On Saturday, April 18, 2026, President Donald Trump signed an executive order (“Order”) which he proclaimed would “dramatically accelerate access to new medical research and treatments based on psychedelic drugs.” Joe Rogan was there for some reason; Trump joked about trying ibogaine, too.
Trump also took the opportunity to complain that his other executive order on controlled substances—marijuana—seems to have stalled. Still, this new one could be helpful. And interesting.
Right to Try versus Expanded Access
The Order directs DEA to establish a pathway under the federal Right to Try Act (RTTA) for psychedelics. RTTA is a federal law that creates a uniform system for terminal patients to gain access to investigational treatments. The Order could be seen as a response to a recent 9th Circuit ruling, where DEA prevailed against a doctor seeking to prescribe psilocybin under RTTA.
Interestingly, the Order doesn’t mention FDA’s Expanded Access program, which is another potential path for patients with life-threatening diseases or conditions. That program was designed for patients to gain access to investigational medical products, including controlled substances—but only if those products are “the object of an [FDA] investigation.”
In the psychedelics context, as in general, the Expanded Access program is more limited than RTTA. This is because various controlled psychedelics, such as ibogaine, are not currently under FDA review. As such, it’s fair to say that the Order prioritizes an approach that is less solicitous of FDA, and less protective of patients. This brings me to my next point.
Focus on ibogaine
Ibogaine is the only psychedelic specifically mentioned in the Order, and it’s called out twice. Many commentators, like our friend Mason Marks, quickly pointed out that “of all the psychedelics, ibogaine is the one that has arguably not met ‘basic safety requirements’ for eligibility under the federal Right to Try Act.” Marks explains that FDA has resisted ibogaine research, partly because of concerns about heart-related risk. Thus, most ibogaine research has been conducted abroad.
On the other hand, states and Veterans’ groups (and Joe Rogan) have shown interest in ibogaine. Texas enacted a law last summer that requires publicly-funded research on ibogaine as a possible treatment for opioid use disorder, depression and PTSD. The state will allocate $100 million toward that project, after starting with $50 million and failing to find an institutional partner to pony up the other half.
Matching state funds, for research?
The Order requires HHS to allocate “at least $50 million” in order to “support and partner with State governments…. to advance psychedelic drugs for serious mental illness.” This section of the Order mentions “technical assistance” and “data sharing” but not direct research. Still, this provision likely relates to the Texas law mentioned above. The Order is telling states that if they pony up funds for this research, they won’t be left hanging—the feds are here with financial and logistical support.
“Timely rescheduling”
The Order contains a short section that requires the Attorney General and HHS to “initiate and complete review of any product containing a Schedule I substance that has successfully completed Phase 3 clinical trials…”. Following Lykos Therapeutics’ MDMA failure, the only company I’m aware of with successful Phase 3 trials for a psychedelic drug is Compass Pathways. Before the Order, Compass had targeted late 2026 to be launch ready for its COMP360 psilocybin formulation, which targets treatment-resistant depression. Yesterday, in the first day of trading following the Order, its stock rose over 42%.
Nothing on religious use
The Order does not mention religious use pathways, which is interesting, because they exist. The Church of Gaia in Spokane, Washington, for example, became the first church to receive official federal approval from DEA to possess and use ayahuasca as a sacrament last year. In 2024, the Church of the Eagle and the Condor reached a settlement with various federal agencies, allowing it to import ayahuasca in either paste or liquid form.
The Order could have addressed religious use; it’s somewhat surprising that it didn’t given the administration’s focus on religious liberty. On the other hand, the Order seems concerned mostly with public health—specifically dying people and veterans. Regardless, the Order leaves the religious use pathway to play out at the agency level and in the courts.
Conclusion
The spirit of the Order is important. Its purpose and policy is to “save lives and reverse the crises of serious mental illness in America.” Whether the Order succeeds is an open question. Federal agencies across the spectrum, including DEA, HHS/FDA and the VA, will need to rally behind the Order. Practically speaking, they will need to coordinate to move policy along in the absence of any further action by President Trump or Congress. Here’s hoping.
