The Psychedelic-Assisted Therapy Pathway in Canada — From First Call to Long-Term Integration

Psychedelic-assisted therapy (PAT) in Canada is a clinical pathway, not a single appointment. From the first information call to the final integration session — and often longer — a competent PAT pathway is a sequence of structured clinical contacts that together make up the therapy. The medication is one component. Most of the work happens before and after the dosing. This article is the end-to-end Canadian guide to that pathway: what each step is, why it exists, how it varies by substance (ketamine off-label, Spravato, psilocybin under Health Canada's Special Access Program, MDMA-AT under SAP), and how ATMA CENA's three-phase model and the coordinated care overlay onto an existing therapeutic relationship operationalize it.

Key takeaways

• PAT is a pathway, not a procedure. A typical Canadian PAT course at a reputable program runs 6–18 weeks of clinical contact across preparation, dosing, and integration — for ketamine, Spravato, SAP psilocybin or SAP MDMA-AT.
• Three phases, equal weight. ATMA CENA's three-phase model — preparation, dosing, integration — treats each phase as clinical work in its own right. The dosing session is one event in that pathway; it is not the therapy.
• Substance-specific calibration. Ketamine and Spravato run on Health Canada-cleared infrastructure (with off-label psychiatric use for ketamine). Psilocybin and MDMA are accessed only through Health Canada's Special Access Program. The pathway adapts at every step.
• Preparation and integration are non-optional. Across every published RCT protocol that produced the modern evidence base — Mitchell 2021/2023 MAPP1/MAPP2 for MDMA-AT (PMID 33972795, 37709999), Goodwin 2022 COMP001 for psilocybin (PMID 36322843), Cohen 2018 for ketamine — preparation and integration are the bookends that make the dosing session therapeutic.
• The coordinated care model lets the pathway layer onto an existing therapeutic relationship rather than displacing it.
• No outcome promises. PAT outcomes are individualized. The pathway exists to support safety and the quality of the clinical process. It does not predict who will respond.

How to read this article

The article is organized as the pathway itself unfolds — chronologically, from the first phone call through long-term aftercare. Each step is summarized here, then deep-linked to the matching guide:

If your existing therapist or psychiatrist is part of the picture, the coordinated care overlay sits across the whole pathway and is described in its own section toward the end of this article.

Compliance and substance framing

Two pieces of language run through everything that follows. Both are stated plainly, in line with Health Canada's regulatory posture in 2026:

Ketamine is approved by Health Canada as an anaesthetic. Use for PTSD, depression, anxiety, and chronic pain is off-label.

Psilocybin and MDMA are accessed only through Health Canada's Special Access Program.

That distinction shapes the pathway at almost every step — what gets paid for, who can prescribe, what facility infrastructure is required, and how each substance fits into a Canadian patient's options. The article will return to it under each step where it matters.

Step 1 — First contact: the information call

Step 2 — Comprehensive intake and clinic vetting

After the information call, two things happen in parallel: a comprehensive medical and psychiatric intake by the clinic, and vetting of the clinic by the patient.

The intake covers medical history (cardiovascular, endocrine, neurological, hepatic), current medications and supplements, allergies, substance-use history, prior psychiatric history (with particular attention to personal or family history of psychotic-spectrum illness for psilocybin and MDMA pathways), prior treatment trials, current symptom severity with validated instruments (PHQ-9, GAD-7, PCL-5 as relevant), and treatment goals. For ketamine and Spravato pathways, baseline blood pressure and focused cardiovascular review are routine. The intake decides whether PAT is appropriate at all, which substance fits, and whether physician-supervised medication taper planning (Step 4) is needed.

The patient's vetting questions distinguish a coherent program from a substance-only operation: prescribing-physician registration; training and registration of the preparation and integration clinicians; protocol structure in sessions and hours; the substance-specific protocol and the published evidence it draws from; facility accreditation (CPSO OHPIP in Ontario, CPSA NHSF in Alberta, CPSBC NHMSFAP in BC, CPSS in Saskatchewan, CPSM NHMSFAP in Manitoba for IV ketamine); monitoring and emergency protocols; and how difficult experiences and adverse events are handled. The full vetting framework is in How to vet a Canadian psychedelic-therapy clinic.

Step 3 — SAP application (where applicable)

If the substance is ketamine or Spravato, the pathway skips this step. Ketamine is a Health Canada-approved anaesthetic used off-label for psychiatric indications; Spravato (esketamine intranasal) is Health Canada-approved for treatment-resistant depression since May 2020 and accessed through Janssen's controlled-distribution Janssen Journey program (DIN 02499290).

If the substance is psilocybin or MDMA, the pathway includes a Health Canada Special Access Program (SAP) application. Following the January 5, 2022 amendment to the Food and Drug Regulations, Health Canada formally restored practitioner access to restricted drugs (including psilocybin and MDMA) through the SAP for psychedelic-assisted psychotherapy, case-by-case. The application is physician-led — patients cannot apply directly. A licensed Canadian physician submits via Health Canada's SAP portal with a clinical justification documenting the patient's serious or life-threatening condition, the conventional treatments that have failed or are unsuitable, and the evidence base supporting the requested drug.

Indications most-approved in practice: end-of-life psychological distress (psilocybin), treatment-resistant depression (psilocybin), and PTSD (MDMA, case-by-case). Review timelines run from a few days for end-of-life cases to several weeks for non-end-of-life indications. Filament Health has supplied SAP-approved psilocybin to many Canadian patients; TheraPsil runs a clinician network and referral pathway that has supported a substantial fraction of approved SAP psilocybin cases. Approval is not coverage — SAP authorization grants legal access; the drug and clinical hours are billed separately, with one notable Quebec public-funding precedent (Farzin/Stephan December 2022) for SAP psilocybin under RAMQ. The full process is in the SAP application complete guide.

Step 4 — Antidepressant tapering (where indicated)

Many patients arrive at PAT already on an antidepressant, often for years. Whether and how it is tapered depends on the substance:

• MDMA-AT (SAP). SSRIs and SNRIs are tapered before dosing — they materially reduce subjective effect and carry a modest serotonin-syndrome risk. MAOIs are an absolute contraindication. Physician-supervised tapers require lead time, which is one reason MDMA-AT preparation runs longer in the Mitchell 2021/2023 MAPP1/MAPP2 protocols.
• Psilocybin (SAP). SSRIs and SNRIs are typically tapered before high-dose psilocybin; the COMPASS COMP001/005/006 program required washout. Lithium carries seizure risk in psilocybin co-administration and is contraindicated in most protocols.
• Ketamine and Spravato. Most psychiatric medications can continue concurrently. Benzodiazepines may blunt subjective and antidepressant effect and are sometimes held the day of dosing.

The prescribing physician makes the taper decision, not the patient. Self-tapering antidepressants is unsafe, especially for SNRIs. The full taper deep-dive is in Antidepressant tapering for psychedelic therapy.

Step 5 — Preparation phase

Preparation is the structured clinical work before the first dosing session. It is not waiting-room time before the medicine. At ATMA CENA it includes: contraindication screening; informed-consent conversation; trauma-informed psychoeducation about the specific substance, dose, and likely subjective effects; intention-setting; anchor-and-grounding skills practice (paced breathing, body scans, orienting techniques) so the patient enters the dosing session with the skills already in their nervous system rather than only in their head; deliberate construction of set and setting (Step 6); and therapeutic-alliance building with the team that will be present in the dosing room.

Length varies by substance — typically 1–3 sessions for routine ketamine onboarding, 2–4 sessions for SAP-pathway psilocybin (mirroring Goodwin 2022 COMP001), and three structured sessions for SAP MDMA-AT (mirroring Mitchell 2021/2023 MAPP1/MAPP2). In MAPP1 and MAPP2, three preparatory sessions and nine integrative sessions wrap around three dosing sessions over ~18 weeks — dosing is three of fifteen total clinical contacts. The deep-dive on what each component accomplishes is in The preparation phase of psychedelic-assisted therapy.

Step 6 — Set and setting

Set and setting are not lighting-and-music aesthetics. They are clinical variables. Set is the patient's mindset, expectations, intentions, and current state walking into the dosing session. Setting is the physical and relational environment — the room, the team, the music, the recline option, the eyeshades, the surrounding clinical infrastructure. The framework, originally articulated by Leary, Litwin and Metzner in 1963 and re-formalized in Hartogsohn's 2017 history of the concept, is one of the best-evidenced predictors of psychedelic experience quality, and it is what preparation has been building.

A reputable program treats set and setting as deliberately constructed: the room (low-stimulation, comfortable, private); team configuration (lead and co-therapist for psilocybin and MDMA-AT per the published protocols); music programming (Step 9); the patient's own preparation in the days before (sleep, nutrition, transport-home logistics); and the team's interpersonal posture during the session itself. The deep-dive, including a clinic-evaluation checklist, is in Set and setting in psychedelic therapy.

Step 7 — Dosing protocols by substance

The dosing session is one event in the pathway, but the protocol differs substantially by substance:

• Ketamine IV (off-label psychiatric): ~0.5 mg/kg over 40 min (Berman 1999, Zarate 2006); 0.5–1.0 mg/kg in chronic-pain protocols per the Cohen 2018 ASRA/AAPM/ASA consensus (PMID 29870458); ~40–60 min experience window.
• Ketamine IM: ~0.5–1.0 mg/kg, 30–45 min window.
• Ketamine sublingual: 150–300 mg lozenge, 60–90 min window, less standardized than IV/IM.
• Spravato (esketamine intranasal, Health Canada-approved for TRD): 56 or 84 mg via single-use devices (28 mg per device); induction twice weekly × 4 weeks; maintenance once weekly weeks 5–8, then every 1–2 weeks per the product monograph.
• Psilocybin (SAP, investigational): 25 mg single dose in Goodwin 2022 COMP001 (PMID 36322843); 6–8 h window.
• MDMA-AT (SAP, investigational): 80–120 mg initial + 40–60 mg supplemental ~90 min later per Mitchell 2021/2023 MAPP1/MAPP2 (PMID 33972795, 37709999); 6–8 h window; three dosing sessions over ~12+ weeks.

More is not better — set, setting, and surrounding clinical work modulate effect substantially; dose-response curves are not linear into higher doses. Dosing decisions are clinical decisions made by the prescribing physician, not protocol look-ups. The full deep-dive is in Dosing protocols across substances.

Step 8 — What to expect in the first dosing session

The first dosing session is the part most patients spend the most time picturing in advance and the part that is most useful to demystify. Across substances, the practical structure has the same shape, even if the substance-specific phenomenology differs.

The patient arrives early, typically two hours before the medication is administered. The team takes baseline vitals, reviews intentions, and confirms readiness. Set and setting — room, music, eyeshades, recline option, team — are confirmed. The medication is administered. The patient is monitored continuously for the experience window, with the team present, conversation usually minimal, music programmed in advance, and clear signals for "I need something" worked out in preparation. After the experience window closes, the team supports re-orientation, confirms transport home with a support person, and books the first integration session — typically within 24–48 hours, while material is freshest.

Patients commonly underestimate three things: how long the day really is (often 5–8 hours of clinic time door-to-door, even for shorter ketamine sessions); how disoriented they will be afterward (driving is forbidden, a support person is required); and how non-verbal large parts of the experience are. The substance-specific walkthrough is in What to expect at your first psychedelic-assisted therapy session.

Step 9 — Music in the dosing session

Music is the one element of the dosing room that does most of its work invisibly. Kaelen's 2018 study "The hidden therapist" (Psychopharmacology 235:505–519, PMID 29396616) interviewed 19 patients receiving psilocybin for treatment-resistant depression and identified music as a central source of guidance, emotional intensification, and "carrying" through difficult passages. Music in PAT is programmed in advance, calibrated to the substance and dose, sequenced to track the arc of the experience window (induction, peak, descent, return), and chosen with attention to lyrical content (typically minimal or absent) and the patient's own preferences worked out in preparation. A reputable program lets the patient hear the music in preparation and adjust before the dosing day. The deep-dive is in Music in psychedelic-assisted therapy.

Step 10 — Difficult experiences and how they are held

Difficult passages — sometimes called "challenging experiences" — are a normal part of the psychedelic experience window, particularly with high-dose psilocybin, MDMA-AT, and at the higher end of ketamine dosing. They are not a treatment failure. The Carbonaro 2016 survey of 1,993 individuals (Journal of Psychopharmacology 30(12):1268–1278, PMID 27578767) found that 39% rated their most challenging psilocybin experience among the top five most psychologically challenging of their lifetime — and 84% endorsed benefiting from it. Difficult does not mean harmful; difficult can be where the therapy happens.

The clinical question is not how to prevent difficulty but how the environment is organized to hold it safely. A reputable program names difficult experiences explicitly in preparation, trains the team in non-directive support, has clear medical-emergency protocols (cardiovascular events for ketamine; serotonin-syndrome signs for MDMA), books integration within 24–48 hours so difficulty does not metabolize alone, and uses validated instruments (e.g., the Challenging Experience Questionnaire) to document and learn from what happened. The full framework is in Difficult experiences in psychedelic therapy.

Step 11 — Integration phase

Many clinicians working in PAT will say plainly that integration is where the therapy actually happens. The dosing session opens material; integration is what converts that material into durable change. The structure across the modern evidence base is consistent: a first integration session within 24–48 hours of dosing, then weekly sessions for 2–6 weeks (sometimes longer). MAPP1 and MAPP2 included nine integration sessions per course of MDMA-AT. COMP001 included structured integration weeks around the single 25 mg dose. KAP integration tends to be shorter and more supplementary, but the principle is the same.

Integration is structured clinical work: sense-making, translation of insights into behaviour change, work with difficult or somatic material from dosing, support-network building, symptom tracking with validated instruments, relapse-prevention work where applicable, and — under coordinated care — coordinated handback to an existing therapist. Approaches drawn on include the Watts and Luoma 2020 Accept-Connect-Embody (ACE) model derived from Acceptance and Commitment Therapy, psychodynamic work, Internal Family Systems, somatic experiencing, and group integration (the Roots to Thrive RTT-KaT community-of-practice model published by Dames et al. 2025 in Frontiers in Psychiatry, PMID 41058650, is one Canadian example). The deep-dive is in The integration phase of psychedelic-assisted therapy.

Step 12 — Combining modalities

PAT does not operate in a vacuum. Most patients who reach a Canadian PAT pathway have already tried, are currently in, or will subsequently engage with other treatments — antidepressant pharmacotherapy, psychotherapy in one or more modalities (ACT, CBT, IFS, EMDR, somatic), TMS, group treatment, lifestyle and movement interventions. The combinations that come up most often: ongoing SSRI/SNRI alongside ketamine or Spravato (generally compatible); SSRI/SNRI taper in advance of MDMA-AT or psilocybin (Step 4); EMDR or IFS as the integration modality after MDMA-AT for PTSD; the Watts-Luoma ACE model as a structured integration scaffolding; rTMS as an alternative or complement for TRD; and coordinated care with an existing therapist (below). The full combination map is in Combining psychedelic therapy with other modalities.

Step 13 — Boosters and maintenance

The formal three phases end. The patient's life does not. Across substances:

• Spravato. Health Canada labelling supports continued maintenance dosing — once weekly for weeks 5–8, then every 1–2 weeks — for patients with TRD who respond to induction.
• Ketamine (off-label). IV/IM/SL boosters are used for selected patients on individualized schedules; there is no single Health Canada-cleared maintenance protocol.
• Psilocybin (SAP) and MDMA-AT (SAP). Re-treatment requires a fresh SAP application and clinical justification. Re-treatment is not routine; the published trials largely tested single-course or small-fixed-number protocols.
• Long-arc integration through coordinated care. Where an existing therapist is part of the picture, integration continues through that ongoing relationship.

The deep-dive on response durability per substance and the decision points for maintenance is in Booster and maintenance sessions.

The ATMA CENA three-phase model — the structural frame

Across all 13 steps above, ATMA CENA operates a three-phase model: preparation, dosing, integration. Each phase is treated as clinical work in its own right, not as scaffolding around a single medication event. Psychotherapy is the through-line across the whole pathway. The team a patient meets in preparation is, by default, the team in the dosing room and through integration. Phase counts and durations vary by substance — ketamine, Spravato, psilocybin SAP, and MDMA-AT each have their own structure within the same overall frame. Aftercare and maintenance are built in; the model does not end at the last formal integration session. The model overview — including how it differs from infusion-only ketamine clinics and Spravato programs that treat the Health Canada label minimum as the ceiling rather than the floor — is in The ATMA CENA three-phase model.

Substance-specific pathway differences at a glance

The pathway frame is constant. The shape inside the frame is not. A side-by-side summary:

For the cluster-level coverage detail across these pathways, see the insurance coverage hub.

The coordinated care overlay — when an existing therapist is part of the picture

For many Canadian patients, the most important therapeutic relationship is one that already exists — a long-term psychotherapist, a psychiatrist, a family physician they trust. The ATMA CENA coordinated care model is designed so the three-phase pathway can layer on top of that existing relationship rather than displacing it. The existing therapist remains primary. ATMA CENA provides the substance-specific preparation, dosing, and post-dosing integration. Material from dosing is brought back into the ongoing therapy, where the long-arc relationship continues integration well beyond the formal post-dosing window. Coordinated care both leverages an established alliance and extends integration's reach. It is one of the principal ways the pathway differs in practice from a substance-only operation. The full description of how coordinated care works — referrals, communication, scope, handoff, and what a partnering therapist can expect — is in the coordinated care overview.

Honest framing: preparation and integration are foundational, not optional

It is worth saying this directly, because the public narrative around PAT often does not. Preparation and integration are not added extras around the dosing session; they are where the therapy happens. Across every published RCT protocol that produced the modern evidence base for PAT — MAPP1 and MAPP2 for MDMA-AT, COMP001 for psilocybin, and the broader KAP literature — preparation and integration are built into the design at substantial scope. Removing either weakens the rest of the pathway. There is no version of credible PAT that is "just the dosing".

Programs offering low-cost dosing without commensurate preparation and integration should be vetted with skepticism. Patients evaluating PAT should plan their time, money, and energy around the whole pathway, not just the dosing booking. Patient under-investment in preparation and integration is one of the more common reasons single-dose effects plateau or diminish. The ATMA CENA three-phase model and the coordinated care overlay are the operationalization of the design principle that the substance is the catalyst and the therapy — preparation through integration — is the work.

Frequently asked questions

How long does a full psychedelic-assisted therapy pathway take?

A typical Canadian PAT course runs roughly 6–18 weeks of clinical contact across preparation, dosing, and integration. Ketamine pathways tend toward the shorter end of that range; SAP psilocybin and MDMA-AT toward the longer end, with the MAPP1/MAPP2 protocol structuring 18 weeks of contact for MDMA-AT.

How many dosing sessions are typical?

It depends on the substance. KAP induction courses typically include 4–6 dosing sessions; Spravato per Health Canada labelling has 8 induction sessions plus maintenance; COMP001-style psilocybin used a single dose; the MAPP1/MAPP2 MDMA-AT protocol used three dosing sessions over ~12+ weeks. Re-treatment for SAP psilocybin or MDMA-AT requires a fresh SAP application.

Do I have to stop my antidepressants?

Only sometimes, and only with physician supervision. Most psychiatric medications can continue concurrently with ketamine and Spravato. SSRIs and SNRIs are typically tapered before MDMA-AT and high-dose psilocybin per the published trial protocols. Lithium is contraindicated with psilocybin in most protocols; MAOIs are an absolute contraindication to MDMA. Self-tapering is unsafe.

Can I drive home after a dosing session?

No. Driving after a dosing session is not allowed. A support person is required for transport home, and patients should plan for the day off work afterward.

What if I have a difficult experience during dosing?

Difficult experiences are a normal part of the psychedelic experience window and not a treatment failure. The Carbonaro 2016 survey found that 39% of respondents rated their most challenging psilocybin experience among the top five most psychologically challenging of their lifetime, and 84% endorsed benefiting from it. The clinical question is how the environment is organized to hold difficulty safely — through preparation, non-directive team support, clear emergency protocols, and integration scheduled within 24–48 hours.

Can I keep my existing therapist?

Yes, and in many cases that is the better arrangement. The coordinated care model is built so the three-phase pathway can layer on top of an existing therapeutic relationship. The existing therapist remains primary; ATMA CENA provides substance-specific preparation, dosing, and post-dosing integration; material from dosing is brought back into the ongoing therapy. See find care near you for more detail.

What's the difference between ketamine and Spravato in the pathway?

Ketamine is approved by Health Canada as an anaesthetic; psychiatric use is off-label. Spravato (esketamine intranasal) is Health Canada-approved for treatment-resistant depression (May 2020) and accessed through Janssen's Janssen Journey program. Spravato has the most established private prior-auth coverage; off-label ketamine has narrower private coverage but established workers' compensation and VAC pathways.

Is psilocybin or MDMA legal in Canada in 2026?

Both remain controlled substances. Psilocybin is Schedule III under the Controlled Drugs and Substances Act; MDMA is Schedule I. Neither is approved as a therapeutic product. Legal access for psychedelic-assisted psychotherapy is via Health Canada's Special Access Program, restored for restricted drugs by the January 5, 2022 amendment. Applications are physician-led and decided case-by-case.

Will my insurance cover any of this?

Coverage is fragmented. Spravato has the most established private prior-auth pathways with documented TRD. Off-label ketamine has narrower private coverage, established WSIB/WCB pathways, and VAC coverage for service-related conditions. SAP psilocybin and MDMA-AT are largely uncovered, with one Quebec RAMQ public-funding precedent for SAP psilocybin. See Insurance Coverage for Psychedelic-Assisted Therapy in Canada for detail.

How do I know if a Canadian psychedelic clinic is reputable?

Vetting questions include facility accreditation (CPSO OHPIP for Ontario IV ketamine, CPSA NHSF for Alberta, CPSBC NHMSFAP for BC, CPSS for Saskatchewan, CPSM NHMSFAP for Manitoba); the prescribing physician's registration; the training of preparation/integration clinicians; the program's protocols in sessions and hours; monitoring and emergency protocols; and how difficult experiences are handled. The full vetting framework is in How to vet a Canadian psychedelic-therapy clinic.

Is PAT a cure? Who shouldn't pursue it?

PAT outcomes are individualized; the published evidence shows responders, partial responders, and non-responders. The pathway supports safety and the quality of the clinical process; it does not predict response, and a good clinical team will not promise outcomes. PAT is not appropriate for everyone — common contraindications include personal or family history of psychotic-spectrum illness (particularly for psilocybin and MDMA), uncontrolled cardiovascular disease (particularly for ketamine, Spravato, and MDMA), pregnancy, and specific medication interactions (MAOIs absolute for MDMA; lithium for psilocybin). Comprehensive intake is the screen that decides whether PAT is appropriate at all.

Medical reviewer

Sources

Peer-reviewed clinical-trial protocols and consensus

1. Mitchell I, Bogenschutz M, Lilienstein A, et al. MDMA-assisted therapy for severe PTSD: a randomized, double-blind, placebo-controlled phase 3 study. Nature Medicine. 2021;27:1025–1033. PMID 33972795. https://pubmed.ncbi.nlm.nih.gov/33972795/
2. Mitchell JM, Ot'alora G M, van der Kolk B, et al. MDMA-assisted therapy for moderate to severe PTSD: a randomized, placebo-controlled phase 3 trial. Nature Medicine. 2023;29:2473–2480. PMID 37709999. https://pubmed.ncbi.nlm.nih.gov/37709999/
3. Goodwin GM, Aaronson ST, Alvarez O, et al. Single-dose psilocybin for a treatment-resistant episode of major depression. NEJM. 2022;387:1637–1648. PMID 36322843. https://pubmed.ncbi.nlm.nih.gov/36322843/
4. Cohen SP, Bhatia A, Buvanendran A, et al. Consensus guidelines on the use of intravenous ketamine infusions for chronic pain from ASRA, AAPM and ASA. Regional Anesthesia & Pain Medicine. 2018;43(5):521–546. PMID 29870458. https://pubmed.ncbi.nlm.nih.gov/29870458/
5. Schwenk ES, Viscusi ER, Buvanendran A, et al. Consensus guidelines on the use of intravenous ketamine infusions for acute pain management. Regional Anesthesia & Pain Medicine. 2018;43(5):456–466. PMID 29870457. https://pubmed.ncbi.nlm.nih.gov/29870457/

Mechanism, set-and-setting, and integration scholarship

6. Hartogsohn I. Constructing drug effects: A history of set and setting. Drug Science, Policy and Law. 2017;3:1–17. doi:10.1177/2050324516683325. https://journals.sagepub.com/doi/10.1177/2050324516683325
7. Kaelen M, Giribaldi B, Raine J, et al. The hidden therapist: evidence for a central role of music in psychedelic therapy. Psychopharmacology. 2018;235(2):505–519. PMID 29396616. https://pubmed.ncbi.nlm.nih.gov/29396616/
8. Carbonaro TM, Bradstreet MP, Barrett FS, et al. Survey study of challenging experiences after ingesting psilocybin mushrooms: acute and enduring positive and negative consequences. Journal of Psychopharmacology. 2016;30(12):1268–1278. PMID 27578767. https://pubmed.ncbi.nlm.nih.gov/27578767/
9. Watts R, Luoma JB. The use of the psychological flexibility model to support psychedelic-assisted therapy. Journal of Contextual Behavioral Science. 2020;15:92–102. https://www.sciencedirect.com/science/article/abs/pii/S2212144719301140
10. Dames S, Kryskow P, Tsang VWL, Argento E. A clinical protocol for group-based ketamine-assisted therapy in a community of practice: the Roots To Thrive model. Frontiers in Psychiatry. 2025. PMID 41058650. https://pubmed.ncbi.nlm.nih.gov/41058650/

Health Canada and federal regulatory primary sources

11. Health Canada — Notice to stakeholders: Requests to the Special Access Program (SAP) involving psychedelic-assisted psychotherapy. Canada.ca. https://www.canada.ca/en/health-canada/services/drugs-health-products/drug-products/announcements/requests-special-access-program-psychedelic-assisted-psychotherapy.html
12. Health Canada — Drug Product Database listing for SPRAVATO® (esketamine nasal spray). DIN 02499290. https://health-products.canada.ca/dpd-bdpp/info?lang=eng&code=98903
13. SPRAVATO® (esketamine nasal spray) Canadian Product Monograph. Janssen Inc. https://pdf.hres.ca/dpd_pm/00076912.PDF
14. Regulations Amending Certain Regulations Relating to Restricted Drugs (Special Access Program). Published January 5, 2022; in force same date. (Documented in source 11 above.)

Canadian SAP supply and clinical infrastructure

15. Filament Health — Drug Access page. Licensed Canadian psilocybin producer; SAP supply. https://www.filament.health/drug-access
16. TheraPsil — therapsil.ca. Canadian non-profit; clinician network; SAP psilocybin program. https://therapsil.ca/sap-psilocybin/
17. Lykos Therapeutics (formerly MAPS PBC) — lykospbc.com. MDMA-AT sponsor. https://lykospbc.com/

Provincial regulators — IV ketamine accreditation

18. CPSO Out-of-Hospital Premises Inspection Program (OHPIP). Ontario. https://www.cpso.on.ca/physicians/your-practice/accreditation-programs/out-of-hospital-premises-inspection-program
19. CPSA Non-Hospital Surgical Facilities (NHSF) Program. Alberta. https://cpsa.ca/facilities-clinics/accreditation/non-hospital-surgical-facilities/
20. CPSBC Non-Hospital Medical and Surgical Facilities Accreditation Program (NHMSFAP). British Columbia. https://www.cpsbc.ca/accredited-facilities/nhmsfap
21. CPSS Non-Hospital Treatment Facilities Program. Saskatchewan. https://www.cps.sk.ca/imis/CPSS/Programs_and_Services/Non-Hospital_Treatmeant_Facilities.aspx?NonHospitalCCO=Non-Hospital+Treatment+Facilities
22. CPSM Non-Hospital Medical and Surgical Facilities Accreditation Program (NHMSFAP). Manitoba. https://www.cpsm.mb.ca/accredited-programs/non-hospital-medical-and-surgical-facilities-accreditation-program
23. CPSM — Intravenous Ketamine Administration notice. Manitoba. https://www.cpsm.mb.ca/news/intravenous-ketamine-administration

ATMA CENA cluster cross-references (internal canonical)

24. ATMA CENA — The ATMA CENA three-phase model. https://psychedelic.healthcare/atma-three-phase-model/
25. ATMA CENA — Preparation phase of psychedelic-assisted therapy. https://psychedelic.healthcare/preparation-phase-psychedelic-therapy/
26. ATMA CENA — Integration phase of psychedelic-assisted therapy. https://psychedelic.healthcare/integration-phase-psychedelic-therapy/
27. ATMA CENA — SAP application process complete guide. https://psychedelic.healthcare/sap-application-process-complete-guide/
28. ATMA CENA — Insurance coverage hub. https://psychedelic.healthcare/insurance-coverage-psychedelic-assisted-therapy-canada/

Related articles

Cross-cluster guides

• Conditions covered by psychedelic-assisted therapy in Canada
• Populations guide — veterans, first responders, healthcare workers, and other populations
• Coordinated care — ATMA CENA's overlay onto an existing therapeutic relationship
• Insurance coverage for psychedelic-assisted therapy in Canada

Substance guides

• Ketamine-assisted therapy in Canada
• Spravato (intranasal esketamine) in Canada
• Psilocybin-assisted therapy in Canada (SAP)
• MDMA-assisted therapy in Canada (SAP)

Pathway guides

• How to vet a Canadian psychedelic-therapy clinic
• Health Canada SAP application process — complete guide
• Antidepressant tapering for psychedelic therapy
• The preparation phase of psychedelic-assisted therapy
• Set and setting in psychedelic therapy
• Dosing protocols across substances
• What to expect at your first session
• Music in psychedelic-assisted therapy
• Difficult experiences in psychedelic therapy
• The integration phase of psychedelic-assisted therapy
• Combining psychedelic therapy with other modalities
• Booster and maintenance sessions in psychedelic-assisted therapy
• The ATMA CENA three-phase model