The Ultimate Guide to Colorado’s Natural Medicine Health Act (SB23-290 Psychedelics Law)

By Joshua Kappel, Juliana Todeschi, George Winfrey, Will Denney

Aug 22, 2025

Author's Note (Updated August 2025): Since first publishing this guide in 2023, Colorado has finalized rules for facilitator licensing, healing centers, cultivators, and testing under the Natural Medicine Health Act (read Colorado Psychedelics Update: Regulators Finalize Natural Medicine Program Rules for more details). This updated guide reflects the current status of Colorado’s regulated psychedelics program including compliance, Indigenous inclusion, and public health protections.

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Background: Proposition 122 and the Passage of The Natural Medicine Health Act

Colorado voters approved Proposition 122, the Natural Medicine Health Act (NMHA), in the 2022 general election. On May 2, 2023, the Colorado Legislature passed SB23-290, the formal implementation bill for Proposition 122. During the 2023 legislative session,  the Legislature worked hard to honor the intention of Proposition 122 as it built out a full policy framework. The bill was signed into law on May 23, 2023. SB23-290 replaced Proposition 122 and went into effect on July 1, 2023. Read on or download an overview of SB23-290 and NMHA’s key components.

Personal Use and Cultivation of Natural Medicines in Colorado

The Personal Use section of Proposition 122 was a hallmark of the NMHA and is a unique psychedelics policy framework in Colorado as compared to other psychedelics frameworks implemented or considered around the country. The personal use provisions broadly decriminalized several types of natural medicine, namely psilocybin, psilocin, ibogaine, dimethyltryptamine (DMT), and mescaline (excluding peyote).

Personal use is defined as “the consumption of natural medicine or natural medicine product; or the amount of natural medicine or natural medicine product a person may lawfully possess, cultivate, or manufacture that is necessary to share with another person who is twenty-one years of age or older within the context of counseling, spiritual guidance, beneficial community-based use and healing, supported use, or related services.” 

While there is still criminal conduct around the possession, use, and sharing of natural medicine in certain contexts (see Criminal Offenses section below), SB23-290 decriminalized:

• Personal use of natural medicine, including the consumption, use, cultivation, and manufacture of natural medicine and natural medicine products 

• Sharing of natural medicine for personal use without remuneration provided it is not part of a business promotion or commercial activity 

• Sharing natural medicine concurrently with bona fide harm reduction or support services where remuneration is exchanged for the bona fide services, provided there is no advertising and proper disclosures were made 

• Ceremonial use of natural medicine 

Individuals using and sharing natural medicine outside of the regulatory framework will be permitted to test products provided they meet certain disclosure requirements. 

Additionally, a police officer is not allowed to arrest nor is the district attorney allowed to prosecute a person for conduct allowed under the NMHA. 

Colorado's Natural Medicine Regulatory Framework

Proposition 122 created the “Regulated Natural Medicine Access Program” and while SB23-290 does not use the same terminology, the bill created the necessary regulatory framework to oversee a regulated market of natural medicine and natural medicine products in the state of Colorado. Specifically, SB23-290 tasked two state regulatory departments—the Department of Regulatory Agencies and the Department of Revenue—with rulemaking around regulated natural medicine, natural medicine products, and natural medicine services. SB23-290 also ensures that there is funding for the regulatory program.

Natural Medicine Advisory Board: Who’s Guiding the Program? 

Proposition 122 created the Natural Medicine Advisory Board within the state Department of Regulatory Agencies, and SB23-290 incorporated these provisions. The Board is tasked with making recommendations to the Department of Regulatory Agencies and the Department of Revenue regarding the implementation of the NMHA’s regulatory framework. The initial Board was appointed by the Governor in January 2023 and confirmed by the Senate shortly after.

The Board consists of fifteen members with varying degrees of expertise, including in the areas of: 

• Natural medicine therapy, medicine and research

• Mycology and natural medicine cultivation

• Licensee qualifications (formally Permitted Organizations)

• Emergency medical services and first responders

• Mental and behavioral health care

• Health insurance and policy

• Public health

• Drug policy

• Harm reduction

• Religious use of natural medicines

• Issues confronting veterans

• Traditional tribal or Indigenous use of natural medicine

• Levels and disparities of access to health care services among different communities

• Past criminal justice reform efforts in Colorado 

The Executive Director of the Department of Revenue sits on the Board as a non-voting member. Seven of the Board’s members will serve a term of two years, and eight members will serve a term of four years. Board members may serve up to two consecutive terms on the Board and are subject to removal for misconduct, incompetence, neglect of duty, or unprofessional conduct.

After the initial term of the Board is up, the Governor must appoint new members but does not need the Senate to confirm the new members. Future Board members will serve a term of four years.

Department of Regulatory Agencies (DORA)

The Department of Regulatory Agencies (DORA) is responsible for regulating facilitators and the practice of facilitation at healing centers. 

The bill defines a “facilitator” as a person twenty-one or over who “has the necessary qualifications, training, experience, and knowledge...to perform and supervise natural medicine services for a participant[.]”  Pursuant to the DORA regulations, individuals who wish to apply for a facilitator license must meet the general requirements of the minimum age in the bill as well as hold a Basic Life Support or equivalent certification in addition to submitting an approved application and paying the application fee. Once an individual has met the general requirements, there are five pathways to licensure as a facilitator: original licensure, endorsement, legacy healer, clinical facilitator, and accelerated clinical facilitator. The additional requirements vary by pathway and may include completing an Approved Training Program (150hrs), 40 hours of supervised practice, and 40 hours of consultation; being licensed as a facilitator in another jurisdiction; substantially equivalent education, credentials, and experience to the foregoing; holding an active and valid license as a medical doctor, psychologist, licensed counselor, nurse practitioner, or physician assistant; among other requirements. In addition to the aforementioned license types, DORA may also issue Distinguished Educator Licenses and Training Licenses. DORA has received and is currently reviewing license applications since January 1, 2025. Facilitators may only have an interest in five natural medicine business licenses at a time. 

DORA has more clearly defined the practice of facilitation through the rulemaking process. Facilitators are responsible for providing “natural medicine services” to individuals and groups of up to 64 participants at healing centers and other authorized locations. “Natural medicine services” include an initial consultation with a screening assessment and the required disclosures for prospective participants to make an informed decision prior to participating in natural medicine services, a preparation session, an administration session where a participant ingests and feels the effects of natural medicine under the supervision of a facilitator while on-site at a healing center, private residence, or other authorized treatment location, and an integration session. DORA has also set a minimum duration of administration sessions based on the total dosage of psilocin administered to a participant from at least one hour per 2 mg to at least 5 hours for up to 50 mg.  regarding  sessions. Additionally, DORA has created rules around consent and physical touch between facilitators and participants.  Participants may consent to supportive touch by a facilitator, other participants, healing center staff, and other non-participant individuals in a physical touch contract in the preparation session prior to the administration session; however, any “supportive touch” must be limited to the hands, feet, or shoulders of the participant.

DORA is also responsible for investigating claims made against facilitators and disciplining bad actors by suspending or revoking licenses. Since facilitators will be a regulated and licensed profession, a corresponding crime was created that covers the practice of facilitation without a license, holding oneself out to be a “facilitator” without a license, or failing to display the facilitation license like other regulated professions. There is an exception to this new crime for “bona fide religious, culturally traditional, or spiritual ceremony” if there are proper disclosures and the ceremony is not associated with commercial, business, or for-profit activity. 

Additionally, there is a new prohibition on exploiting cultural sensitivities with advertising. 

DORA is authorized to take disciplinary action and utilize enforcement should there be proof that a licensee violated established grounds for discipline. Some of the violations include breaking a statute or rule, being convicted of a felony, lying on an application, failing to meet professional standards, excessively using alcohol or controlled substances, false advertising, and failing to display a license correctly.

DORA has also issued rules for accurate record-keeping and safeguarding participant confidentiality, creating equitable access to the regulated program, and collecting and publicly publishing data on the program’s implementation and administration in coordination with the licensing authority. They have also defined additional parameters for a facilitator to provide and supervise natural medicine services at authorized locations other than a licensed healing center, like a healthcare facility or private residence, to accommodate participants who may have difficulty traveling to a healing center. 

Tribal and Indigenous Working Group

In C.R.S. 12-170-107, SB23-290 created a Tribal and Indigenous Working Group within DORA. The working group is tasked with “engaging and creating a dialogue to identify issues related to the commercialization” of natural medicine products and services. Specifically, the working group will explore how to avoid misappropriation and exploitation of tribal and Indigenous communities, cultures, and religions; conservation issues with natural medicine sourcing and cultivation; how to avoid the excessive commercialization of natural medicine products and services; and to advise the Natural Medicine Advisory Board, DORA, and DOR regarding best practices in building trust with these communities.

Colorado Department of Revenue (DOR)

SB23-290 created the Natural Medicine Division, which is housed in the Department of Revenue (DOR) and tasked with enforcing the new Colorado Natural Medicine Code. Under the new Code, DOR is responsible for regulating the cultivation, manufacture, testing, storage, distribution, transportation, transfer, and dispensation of regulated natural medicine and regulated natural medicine products. The new Natural Medicine Division is responsible for licensing each stage of the supply chain.

While Proposition 122 created a general healing center license, SB23-290 opted to break each category of the supply chain of natural medicine businesses into a separate license type. Natural Medicine Division will be responsible for licensing not only healing centers but also cultivation facilities, manufacturing facilities, and testing facilities as well as individual owners and natural medicine handlers. For businesses preparing to enter the regulated program, securing compliant real estate is one of the first steps. See our guide on how to find compliant property for your Colorado natural medicine business.

DOR is currently working to approve and regulate natural medicine businesses and natural medicine products including psilocybin and psilocin. The Natural Medicine Advisory Board is also required to prioritize expanding the list of approved natural medicines to include ibogaine and may do so at any time. Under the law, dimethyltryptamine (DMT) and mescaline (excluding peyote) can be added to the regulated program after 2026. Notably, synthetics and synthetic analogs are completely excluded from the definition of natural medicine under the regulated program. This includes synthetics derived from natural sources. 

Additionally, DOR is responsible for rulemaking around the proper regulation and control of the natural medicine supply chain and must consult the Natural Medicine Advisory Board when considering and promulgating rules.

As of October 25, 2024, DOR has made rules regarding: 

• Licensee oversight requirements

• New license types including for owner, natural medicine handler, cultivation facility, manufacturing facility, and testing facility

• A schedule for application, licensing, and renewal fees

• Qualification and eligibility requirements for licensure, including environmental, social, and governance criteria

• Privileges and restrictions of licenses, including ownership restrictions

• Co-location of healing centers with a cultivation or manufacturing facility or other healthcare facility in addition to requirements and restrictions

• Limit on the financial interest any one licensee can hold to no more than five licensed natural medicine businesses

• Security, storage and transportation requirements including transportation limits and manifests

• Record-keeping and both on and off-premises storage requirements

• Preventing transfer and diversion to those under twenty-one

• Advertising standards, including a prohibition on the misappropriation and exploitation of tribal and Indigenous communities, cultures, and religions

• Waste disposal and destruction requirements

• Sanitary requirements and safety inspections

• Packaging and labeling requirements

• Testing requirements and health and safety standards and regulations

• Inventory tracking

• A schedule for penalties and fees for rule violations

• Law enforcement guidance

• The prohibition of misrepresentation and unfair practices

As DOR expands the list of available natural medicine and natural medicine products, they may continue to make and amend the above rules as well as additional rules regarding different standards for different types of natural medicine and natural medicine products.

In addition to rulemaking, DOR is responsible for conducting licensee investigations, fingerprint-based background checks and disciplinary hearings; developing the forms, licenses, and identification cards necessary for licensees; and working with DORA to prepare a public report on the regulated program’s implementation and administration. DOR is also responsible for developing and promoting public education campaigns around the use of natural medicine and natural medicine products and collecting information on adverse events, consumer protection claims, and other behavioral health reporting from its licensees. 

Colorado Department of Public Health and Environment (CDPHE)

DOR worked with the Colorado Department of Public Health and Environment (CDPHE) to promulgate rules regarding testing standards and qualifications for regulated natural medicine and natural medicine products. Additionally, the two departments have established procedures around laboratory certification criteria, testing procedures and frequency, and conflicts of interest permissions and prohibitions for licensees. 

Local Governments and Local Authorities

SB23-290 did not amend the NMHA regarding localities. Local jurisdictions may only regulate the time, place, and manner of healing centers and cannot prohibit a facilitator from offering natural medicine services within the jurisdiction. Additionally, localities are prohibited from adopting ordinances and regulations that are unreasonable or conflict with the NMHA. 

While some localities, such as Denver and Boulder, have adopted zoning regulations regarding natural medicine businesses, other smaller localities have placed a moratorium on such businesses while the locality continues to study the topic. Local jurisdictions also consider ESG factors when approving business operations. Our ESG licensing overview can help you prepare.

Legal Protections Under the Natural Medicine Health Act

SB23-290 codified many protections around the use of natural medicine and the provision of natural medicine services, including:

• Organ transplant eligibility 

• Health insurance coverage 

• Use while on probation and parole 

• Child-rearing 

• Public assistance (unless federal law provides otherwise) 

• Confidentiality for those who engage in regulated natural medicine services 

• Manufacture and sale of paraphernalia 

Occupational Protections

Furthermore, professionals in the state holding an occupational license, registration, or certification will not be subject to professional discipline or loss of their license, registration, or certification solely for providing natural medicine or natural medicine services, giving advice about the use of natural medicine, or engaging in the personal use of natural medicine. However, this provision does not protect those who engage in conduct related to natural medicine that violates the scope of their practice or other professional standards. 

280E

The Natural Medicine Health Act authorizes state tax deductions that are eligible to be claimed as federal income tax deductions, but are disallowed by Section 280E in the federal tax code because natural medicine is a federally controlled substance. 

Record Sealing

SB23-290 allows those convicted of offenses that would no longer be a crime under the bill to seal their criminal records at no cost. 

Criminal Offenses Under Colorado Psychedelics Law

While SB23-290 formally decriminalized natural medicine for personal use and set up a regulatory framework for adults twenty-one and over to access natural medicine, it also clarified what conduct remains criminal under Colorado state law. 

On the regulated side, it is strictly prohibited for licensees to knowingly transfer natural medicine or natural medicine products to a person under twenty-one years of age. Additionally, it is forbidden to adulterate, alter, or attempt to adulterate or alter a sample of natural medicine or natural medicine product to circumvent testing requirements, and it is a crime to practice facilitation of natural medicine services without a license or to hold yourself out as a facilitator without a license. There is an exception to this new offense for religious, traditional, or spiritual ceremonies not associated with a business, commercial or for-profit activity. 

On the personal use side, it is unlawful for persons under twenty-one to possess or consume natural medicine and violations of the law will result in a petty offense. Additionally, one may not cultivate natural medicine in an area on private property that exceeds a space of 12x12 feet unless their locality so provides, and a violation results in a petty offense and a $1000 fine. It is also prohibited and a petty offense to cultivate natural medicine outside of an enclosed locked space. Living plants that are possessed, displayed, cultivated, purchased, or sold for ornamental purposes only are exempt from all offenses related to natural medicine. Under SB23-290, it is now a level 2 drug felony to manufacture natural medicine products using an “inherently hazardous substance” or to knowingly allow someone to use one’s property for such.

It is also prohibited to “openly and publicly” display or consume natural medicine. Under C.R.S. § 18-18-102(20.3), “openly” means the conduct is observable to the public or a substantial number of the public, and “publicly” means the conduct took place somewhere a substantial number of the public has access to without restriction (e.g. streets, highways, transportation facilities, parks, common areas of buildings, etc.). Any conduct that takes place on private residential property by an occupant and their guests is not considered “open and public.” 

The following remain crimes and are not protected under Colorado law:

• Sharing ibogaine 

• Dispensing, selling, distributing, or possessing with the intent to dispense, sell, or distribute natural medicine or natural medicine product to someone under twenty-one years of age 

• Dispensing, selling, distributing, or possessing with the intent to dispense, sell, or distribute natural medicine or natural medicine product for remuneration or any commercial or business purpose

• Manufacturing, cultivating, possessing, consuming, using, dispensing, or distributing natural medicine or natural medicine product, or possessing with intent to manufacture, cultivate, possess, consume, use, dispense, or distribute natural medicine product for a purpose other than personal use 

• Dispensing, selling or distributing natural medicine or natural medicine products, or possessing with intent to dispense, sell, or distribute natural medicine products as part of a business promotion or other commercial activity 

• Driving under the influence of natural medicine or natural medicine product, or otherwise operating a vehicle, aircraft, boat, machine, or other device under the influence of natural medicine or natural medicine product  

When Remuneration Is Allowed for Support Services

Certain services may receive remuneration for those services defined under personal use. An exception is made on remuneration “for bona fide harm reduction services or bona fide support services used concurrently with the sharing of natural medicine or natural medicine product, provided that there is no advertisement related to the sharing of natural medicine, natural medicine product, or the services provided, and provided that the individual providing the services informs an individual engaging in the services that the individual is not a licensed facilitator.”

Conclusion

This bill is the most comprehensive piece of legislation ever passed by a state government related to a state-authorized natural psychedelic medicine program. Together with the regulations from DOR and DORA, it builds upon the values of the NMHA with a renewed focus on indigenous voices, safety, and regulatory efficiency. As a reminder, the measure went into effect on July 1, 2023, and both DOR and DORA are currently accepting applications for natural medicine licenses.

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Stay Informed

• Get the Latest Updates: Sign up for psychedelic and emerging therapies email updates from Vicente LLP.

• NMHA Tracker: Vicente LLP partnered with Psychedelic Alpha to create the Colorado Natural Medicine Health Act Tracker, which covered every phase of implementation from early rulemaking to final regulations through regularly published Colorado Natural Medicine Advisory Bulletins.

• Colorado Psychedelics Update and Q&A: Learn about regulations for healing centers, cultivators, and testing licenses, plus what steps you can take today to prepare for licensure. Watch the session here.

Our Psychedelics & Emerging Therapies team is here to help. Contact us today for guidance on licensing, compliance, and navigating Colorado’s Natural Medicine Program.