With “psychedelics” headlining articles left and right, and “harm reduction” turning into a household name, this year is bound to be a revolutionary time for advancements and policy changes in the drug space. Even the U.S. government is jumping on board, with a budget of $509.4 million specifically dedicated to harm reduction efforts—up 26% from last year. 

We’ve compiled a list of our predictions and speculations for this upcoming year, with high hopes for the changes yet to come.

We’ve been tracking MAPS’ progress on bringing MDMA to the main stage, and it seems like this year could be the time for federal recognition and widespread accessibility of MDMA as a therapeutic tool. Time Magazine reported that “Rick Doblin, MAPS’ founder and executive director, says his group is preparing to apply for FDA approval based on [the results of both phase 3 trials of MDMA as a treatment for PTSD]. If all goes well, he says, the drug could be approved as soon as 2024.”

Fentanyl test strips are currently legal in 41 states, and as harm reduction becomes more widely understood, state governments are recognizing the necessity of test strips in reducing overdose. There are 27 states where all drug checking equipment (DCE) is legal, and 14 additional states where the possession of fentanyl testing equipment is clearly legal. 

The Network for Public Health Law, which reported these numbers, clarified further, explaining, “We emphasize that the fact that a state has not clearly legalized the possession or distribution of drug checking equipment does not necessarily mean that those activities are illegal. Indeed, many states in which drug checking equipment is not clearly legal distribute it via health departments and other entities.” This apparent discrepancy further suggests a near-future change in the legal status of these tools.

Along with MAPS’ studies of MDMA as a viable treatment option for PTSD, they are also examining psilocybin as a treatment option for the same disorder. In late 2022, the New England Journal of Medicine also published a promising phase-two trial on how psilocybin could be utilized for treatment-resistant depression. That same year, a U.S. Department of Health and Human Services official even stated that FDA approval of MDMA and psilocybin was “anticipated” within “approximately 24 months.”

Similarly, psilocybin legalizations may be expected this upcoming year. Following the legalization in Oregon and Colorado, other states are beginning to adopt promising legislation to follow suit.

In the U.S. government’s 2024 National Drug Control Strategy and Budget Summary, it describes the intention to expand the accessibility of naloxone. The summary states the government will “deliver more life-saving naloxone to communities hit hard by fentanyl. By expanding use of Federal funds to purchase naloxone, releasing guidance to make it easier for programs to obtain and distribute naloxone to at-risk populations, and prioritizing the review of over-the-counter naloxone applications, the Administration is taking new steps to encourage and aid states in their efforts to use existing funding to purchase naloxone and distribute it in their communities.”

A wider accessibility of this opioid-reversal drug might also mean the lowering of over-the-counter prices, so that anyone could walk into a pharmacy and purchase naloxone to have on hand, regardless of financial limitations.

Though it certainly feels like cannabis is legal nationwide (and enforcement seems to echo this sentiment) the actual legislature hasn’t quite caught up.

Currently, according to DISA Global Solutions, cannabis is fully legal in the District of Columbia and 24 states, decriminalized in 32 states, legal for medicinal use in 38 states.

With the potential legalizations of psilocybin, and the increased acceptance of drugs like MDMA, LSD, and ayahuasca in the therapeutic space, cannabis will only continue to become normalized.

Syringe Service Programs (SSPs) have received a fair amount of public backlash in the past. But with a better understanding of just how valuable this resource is in reducing overdose, and in leading drug users to recovery, SSPs are becoming more widely accepted. The Syringe Services Programs: Summary of State Laws reports that “Although only 38 states, the District of Columbia, and Puerto Rico either explicitly or implicitly authorize SSPs through statute, regulation, or executive order, as of July 2023, there are at least 534 operational SSPs located in 45 states, the District of Columbia, and Puerto Rico.” With harm reduction education on the rise, it is likely that even more of these resources will become available nationwide.

Deep Dive Resources

1. Psychedelics May Be Part of U.S. Medicine Sooner Than You Think
2. Single-Dose Psilocybin for a Treatment-Resistant Episode of Major Depression
3. NATIONAL DRUG CONTROL STRATEGY FY2024 BUDGET SUMMARY
4. Legality of Drug Checking Equipment in the United States as of August 2023
5. Syringe Services Programs: Summary of State Laws