Puerto Rico

Key Insights

1
Patients can access only FDA-approved esketamine for treatment-resistant depression; no psychedelic is locally approved, and other compounds remain off-label or unavailable.
2
Puerto Rico now has 1 active trial, and the database shows 1 total study: esketamine and placebo are the only compounds in play.
3
Puerto Rico’s standout milestone is not a classic psychedelic first but a 2026 University of Puerto Rico randomised trial testing esketamine with preparation and integration therapy.
4
Momentum rests on the University of Puerto Rico Medical Sciences Campus, whose new trial update on 27 January 2026 signals the field’s current centre of gravity.

Medical Only (Private)

Reimbursed Care Access

Puerto Rico, as a U.S. territory, generally follows U.S. federal controlled-substance scheduling while also maintaining its own territorial controlled‑substances code. FDA‑approved products (notably esketamine/Spravato) are available under the federal REMS/labeling framework and can be administered in certified healthcare settings in Puerto Rico; off‑label ketamine infusions are widely offered by private clinics but are generally not reimbursed by public insurance. Classical serotonergic psychedelics (psilocybin, MDMA, DMT, 5‑MeO‑DMT, mescaline, 2C‑series, ayahuasca, ibogaine) remain controlled and without authorized routine medical use outside approved clinical research. [https://law.justia.com/codes/puerto-rico/2023/title-twenty-four/part-v/chapter-111/subchapter-ii/2202/|Puerto Rico Controlled Substances Code] [https://www.fda.gov/drugs/human-drug-compounding/fda-warns-patients-and-health-care-providers-about-potential-risks-associated-compounded-ketamine|FDA: Ketamine & Compounded Products]

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