Two signatures, 48 hours apart, just changed how psychedelic medicine arrives in America.

On April 18, President Donald Trump signed an executive order accelerating federal review of psychedelic drugs for serious mental illness. Within days, the FDA awarded three commissioner’s national priority vouchers — to Compass Pathways for psilocybin-assisted therapy in treatment-resistant depression, Usona Institute for psilocybin in major depressive disorder, and Otsuka for methylone (a relative of MDMA) in PTSD. These vouchers may compress what is typically a 10-to-12-month FDA review down to as little as one or two months.

On April 20, with far less fanfare, Governor Jared Polis signed Colorado’s  Senate Bill 26-31. The bill specifies that the moment the DEA reschedules an FDA-approved Schedule I drug, Colorado’s law follows automatically. Pharmaceutical psilocybin will be legal to dispense in Colorado the instant federal approval lands.

I’m hopeful about this. Patients with treatment-resistant depression have been waiting a long time. So have veterans with PTSD. So have practitioners who have spent years preparing to do this work with care.

I am also worried. Not about what’s coming, but about what we might accidentally let go of in the rush to receive it.

SB-31 explicitly carves out natural medicine and marijuana, leaving Colorado’s  Proposition 122 framework — the voter-approved natural medicine program with its facilitator-led healing centers — entirely intact. That carve-out matters more than it appears. Most states pursuing psychedelic policy are picking a single lane, choosing between a medical, prescription-based pathway and a community-based, facilitator-led one, as though the two were incompatible. Colorado is choosing both.

This is rarer than people realize, and it is more honest about how healing actually works.

The pharmaceutical pathway and the natural medicine pathway are not competing rivers. They are tributaries of the same watershed. Different people need different doors. A patient with treatment-resistant depression whose insurance will eventually cover psilocybin-assisted therapy needs one door. Someone seeking to grieve a loss in community, or to find their way back to themselves through ceremony, needs another. Both are legitimate. The question Colorado now faces is not which path wins, but whether we can hold both with integrity as the federal pace quickens.

Here is what I worry the temptation will be: Now that medicalized access is coming, perhaps some will think that the work of expanding community access is done. The healing centers, the facilitator licensing, the careful and slow work of Prop 122 implementation — all of it can be de-prioritized, the thinking goes, because patients will soon be able to get psilocybin from a doctor and a pharmacy.

This would be a profound mistake. Medicalized access and community access serve different needs, draw on different lineages of knowledge, and answer different kinds of suffering. Collapsing the two is misunderstanding what these medicines are asking of us. The work of reform and opening up access is not done. Colorado voters chose a wider path with Prop 122.

So here is what I would ask in this particular moment.

To Colorado legislators and regulators: Keep faith with the voters. The careful work of Prop 122 implementation — facilitator licensing, healing center regulation, training standards, equitable access, and the ongoing rulemaking around whether and how ibogaine will be incorporated — is exactly the work that makes a wider path real. Fund it. Staff it. Defend it from the gravitational pull of a federal model that will, by virtue of its pace and resources, threaten to absorb everything in its orbit.

To my colleagues who will soon be prescribing or administering these medicines: Please, let us not treat psilocybin-assisted therapy as the next SSRI. A one-to-two-month FDA review does not give practitioners one-to-two months to become ready. Genuine readiness to hold non-ordinary states of consciousness with skill, to attend to set and setting, to support the integration that follows, takes far longer than the regulatory clock. Get trained well, and get trained before you prescribe, not after.

To Coloradans: The next year of natural medicine rulemaking will shape what Prop 122 actually delivers in your community. Public input matters here. Show up for it.

To other states watching Colorado: A wider path is possible. The federal acceleration does not require abandoning community-based access. It makes protecting it more urgent, not less.

The medicines are coming, faster than we expected. The question is whether we will meet them with the depth and care this moment asks of us, and whether we will keep faith with the wider path Coloradans already chose.

We can hold both. But only if we choose to.