A Nation in Crisis: Canada’s Urgent Need for Psychedelic Policy Reform

Canada is in the throes of a mental healthcare crisis. According to CAMH, 1 in 5 Canadians experience a mental illness every year. By age 40, half of all Canadians will have faced a mental illness diagnosis. Statistics Canada reports that in 2022, more than 5 million Canadians aged 15 and older suffered significant symptoms of mental illness.

These numbers are staggering, and frankly, damaging at a societal level. Mental health challenges cost Canadian society over $50 billion annually. The effects of this crisis are visible everywhere; walk through any downtown core, in any Canadian city, and you’ll see people in psychological distress, losing their battle against substance use disorders —individuals who have literally fallen through the cracks.

The cracks... They are more like canyons. Canadians often wait six months or longer to see a mental healthcare practitioner, who may only have a few rushed minutes for them. Out-of-pocket therapy costs typically run $100 to $300 per session, which is simply unaffordable when combined with skyrocketing living expenses. The result is a mental healthcare system on the verge of collapse—one that leaves individuals, families, and our economy reeling.

Amid this crisis, psychedelics like psilocybin and MDMA have shown remarkable results in clinical trials for depression, PTSD, and end-of-life anxiety. Ibogaine has shown promise in treating even the worst substance use disorders, such as opiate addiction. Yet for the average Canadian seeking relief, the legal pathways to access psychedelic-assisted therapy remain narrow, inconsistent, and grossly inadequate.

Our Only Recourse

Alberta

Alberta has taken a groundbreaking step by becoming the first (and so far only) province in Canada to formally regulate psychedelic-assisted therapy. Under the Mental Health Services Protection Regulation, clinics must be licensed, overseen by a psychiatrist, and follow strict standards for safety and supervision. This move creates a legal framework that legitimizes psychedelic medicine and sets an important precedent.

Yet despite its promise, the policy is far from sufficient. Access is still limited to private clinics, where treatment can cost thousands of dollars per session, putting it out of reach for most Albertans. Meanwhile, no other province has followed suit, leaving the rest of Canada with a patchwork of inconsistent and inadequate access. Alberta’s model is a step forward, but without public funding and nationwide adoption, it remains a symbol of progress rather than a true solution.

Ketamine and Esketamine

Outside of Alberta, ketamine is the only psychedelic-like treatment option Canadians can legally access. Esketamine (Spravato®) is approved by Health Canada for treatment-resistant depression, while generic ketamine is often prescribed off-label in private clinics.

Clinicians are doing meaningful work in provinces like British Columbia, Saskatchewan, Manitoba, and Ontario. However, the clustering of these clinics in urban centres, their sparsity in Atlantic Canada, and their complete absence in PEI, Newfoundland, and the territories reveal a deep geographic inequity of access.

This is compounded by cost: ketamine-assisted psychotherapy can run $1,200+ per session, and requires a commitment of at least six sessions for long-term benefit. For most Canadians, accessing the fastest-acting antidepressant is not a treatment option, rather an unaffordable privilege.

Canada, why is this? We already know esketamine is safe, effective, and regulated. We already have clinicians providing excellent results in private practice. What’s stopping our provincial health ministries from funding public clinics to deliver the same care—at no or low cost—within the healthcare system?

Instead, Canadians choosing this treatment face thousands in out-of-pocket bills, with inconsistent insurance coverage, further widening the gap between need and access. Concerns about misuse of Ketamine are valid, but private clinics already follow strict protocols to screen and monitor patients. There is no reason those same protocols can’t be implemented in public Ketamine Assisted Psychotherapy clinics.

Another potential solution to bridge the gap in access is the creation of government-funded therapy vouchers for Ketamine-Assisted Psychotherapy (KAP). Instead of leaving Canadians to shoulder thousands of dollars in out-of-pocket expenses, these vouchers would subsidize part of the cost (or the full cost), making treatment more affordable and equitable. This approach would not only leverage the existing network of private clinics already delivering safe and effective care, but it would also signal governmental recognition of KAP as a legitimate medical option. Subsidizing access could reduce crisis hospitalizations, keep more people in the workforce, and ultimately save the healthcare system money in the long run. While not a complete solution (since geographic inequities and systemic barriers would still need to be addressed) a voucher program could serve as a pragmatic and immediate step toward broadening access to psychedelic therapies in Canada.

The Special Access Program

Technically, the Special Access Program (SAP) allows physicians to request psychedelics like psilocybin or MDMA for patients with serious conditions where conventional treatments have failed. A regulatory “class exemption” even permits practitioners to handle these substances once approval is granted.

In practice, the SAP is a bureaucratic nightmare. Physicians and other healthcare practitioners are already stretched thin, and piling on stacks of paperwork for uncertain approvals is an almost impossible ask. Very few are willing to take it on.

This leaves patients—often those for whom conventional treatments have failed—facing not only their illness, but also the added burden of surviving the denial of access to potentially life-changing therapies.Even more troubling, approvals are becoming increasingly rare. Advocacy group PsyCan recently reported a sharp decline in Health Canada SAP approvals.

The reality is that programs like SAP, while well-intentioned, collapse under their own inefficiency. Legislative changes without real-world infrastructure are little more than gestures—figments of moral imagination. If there was a genuine will to regulate these medicines effectively and in the public interest, the government would invest in the systems and infrastructure necessary to make access both safe and practical.

Section 56(1) Exemptions

The Minister of Health can grant exemptions under section 56(1) of the Controlled Drugs and Substances Act, allowing individuals or groups to legally use psychedelics if it is deemed “in the public interest.” In theory, this could include researchers, clinicians, first responders, or medical staff.

In practice, only a handful of exemptions have been granted. To meet the real demand in a nation facing a mental health crisis, thousands more exemptions would need to be issued, across hundreds of practitioners. Instead, the tool is used sparingly, rendering it symbolic rather than transformative.

Policy Paralysis

At this point, the Canadian government is willfully allowing its most vulnerable citizens to remain suffering. Prohibitionist policies are propping up a broken status quo, even while science points to better options. Anxiety and depression have become the “common cold” of mental health—persistent, debilitating, and often poorly treated by existing medications. Millions cycle through SSRIs and other drugs with limited or no relief. Resources keep being poured into an outdated standard of care, leaving both patients and practitioners overwhelmed. Meanwhile, psychedelics are proving to be safe and effective alternatives. And yet, Canada’s legislative system hasn’t caught up with the urgency of the crisis or the abundance of evidence in front of us.

A Call for Courage

The current rules of the game, damaging as they are, must still be followed. Statutes haven’t changed, and for now they continue to create roadblocks for Canadians seeking access to psychedelic medicines. That’s why the work of activists and advocates remains so critical. Changing public discourse (and, in turn, public policy) around the safety and efficacy of these medicines has proven to be a slow, uphill process in Canada.

The casualties of the War on Drugs are not abstract—they are everyday Canadians unnecessarily suffering.

Part of effective activism, however, lies in using the narrow legal pathways that already exist. More applications for Section 56(1) exemptions and SAP approvals must be submitted if the federal government is to take notice. Provincially, louder advocacy is needed from practitioners, patients, and other stakeholders to push for meaningful reform.

We are at a crossroads. Canada can continue clinging to outdated policies, leaving millions to languish, or it can act boldly. That means:

• Funding public access to ketamine and esketamine treatment.

• Streamlining the Special Access Program to work for busy physicians and patients.

• Investing in psychedelic healthcare infrastructure and training for practitioners in all psychedelic-assisted therapy modalities.

• Expanding Section 56 exemptions so qualified practitioners can meet demand.

• Integrating psychedelic-assisted therapy into the public healthcare system nationwide.

  
  

Canada’s mental health crisis is real, urgent, and devastating. Psychedelics are no silver bullet, but they are powerful tools that could afford millions of Canadians respite.

It’s time to put an end to psychedelic policy paralysis—because the cost of inaction is measured in lives lost and suffering.