Massachusetts voters are considering Question 4, which would make their state the third to decriminalize psilocybin mushrooms, following Oregon and Colorado. The measure would allow adults 21 and older to possess, use, and cultivate specific psychedelics, as well as establish a tax system and regulatory board for licensed providers. Current polling shows voters evenly split at 43% for and against.

There are disagreements over psilocybin’s potential medical benefits and concerns about its safety. Advocates point to promising research, including a recent large phase two trial showing significant depression symptom reduction with a single dose combined with psychotherapy. The FDA granted psilocybin special designation in 2018 to accelerate research into depression treatment, and over 200 trials are currently ongoing.

However, experts like Luke Niforatos of the Foundation for Drug Policy Solutions warn that public enthusiasm is outpacing scientific evidence. Critics argue that broad decriminalization could lead to dangerous unregulated use, citing increasing poison center calls and recent incidents like contaminated products causing illnesses and deaths.

Drug policy experts outline two potential paths forward: a regulated FDA approval process for medical use under doctor supervision, or a less restrictive “medical marijuana model” at the state level. The latter has led to gray markets in places like Oregon and Washington D.C., where mushrooms are openly sold through various loopholes.

Critics argue more research is needed before broad legalization, while advocates believe access should be granted now given psilocybin’s potential benefits and relatively low addiction risk.

Read more: Mushrooms hit the ballots as researchers grapple with the dangers of psychedelics