Quebec is the only Canadian province with an established public-funding precedent for psilocybin-assisted therapy. In December 2022, Drs. Houman Farzin (palliative psychiatrist, Jewish General Hospital, McGill) and Jean-François Stephan successfully billed RAMQ — Quebec's provincial health insurance — for psilocybin-assisted psychotherapy delivered to a Quebec patient with end-of-life distress under Health Canada SAP authorization. The June 2022 actual treatment was billed in December 2022; RAMQ subsequently modified medical billing codes to permit further public claims for SAP-approved Quebec patients. This was the first publicly funded psychedelic therapy in Canada, and it remains a Quebec-specific pathway. This article walks through the Quebec regulatory and clinical landscape: the RAMQ billing precedent, Bill 21 (loi 21) reserved-act psychotherapy implications, Bill 96 language considerations, Quebec providers including Drs. Farzin and Stephan and the Neurotherapy Montreal psychedelic-assisted psychotherapy service, and how Quebec patients access SAP-pathway psilocybin therapy with the public-funding option that does not exist elsewhere in Canada.
Key takeaways
- Quebec is the only Canadian province with established public-funding precedent for psilocybin-assisted therapy. Drs. Houman Farzin and Jean-François Stephan billed RAMQ in December 2022 for SAP-approved psilocybin-assisted psychotherapy delivered to a patient with end-of-life distress.
- RAMQ modified billing codes subsequently to permit further public claims for SAP-approved Quebec patients. The pathway is real but capacity-limited and dependent on physician engagement.
- Bill 21 (loi 21, 2009) reserves psychotherapy as a regulated act in Quebec. Only physicians, psychologists, and Ordre des psychologues du Québec (OPQ) permit holders may deliver the psychotherapy component of psilocybin-assisted therapy.
- Bill 96 (Charter of the French Language, 2022) has implications for healthcare communication; confirm clinic language capabilities before booking.
- Quebec providers: Drs. Farzin and Stephan; Neurotherapy Montreal (psychedelic-assisted psychotherapy service); P.A.T.H. Therapy Canada (multi-provincial); other Quebec psychiatrists and palliative-care providers with SAP-pathway experience.
- Eligibility for Quebec RAMQ pathway: SAP authorization in place, Quebec residency, eligible indication (typically end-of-life distress), Quebec-based prescribing physician willing to apply for SAP and bill RAMQ.
The December 2022 RAMQ precedent
In December 2022, Drs. Houman Farzin (palliative psychiatrist, Jewish General Hospital, McGill University) and Jean-François Stephan billed RAMQ for SAP-approved psilocybin-assisted psychotherapy delivered to a Quebec patient with end-of-life distress. The actual treatment took place in June 2022 under Health Canada SAP authorization; the billing was processed in December 2022 after Dr. Stephan submitted an evidence letter (cosigned by 15 Quebec colleagues) arguing that both physicians qualified for billing under existing medical codes.
Significance: this was the first publicly funded psychedelic therapy in Canada. RAMQ subsequently modified medical billing codes to permit future psilocybin-assisted psychotherapy claims for SAP-approved Quebec patients. The TheraPsil documentation of this case is at https://therapsil.ca/quebec-first-province-to-cover-costs-of-psilocybin-assisted-psychotherapy-done-by-two-physicians/.
The RAMQ pathway requires:
- SAP authorization in place (Health Canada Special Access Program approval for the individual patient)
- Quebec residency with valid RAMQ coverage
- Eligible indication — most commonly end-of-life distress, where the foundational evidence (Griffiths 2016, Ross 2016, Agin-Liebes 2020) and SAP-foundation indication align
- Quebec-based prescribing physician willing to apply for SAP and bill RAMQ — the bottleneck most patients face
The honest framing: the pathway is real but capacity-limited. The number of Quebec physicians applying for psilocybin SAP and billing RAMQ remains small relative to demand.
Bill 21 — psychotherapy as a reserved act
Quebec is the only Canadian province where psychotherapy is a reserved act under Bill 21 (loi 21), enacted in 2009 (chapter 28). The implication for psilocybin-assisted therapy:
Only the following may deliver psychotherapy in Quebec:
- Physicians
- Psychologists (members of Ordre des psychologues du Québec, OPQ)
- Members of designated professional orders holding a psychotherapy permit from OPQ — including guidance counsellors, criminologists, occupational therapists, nurses, psychoeducators, social workers, and family therapists
The OPQ psychotherapy permit requires:
- Provincial professional licensure
- Graduate-level program (social work, counselling, psychology, etc.)
- 765 hours of theoretical psychotherapy training
- 300 hours of supervised direct clinical work (≥10 clients, ≥10 hours each)
For psilocybin-assisted therapy in Quebec, this means: the therapy team supporting preparation, dosing, and integration must include a physician, psychologist, or OPQ permit holder for the psychotherapy component. Unregulated coaches or counsellors without OPQ authorization cannot deliver the psychotherapy component of psilocybin-assisted therapy in Quebec.
For the Quebec ketamine-cluster context (which addresses Bill 21 in detail), see Ketamine Therapy in Montreal.
Bill 96 — French-language framework
Bill 96 (loi 14, 2022) amended the Charter of the French Language to require provincial health services to communicate in French by default, with specific exceptions for English-eligible patients (English education eligibility certificate, Indigenous, recent immigrants, pre-2021 English files). The implications for psilocybin-assisted therapy:
- Clinic language capabilities: confirm whether the clinical team conducts preparation, dosing, and integration sessions in French, English, or bilingual.
- Documentation: SAP applications, consent forms, and clinical records may default to French.
- Bilingual access: Drs. Farzin and Stephan, the Jewish General Hospital, and Neurotherapy Montreal historically operate bilingually; specific patient experience varies.
Most Quebec psychedelic-assisted therapy clinics offer bilingual service; confirm with the clinical team during the SAP-pathway intake.
Quebec providers
The established Quebec psilocybin-pathway clinical landscape:
Dr. Houman Farzin
Palliative psychiatrist at the Jewish General Hospital, McGill University. The first Canadian physician to bill RAMQ for SAP-approved psilocybin-assisted therapy (December 2022). Farzin's clinical practice focuses on palliative-care psychiatry, including end-of-life distress in patients with terminal illness. He has been a public advocate and educator for Canadian psilocybin SAP-pathway work.
Dr. Jean-François Stephan
Co-clinician on the December 2022 RAMQ-billed psilocybin-assisted therapy. Quebec-based palliative or psychiatric physician with SAP-pathway experience.
Jewish General Hospital — Department of Psychiatry
The Jewish General Hospital has been at the centre of Quebec psilocybin SAP work, alongside its broader contributions to Quebec mental-health innovation including the Montreal Model of ketamine-assisted therapy developed by Dr. Kyle Greenway and colleagues. See Ketamine Therapy in Montreal for the ketamine-side context.
Neurotherapy Montreal
Neurotherapy Montreal is a Montreal-based clinic offering psychedelic-assisted psychotherapy (PAP) services. Their published service describes psilocybin-assisted psychotherapy for depression, anxiety, and end-of-life care within their integrated PAP model.
P.A.T.H. Therapy Canada
P.A.T.H. is a multi-provincial provider with online + clinic-based psychedelic-assisted therapy services across Quebec, Ontario, BC, and Alberta. They offer preparation and integration support for SAP-pathway patients.
Roots to Thrive (BC, accessible to Quebec patients)
While not Quebec-based, Roots to Thrive in Nanaimo BC offers Canada's first SAP-authorized psilocybin-assisted group therapy for end-of-life patients, accepting Canadian patients who travel to BC for the program.
Other Quebec resources
Quebec providers continue to develop SAP-pathway capacity. The TheraPsil network maintains a directory of trained Canadian clinicians; PsyCan (Psychedelics Canada) provides updated provider information.
INESSS and broader Quebec coverage
INESSS (Institut national d'excellence en santé et services sociaux) is Quebec's drug evaluation body. INESSS does not currently include psilocybin in its formulary recommendations. The Farzin/Stephan RAMQ billing precedent operates outside the standard INESSS-formulary framework — billing was achieved through interpretation of existing medical billing codes for SAP-authorized treatments.
Comparison to other Quebec psychedelic medicine coverage:
- Spravato (esketamine for TRD): INESSS recommended against listing in November 2020. Not on RAMQ formulary.
- Off-label generic ketamine: Standard Quebec medical practice for psychiatric off-label use applies; no specific RAMQ public funding pathway analogous to the psilocybin Farzin/Stephan model.
- Psilocybin SAP-pathway: RAMQ billing precedent established December 2022; the only established public-funding Canadian pathway for any psychedelic therapy.
For broader cost framing, see Psilocybin-Assisted Therapy Cost in Canada.
How ATMA CENA supports Quebec patients
ATMA CENA's role for Quebec SAP-pathway patients:
- The medical SAP application is initiated by the Quebec patient's prescribing physician — not ATMA CENA directly.
- ATMA CENA supports preparation and integration through the three-phase psychedelic-assisted therapy model.
- ATMA CENA's care coordination model is particularly relevant for Quebec patients given Bill 21's reserved-act psychotherapy framework: the Quebec-based therapist (physician, psychologist, or OPQ permit holder) remains primary, while ATMA CENA's clinical infrastructure supports the broader frame.
- ATMA CENA's training program prepares clinicians for psychedelic-assisted therapy work consistent with Bill 21 requirements for psychotherapy delivery in Quebec. See Psychedelic Therapy Training in Canada.
- ATMA CENA does not directly bill RAMQ. RAMQ billing is initiated by the Quebec-based prescribing physician under the Farzin/Stephan precedent and modified billing codes.
For Quebec-specific clinical orientation, ATMA CENA intake call can discuss the specific Quebec resources, Bill 21 framework, and how coordinated care arrangements with Quebec providers fit the patient's situation.
Frequently asked questions
Is psilocybin therapy publicly funded in Quebec? For SAP-approved Quebec patients with eligible indications (typically end-of-life distress), yes — through the Farzin/Stephan RAMQ billing precedent established December 2022. The pathway requires Quebec residency, SAP authorization, and a Quebec-based prescribing physician willing to apply for SAP and bill RAMQ.
Why is Quebec the only province with public funding? The December 2022 Farzin/Stephan billing was the first instance of any province's medicare system processing a psilocybin-assisted therapy claim. RAMQ's subsequent modification of billing codes operationalized the precedent. Other provincial drug plans have not followed; CDA-AMC has not recommended psilocybin reimbursement.
Who is Dr. Houman Farzin? Quebec palliative psychiatrist at the Jewish General Hospital, McGill University. The first Canadian physician to bill RAMQ for SAP-approved psilocybin-assisted therapy. Public advocate and educator for Canadian psilocybin SAP-pathway work.
What does Bill 21 mean for my psilocybin therapy in Quebec? The psychotherapy component of psilocybin-assisted therapy must be delivered by a physician, psychologist, or OPQ psychotherapy permit holder. Unregulated coaches or counsellors cannot deliver the psychotherapy component in Quebec. Most Quebec providers operate within this framework.
Can I do psilocybin therapy in French? Yes — most Quebec psilocybin-pathway clinics offer bilingual or French-default service. Confirm with the clinical team. Bill 96 has implications for healthcare communication that may shape documentation language.
Where can I access psilocybin therapy in Quebec? Drs. Farzin and Stephan (palliative-psychiatry pathway), Jewish General Hospital, Neurotherapy Montreal, P.A.T.H. Therapy Canada (multi-provincial), and other Quebec psychiatrists and palliative-care providers with SAP-pathway experience.
Do I have to be terminally ill to get RAMQ coverage? The established Farzin/Stephan precedent was for end-of-life distress. The RAMQ pathway is most established for this indication. Other indications (TRD, demoralization, AUD) may also be RAMQ-billable under modified codes for SAP-approved patients, but the case-by-case clinical reality varies; confirm with your prescribing physician.
What if I'm not a Quebec resident? The RAMQ pathway requires Quebec residency. Non-Quebec residents pursuing psilocybin SAP face the standard out-of-pocket cost of CAD $2,500–$6,500 (Filament-supplied drug often at no charge). Quebec providers can support out-of-province patients on private-pay basis.
Is the RAMQ pathway capacity-limited? Yes. The number of Quebec physicians applying for psilocybin SAP and billing RAMQ remains small relative to demand. Patients should expect a meaningful search for a willing prescribing physician.
Does ATMA CENA have a Quebec clinic? ATMA CENA's corporate clinics are in Edmonton and Calgary; ATMA CENA's Quebec member clinic is Clinic Dr. Bita in Westmount (Montreal). Confirm specific psilocybin-pathway scope at intake. See Ketamine Therapy in Montreal for ATMA CENA Montreal context.
What about MDMA-assisted therapy in Quebec? MDMA-AT is also SAP-only in Canada; the same January 2022 amendment authorizes physician-initiated MDMA SAP applications. Quebec providers including Drs. Farzin and Stephan have SAP-pathway experience that extends to MDMA-AT for PTSD where applicable.
Can my existing therapist work with me through coordinated care model? If your existing therapist is a Quebec physician, psychologist, or OPQ permit holder under Bill 21, yes — through the coordinated care model. Your existing therapist can remain primary while ATMA CENA's clinical infrastructure provides the broader support frame.
Sources
- ATMA CENA — find care near you: https://psychedelic.healthcare/find-care
- TheraPsil — Quebec first province to cover psilocybin therapy: https://therapsil.ca/quebec-first-province-to-cover-costs-of-psilocybin-assisted-psychotherapy-done-by-two-physicians/
- Quebec Bill 21 (2009, c.28) — psychotherapy as a reserved act: https://www.publicationsduquebec.gouv.qc.ca/fileadmin/Fichiers_client/lois_et_reglements/LoisAnnuelles/en/2009/2009C28A.PDF
- Ordre des psychologues du Québec — psychotherapy permit: https://www.ordrepsy.qc.ca/web/english/who-practices-psychotherapy
- Bill 96 (Charter of the French Language, 2022): https://www.publicationsduquebec.gouv.qc.ca/fileadmin/Fichiers_client/lois_et_reglements/LoisAnnuelles/en/2022/2022C14A.PDF
- Health Canada — SAP psychedelic-assisted psychotherapy: https://www.canada.ca/en/health-canada/services/drugs-health-products/drug-products/announcements/requests-special-access-program-psychedelic-assisted-psychotherapy.html
- Neurotherapy Montreal — Psychedelic-Assisted Psychotherapy: https://neuromtl.com/service/psychedelic-assisted-psychotherapy-pap/
- ATMA CENA — Montreal member clinic (Clinic Dr. Bita): https://psychedelic.healthcare/
Related articles
- Psilocybin Therapy in Canada
- How to Access Psilocybin Therapy in Canada (SAP)
- Health Canada SAP for Psilocybin
- Psilocybin-Assisted Therapy Cost in Canada
- Psilocybin Therapy for End-of-Life Distress
- Is Psilocybin Legal in Canada?
- Ketamine Therapy in Montreal
- Find care near you
Last updated: 2026-05-06