As a board-certified emergency medicine physician and former paramedic, I see the mental health crisis up close every day. It goes far beyond statistics and headlines. These are real patients in my emergency room, often waiting hours or days for an inpatient psychiatric bed to become available. For children, those waits can stretch into weeks.
The ER is a terrible environment for someone experiencing a mental health crisis, with harsh light and loud noises. Yet, the breakdown doesn’t end at the emergency room door.
One might expect that once a patient finally gets to a psychiatric hospital, they will receive meaningful care, but that’s rarely the case. Most patients are started on antidepressant medications known as SSRIs or SNRIs, drugs that take months to take effect, yet most will be discharged home in three to four days. Not surprisingly, up to 28% of these patients end up back in the emergency department within a month, only to start the same cycle again.
Americans deserve better options.
That’s why President Trump’s April 18th executive order on psychedelics stands out. It’s not a panacea, but it does open the door for patients who feel they’ve run out of options. It also follows through on commitments he made, including in conversations with Joe Rogan, who has helped bring more attention to these therapies.
PTSD isn’t just a diagnosis on a chart. It can mean constant anxiety, flashbacks, and isolation. And for many patients, especially those dealing with severe depression, they’ve already tried what’s out there, and it hasn’t worked. That’s usually when the frustration really sets in.
Four generations of antidepressants, representing over 30 prescription medications, have been approved by the FDA in the last 70 years. Yet all are based on a 1965 theory of depression that has been questioned since the 1970s and was debunked in 2022. Newer hypotheses have gained increased traction, and medications are being developed to address these potential causes. However, most of these medications are not new, they are repurposed anesthetics, drugs of abuse, or plant medicines.
Part of what makes this moment different is that this isn’t just theoretical. Psychedelic medications derived from natural compounds, such as plants, are already being used to treat depression. In places like Oregon, Colorado, and New Mexico, psychedelic treatment is happening in licensed and regulated settings. In other places, from Peru to Mexico to Costa Rica, it’s taking shape without that structure.
That gap between real-world use and policy has been there for years, yet this is the first serious effort to address it. The order pushes agencies to move faster where they can. It calls for clearer pathways so eligible patients can access treatment and better coordination across agencies, which hasn’t always been present.
A major concern has been timing. Even when everything goes right, traditional clinical trials can take seven to ten years before something becomes widely available. For patients who are struggling now, that’s a long time to wait. Sometimes it’s too long.
There are signs that people inside the system understand that. At HHS, Robert F. Kennedy Jr. has been direct about the need to rethink how we approach mental health. And at the FDA, voices like Dr. Marty Makary have been pushing for a system that doesn’t get bogged down in its own processes while patients wait on the other end.
The research is hard to ignore. Studies on psilocybin, the primary active compound in “magic mushrooms,” have shown large antidepressant effects and even remission for patients with major depressive disorder (MDD). Recent early-stage research on ibogaine (iboga) has shown a promising ability to reduce heroin and opioid cravings.
Part of the challenge is that the science doesn’t always fit neatly into the system we’ve built. In medicine, isolating a single compound is usually the goal. But when it comes to brain chemistry, we’ve still got a lot to learn. In many cases, multiple active ingredients work synergistically, making some whole or minimally processed nature-based treatments beneficial, even if they don’t fit cleanly into our medical model.
This doesn’t mean that natural products are inherently safe, some of the deadliest poisons, like oleander and ricin, come from plants. We must be honest about the risks, including cardiac toxicity and accidental injury. And like other medications, these substances can be misused. There are legitimate concerns about abuse and dependence, particularly when used outside of supervision or in daily “micro-dosing.” But that shouldn’t overshadow the fact that many patients don’t have good options today, and some of these therapies show real promise when used properly.
To be clear, this isn’t about broad legalization. It shouldn’t be. This is about safe, supervised treatment for people with serious conditions who don’t have other good options.
It’s also worth emphasizing that this isn’t a fringe issue. Americans, including military veterans, travel within the US and overseas to access these treatments, often through underground channels. The use is already widespread. Ignoring it doesn’t make it disappear, it simply pushes patients toward treatment that is often more dangerous and more expensive.
Signing an order is just the beginning. There’s still a long road ahead. Access will be limited at first, and there are real questions around safety, training, and cost that need to be worked through.
There hasn’t been much movement in this space for a long time. If this is handled the right way, that could start to change.
If marijuana, a recreational drug, can be reclassified from Schedule 1 to Schedule 3, why can we not do the same with plant-based psychedelics?
Mental health challenges affect more lives than most people realize. We owe it to those who are struggling to keep pushing for solutions grounded in science and actually make a difference. This order is a start, now we need to take the rest of the steps forward.
Dr. Jared Ross is a board-certified emergency medicine physician. Before medical school, Jared was a firefighter, paramedic, and SWAT team member. He is actively involved in EMS as the medical director for several agencies and maintains his paramedic license. Dr. Ross also practices addiction medicine and alternative psychiatry. He is a frequent contributor and guest for print and broadcast media, commenting on a wide range of medical topics and healthcare policy. He can be reached at DrJaredRoss.com and on X @DrJaredRoss
