Prescribing, referring, and recommending: where the legal lines are for clinicians

Last reviewed: August 2026 · Psychedelic law changes quickly — verify current status before relying on this page.

For licensed healthcare professionals who want to understand precisely what they can and cannot do when a patient is interested in psilocybin — including what “prescribing,” “referring,” and “recommending” mean legally in this context, and where each activity sits relative to federal law, Oregon law, and professional board obligations.

The short answer

A clinician cannot prescribe psilocybin. No prescribing pathway exists under federal or Oregon law for psilocybin outside of a DEA-registered research protocol. What a clinician can do — now explicitly protected from board discipline under HB 2387 for clinicians regulated by seven specified Oregon boards — is discuss psilocybin services as a treatment option, point patients toward Oregon’s licensed program, review medications before access, and provide clinical support before and after a session. The legal line runs between discussion and clinical support on one side, and prescription and administration on the other. A clinician who understands exactly where that line falls is positioned to provide genuine clinical value without crossing into prohibited territory.

Prescribing: not possible under current law

Psilocybin is a DEA Schedule I controlled substance under the federal Controlled Substances Act. Schedule I substances have no currently accepted medical use in treatment under federal law, and no DEA registration category allows a clinician in ordinary practice to prescribe, possess, dispense, or administer psilocybin to a patient outside of a federally approved research protocol.

This means a physician, nurse practitioner, physician assistant, or other prescribing clinician cannot write a prescription for psilocybin regardless of state law. Oregon’s state-licensed program does not create a prescribing pathway — it creates a facilitation pathway, which is a different legal category entirely. Clients access the Oregon program without a prescription, without a clinician’s authorization, and without any clinical gatekeeping beyond the facilitator’s use of the OPS client information form.

The prescribing prohibition is categorical. A clinician who attempts to write a prescription for psilocybin — as a direction to a pharmacy, as documentation for a service center, or in any other form — is engaging in conduct that is not legally authorized under the CSA, regardless of their therapeutic intent.

When prescribing may become possible

This is changing. COMPASS Pathways’ Phase 3 trials for COMP360 psilocybin in treatment-resistant depression met their primary endpoints in June 2025 (COMP005) and February 2026 (COMP006), and a rolling NDA submission to the FDA is planned for late 2026. If the FDA approves COMP360, rescheduling to at least Schedule II would follow automatically — a Schedule I substance cannot have “currently accepted medical use in treatment” after FDA approval. Schedule II status would create a legal prescribing pathway for clinicians in all states for the approved indication, through standard DEA Schedule II prescribing authority. That pathway does not exist yet. Until it does, there is nothing a clinician can prescribe.

Referring: what this means and does not mean

Oregon’s psilocybin program has no formal referral system. A patient self-refers by contacting a licensed service center directly — not through a clinical referral. A clinician does not initiate, authorize, or facilitate access in any formal sense. There is no referral letter, no authorization form, and no clinical gatekeeper role for the prescribing clinician in the OPS intake process.

What a clinician can do is point a patient toward the program. Under HB 2387, clinicians regulated by the seven identified Oregon boards are explicitly protected from board discipline for discussing psilocybin services as a treatment option and directing patients toward licensed services. That discussion — including telling a patient about Oregon’s program, explaining how it works, and sharing the OPS Licensee Directory — is protected conduct.

A formal written “referral letter” to a service center has no defined role in the OPS process and is not required. A clinician who provides one is not violating any rule, but should be clear that it carries no clinical or regulatory weight in the OPS intake process — the service center does not need it and the client does not need to present it.

Recommending: the clinical conversation

Recommending psilocybin services — in the sense of having a clinical conversation about whether the Oregon program might be appropriate for a specific patient — is the activity most directly at the heart of HB 2387’s discussion protection. A clinician regulated by one of the seven boards can:

Tell a patient that Oregon’s licensed psilocybin program exists and describe what it involves. Share what the current evidence suggests about psilocybin’s potential for the patient’s specific condition — depression, PTSD, end-of-life distress, substance use disorders — while being accurate about the evidence’s limits. Help the patient weigh whether the program’s structure and cost fit their situation. Review medications and flag contraindications before the patient proceeds. Provide integration-supportive clinical care after the session.

What the protection does not cover: recommending psilocybin use outside the licensed Oregon program; making representations about psilocybin services that exceed what the evidence supports; or structuring a recommendation in a way that creates a formal clinical duty to monitor the patient through the facilitation process in a manner that exceeds the clinician’s actual role.

What clinicians cannot do

No clinician can possess, handle, or administer psilocybin products. This applies even at Oregon licensed service centers — the psilocybin product is handled by the service center’s licensed personnel, and a clinician present at a session (if present at all) cannot handle the product.

A dual-licensed clinician under HB 2387 cannot provide clinical services during the administration session. The administration session is facilitation-only regardless of what the preparation and integration sessions permit.

A clinician cannot bill Medicare, Medicaid, or standard commercial insurance for psilocybin services or for clinical time that is characterized as psilocybin treatment. The psilocybin session is entirely out-of-pocket under current insurance frameworks. Clinical services surrounding the session — assessment, preparation therapy, integration therapy — may be billable under standard clinical codes when provided by a licensed clinician for a diagnosed condition, independent of the psilocybin access itself.

A clinician cannot direct a patient to obtain psilocybin outside the licensed Oregon or Colorado programs. Pointing a patient toward a retreat center that is not operating within a state-licensed framework, or toward personal use in any context, is outside what HB 2387 protects and outside what any clinical recommendation standard would support.

Federal law and the clinical context

Discussing psilocybin services with a patient does not violate federal law. Discussion is not possession or administration. A clinician who points a patient toward Oregon’s licensed program, toward a clinical trial, or toward publicly available research information is not engaging in federally regulated conduct.

The federal analysis changes in specific employment contexts. Clinicians at VA hospitals, federally qualified health centers, or institutions receiving federal research grants operate under federal drug-free workplace rules and federal funding conditions that may constrain what they can recommend, even where Oregon law explicitly protects the discussion. A clinician in any of these contexts should get specific legal advice before engaging in clinical psilocybin discussions with patients.

The split-billing model

One emerging practice structure separates the clinical work from the psilocybin session in a way that allows the clinical work to be billed through standard insurance channels. The psilocybin session itself — administered through the Oregon licensed program, entirely out-of-pocket — is distinct from the clinical assessment, preparation therapy, and integration therapy provided by the licensed clinician, which may be billable as standard mental health services when provided for a diagnosed condition. A clinician who structures their practice this way should have clear documentation that the billable clinical services are independent of the psilocybin access pathway, not characterized as psilocybin treatment.

When public information may be enough

HB 2387 and ORS 475A.338 are available through the Oregon Legislative Assembly. The CSA’s Schedule I provisions (21 U.S.C. § 812) and the DEA’s prescribing authority framework are publicly available through dea.gov. The OPS Licensee Directory is at oregon.gov/psilocybin.

When you should speak with a lawyer

A clinician who works in a federally funded setting and wants to understand whether HB 2387’s discussion protection applies to their employment context should get legal advice before engaging in clinical psilocybin conversations. A clinician who wants to structure a practice involving clinical preparation and integration services alongside patient access to Oregon’s program — including the billing implications of that structure — should consult an attorney before establishing the practice. A clinician who has received a board inquiry or a patient complaint related to psilocybin recommendation should retain counsel before responding.

You might also want to read

• Can physicians discuss or recommend psilocybin services to patients?
• Dual licensure: what HB 2387 changed for Oregon clinician-facilitators
• What clinicians need to know about screening patients for psychedelic services
• Psychedelic-assisted therapy and the standard of care
• Malpractice exposure for clinicians involved in psychedelic services