In 2006, the Supreme Court paved the way for the sacramental use of a hallucinogen, hoasca, to be imported, distributed and ingested by a religious group. This case has broad implications for religious freedom for using sacramental psychotropics and how such cases might be decided in the future. This article outlines the arguments used both by the church and by the government. It lists the facts of the cases, explains and analyzes the decision, evaluates the likelihood of expansions of religion-based exceptions for entheogen use in light of the Supreme Court's decision and offers a profile for those groups most likely to receive such an exemption. Keywords: controlled substances, entheogens, First Amendment, hoasca, sacramental dugs, spirituality