Abstract
<title>Abstract</title> <p>Background U.S. states are pursuing psychedelics reform through three structurally distinct legislative pathways that differ in how scientific evidence is gathered, deliberated, and communicated prior to legislative action. Research evidence on how legislative pathways shape the speed, content, and adoption of legislative reform remains limited. This study systematically documents the national reform landscape, compares how pathway type shapes the speed, content, and adoption of legislative reform, and examines determinants and cross-state diffusion of task force-supported reform. Methods Guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework, this qualitative multiple case study uses legal mapping to pursue three sequential aims. Aim 1 updates and extends a national legal mapping of U.S. state psychedelic legislative reform from Feb 2019 to May 2025 and classifies each initiative by pathway type and key legislative milestones. Aim 2 compares the speed and content of legislative reform across pathway types by measuring elapsed time between key milestones and assessing the degree to which enacted legislation aligns with task force recommendations across nine dimensions. Aim 3 examines determinants and cross-state diffusion of task force-supported reform by identifying determinants of reform adoption across EPIS phases and tracing how reform content diffuses across states. Discussion This protocol produces the first systematic cross-state dataset of psychedelics reform pathway classification and milestone timing, and advances methods for measuring the speed of state legislations on health innovation reforms by operationalizing legislative pathways as time-stamped phase-specific processes. It is among the first studies to empirically compare legislative pathways as dissemination strategies and to examine legislatively mandated task forces as policy learning mechanisms to facilitate adoption. Findings will inform future state decisions about which legislative pathway to pursue and whether to establish task forces, based on political contexts, in emerging health policy domains.</p>