawGroup.
419
Id.
420
Id.
421
See Oregon Psilocybin Services—Public Listening Sessions, supra note 370.
422
OPAB Licensing Subcommittee Meeting Recording, OR. HEALTH AUTH.,
https://www.oregon.gov/oha/PH/PREVENTIONWELLNESS/Documents/Complete%20PA
B-LS%20Meetig%2012.2.21.m4a [https://perma.cc/Q35E-BMDF] (last visited Feb. 10,
2023) (providing access to recording of Oregon Board’s December 2, 2021, Licensing
Subcommittee meeting).
423
Id.
424
Id.; see also OPAB Meeting Recording, OR. HEALTH AUTH., https://www.oregon.gov
/oha/PH/PREVENTIONWELLNESS/Documents/OPAB%20Meeting%20Recording%20-
%202022-01-26.m4a [https://perma.cc/55C9-J6DR] (last visited Feb. 10, 2023) (providing
access to recording of Oregon Board’s January 26, 2022, meeting).
425
See OPAB Licensing Subcommittee Meeting Recording, supra note 422.
2023] MICRODOSING PSYCHEDELICS 631

psilocybin services and increase access, helping to achieve Measure 109’s stated
goal of improving “the physical, mental, and social well-being of all people” in
Oregon, as well as helping to fulfill the Oregon Board’s mandate to “develop a
long-term strategic plan to ensure that psilocybin services will become and
remain safe, accessible, and affordable” for everyone in the state who is twenty-
one years of age or older.426
Before the licensing subcommittee’s recommendations could be formally
submitted to the OHA, they had to be voted on and approved by the full Board.427
Then the OHA must adopt them if they are to become part of the state’s
administrative rules.428 The Oregon Board approved the subcommittee’s
recommendation regarding variable length administration sessions, which were
subsequently submitted to the OHA for consideration and potential adoption.429
However, in its final rules, the OHA instead adopted a tiered approach to
administration session duration.430 Under these rules, the minimum duration of
each session increased in a stepwise manner depending on the dose of psilocybin
administered.431 For instance, the final rules require clients consuming between
five and ten milligrams of psilocybin to remain at a service center for a minimum
of two hours, and clients consuming between ten and twenty-five milligrams
would be required to remain under supervision for a minimum of four hours.432
The highest tier requires clients who consume between thirty-five and fifty
milligrams to remain at service centers for a minimum of six hours.433
There are numerous ways the OHA could have prohibited microdosing or
made it overly burdensome. For instance, the OHA could have required clients
to complete a preparation session before every administration session. However,
the finalized rules allowed a single preparation session to remain valid for all
administration sessions completed at the same service center within twelve
months of the preparation session.434
By imposing a minimum dose of psilocybin above the microdosing range, the
OHA could have effectively banned the practice.435 The Products Subcommittee

426
Id.; OR. REV. STAT. § 475A.205(1)(b) (2022).
427
See Oregon Psilocybin Services—Administrative Rules, OR. HEALTH AUTH.,
https://www.oregon.gov/oha/PH/PREVENTIONWELLNESS/Pages/Psilocybin-
Administrative-Rules.aspx [https://perma.cc/5ZXH-6W3D] (last visited Feb. 10, 2023).
428
See id.
429
See OR. HEALTH AUTH., LICENSING SUBCOMMITTEE ROLL CALL AND VOTE COUNT 5
(2021), https://www.oregon.gov/oha/PH/PREVENTIONWELLNESS/Documents/Licensing
%20Roll%20Call%20and%20Vote%20Count%2012.2.2021.pdf [https://perma.cc/KMG4-
7EX8].
430
See OR. ADMIN. R. 333-333-5250 (2022).
431
See id.
432
Id.
433
Id.
434
Id.
435
Emerge L. Grp., supra note 418, at 26:37.
632 BOSTON UNIVERSITY LAW REVIEW [Vol. 103:573

had raised the possibility of instituting a minimum dose.436 However, the Oregon
Board declined to approve such a rule, and the OHA has yet declined to adopt
one, likely because starting clients at lower doses could promote safety as
described above, and therefore, implementing a minimum dose could be
dangerous.437 It would also be difficult to enforce. The OHA also could have
prohibited microdosing by imposing a minimum waiting period between
administration sessions.438 If a waiting period was longer than the off-day period
of most microdosing protocols, then microdosing would be rendered
impossible.439
Though mandatory waiting periods would impede microdosing, they could be
less dangerous and controversial than rules requiring a minimum dose because
clients could still be started on low doses of psilocybin.440 However, a waiting
period would require people starting at lower doses to wait longer before
returning for a standard dose.441 In other words, clients started on low test doses
of psilocybin might be prohibited from subsequently taking a standard dose
unless special exceptions were made for test doses. Regardless, in addition to
prohibiting microdosing, waiting periods would make supported adult-use
programs like Oregon’s overly complex and cumbersome to oversee.
Minimum waiting periods could have other harmful effects. For instance, by
prohibiting microdosing or making it overly burdensome, waiting periods would
encourage people to microdose using illicitly obtained substances without
guidance or support from facilitators.442 In Oregon, the OHA’s finalized rules
imposed no waiting periods between administration sessions.443 However, they
imposed a waiting period of twenty-four hours between a preparation session
and the first administration session that follows it.444
Rules that inhibit microdosing may be undesirable because the evidence
presented above suggests that microdosing may have a variety of benefits and
few associated risks if implemented with sensible rules and accompanied by

436
See Oregon Psilocybin—Products Subcommittee Meetings Archive, OR. HEALTH
AUTH., https://www.oregon.gov/oha/PH/PREVENTIONWELLNESS/Pages/Psilocybin-
Products-Subcommittee-Meetings-Archive.aspx (last visited Feb. 10, 2023) (providing access
to recording of Oregon Board’s December 9, 2021, Products Subcommittee meeting).
437
See Emerge L. Grp., supra note 418, at 27:25.
438
Id.
439
Id.
440
See id.
441
See supra Section III.A.1.
442
See supra Section III.A.1.
443
See OR. ADMIN. R. 333-333-5200 (2022) (outlining requirements for administration
sessions, none of which mandate waiting period).
444
See OR. ADMIN. R. 333-333-5000(1) (“A facilitator must complete a preparation session
with every client who will participate in an administration session at least twenty-four
hours . . . prior to the commencement of the client’s first administration session with the
facilitator.”).
2023] MICRODOSING PSYCHEDELICS 633

adequate consumer education.445 Moreover, banning or restricting microdosing

could be unpopular because the public has expressed strong support for the
practice.
During a series of three public listening sessions held on December 13, 14,
and 15, 2021, members of the public shared their thoughts on microdosing under
Measure 109.446 At the December 13th session, five speakers stated their
views.447 One urged the OHA to consider shorter administration sessions for
microdosing while emphasizing that it could be a great way to introduce the
public to psilocybin.448 Presumably, some people may be hesitant to start with a
large dose, and others may wish to avoid having psychedelic experiences
altogether. For these individuals, microdosing may be a viable alternative.
Another speaker framed microdosing as a means of advancing equity and
diversity in the emerging Oregon psilocybin industry.449 This commentator
argued that microdosing is clearly allowed under Measure 109 because,
regardless of whether clients are consuming a standard dose or a microdose at a
service center, they are “consuming psilocybin” as required by the Measure.450
To conclude, the speaker urged Board members to allow a range of doses from
the lowest dose possible to a reasonable maximum dose.451 This speaker, who
expressed plans to become a licensed psilocybin facilitator and service center
operator, argued that the lowest possible dose should be available for sensitive
clients who could benefit from smaller doses.452
A third speaker expressed disbelief that anyone would suggest that
microdosing was not allowed under Measure 109.453 “As far as Measure 109 is
concerned . . . it is very clear from the wording that microdosing is within the
scope of the measure, and I see no reason why it should be under debate
anymore,” said this speaker.454 A fourth speaker stated that microdosing sessions
should only last from thirty to sixty minutes.455 The speaker added, “I want to
make sure the Oregon Board keeps that in mind as minimum time requirements
are created.”456 A final commentator said, “it is essential and absolutely
necessary for this to be allowed . . . in terms of equity, accessibility, and
safety.”457

445
See supra Section II.D.
446
Oregon Psilocybin Services—Public Listening Sessions, supra note 370.
447
Id.
448
Id.
449
See id.
450
Id.
451
Id.
452
Id.
453
Id.
454
Id.
455
Id.
456
Id.
457
Id.
634 BOSTON UNIVERSITY LAW REVIEW [Vol. 103:573

There may be other ways to reduce the cost of microdosing within supported
adult-use frameworks. For both standard dosing and microdosing, the Oregon
Board has discussed recommending group administration sessions in which
multiple people consume psilocybin together with the support of facilitators.458
In the context of standard dosing, groups of clients could pay significantly less
for a single administration session by sharing the cost of the facilitators’
services. The Licensing Subcommittee has recommended a maximum client-to-
facilitator ratio for group sessions of eight-to-one for standard dosing.459
Similarly, clients could reduce the cost of microdosing by visiting a center where
multiple clients are observed and supported by facilitators simultaneously. In
this context, the licensing subcommittee has recommended a maximum client to
facilitator ratio of ten to one.460 When combined with shortened administration
sessions, group microdosing could significantly reduce the cost of services.
It is also possible to create subscription plans or memberships that further
reduce the cost of microdosing in supported adult-use frameworks. By
purchasing a month-long microdosing subscription, or paying week by week,
clients could avoid paying a larger lump sum. Creating cooperative business
structures where groups of individuals share ownership of service centers may
further reduce prices. There has also been discussion of licensing religious
organizations as service centers in Oregon.461 As nonprofit organizations,
religious groups could offer microdosing to their members at reduced rates.
Decriminalization of psychedelics is an alternative to supported adult use that
has advantages for microdosing. However, under some decriminalization
frameworks, such as the one created by Oregon’s Measure 110, people who wish
to microdose cannot do so without incurring fines or being stigmatized as people
with substances use conditions by being required to attend substance use
counseling sessions.462 Furthermore, people living in jurisdictions with only
partial decriminalization frameworks have no legal means of obtaining
psychedelic substances for microdosing.463 Measure 110, and other proposed
laws that partially decriminalize psychedelics, do not decriminalize purchasing,
cultivating, or sharing of psychedelics, which requires people who wish to
microdose to break state drug laws to obtain psychedelic substances for
microdosing. Because many activities associated with microdosing remain
illegal in these jurisdictions, people are discouraged from openly discussing
microdosing and from reporting bad actors who sell counterfeit or adulterated
substances or otherwise exploit people who microdose.

458
See id.
459
See OR. HEALTH AUTH., LICENSING SUBCOMMITTEE ROLL CALL AND VOTE COUNT 3
(2022), https://www.oregon.gov/oha/PH/PREVENTIONWELLNESS/Documents/Licensing
%20Subcommittee%20Roll%20Call%20and%20Vote%20Count%201.6.2022.pdf
[https://perma.cc/VQP6-4P73].
460
See id.
461
See Oregon Psilocybin Services—Public Listening Sessions, supra note 370.
462
See supra Section I.B.2.
463
See supra Section I.B.2.
2023] MICRODOSING PSYCHEDELICS 635

Some of these concerns can be addressed by decriminalizing the

noncommercial cultivation and sharing of psychedelics. The personal use
section of Colorado’s Proposition 122 takes this approach. Seattle’s psychedelic
decriminalization resolution takes a similar approach by decriminalizing the
cultivation and sharing of several psychedelics for “religious, spiritual, healing,
or personal growth practices . . . without financial or other consideration.”464
Oakland, California’s decriminalization resolution took a similar approach.
As an additional safeguard, cities and states that decriminalize can pass
provisions that provide education to various stakeholders on best practices for
discussing and practicing microdosing. These provisions could create
community outreach programs that educate the public on how to minimize the
associated risks. Programs should also teach healthcare providers about
microdosing, and how to discuss it with their patients, and educate emergency
responders about state and local psychedelic laws and how to respond safely and
ethically to calls involving these substances. To prevent people from
microdosing with adulterated or contaminated products, cities and states can also
authorize or decriminalize drug-checking centers where people can take samples
for testing without fear of being arrested and prosecuted.
Another alternative to supported adult use is retail sales, which is the approach
that many states have taken to adult-use cannabis.465 However, there are
currently no jurisdictions outside the Netherlands that use such a retail model
for psychedelics.466 Retail dispensaries can sell psychedelics directly to
consumers who can then consume standard doses or microdoses at home.467 In
the Netherlands, several companies sell premeasured microdoses over the
counter through retail stores called smart shops.468 Particularly when it comes to
microdosing, the retail sales model has significant advantages over supported
adult use. For instance, the model eliminates the need for facilitators and service
centers that are part of Oregon’s supported adult-use model. Psychedelics could
potentially be sold at existing cannabis dispensaries eliminating the need to
establish new retail stores. The staff of Dutch smart shops typically advise
consumers on proper dosing of psychedelics and may provide pamphlets with
additional information.469 In a U.S. retail model, the budtenders of cannabis
dispensaries could assume this role. The United States may not be ready for retail

464
Seattle City Council, Res. No. 32021, at 3-4 (Oct. 4, 2021), http://seattle.legistar.com
/ViewReport.ashx?M=R&N=Text&GID=393&ID=4515134&GUID=8CD61F8D-9B90-
4957-8008-495858A86A3A&Title=Legislation+Text [https://perma.cc/FXV5-R2VW].
465
See Dills et al., supra note 394.
466
See Pharmadrug’s Supersmart Launches Psilocybin Online Retail Platform in the
Netherlands, PSYCHEDELIC INV. (June 7, 2022) [hereinafter Psilocybin Online Retail
Platform], https://psychedelicinvest.com/pharmadrug-launches-online-retail-platform-in-
the-netherlands/ [https://perma.cc/LBY6-5HME].
467
See id.
468
See id.
469
Id.
636 BOSTON UNIVERSITY LAW REVIEW [Vol. 103:573

sales of psilocybin or other psychedelics. Yet, it remains a potential model that

could reduce overly burdensome regulations and barriers to access.

IV. LEGAL AND REGULATORY RECOMMENDATIONS

The following discussion makes legal recommendations to promote safe and
equitable access to microdosing. Recommendations are made for legal
frameworks that involve decriminalization, supported adult use, retail, and
therapeutic models for psychedelics regulation.

A. Decriminalization Frameworks
Decriminalization frameworks reduce or eliminate the criminal penalties
associated with psychedelics, which may allow people to microdose without
concern for being arrested.470 However, many decriminalization frameworks do
not create legal paths for people to obtain safe supplies of psychedelics for
microdosing.471 To create these pathways, jurisdictions could implement
resolutions, ordinances, or legislation to decriminalize the cultivation and
noncommercial sharing and gifting of psychedelics in addition to their
possession and consumption, which will provide people with a means of
obtaining microdoses without having to risk arrest or prosecution.
These legal reforms bring microdosing out of the shadows, making people
more likely to report instances of abuse and harmful or misrepresented products.
They also respect the traditional mode of consuming psychedelics, which is
more communal than commercial.472 However, because people will consume
products that are not tested systematically, there is some risk of product
adulteration and contamination. To help reduce the risk, jurisdictions that
decriminalize should draft legislation that creates drug-checking centers that test
samples submitted by the public to ensure they have not been contaminated or
adulterated. Legislators should fund education and training on microdosing
safety for a variety of stakeholders including healthcare providers, first
responders, and the public.
Finally, when drafting legislation, jurisdictions that decriminalize should
include provisions that protect employees from employer retaliation for
microdosing if they are not noticeably impaired at work. These kinds of
protections have been built into the proposed Washington State Psilocybin
Services Wellness and Opportunity Act, which prohibits employers from
retaliating against employees for participating in psilocybin services as long as
they are not noticeably impaired in the workplace.473 Recommendations for
supported adult-use frameworks are considered next.

470
See Ponté, supra note 164, at 21.
471
See supra Section I.B.2.
472
See George et al., supra note 2, at 11.
473
S. 5660, 67th Leg., Reg. Sess (Wash. 2022) (“An employer in the state of Washington
may not discriminate against an employee for receiving psilocybin services as sanctioned
under this chapter absent the employee’s visible impairment at work . . . .”).
2023] MICRODOSING PSYCHEDELICS 637

B. Supported Adult-Use Frameworks

Supported adult-use frameworks have the benefit of ensuring that people can
microdose with more consistent products that have been tested by state-
sanctioned laboratories under the supervision of trained and licensed facilities.
However, Oregon is currently the only state with a supported adult-use
framework that allows for microdosing. The text of Measure 109 neither
specifies a minimum psilocybin dose nor minimum duration for administration
sessions.474 However, the OHA’s rules set a minimum session duration of thirty
minutes for clients consuming a psilocybin dose less than 2.5 milligrams.475 The
following recommendations are intended to guide the OHA, the Oregon
legislature, and other jurisdictions and agencies that craft legislation and rules
for the supported adult use of psychedelics.
To encourage people to choose microdosing products that have been tested
for safety, supported adult-use jurisdictions should create legislation and rules
that allow the production of microdosing products with accurate and consistent
doses. Accordingly, when drafting legislation and rules, they should avoid
setting minimum doses for psychedelics or lower limits on the duration of
administration sessions. These limitations may pose a safety risk and would be
challenging and expensive to enforce. Instead, they should create legislation and
rules that train psychedelic facilitators to determine the appropriate dose and
duration for each administration session.
When drafting legislation and rules, supported adult-use jurisdictions should
avoid implementing waiting periods between psychedelic administration
sessions. Requiring waiting periods will make microdosing challenging or
impossible and encourage people to microdose using illicit products of unknown
origin and purity. It may also prevent people from starting with low doses of
psychedelics to determine how sensitive they are, or whether they have allergies
to ingredients in psychedelic products, which poses safety risks. This concern
could be partially addressed through rules that allow for booster doses following
the successful administration of a microdose or minidose.476 Then people could
consume a small test dose followed by a larger standard dose hours or days later
if they react positively to the test dose.477 However, in addition to making
microdosing more burdensome, and potentially more dangerous, rules that
create waiting periods between administration sessions could be challenging and
expensive to enforce. It is likely safer and more practical to adequately train
facilitators and empower them to determine the optimal dosing schedules for
clients.
To create flexible systems that can efficiently accommodate a spectrum of
doses, supported adult-use jurisdictions should craft legislation and rules that
allow for variable length administration sessions, as recommended by the

474
Emerge L. Grp., supra note 418, at 26:37, 29:30.
475
OR. ADMIN. R. 333-333-5250(1)(a) (2022).
476
See supra Section III.C.
477
See supra Section III.A.1.
638 BOSTON UNIVERSITY LAW REVIEW [Vol. 103:573

Oregon Board. Variable length administration sessions can be adjusted to

accommodate the full range of psychedelic doses from microdoses and
minidoses to standard doses and large doses. This approach is preferable to the
tiered approach required by the OHA’s finalized rules,478 which are too rigid and
oversimplify the relationship between dose and client response. Legislators and
regulators should fully integrate microdosing into psychedelic facilitator
training programs. Facilitators should be trained to understand and implement
different microdosing protocols. They should also be familiar with the state of
microdosing science and how to explain it clearly to clients lacking medical or
scientific backgrounds.
To reduce the cost of microdosing, supported adult-use jurisdictions should
draft rules that allow group microdosing sessions where facilitators
simultaneously support and advise multiple clients. Group microdosing may
take the form of microdosing cafes or shared workspaces where people consume
microdoses and read, work, or socialize with support from trained facilitators
who act as coaches or guides. To further reduce costs, jurisdictions should draft
rules that allow nonprofits, religious organizations, and cooperatives to provide
microdosing services at reduced rates.
People with certain disabilities and health conditions may have mobility
impairments that affect their ability to travel to psychedelic service centers.479
Accordingly, to ensure that a safe and legal means of microdosing is available
to all, supported adult-use jurisdictions should draft legislation and rules that
allow for at-home administration sessions when people cannot travel to a service
center due to disability or illness. The proposed Washington Psilocybin Services
Wellness and Opportunity Act currently contains this type of provision.480 For
similar reasons related to accessibility, jurisdictions should allow for a variety
of product types to ensure that people with disabilities have equal access to
microdosing. Otherwise, people with certain health conditions, such as
dysphagia—a condition that makes swallowing difficult—may be unable to
consume psychedelics.481 Allowing a variety of products that can be consumed
in different ways helps ensure that these individuals have access. Though the
Oregon Board recommended a variety of product types, including transdermal
patches and sublingual strips that deliver psilocybin,482 the OHA’s current rules
allow only for psilocybin products that are consumed orally or enterally (through

478
See OR. ADMIN. R. 333-333-5250.
479
See S. 5660, 67th Leg., Reg. Sess (Wash. 2022).
480
See id.
481
See Dysphagia (Difficulty Swallowing), CLEVELAND CLINIC, https://my.cleveland
clinic.org/health/symptoms/21195-dysphagia-difficulty-swallowing [https://perma.cc
/6DZW-ZE8A] (last updated Mar. 24, 2020).
482
See Equity SC Products Recommendations Summary (11/17/2021), OR. HEALTH AUTH.,
https://www.oregon.gov/oha/PH/PREVENTIONWELLNESS/Documents/Equity%20Produ
ct%20Rec%20Summary%2011.17.xlsx [https://perma.cc/6QZD-B5KT] (last visited Feb. 10,
2023).
2023] MICRODOSING PSYCHEDELICS 639

the digestive tract).483 This limitation could leave some potential clients with no
options for participating in the state’s psilocybin services program.
During the implementation of Oregon’s Measure 109, there has been some
debate regarding whether microdosing is permitted under the statute. To avoid
unnecessary confusion in the future, the drafters of future legislation could
implement language stating that microdosing cannot be prohibited and must be
regulated by administrative rules when drafting psychedelics legislation.
Moreover, when legislation creates advisory boards, task forces, or working
groups to evaluate potential legislation or administrative rules, it should put the
safe and equitable implementation of microdosing within the scope of the body’s
mandate.
Finally, to promote public safety, supported adult-use jurisdictions should
fund education and training on microdosing safety for a variety of stakeholders
including healthcare providers, first responders, and the public. They should
include a legislative provision protecting employees from employer retaliation,
as well as whistleblower protections and affirmative duties that encourage
facilitators and employees of psychedelic manufacturers and service centers to
report misconduct. As stated previously, the proposed Washington State
Psilocybin Wellness and Social Opportunity Act contains provisions to protect
employees.484 Regarding whistleblower protections and affirmative duties to
report, the licensing subcommittee of the Oregon Board recommended such
measures in a facilitator code of ethics that it approved in early 2022.485 The
OHA largely incorporated those recommendations into its final rules.486

C. Retail Models
In the Netherlands, people can microdose at home because the Dutch smart
shop model effectively functions like the U.S. cannabis dispensary model.487 In
smart shops, customers can purchase products that are designed for microdosing
and consume them without supervision.488 This approach differs from supported
adult-use models created by Measure 109 in Oregon, and proposed legislation
in other states, which requires licensed facilitators to administer psychedelics to
clients.489 However, like supported adult-use frameworks, retail models have the
benefit of creating a safe and legal supply of microdoses that can be tested for

483
See OR. ADMIN. R. 333-333-2120; Oregon Psilocybin Services—Public Listening
Sessions, supra note 370.
484
Wash. S. 5660.
485
See ETHICAL PRINCIPLES/CODE OF CONDUCT FOR PSILOCYBIN FACILITATORS (2022),
https://www.oregon.gov/oha/PH/PREVENTIONWELLNESS/Documents/Ethical%20Princi
ples-Code%20of%20Conduct%20for%20Jan%206%20Meeting%201-2-2022.pdf
[https://perma.cc/9MFG-DGMD].
486
See OR. ADMIN. R. 333-333-4700, -4810, -5120.
487
Psilocybin Online Retail Platform, supra note 466.
488
See id.
489
See supra Section I.B.
640 BOSTON UNIVERSITY LAW REVIEW [Vol. 103:573

adulterants and contaminants.490 They would also bring microdosing out of the
shadows, making people more likely to report misconduct or harmful
psychedelic products.491
Under retail models, consumer education is key to promoting safe and
enjoyable microdosing experiences. Legislation and rules might require sales
staff to educate consumers on microdosing safety and common protocols. They
could provide consumers with pamphlets containing additional information,
which is common practice in Dutch smart shops. However, these materials are
often written and created by the companies that produce the products.492 In a
state retail model, an agency or working group could produce educational
materials that are provided to consumers at the point of sale.

D. Medical Frameworks
When the FDA approves psychedelics like psilocybin for treating certain
medical conditions, such as treatment-resistant depression, the agency will
undoubtedly implement REMS that mandate how the substances can be
administered, who can administer them, and where they can be administered.
These restrictions could significantly impede the off-label use of microdosing as
a treatment option. In addition to encouraging people to shift to illicitly sourced
microdosing products, which has associated risks, overly restrictive REMS
could impede the accumulation of research data that could be gained through
off-label prescribing. Low dose off-label prescribing is common with other
medications, and it should be allowed for psychedelics. Accordingly, the FDA
should only adopt evidence-based REMS that are sensitive to the needs of
affected communities and drafted in consultation with them. In 2021, in response
to widespread criticism, the FDA relaxed REMS implemented for mifepristone,
a drug that has been used safely to end pregnancies and treat early
miscarriages.493 Because poorly crafted REMS can be burdensome and
negatively impact the quality and availability of medical care, it is important to
get them right the first time.494
In addition to crafting only evidence-based REMS with input from regulated
communities, jurisdictions that create medical frameworks for psychedelics
should fund research on microdosing to advance our scientific understanding of
the practice.

490
See supra Section IV.B.
491
See supra Section IV.A.
492
Psilocybin Online Retail Platform, supra note 466.
493
See Steve Inskeep & Sarah McCammon, The FDA Relaxes Controversial Restrictions
on Access to Abortion Pill by Mail, NPR (Dec. 17, 2021, 5:07 AM),
https://www.npr.org/2021/12/17/1065083161/the-fda-relaxes-controversial-restrictions-on-
access-to-abortion-pill-by-mail [https://perma.cc/W4KV-DCSB]; see also Julia Kaye, Rachel
Reeves & Lorie Chaiten, The Mifepristone REMS: A Needless and Unlawful Barrier to Care,
104 CONTRACEPTION 12, 12 (2021).
494
See Kaye et al., supra note 493, at 13-14.
2023] MICRODOSING PSYCHEDELICS 641

CONCLUSION
Microdosing is a growing trend in which people consume low doses of
psychedelic substances once or twice per week to boost cognitive performance,
enhance mood, or decrease symptoms of depression, anxiety, or pain. However,
as more cities and states decriminalize or legalize psychedelics, their statutes,
ordinances, and resolutions do not address microdosing, which may incentivize
people to microdose using illicit products of unknown origin and purity. To
promote safety and equitable access to microdosing, jurisdictions should address
the practice in their legal reforms.
Cities and states that pursue a decriminalization approach to psychedelics
regulation should ensure that people have a legal means of obtaining safe
supplies of the substances for microdosing. This goal can be achieved by
educating the public, decriminalizing microdose production and sharing, and
implementing drug-checking sites to test substances for identity and purity.
Jurisdictions that create supported adult-use frameworks should draft legislation
and rules that allow for safe and equitable microdosing. They should avoid
setting minimum doses, requiring waiting periods between administration
sessions, and mandating minimum durations for those sessions. Moreover,
supported adult-use jurisdictions should integrate microdosing into facilitator
training programs and allow for products and services that make microdosing
accessible for people with disabilities. To reduce costs, they should support
models that reduce the costs of microdosing such as nonprofit and cooperative
business structures and group microdosing services. Successful implementation
of these measures should be within the statutory mandate of state agencies,
advisory boards, and working groups. Jurisdictions that create retail models
could require sales staff to be trained on microdosing protocols and to provide
additional sources of information to consumers. Finally, jurisdictions that create
medical frameworks should invest in microdosing research, implement only
evidence-based REMS, and consult regulated communities when drafting
REMS. In all cases, microdosing education is paramount. Moreover, to promote
public safety, all jurisdictions should create safeguards for employees and
facilitators who report misconduct or dangerous products and services.