China

The Chinese story starts with control, not liberalisation. Official drug-control and travel materials describe narcotic and psychotropic drugs through a criminal-control and medical-use lens. Classical psychedelic compounds relevant internationally to this field appear in Chinese control materials as prohibited psychotropics or non-medical controlled substances, while ketamine occupies the unusual position of being both controlled and a legitimate medical anaesthetic. # # #

Modern Chinese clinical work restarted through ketamine rather than classical psychedelics. A 2019 Chinese study reported rapid anti-suicidal effects from repeated ketamine infusions in depressed patients with suicidal ideation. In 2021, the PASSION randomised trial linked to Beijing institutions reported that intraoperative ketamine alleviated depressive symptoms in patients undergoing intracranial tumour resection. # #

A regulatory turning point came in 2023. Janssen announced that NMPA had approved esketamine nasal spray for use with an oral antidepressant to alleviate depressive symptoms in adults with depression and acute suicidal ideation or behaviour. The China-linked phase 3 esketamine registration study was also published in 2023: it did not show day-28 superiority on the primary endpoint, but it did show rapid improvement within 24 hours, with safety consistent with known esketamine effects. # # #

The field broadened in 2024 and 2025, still around ketamine and esketamine. A BMJ trial from China reported fewer postpartum major depressive episodes after a single low dose of esketamine in mothers with prenatal depression. Guangzhou-linked adolescent work reported rapid antidepressant effects and short-term cognitive findings for repeated intravenous esketamine. By 2025, Chinese professional and review literature was focused on how to manage ketamine and esketamine safely and consistently in hospital-based rapid-treatment services. # # # #

If one mainland city deserves the clearest psychedelic-adjacent spotlight, it is Guangzhou. The Affiliated Brain Hospital of Guangzhou Medical University and Guangzhou Medical University cluster is visible across adult suicidal-depression protocols, adolescent intravenous esketamine trials, earlier repeated-ketamine work and the rapid-treatment-centre review. # # # # #

Beijing is the other indispensable node. It matters because national regulators and payer bodies are based there, and because Beijing institutions have generated visible clinical evidence and implementation signals, including the PASSION perioperative ketamine trial, postpartum esketamine work from Peking University First Hospital collaborators, and hospital reports of supervised esketamine nasal-spray use. # # # # #

The regional pattern is therefore narrower than a broad psychedelics market. Guangzhou carries the strongest psychiatric ketamine and esketamine research signal, while Beijing combines regulatory authority, tertiary hospitals and early implementation visibility. # # #

Boao Lecheng in Hainan is relevant policy context because it can allow urgently needed imported drugs and devices under special local rules. It should not be described as a general mainland access hub for classical psychedelics unless a specific product authorisation is verified. # #

Over the next 12 to 24 months, the most plausible Chinese changes are incremental and clinical rather than ideological. Expect more investigator-led studies in adolescent depression, perioperative and peripartum populations, biomarkers, ECT augmentation and rapid-treatment-centre operations. # # #

On regulation and reimbursement, the likely movement is towards clearer hospital workflows and payer positioning for fast-acting antidepressant products. The 2025 NHSA directory architecture sharpens the distinction between basic insurance and commercial innovation-drug coverage. A near-term mainland access route for psilocybin- or MDMA-assisted therapy looks unlikely on current evidence. # # #

Actual patient access will still depend on three bottlenecks: hospital willingness to run tightly monitored programmes, psychotropic-control compliance and payment. Even if guidance improves, practical access is most likely to expand first in major urban tertiary centres such as Guangzhou and Beijing rather than in community psychiatry or routine private-clinic care. # # #