NHPR’s environmental podcast Outside/In dropped a freshly re-aired episode this weekend that lands squarely in the middle of one of the year’s most surprising shifts in federal health policy. The episode revisits the story of Kathy Kral, a cancer patient who joined a clinical trial to see whether psilocybin, the active compound in so-called magic mushrooms, could help her confront a parallel diagnosis of major depression and the fear of death that came with it. As NHPR’s Felix Poon and the Outside/In team lay out in the episode, Kral’s experience is now being read in a strikingly different policy context than when the show first aired.

The reason is that on April 18, 2026, President Donald Trump signed an executive order directing the Food and Drug Administration to fast-track the review of certain psychedelic compounds for the treatment of serious mental illness. The signing ceremony, attended by Department of Health and Human Services Secretary Robert F. Kennedy Jr. and podcaster Joe Rogan, included a moment that has been widely shared in the days since. According to multiple accounts, including NPR’s coverage of the signing, the president joked from the Resolute Desk during the signing, “can I have some, please?”

The combination of the new federal direction and an old patient story is what gives this week’s Outside/In episode its weight. It is one thing to listen to a personal account of a clinical trial when psychedelic-assisted therapy is a fringe research interest. It is quite another to listen to it when the FDA is being directed by the White House to consider psilocybin for approval within a measure of weeks rather than years.

What the Executive Order Actually Does

The executive order Trump signed on April 18 directs an estimated $50 million in federal funding toward accelerating research on psychedelic treatments and orders the FDA to issue what the agency calls national priority vouchers for a small set of psychedelic drug candidates. FDA Commissioner Marty Makary said in subsequent remarks that the vouchers would allow the agency to compress what would normally be a multi-year review into a much shorter window, potentially measured in weeks for the most advanced candidates.

The first three vouchers, according to the FDA and reporting from STAT and CNBC, are being directed to candidates that target three specific conditions. Two are psilocybin programs, one for treatment-resistant depression and one for major depressive disorder. The third is a methylone program targeting post-traumatic stress disorder. Methylone is a synthetic compound that has shown promising results in early-phase trials for veterans suffering from severe PTSD.

The executive order also directs the Department of Veterans Affairs to expand its participation in psychedelic trials. The VA is now actively participating in at least five trials of these drugs across New York, California and Oregon, with additional sites under consideration. Trump emphasized the veteran-care angle in his remarks at the signing, citing the relatively high rates of treatment-resistant depression and PTSD among returning service members.

For Granite State residents, the veteran connection is not academic. New Hampshire has one of the older veteran populations in the country, and several VA facilities, both in New Hampshire and across the border in Massachusetts and Vermont, serve patients who could become eligible for psychedelic-assisted therapy if the FDA process plays out as Makary has suggested.

Inside the Outside/In Episode

The Outside/In episode itself, produced by Felix Poon, centers on Kathleen “Kathy” Kral and her decision to enroll in a clinical study at Sunstone Therapies, a Maryland-based clinic that has been one of the leading sites for psilocybin-assisted therapy in oncology patients. The episode features Kral, oncologist Manish Agrawal and a third participant identified as Norma Stevens.

Kral’s diagnosis was a one-two punch. She had been treated for cancer when, in the course of that treatment, she met the criteria for major depression. Studies have long shown that depression rates among cancer patients are substantially higher than in the general population, and that the depression is often resistant to conventional pharmacological treatment. In Kral’s case, antidepressants had not produced the kind of relief she or her care team were hoping for.

The clinical study Kral joined had striking outcomes. As the episode reports, 80 percent of participants in the trial experienced a significant reduction in depression. Half were no longer depressed at all after the treatment regimen, which combines a single supervised psilocybin session with extensive preparatory and integration therapy. That second piece, the therapy that frames the experience, is something most researchers stress is just as important as the drug itself.

The episode does not shy away from the strangeness of what Kral describes. She talks about her fear of dying, her sense of unfinished business and a guided session in which she confronted both. Outside/In has a track record of taking on hard subjects with the kind of care this material deserves, and this episode is consistent with that approach.

A Granite State Through-Line

There is, on the surface, no New Hampshire institution at the center of either the executive order or the clinical trial Kral participated in. But the policy shift has implications for several Granite State systems already grappling with how to handle the new federal direction.

The New Hampshire Department of Health and Human Services has been monitoring federal psychedelics policy in the same way it tracks other rapidly evolving medical regulatory questions, particularly given how interest in alternative treatments for major depression and PTSD intersects with the state’s ongoing mental health workforce challenges. New Hampshire still has long waits for inpatient psychiatric beds, and the rural reach of the state’s mental health centers is uneven. Any new treatment option that demonstrates rapid and durable effects on treatment-resistant depression would matter for that workforce conversation.

For continuing coverage of how state lawmakers are approaching the mental health system, see our piece on Gov. Ayotte’s pressure campaign over the SB 498 children’s mental health bill and our reporting on how the NH Senate handled vaccine religious exemption legislation this session. And for context on how the federal-state relationship is shaping other corners of New Hampshire public health, see our reporting on the Conservation Law Foundation’s appeal of the EPA PFAS permit at Manchester’s wastewater facility.

What the Science Says, in Plain Terms

Psilocybin, in clinical study form, is not a recreational dose taken at a music festival. It is administered in a controlled setting, usually accompanied by trained therapists, after weeks of preparation. Participants typically wear eye shades, listen to a carefully selected playlist (one of which is available, the episode notes, on the Sunstone Psilocybin Spotify playlist used during therapy sessions) and process the session with their care team in the days after.

The body of clinical evidence on psilocybin for treatment-resistant depression has been building since the early 2010s, when researchers at Johns Hopkins, Imperial College London and New York University began publishing data showing significant and durable reductions in depressive symptoms after a single supervised session. Subsequent trials at Compass Pathways, Usona Institute and several university sites have replicated key findings.

What the executive order does is short-circuit some of the time it would have taken for those findings to make it through the FDA’s full review and approval process. Supporters argue that, given the scale of treatment-resistant depression and PTSD in the United States, particularly among veterans, the existing pathway has been too slow. Skeptics warn that fast-tracking schedule I substances carries genuine risk, including the risk of approving treatments in advance of fully characterized safety data, and that the public conversation has moved faster than the science in important areas like long-term effects.

A New Conversation in Living Rooms

What makes the Outside/In episode resonate at this particular moment is not the policy debate but the deeply personal way Kral describes her experience. The episode rebroadcast invites listeners, whether they support or oppose the federal direction, to sit with what an individual patient gained or lost.

That is the conversation now playing out in New Hampshire living rooms, in cancer-support groups in Manchester and Concord, in veterans halls in Berlin and Lebanon, and at kitchen tables across the state. The federal government has changed the trajectory of psychedelic medicine. The Granite State will, in its usual way, work out its own answer one family at a time.

For Outside/In listeners new to the show, the episode is available through NHPR’s podcast feed and at outsideinradio.org, where a full transcript and credit list are posted. The episode is produced by Felix Poon.

What is psilocybin and how is it used in clinical research?

Psilocybin is the active psychedelic compound in certain mushroom species. In clinical research, it is given as a single supervised dose, paired with preparatory and integration therapy sessions and administered by trained clinicians. Studies on treatment-resistant depression and end-of-life distress in cancer patients have shown durable effects from one to two sessions.

What did Trump's executive order on psychedelics actually do?

The April 18 executive order directs roughly $50 million in federal funding toward psychedelic research and instructs the FDA to issue national priority vouchers for select psychedelic candidates. FDA Commissioner Marty Makary has said the vouchers can compress the review timeline from years to potentially weeks for the most advanced programs. The Department of Veterans Affairs is also directed to expand its participation in psychedelic clinical trials.

Which drugs are being fast-tracked first?

The first three FDA national priority vouchers cover psilocybin for treatment-resistant depression, psilocybin for major depressive disorder, and methylone for post-traumatic stress disorder. The methylone candidate is being studied primarily in veteran populations with severe PTSD.

Did Kathy Kral's psilocybin trial show meaningful results?

According to the Outside/In episode, the clinical study Kral participated in reported that 80 percent of participants experienced a significant reduction in depression, and half were no longer depressed at all after the treatment regimen, which combined a single supervised psilocybin session with extensive preparatory and integration therapy.

Is psilocybin therapy available in New Hampshire right now?

Psilocybin remains a Schedule I substance and is not yet FDA-approved. Clinical trial participation is limited to specific accredited research sites, most of which are outside New Hampshire. If the FDA's fast-tracked review under the April executive order leads to an approved indication, that calculus could change over the coming years, with implications for New Hampshire's mental health workforce and access to treatment.

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