Occasionally, you look up and realize something didn’t just progress. It shifted.
That’s what happened over the past week.
Two separate federal actions – one focused on psychedelics and the other on cannabis – may seem unrelated at first glance. Different substances. Different histories. Different levels of acceptance. But when you step back and look at them together, they tell a much bigger story.
The landscape around “alternative” treatments for mental health isn’t just evolving anymore. It’s accelerating. Today is what I’ve been discussing as a possibility since 2014.
My RxProfessor journey started by addressing work comp’s over-prescribing of opioids in 2003. As use declined, the next logical question was what would replace them for patients with real issues. NSAID’s were the conservative answer, but I didn’t stop there. The emergence of CBT and a biopsychosocial treatment model became a focus of mine in 2010. The 2014 Vialpando decision in New Mexico affirming medical use of cannabis for an injured worker piqued my interest. In 2019, I took on an advisory role with a company that offered virtual reality and through that became a fan of neuroplasticity. A conversation with a medical director in 2022 opened my eyes to the increasing use of psychedelics (specifically psilocybin) for PTSD.
My initial question of “what will replace opioids” became a quest to stay on top of the various options.
I did not address any of them from a perspective of advocacy, but from a place of awareness. Whether you agree with these therapies or not is almost beside the point. What matters is that they are moving – scientifically, culturally, federally – toward broader acceptance. When that happens, workers’ compensation doesn’t get to sit on the sidelines.
We must be ready. As you may know, the first step in risk management is identification.
President Trump issued an Executive Order on April 18 regarding psychedelics. It was interesting to see Joe Rogan and military veterans at the press conference who have advocated for ibogaine to treat mental illness and PTSD. This EO is a clear signal that the federal government is prioritizing the development and accessibility of new treatments for serious mental illness. This includes the potential of rescheduling after expanded clinical trials. That’s not fringe anymore. That’s policy.
While psychedelics may still feel like a future conversation for many in our industry, the reality is that the groundwork is being laid right now. Dollars are being budgeted. Clinical research is expanding. Regulatory pathways are being explored. And most importantly, the narrative is changing from skepticism to structured exploration. If you think about it clearly, the use of psychedelics in the Veterans Administration is workers’ compensation.
Today (April 23), President Trump made official what has been pondered for many years … moving cannabis from Schedule I to Schedule III. This was the next logical step after a December 2025 EO that expanded research. The DEA has already announced a June 29 hearing to define the pathway. The FDA, DEA, and NIDA decided in 2016 to not make that adjustment, which I wrote about in “Marijuana science still half-baked (?).” While this isn’t officially a legalization of cannabis, these changes make it more normalized, accessible, and embedded in conversations about care.
And that’s where this becomes very real for workers’ compensation. I’ve argued for 20+ years that we do not operate in a vacuum. We operate in a system where injured workers are influenced by what their doctors recommend, what their communities accept, and what the broader healthcare system begins to adopt. As alternative treatments, whether psychedelics or cannabis, continue to gain legitimacy, they will eventually show up in our claims. Spoiler alert … cannabis has intersected with work comp since 2014, at times very publicly but also (and I know from private conversations) more broadly outside the spotlight.
The question is not if. It is when, and how prepared we are when they do.
One of the consistent challenges in our industry is that we tend to react to change rather than anticipate it. We wait until something becomes an issue before we build a strategy around it. This is one of those moments when the signals are strong enough – and early enough – that we don’t have to be caught off guard.
So, what does that look like in practice?
It starts with education. Understanding what these treatments are, what the research says (not just headlines), and where they may or may not be appropriate. It continues with policy awareness which includes tracking how federal direction influences state statutes, regulatory frameworks, and payer / employer obligations. It also requires open dialogue with providers, employers, and other stakeholders about how these therapies might intersect with return-to-work, safety, and overall claim management. And it requires creating policies around how their “reasonable and necessary” use for injured workers will be addressed.
It also requires something that may be even more important: perspective.
At the center of all of this is the injured worker. Many of them are dealing with chronic pain, trauma, sleep deprivation, depression, anxiety … often all at once. If new treatment options emerge that have the potential to improve outcomes, we must at least be willing to understand them, even if we’re not ready to fully embrace them.
That doesn’t mean abandoning evidence-based care. It doesn’t mean ignoring risk. And it certainly doesn’t mean opening the floodgates without structure or oversight. For example, the FDA Commissioner Dr. Marty Makary specifically mentioned that clinical oversight of psychedelics is a requirement. This is not a return to Timothy Leary or Cheech & Chong.
But it does mean acknowledging that the definition of “acceptable treatment” is changing. It’s changing faster than it has in a long time. And you may have no control over the pace of change.
One week didn’t decide the future.
But it made the direction unmistakably clear.
The evolution of alternatives is no longer a slow burn.
It’s here. And it’s picking up speed.
If you’re in the work comp industry and haven’t been paying attention, today is your wake-up call.
