In addition to deciding their pick for president of United States, Massachusetts voters in November will weigh in on five ballot initiatives. This is the second in a series of stories explaining each question of the Massachusetts Ballot Questions in the 2024 Election.

Question 4 would allow residents over 21 to possess and consume certain natural psychedelic substances in their homes or under the supervision of trained facilitators at licensed therapy centers. It would also create a commission, similar to the Cannabis Control Commission, to oversee the licensing of facilitators and centers and the regulation and taxation of the substances.

Unlike cannabis, the substances — psilocybin (magic mushrooms), psilocyn, ibogaine, mescaline and DMT — would not be sold in retail stores. They could only be accessed if grown at home or through a licensed therapy center.

How would the psychedelic drugs be taxed?

The proposal includes a 15% excise tax on the substances and bars the advertisement and sale of homegrown product. Local producers could only share their products.

Psychedelic drugs or natural plant medicines: What’s illegal or legal

Eight communities in Massachusetts — Amherst, Cambridge, Easthampton, Medford, Northampton, Provincetown, Salem and Somerville — have already told their police forces not to prioritize investigations into possession and use of psychedelics, or natural plant medicines. These are still considered illegal, and some are included as Schedule 1 drugs by the Drug Enforcement Administration.

The DEA defines Schedule 1 as those substances “with no currently accepted medical use and high potential for abuse.”

How would patients be able to get the psychedelic substances?

Personal use of the substances would start in December. The rollout of licensed therapy centers could take up to two years.

New Approach PAC, a Washington-based organization that has supported legalization of marijuana, formed Massachusetts for Health Options with the intention of creating a legal framework for therapeutic use of psychedelic drugs. Boston, as a longtime leader and innovator in health care, could be the perfect next market, according to proponents of Question 4.

Some therapists have found benefits to “microdosing” with psychedelics and natural plant medicines in treating depression, anxiety, post-traumatic stress disorders and even cluster headaches.

Opponents warn of risks from some of the substances for self-medicating residents, primarily ibogaine, which affects the heart, and the substances in DMT, a plant-derived hallucinogenic. Complications can include increased heart rates and blood pressure, chest pains and agitation.

The intensity of hallucinations could also lead to complications and psychosis.

Opponents also foresee a rise in black-market sales of homegrown product.

Have other states legalized use of psychedelics?

If the ballot measure passes in November, Massachusetts would be the third state to address the issue of natural plant medicines and psychedelic substances.

Oregon legalized only one substance, psilocybin, for adult use. It opted to restrict access to the drug through licensed, for-profit therapy centers, barring home production and home use. Proponents of Question 4 envision using Oregon as a model for Massachusetts.

Colorado voters agreed to legalize psilocybin, ibogaine, mescaline and DMT for “personal use.” The state is planning to license “healing centers” that can provide psilocybin and supervise its use, but none has opened yet.

James Davis, co-founder of the advocacy group Bay Staters for Natural Medicine, wants the state to step on the brakes on implementing Oregon’s approach, citing the high cost of accessing the therapy in Oregon.

He said his group has chosen not to support the ballot question due in part to the high cost of setting up treatment centers, and questions about whether the Cannabis Control Commission is the right model for a regulatory agency for psychedelics.

Who is spending money to support, and oppose, Question 4?

Proponents of Question 4 have amassed almost $5 million to promote a yes vote.

The majority of the largest donors are from other states, including California, Florida, New York and Utah. The One God Faith group, based in Vista, California, donated $1 million. Some large donors list Massachusetts addresses, including Eliza Dushku Palandjian, a Boston student with a Soldiers Field Road address who donated $100,000; Dharmesh Shah, a tech officer listing a Belmont address who gave $600,000; David Balter, a cryptocurrency entrepreneur in Boston who gave $200,000; and Salguero Holdings LLC of Cambridge, which donated $200,000, according to the Office of Political and Campaign Finance.

In contrast, the Coalition for Safe Communities, which opposes the ballot initiative, has yet to report any funds.

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