Post-trial Psilocybin Access: Reflections on R (On the Application of EB)

By Prof. Muireann Quigley and Dr. Louise Hatherall

University of Birmingham

EB – whose name is protected by an anonymity order – has had anorexia nervosa since she was a teenager. It has shaped almost every aspect of her life: her energy, her concentration, her ability to work, to travel, to manage a routine. She has tried multiple treatments, but none of them has worked. Then, in 2022, she took part in a clinical trial investigating psilocybin as a potential treatment. For the first time, something helped. Then the trial ended, and she was left with no means of lawfully accessing the treatment.

Psilocybin is a controlled drug under the Misuse of Drugs Act 1971, meaning possession without a Home Office licence is a criminal offence. Given the therapeutic benefit she experienced, EB wanted to obtain a licence to continue medically supervised access to psilocybin. However, although applications for licences to possess and use controlled drugs can be made under the Misuse of Drugs Regulations 2001, current Home Office policy does not permit such applications by individuals. EB nonetheless wanted to try.

The process was estimated to cost around £40,000 and would require specialist legal expertise that EB couldn’t afford. She applied, with pro-bono assistance, for exceptional case funding – a form of legal aid available in cases where refusing it could risk breaching a person’s human rights. The Director of Legal Aid Casework turned her down, deciding the case was not obviously about healthcare. In the Director’s own words, it concerned “the client’s proposal, as an individual, to possess and take psilocybin” – a controlled substance whose therapeutic value had “not yet been proven scientifically” [1].

EB challenged that decision through judicial review – a process by which the courts examine whether decisions by public bodies have been made lawfully. In February 2026, the High Court found in EB’s favour, quashing the decision to refuse legal aid and ordering a fresh decision to be made.

Ultimately, R (On the Application of EB) is a case about how public bodies make decisions – specifically about whether to grant legal aid – rather than one about access to psilocybin. It is nonetheless worth examining for what it reveals about how psychedelics continue to be misunderstood and the consequences of those misunderstandings in the hands of decision-making bodies.

Continued Misunderstandings

In her judgment, Judge Alegre found that the Director of Legal Aid Casework had made a series of fundamental errors. In particular, she found that the characterisation of EB’s application as concerning personal drug use was an “incorrect assumption that [her] application does not relate to medical or psychological healthcare or treatment. That is clearly wrong.”[2] The Judge concluded that, in reaching their decision, the Director had “patently failed to consider the importance of the issues at stake." [3]

The Director in this case didn’t just get the facts wrong – they appear to have approached the entire decision-making process through the lens of drug misuse rather than therapy. By mischaracterising the claim as being about drug use rather than healthcare, the Director failed to engage with the real issues: the severe impact of EB’s condition on her daily life, and whether denying her access to medical treatment risked breaching her human rights.

The assumption that someone seeking access to psilocybin must be seeking personal, unsupervised drug use – rather than continuing supervised medical treatment – reflects ongoing attitudes rooted in decades of prohibitionist policy. Psilocybin sits in Schedule 1 of the Misuse of Drugs Regulations, a category reserved for substances with no accepted medical use. Yet, that classification is increasingly difficult to square with the evidence. While debate continues about exact contours of current evidence, the idea that there is ‘no accepted medical use’ is becoming harder to sustain.

EB had participated in a clinical trial at one of the UK’s leading research institutions, and, by her own reported experience, this was the only treatment which had helped her. The Director’s mischaracterisation of her application for a licence, therefore, was not just factually wrong – it was, as the Judge found, the foundation on which the entire decision rested. When institutional decision-makers default to old assumptions about the use of these substances rather than engaging with the actual medical context, the consequences are borne by the patients. Here the Judge noted that, sadly, EB “is now experiencing the condition worse than before because she has lost hope of recovery.”[4]

Beyond the Clinical Trial

Beyond the errors in the decision-making process regarding legal aid, EB’s situation points to a structural problem that affects patients across the clinical trial landscape, not just those in psychedelic research.

Clinical trials are not treatment programmes. When a trial ends, participants don’t automatically retain access to the medicine they’ve been taking – even if it worked, even if nothing else has. The journey from promising trial results to legally accessible medicine is long. Trials themselves can take a decade or more to complete. After that, new medicines must pass through regulatory approvals, including assessments of safety, efficacy, and value for money, before reaching patients. There are no guarantees.

For psilocybin, those hurdles are higher still. Because it is a controlled substance, legal access would require not just regulatory approval but changes to the law – specifically, rescheduling under the Misuse of Drugs Regulations. That requires political will, and political will requires the kind of institutional understanding that EB’s case suggests is still patchy.

The result is an access gap: patients who find effective treatment in a trial, then lose access when it ends, with no clear legal route to access. EB’s case demonstrates what that gap looks like in practice – a seriously ill woman, a treatment that worked, and a legal and regulatory system with no obvious mechanism for addressing the gap.

What Happens Next

The High Court’s ruling is a win for EB, but a limited one. It means the decision regarding legal aid must be made anew. However, this doesn’t guarantee a different outcome. In judicial review cases, the same conclusion is sometimes reached again, even once the procedural errors are corrected. This means that EB could still fail to secure legal aid funding. And even if she successfully secures legal aid funding, she would then face the complexities of attempting to obtain a licence as an individual, something that runs contrary to current Home Office policy.

What EB’s case does, though, is put the problem on record. The mischaracterisation of psilocybin-assisted therapy as personal drug use is now the subject of a High Court judgment finding it to be clearly wrong-headed. The post-trial access gap is documented in detail in the Judge’s findings. And the human cost is part of the legal record.

None of this will fix the structural problems. But it does make them harder to ignore.

[1] R (On the Application of EB) v Director of Legal Aid Casework [2026] EWHC 402 (Admin) at [27].

[2] R (On the Application of EB) at [33].

[3] R (On the Application of EB) at [49].

[4] R (On the Application of EB) at [51].