In 2026, Switzerland is the only country in the world where a doctor can request, case by case, authorisation to treat a patient with LSD, psilocybin or MDMA, a mechanism that in under a decade multiplied the number of approved treatments several times over, up to thirty-eight times more in the case of MDMA. Over the same period, a Boston laboratory founded by the neuroscientist who documented how these molecules rebuild the brain’s dendrites raised seventy million dollars to design a version without hallucination, patentable and sellable like any other drug. Meanwhile, the British company Compass Pathways is defending before American courts the ownership of a crystalline form of psilocybin that independent researchers say they found in samples from the sixties. None of these three movements, the Swiss clinic, the laboratory dismantling the molecule and the patent litigation, mentions the Mazatec, Huichol or Amazonian peoples whose ritual knowledge preceded the discovery of the TrkB receptor by centuries.
The molecule that repairs neurons
The mechanism behind this therapeutic boom was only clarified in 2023. Classic psychedelics do not only activate the serotonin 5-HT2A receptor from outside the neuron, as was thought for decades. They cross the cell membrane and act directly on the TrkB receptor from within.
TrkB is the natural receptor for brain-derived neurotrophic factor, the protein the body uses to order the growth and repair of neural connections. By binding to TrkB from inside the cell, LSD imitates and amplifies the signal that protein normally triggers, but with greater efficiency, because it reaches a site on the receptor that the natural protein, being larger, cannot access as easily. Neuroscientist David Olson, of the University of California, Davis, had already documented in 2018, in rat neurons and fruit fly models, that a single dose of LSD, DMT or psilocin measurably increased dendrite density and the number of dendritic spines, the structures where synapses form. A neuron exposed to the molecule grows more branches and more points of contact with its neighbours, a process equivalent to rebuilding a communication tissue impoverished by chronic stress or trauma.
That regenerative property, rather than the hallucinogenic effect itself, is what Olson now tries to isolate and preserve in a study seeking to dissociate TrkB activation from activation of the 5-HT2A receptor responsible for hallucinations. If the hypothesis holds, structural plasticity would be separated, at least in theory, from the subjective experience that for decades defined what it means to take a psychedelic.
Switzerland, the exception turned norm
Switzerland has held, since 2014, the only continuous legal mechanism on the planet for the therapeutic use of psychedelics on a case-by-case basis.
The Federal Office of Public Health authorises individual doctors to treat a patient with LSD, psilocybin or MDMA when conventional therapies have failed, under strict clinical supervision. The system inherits an earlier window of exception, opened between 1988 and 1993 for a dozen therapists, closed by the international prohibitionist wave and timidly reopened in 2007 by psychiatrist Peter Gasser, who relaunched clinical research on LSD in the country. Since then, the number of authorisations has kept rising.
Exceptional authorisations from the Swiss Federal Office of Public Health for therapeutic use rose from 6 to 231 for MDMA, from 6 to 134 for LSD and from 43 to 410 for psilocybin between 2016 and 2025, according to figures published by the newspaper 20 Minutes.
The Swiss association bringing together professionals in the field, the Swiss Society for Psychedelic-Assisted Therapy, documented in January 2025, in a cumulative count distinct from the annual comparison cited above, that some sixty doctors had received authorisation since 2014, that 1051 authorisations had been issued between 2016 and November 2023, split into 351 for MDMA, 338 for LSD and 362 for psilocybin, and that the total number of treatments carried out is estimated between 2000 and 3000. A typical treatment lasts three years on average, with about seventy hours of talk psychotherapy and seven sessions with the substance, a format incompatible with the brief-consultation logic of general medicine. No official training certification for this kind of therapy exists yet, and the association itself acknowledges that the Swiss fee system does not currently account for this practice, leaving unresolved who ends up paying the bill.
That legal access carries, in any case, a cost that falls largely on the patient, and depends on finding one of the few doctors willing to file a request with the federal authority. The gap between this regulated, minority route and the population’s real demand has, in recent years, been filled by a parallel supply operating outside any control.
A report by 20 Minutes documented in June 2026 the multiplication of clandestine psychedelic retreats in the cantons of Vaud, Neuchâtel, Bern and Basel, with fees ranging from a few hundred to several thousand francs and organisers that cantonal authorities cannot pin down precisely. The Federal Office of Public Health warns that these offerings expose participants to risks of abuse and psychological complications that the medical route is designed to prevent. The same country that exports this reputation for therapeutic vanguard is, then, the stage for an informal market growing in its shadow.
The race to patent the trip without the trip
The same science underpinning Swiss medicine drives, on the other side of the Atlantic, a corporate race to design a drug without the psychedelic experience.
Delix Therapeutics, the company Olson co-founded in Boston in 2019 with Nick Haft, develops non-hallucinogenic psychoplastogens seeking to replicate the neural repair effect without activating the 5-HT2A receptor. The company raised seventy million dollars in funding, launched a phase-one clinical trial for its compound DLX-001 and published in the journal Science the molecular mechanism underlying this bet. The stated goal is a drug a general practitioner could prescribe without the intensive psychotherapeutic supervision that any LSD or psilocybin session requires today, and that an insurer could reimburse the way it reimburses any antidepressant.
Compass Pathways, headquartered in London, holds five American patents on synthetic psilocybin, four of them covering a specific crystalline form the company calls Polymorph A. Freedom to Operate, a US non-profit, challenged two of those patents in December 2021, arguing that this same crystalline structure already appeared in psilocybin samples synthesised in the sixties and in 2008, well before Compass claimed it as its own invention.
The dispute was settled in June 2022, when the Patent Trial and Appeal Board, the administrative body of the American patent office, upheld the two contested patents and called Freedom to Operate’s arguments unfounded and unpersuasive. The ruling admits no appeal, and the organisation had spent nearly a million dollars on scientific expert opinions to support a case it lost entirely.
That timeline is, moreover, accelerating because of an explicit political decision. On 24 April 2026, the FDA announced an accelerated review pathway for three companies researching psilocybin against depression, Compass among them, and for methylone against post-traumatic stress, shortly after President Donald Trump signed an executive order to speed up approval of psychedelic drugs. Health Secretary Robert F. Kennedy Jr. stated at the time that the administration was accelerating research, approval and access to these treatments. Compass had already announced in November 2025 that it expected an FDA decision toward late 2026 or early 2027, nine to twelve months earlier than planned. If approval arrives, its patented psilocybin would be the first treatment of its kind authorised for severe depression in the United States, on the basis of advanced-phase trials that specialised coverage itself still describes as limited.
Lykos Therapeutics illustrates how much this race can stumble even when the science appears solid. Heir to more than three decades of work by the organisation MAPS on MDMA, the company filed with the American regulatory agency an approval request to treat post-traumatic stress.
The FDA rejected in August 2024 Lykos Therapeutics’ request to approve MDMA-assisted therapy against post-traumatic stress, citing deficiencies in clinical trial design and allegations of inappropriate conduct during treatment sessions.
The company restructured after the rejection and stated it would continue the process, while other companies in the psychedelic sector adjust their own clinical trials to avoid the same outcome. The episode did not halt investment in the sector, but it did shift much of its enthusiasm toward compounds like those of Delix and Compass, precisely because, in these companies’ eyes, they promise to bypass what they consider the unpredictable terrain of a therapy dependent on the patient’s subjective experience and the judgment of whoever accompanies it.
The peoples who discovered the trip are absent from the patent
None of the Swiss figures nor the American patents mentions those who used these molecules long before a laboratory gave them a chemical name. Psilocybin reached Western science in 1955, when American banker Robert Gordon Wasson took part, in Huautla de Jiménez, in a ritual ceremony led by Mazatec healer María Sabina, pressured, by Wasson’s own later account, by municipal authorities into accepting his presence. Sabina was shunned by her community after Wasson published the discovery, her house was burned and her son murdered, and she died in poverty without ever receiving recognition comparable to what Western science built upon her knowledge. Peyote, a sacred substance for the Huichol peoples and other Indigenous nations of Mexico and the southwestern United States, is the plant source of mescaline. An Amazonian plant pharmacopoeia, developed over generations by Indigenous communities, in turn underlies the use of dimethyltryptamine, active in LSD by structural analogy and central to ayahuasca.
Indigenous organisations across North and South America now demand, invoking the Nagoya Protocol on access to genetic resources, some mechanism of economic reciprocity from an industry that in 2026 moves billions of dollars in investment and stock valuation without that money returning, in any recognisable proportion, to the communities of origin. The still-nascent academic debate on the matter converges on one point, none of the pharmaceutical patents in dispute acknowledges a debt to the knowledge that made the research possible. An article published in 2026 on Indigenous knowledge systems and psychedelic science, signed by a team including representatives of Native American communities, documents this same demand for reciprocity and warns that most research protocols still exclude the communities of origin, neither in study design nor in benefit sharing.
The TrkB receptor does not distinguish between a clinical session in Zurich, a phase-one trial funded by venture capital in Boston and a nighttime ceremony in the Mazatec sierra, the molecule repairs the same dendrites in any case, but the money, the intellectual property and the historical recognition follow entirely different routes…
G.S.
Sources
- Psychedelics promote plasticity by directly binding to BDNF receptor TrkB
- Psychedelic drugs promote neural plasticity in rats and flies
- Towards an understanding of psychedelic-induced neuroplasticity
- Suisse, les retraites psychédéliques illégales se multiplient
- Recommandations pour le traitement, Thérapie assistée par psychédéliques (SAEPT)
- Delix Therapeutics Study Demonstrates that the Non-Hallucinogenic Neuroplastogen Zalsupindole Promotes Neuroplasticity
- Delix Therapeutics Scores 70 Million for Non-hallucinogenic Psychedelic Analogs
- Judges Deny Challenge to Psilocybin Patent
- Compass Pathways expects earlier FDA approval decision on its psilocybin drug
- FDA Releases Complete Response Letter on Declining MDMA-Assisted Therapy for PTSD
- The Promise of Nagoya, Indigenous Reciprocity in the Psychedelic Renaissance
- María Sabina, Mushrooms, and Colonial Extractivism (Chacruna)
- RFK, Jr., puts psychedelics on fast track to FDA review and approval (Scientific American)
