Before the executive order said a word, the room told the story. When President Donald Trump signed his psychedelics order on April 18, 2026, the public-facing coalition around him was made up of media power, veterans’ advocacy, Texas politics, federal health officials, and pharmaceutical regulation. Joe Rogan stood near the president. Marcus Luttrell, whose memoir became the Hollywood film Lone Survivor, and his twin brother Morgan Luttrell, now a Republican congressman, were there. Bryan Hubbard of Americans for Ibogaine was there. So were FDA Commissioner Marty Makary, NIH Director Jay Bhattacharya, and HHS Secretary Robert F. Kennedy Jr.
No Indigenous leaders were in the room. No religious practitioners. No representatives of the communities most harmed by the War on Drugs. No advocates for the cognitive liberty traditions that made this moment politically possible. That absence is what stayed with me most.
“No Indigenous leaders were in the room. No religious practitioners. No representatives of the communities most harmed by the War on Drugs. No advocates for the cognitive liberty traditions that made this moment politically possible. That absence is what stayed with me most.“
Three Pathways, One Chosen
Harvard Law School’s I. Glenn Cohen has argued that psychedelic policy in the United States is shaped by competition between three pathways. The first is the FDA pathway: medicalization through clinical research, pharmaceutical approval, and prescription access. The second is the religious freedom pathway, which has allowed organizations like the Native American Church, Santo Daime, and União do Vegetal to maintain ceremonial practice. The third is what Cohen calls the residual pathway: everyone seeking psychedelics for cognitive liberty, spiritual exploration, harm reduction, or community ceremony outside formal religion (Cohen & Marks, 2026).
Trump’s executive order is a definitive choice for pathway one, and a refusal to engage with the other two.
Six days after the signing, the FDA announced priority vouchers for three psychedelic programs. Compass Pathways received one for its lab-made version of psilocybin, the active compound in psychedelic mushrooms. Usona received one for a similar synthetic psilocybin. Transcend Therapeutics received one for methylone, a fully synthetic compound chemically related to MDMA (Reuters, 2026). All three are patentable synthetic compounds. Psilocybin mushrooms, the natural source of the molecule that two of these vouchers target, remain federally criminalized. The executive order does nothing to change that.
Cohen put it plainly: there was no discussion at all of the religious use of psychedelic drugs (Cohen & Marks, 2026). The omission is telling.
The Texas Pipeline
This was not a policy that emerged from the federal psychedelic research community, the Indigenous policy networks, or the harm reduction field. It emerged from a coordinated political project anchored in Texas.
In 2025, the Texas legislature passed Senate Bill 2308, putting fifty million dollars in state money toward ibogaine clinical trials and requiring a matching fifty million from a private drug developer. Governor Greg Abbott signed it into law in June. When no drug company stepped up to provide the match, Texas backfilled it with public funds. The architects of the bill were Rick Perry, Trump’s first-term Energy Secretary, and Bryan Hubbard, CEO of Americans for Ibogaine. Perry and Hubbard appeared on The Joe Rogan Experience on April 1, 2026, to make the case for federal action. Seventeen days later, Trump signed the executive order. Rogan was there, recounting the text exchange with Trump that initiated it (Berghaus, 2026).
This is what an industry takeover looks like in real time: political access, public funding, and private companies beginning to organize around the same FDA pathway.
“This is what an industry takeover looks like in real time: political access, public funding, and private companies beginning to organize around the same FDA pathway.“
Who Gets Healed, and for What?
The order is unambiguous about its priority population. Veterans are named explicitly. The political coalition behind the order has consistently framed psychedelic medicine as a solution to the veteran suicide crisis (The White House, 2026). At the signing, Marcus Luttrell told the President the order was going to “save a lot of lives” (PBS NewsHour, 2026).
I want to take this argument seriously before I challenge it. The veteran suicide crisis is real. The trauma is real. The need for effective treatment is real. As the son of a Marine veteran, I know this is not an abstract policy debate. I want people who are suffering to get help. I also want us to ask what kind of help we are building, who controls it, and who gets left outside.
But there is a question the medicalization frame refuses to ask: what kind of trauma, exactly, are we treating?
The clinical literature increasingly distinguishes between post-traumatic stress disorder and moral injury—the psychological wound that follows from acts that violate one’s own moral code (Litz et al., 2009). Civilian PTSD typically follows from being subjected to violence: assault, accident, abuse. Combat veterans often carry that, too. But many also carry the wound of having inflicted violence—of having killed people whose names they did not know, in wars whose justifications, goals, and consequences remain deeply contested.
This is not a condemnation of individual service members. Many are drawn from working-class communities for whom military service is one of the few accessible paths to health care, education, and economic stability. The structural coercion that channels them into uniform is itself a form of violence.
But the medicalization frame turns moral injury into PTSD, turns PTSD into a treatable individual pathology, and treats the pathology so that the underlying system can continue undisturbed. The wars that produce the trauma do not end. The economic conditions that funnel poor and working-class young people into combat do not change. We just get better at treating the damage while leaving the machine intact.
A liberation-psychology lens (Watkins & Shulman, 2008) would ask different questions. It would ask why the trauma exists. It would ask whether treating individual symptoms while leaving the trauma-producing systems intact is healing or maintenance. It would ask who benefits from a healed soldier and what that healed soldier is being healed for. The executive order asks none of these questions. It funds the answers it wants.
Who Gets to Heal
If the medicalization pathway determines who is healed, it also determines who does the healing. The picture is starker than the field has been willing to admit.
The clinical and commercial psychedelic field has been repeatedly criticized as white-dominant in its research frameworks, training pipelines, and professional networks. Major companies and institutions may now use diversity language, but the underlying capital structure and professional pipeline remain shaped by racialized access to money, credentials, and institutional power (George et al., 2020).
Diversity training is not the answer. We can have all the cultural competency training in the world, but if the leadership, the clinical workforce, and the trial participants are overwhelmingly white, the pathway will continue to produce white-centered care. Even if we successfully recruited and retained more BIPOC therapists, those therapists would be trained in models—manualized protocols, Western diagnostic categories, and insurance systems that only recognize healing when it fits a billable diagnosis—that were developed within and for a white-dominant medical framework (George et al., 2020).
The retreat economy mirrors the clinical economy. Whether the medicine is psilocybin in Jamaica, ayahuasca in Costa Rica, or 5-MeO-DMT in Mexico, the facilitator teams are typically white, the participants are typically white, and the ceremonial frameworks are typically reconstructions of Indigenous practice without the Indigenous practitioners. Both extract from Indigenous lineages without integrating Indigenous people, knowledge stewardship, or compensation.
Discover the Indigenous Reciprocity Initiative of the Americas
The Alternative We Are Not Funding
There is another pathway, and it is the one we should be defending.
The decriminalization and cognitive liberty pathway treats psychedelic access as a matter of fundamental rights rather than medical necessity. It does not require a diagnosis. It does not require a prescription. It does not require a corporate manufacturer to control supply. It permits religious and ceremonial use. It permits Indigenous communities to exercise sovereignty over the plant medicines that originated with them. It permits adults to make informed decisions about their own consciousness without seeking permission from a federal agency.
This pathway is not opposed to medical research. We can have rigorous clinical trials and decriminalized community access at the same time. But the executive order treats them as if they were opposed. By pouring federal resources into the medicalization pathway alone, the order makes an implicit claim: that legitimate access to psychedelics is access mediated by the FDA, the DEA, and the pharmaceutical industry. Everything outside that channel is, by omission, illegitimate.
That premise is not neutral. It is the same premise that produced the War on Drugs, mass incarceration, and the racially disparate enforcement that has destroyed entire communities (Herzberg & Butler, 2019). The executive order does not break from that premise. It refines it. It permits a small, profitable window of access for those whose suffering can be matched to a billable diagnosis and an FDA-approved compound. The rest of us, and the rest of the relationships humans have always had with these plants, remain outside the law.
What Now?
If we believe in a psychedelic renaissance that serves more than the next quarter’s clinical trial enrollment, we have to act on that belief.
Defend religious-use protections. Support the Native American Church, Santo Daime, União do Vegetal, and emerging psilocybin-using churches in their ongoing legal work.
Practice reciprocity with Indigenous communities. Center Indigenous voices in research design, publication, and policy. Ensure that the financial benefits of commercialized plant medicines flow back to the communities whose knowledge made those medicines available to the rest of the world.
“If we believe in a psychedelic renaissance that serves more than the next quarter’s clinical trial enrollment, we have to act on that belief.“
Build structural support for BIPOC practitioners. Scholarships are necessary but not sufficient. We need paid training, mentorship pipelines, and paradigm reform that move beyond cultural competency training toward genuine structural change.
Push for decriminalization, not only legalization. Legalization, as the executive order makes clear, is a process of state and corporate takeover. Decriminalization is a process of returning sovereignty to individuals and communities.
And refuse the premise that consciousness requires a permission slip. The window the executive order has opened will be wide enough only for the pharmaceutical industry to walk through. The rest of us will remain outside, still waiting for the federal government to tell us when we are allowed to encounter our own minds.
The executive order chose its side. The question now is which side we will choose, and what we are willing to do to make that choice real.
References
Berghaus, R. (2026, April 24). Trump’s psychedelics executive order and how Texas inspired (and may benefit from) it. The Microdose. https://themicrodose.substack.com/p/trumps-psychedelics-executive-order
Cohen, I. G., & Marks, M. (2026, April 18). A new executive order on psychedelics: Q&A with I. Glenn Cohen and Mason Marks (S. Baruch, Interviewer). Petrie-Flom Center, Harvard Law School. https://petrieflom.law.harvard.edu/2026/04/18/a-new-executive-order-on-psychedelics-q-a-with-i-glenn-cohen-and-mason-marks/
George, J. R., Michaels, T. I., Sevelius, J., & Williams, M. T. (2020). The psychedelic renaissance and the limitations of a white-dominant medical framework: A call for Indigenous and ethnic minority inclusion. Journal of Psychedelic Studies, 4(1), 4–15. https://doi.org/10.1556/2054.2019.015
Herzberg, G., & Butler, J. (2019, March 13). Blinded by the White: Addressing power and privilege in psychedelic medicine. Chacruna. https://chacruna.net/blinded-by-the-white-addressing-power-and-privilege-in-psychedelic-medicine/
Litz, B. T., Stein, N., Delaney, E., Lebowitz, L., Nash, W. P., Silva, C., & Maguen, S. (2009). Moral injury and moral repair in war veterans: A preliminary model and intervention strategy. Clinical Psychology Review, 29(8), 695–706. https://doi.org/10.1016/j.cpr.2009.07.003
PBS NewsHour. (2026, April 18). Trump signs order to hasten review of psychedelics. https://www.pbs.org/newshour/politics/trump-signs-order-to-speed-review-of-psychedelics
Reuters. (2026, April 24). US FDA moves to fast-track psychedelic drugs after Trump order. https://www.reuters.com/business/healthcare-pharmaceuticals/us-fda-moves-fast-track-psychedelic-drugs-after-trump-order-2026-04-24/
The White House. (2026, April 18). Accelerating medical treatments for serious mental illness [Executive order]. https://www.whitehouse.gov/presidential-actions/2026/04/accelerating-medical-treatments-for-serious-mental-illness/
Watkins, M., & Shulman, H. (2008). Toward psychologies of liberation. Palgrave Macmillan.
Art by Michelle Velasco.
