Consider a veteran living in Deming. He has carried a PTSD diagnosis for twenty years. He has tried the medications and the talk therapy. He heard the state passed a medical psilocybin law and that people like him were the reason it passed. He wants to know what it takes.

His care is at the VA, and the VA cannot help him with this.

Like most veterans in southwestern New Mexico, his healthcare runs through the VA. The nearest clinic is in Silver City, about fifty miles north, or Las Cruces, about sixty miles east. Anything beyond outpatient care means Albuquerque, close to four hours each way.

None of that is available to him here. Psilocybin remains federally illegal. VA providers are federal employees at federal facilities. They will not certify him into this program, and they are unlikely to sign a physical examination knowing what it is for. Whatever relationship he has built with his VA provider over the years, on this he starts from nothing.

He now needs two doctors he does not have.

He needs a certifying clinician. Under these rules, that person must hold a New Mexico controlled substance number, which means a physician, psychiatrist, or nurse practitioner. His counselor cannot do it, and neither can a licensed clinical social worker, though under these same rules either could be the practitioner who hands him the psilocybin and sits with him for the entire experience.

New Mexico is the only state that lost practicing physicians between 2019 and 2024. More than ninety percent of its counties are federally designated shortage areas. Luna County is one of them. And he is not looking for any prescriber. He is looking for one who already applied to the Department, completed the eight-hour module, and waited for their own approval. Publication of a certifying clinician’s contact information is optional under these rules, so some who enroll will not appear anywhere he can search.

When our team surveyed the medical cannabis certification market this year, running the same search a patient would run, we found no certification provider of any kind in Deming.

Assume he finds someone, probably by telehealth, probably in Albuquerque. That clinician cannot examine him. So the rules require a second provider, someone who has physically examined him within the previous six months, either to have done that exam already, to furnish records, or to take a call and document a consultation.

He does not have that person. His exams were at the VA.

So the path is: find a doctor in or near Deming willing to see him, pay for that visit, complete a physical, then take those records to a stranger on a video call who will decide whether he gets in.

Two new doctors, neither of whom knows him, before anything begins.

What that costs a veteran.

For a person without PTSD this is bureaucracy- annoying, expensive, and surmountable.

For a veteran with PTSD, avoidance is not a personality trait. It is a symptom cluster and a diagnostic criterion. Every added step is a place where avoidance wins. The unreturned call. The receptionist who asks what the appointment is for. The form. The wait. A barrier that looks small from a desk in Santa Fe is not small from inside this condition, and the people who designed this process will never see the ones it stops, because the ones it stops do not appear anywhere in the data.

There is also what it costs to explain yourself twice to strangers. He will sit with a doctor he has never met and describe twenty years of the worst things that happened to him, in enough clinical detail to have a diagnosis confirmed, knowing that this person decides whether he gets through the door. Then he will do it again on a video call with someone else.

And here the design does something worse than slow him down. It gives him a reason to lie.

He needs to say enough to qualify and not so much that he is denied. So the drinking gets minimized. The bad stretch two years ago goes unmentioned. The medication he has been skipping does not come up. He is not being deceptive. He is doing what anyone does at a gate held by someone who does not know him and will not see him again.

The Department has designed its safety screening to run through the encounter least likely to produce honest disclosure.

The application

He and the clinician file electronically. He needs a driver’s license or comparable photo identification. He signs an affirmation. The clinician submits their license, their controlled substance number, his diagnosis, and an attestation that the benefits likely outweigh the risks.

Then he waits for the Department  to decide, up to thirty days.

It is worth asking what that step is for? A licensed clinician has examined him, confirmed a qualifying diagnosis, and made a professional judgment that this treatment is appropriate. The Department is not in a position to second-guess that judgment. It has not examined him and does not know him. It holds no clinical information the clinician does not already have. Whatever the agency is reviewing, it is not the medical question, because the medical question was answered by the only person present who was qualified to answer it.

There is no expedited path. End-of-life care is a qualifying condition, and a dying patient waits the same thirty days. If he is denied, he may request an administrative review. It is not a hearing, and under 7.35.3.25(E) there is no right to judicial review.

Arriving at the practitioner

Say he is approved. He holds a state determination that he is medically appropriate for psilocybin.

He walks into a practitioner’s office and says he is ready. A doctor cleared him. The Department cleared him. He has been working toward this for months.

Any responsible practitioner will stop him. We have just met. Let me take a history and get to know you.

Everything the certifying clinician did now happens again, with someone who has an actual relationship with him and will be in the room when it matters. Not because the practitioner is being difficult, but because no competent provider takes psilocybin responsibility for a patient on a stranger’s paperwork.

He came in expecting to begin. He is starting over. That has to be managed before the work can start.

Preparation

He and the practitioner do preparation sessions until he is ready. This is where trust is built, and in the published trials the strength of that relationship at the final preparation session predicted depression scores a full year out.

The facilitators do not participate. Under the proposed definitions, preparation is a therapeutic encounter between a practitioner and a patient.

Administration day

He is placed in a group of ten. That requires two practitioners and five facilitators.

He has briefly met the five facilitators and toured the space. That is the extent of it, because the rules did not permit them to prepare with him. Some may be students, since a student with fifty practicum hours can substitute for a facilitator, expressly including for billing. He has not met them either, and he is paying for them.

He then spends six to eight hours in an altered, highly suggestible state with people he does not know. At one facilitator for every two patients against one practitioner for every eight, they are the primary human presence in that room.

Integration

Something happened in there. It usually does. And in the course of it he connected with one of the facilitators, another veteran, someone who has been through this and understood what he was describing without needing it explained.

He cannot do integration with that person. Integration is defined as a therapeutic encounter between a practitioner and a patient. So he sits with the therapist and works it through with clinical tools, which are real tools and do real work.

But what came up is not the kind of thing that resolves in conversation. It is in his body, mobilized, and it needs somewhere to go. The peer would have known that. The peer would have said, “Here is what I do, come train with me.” That is not something a licensed clinician can offer him, and the rules have handed integration exclusively to the licensed clinician.

One thing worth noticing

In 7.35.3.20(H)(5), the Department gave itself authority to waive or reduce the practitioner and facilitator staffing ratio if it determines the ratio presents a barrier to patients.

That is the requirement putting trained people in the room during the hours when something could go wrong. The Department built itself flexibility there.

It built no such flexibility into the controlled substance number. It reserved discretion on the safety requirement and locked in the credential.

The ending this usually has

Everything above assumes he makes it through.

Most will not. Most will stop at the first closed door, or the second, or somewhere in the six months between the exam and the appointment that never got scheduled. Nobody will record that they tried. There is no line in any report for the veteran who called once, got voicemail, and did not call back.

He goes home to Deming. Nothing has changed except that he tried and it did not work, and now he knows the thing he heard about was not really built for him.

Some night after that, instead of reaching for the phone, he reaches for something else.

The VA counts 17.6 veteran suicides a day. Independent research that includes overdose deaths puts it closer to 44. He will be one of them, and no one will connect it to a definition in a rule.

The Rule that Creates this Problem and What We Can Do to Solve It

The Department of Health has published the proposed rules and scheduled a public hearing for Friday, October 2, 2026, at 9:00 a.m. at the Harold Runnels Building, 1190 St. Francis Drive in Santa Fe, with video and telephone participation available. Written comment must be received by the close of that hearing and goes to Jacob Clark at jacob.clark@doh.nm.gov. Comments are published on the Department’s website within three days and become part of the public record. After October 2 the rules move toward promulgation.