Psychedelic Therapy for Addiction and Substance Use Disorders in Canada

Psilocybin-assisted therapy reduced heavy-drinking days by 13.86 percentage points in a 2022 phase 2 RCT (n=93), and ketamine shows an early signal for alcohol and cocaine use disorders. No psychedelic is Health Canada-approved for addiction. This guide explains what the evidence does and does not say, and who may be a candidate in Canada.

Medically reviewed by Jacque Lovely, RN, MN, MBA, PMP, Reg #74334 on 2026-05-27.

Key takeaways

• Substance use disorders (SUDs) affect roughly 1 in 5 Canadians in their lifetime [Statistics Canada CCHS].
• Standard-of-care addiction treatment is foundational and must not be interrupted: opioid agonist therapy (OAT) for OUD, naltrexone or acamprosate for AUD, varenicline for tobacco, and CBT or contingency management across all SUDs.
• Psilocybin has the strongest published SUD evidence: Bogenschutz et al. 2022 JAMA Psychiatry phase 2 RCT (n=93) showed a 13.86 percentage-point reduction in heavy-drinking days at 32 weeks [Bogenschutz 2022].
• Psilocybin for SUD is investigational: legal access in Canada requires Health Canada approval on a case-by-case basis, initiated by a physician, and that approval is granted primarily for treatment-resistant depression or distress associated with a life-threatening illness. Approval for an alcohol use disorder indication cannot be assumed.
• Ketamine carries its own paradox: early evidence supports its use for AUD and cocaine use disorder [Dakwar 2019; Dakwar 2020], but ketamine itself has misuse potential, and active or unstable SUD is a contraindication that typically requires stabilization before any ketamine course can proceed.
• No psychedelic-assisted therapy is approved by Health Canada for any SUD indication.
• Psychedelic-assisted therapy does not replace OAT for OUD. Patients must not interrupt methadone or buprenorphine/naloxone without close coordination with their OAT prescriber.

If you have a substance use disorder and are exploring whether psychedelic-assisted therapy might fit your situation, book a free 15-minute information call with ATMA CENA's clinical team. The call is educational, not a commitment.

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What is a substance use disorder?

Substance use disorder (SUD) is a DSM-5 diagnosis applied when the pattern of substance use causes clinically significant impairment or distress. Severity is rated by the number of diagnostic criteria met: mild (2 to 3 criteria), moderate (4 to 5 criteria), or severe (6 or more criteria). Specific diagnoses include alcohol use disorder (AUD), opioid use disorder (OUD), cocaine use disorder, tobacco use disorder, cannabis use disorder, stimulant use disorder, and hallucinogen use disorder, among others.

Canada is in an ongoing opioid-toxicity crisis. The Public Health Agency of Canada reports that opioid-related deaths have exceeded 40,000 since 2016, with the crisis driven primarily by illicitly manufactured fentanyl and its analogues [PHAC 2024]. Standard-of-care treatments are evidence-based, provincially funded in most cases, and save lives. For OUD specifically, opioid agonist therapy with methadone or buprenorphine/naloxone is first-line and foundational. Psychedelic-assisted therapy is an emerging adjunct being studied as a complement to, not a replacement for, these treatments.

Watch out: Patients with hallucinogen use disorder, meaning a problematic relationship with psychedelic substances themselves, require specialized assessment before being considered for any psychedelic-assisted therapy. Hallucinogen use disorder is a recognized DSM-5 diagnosis and is part of ATMA CENA's intake screening.

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The central paradox: who this does and does not serve

The most important thing to understand about psychedelic therapy for addiction is that it comes with structural tensions that honest clinicians acknowledge up front.

The psilocybin paradox. The strongest published evidence for psilocybin in SUD is in alcohol use disorder [Bogenschutz 2022]. However, legal access to psilocybin in Canada requires Health Canada approval on a case-by-case basis, initiated by a physician. That approval is granted primarily for adults with treatment-resistant MDD or distress associated with a life-threatening illness. An AUD indication would require a separate, case-by-case application and would sit outside those primary uses, meaning approval is not routine and cannot be assumed. A patient with AUD as a primary diagnosis, without comorbid TRD or life-threatening illness, faces a genuinely uncertain access pathway.

The ketamine paradox. Ketamine shows early evidence for AUD and cocaine use disorder [Dakwar 2019; Dakwar 2020], and is more accessible as an off-label psychiatric medication. But ketamine itself carries misuse potential, particularly in patients with existing stimulant or dissociative drug use histories. And the standard contraindication framework requires that active or unstable SUD be stabilized before a ketamine course can proceed. A patient whose AUD or cocaine use is currently active or medically unstable is not a typical candidate for ketamine-assisted psychotherapy until stabilization has occurred. This is not a barrier invented by individual clinicians; it reflects the fact that ketamine interacts with existing tolerance, withdrawal risk, and medical safety, and that the psychotherapy frame that makes ketamine more than an infusion depends on a patient who can meaningfully engage with it.

This does not mean psychedelic-assisted therapy is unavailable to people with SUDs. It means the pathway requires careful clinical assessment, honest conversations about access, and usually coordination with a patient's existing addiction medicine team.

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Psilocybin for alcohol use disorder: what the evidence shows

Of all the psychedelic-SUD research published to date, psilocybin for alcohol use disorder has the strongest clinical trial evidence base.

Bogenschutz et al. 2022 (JAMA Psychiatry, PMID 36001306) is the pivotal study. This was a double-blind phase 2 RCT (n=93) comparing psilocybin-assisted therapy against a diphenhydramine active placebo, both combined with psychotherapy. At 32 weeks, the psilocybin group showed 9.71% heavy-drinking days versus 23.57% in the placebo group, a difference of 13.86 percentage points (95% CI 3.00 to 24.72; P=.01) [Bogenschutz 2022]. This is a significant but partial effect: it represents a meaningful reduction in heavy drinking, not universally achieved abstinence.

An earlier open-label proof-of-concept study by the same lead author (Bogenschutz 2015, PMID 25586396) found that abstinence rates increased substantially following psilocybin sessions, with the intensity of the psilocybin experience predicting subsequent drinking change (r=0.76 to 0.89) [Bogenschutz 2015]. This correlation between the experiential quality of the session and the therapeutic outcome is consistent with what is observed across psilocybin trials for other conditions.

Psilocybin for tobacco cessation. Garcia-Romeu et al. (2014, Current Drug Abuse Reviews, PMID 25563443) reported 80% biologically confirmed 6-month abstinence in a small open-label study (n=15). Johnson et al. (2017, Am J Drug Alcohol Abuse, PMID 27441452) found a sustained signal at 12-month follow-up. These are open-label studies with small samples, not RCTs, and the evidence base is at an earlier phase than the AUD work.

What phase 3 data exist? As of 2026-05-27, no phase 3 RCT has been completed for any psychedelic-assisted therapy in any SUD indication. Phase 2 data support further investigation; they do not establish efficacy at a regulatory standard.

Access and off-pathway framing. Psilocybin and MDMA are restricted drugs under Canada's Controlled Drugs and Substances Act. Patient access is available only through Health Canada approval, reviewed case-by-case and initiated by a physician. That approval is granted primarily for adults with treatment-resistant MDD or distress associated with a life-threatening illness; MDMA approval is granted primarily for PTSD. An AUD-primary application is investigational, sits outside those primary uses, and approval cannot be assumed [Health Canada]. Patients should not book preparation sessions or make financial commitments based on an expectation of approval for an addiction indication.

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Ketamine for addiction: early evidence, honest limits

Ketamine is approved by Health Canada as an anaesthetic. All psychiatric use, including for TRD, anxiety, PTSD, and SUD-related applications, is off-label, regulated by provincial colleges of physicians and surgeons. Ketamine-assisted psychotherapy (KAP) is the delivery model that combines subanesthetic ketamine administration with psychotherapy; it is not the same as infusion-only ketamine clinics.

Alcohol use disorder. Dakwar et al. 2020 (Am J Psychiatry, PMID 32340401) conducted a randomized midazolam-controlled pilot trial (n=40) of a single ketamine infusion combined with motivational enhancement therapy for AUD. The ketamine group showed greater reductions in drinking and greater increases in motivation to quit [Dakwar 2020]. This is pilot-level evidence: important as a signal, but not a basis for claiming established efficacy.

Cocaine use disorder. Dakwar et al. 2019 (Am J Psychiatry, PMID 31272208) conducted an RCT of a single ketamine infusion combined with mindfulness-based behavioural modification for cocaine dependence (n=55). The ketamine group showed significantly reduced cocaine use and cocaine craving [Dakwar 2019]. Again, a single RCT is a signal, not established efficacy.

The misuse-potential issue. Ketamine is a dissociative with established misuse potential, particularly in patients with stimulant or dissociative drug use histories. The clinical framing is not that ketamine is contraindicated for everyone with SUD, but that:

1. Active or unstable SUD is a standard contraindication requiring stabilization before a ketamine course.
2. Patients with a personal history of ketamine, PCP, or dissociative drug misuse require specialized assessment.
3. The psychotherapy integration that makes KAP more than a pharmacological intervention depends on a patient who can meaningfully engage with preparation and integration work.

ATMA CENA's SUD intake assesses each patient's current use, dependence, and stability, and stabilization is generally required before a ketamine course is offered. The information call is the right place to discuss the specific thresholds that would apply to your situation.

Krupitsky et al. (1997, 2002, PMID 12495781) conducted earlier Russian trials of ketamine-assisted psychotherapy for AUD and heroin dependence. These showed promising signals but used methodological approaches that differ from current RCT standards and should be understood as historical context rather than current evidence.

Spravato (esketamine) is not for SUD. Spravato (intranasal esketamine) is Health Canada-approved for treatment-resistant MDD only. It is not approved for any SUD indication, and off-label use for SUD is not appropriate given the absence of trial evidence and the stronger existing AUD evidence from psilocybin trials.

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The contradiction: SUD as both target condition and contraindication

The honest tension in this area is that SUD simultaneously represents the condition clinicians want to treat with psychedelic-assisted therapy, and one of the most common reasons that psychedelic-assisted therapy cannot safely proceed.

The standard contraindication framework is as follows. Active or unstable SUD, particularly where there is active physiological dependence with withdrawal risk, is a contraindication to initiating psychedelic-assisted therapy. Reasons include:

• Withdrawal risk: alcohol and benzodiazepine withdrawal can be medically serious; dosing a patient through withdrawal is unsafe.
• Pharmacological interactions: benzodiazepines can attenuate ketamine's antidepressant effect [Andrashko 2020]. MDMA and SSRI/MAOI interactions carry serious risk. Naltrexone, used for AUD and OUD, may interact with opioid-based elements of ketamine metabolism.
• Engagement capacity: the psychotherapy frame that produces therapeutic outcomes in psychedelic trials depends on meaningful preparation and integration; patients whose SUD is currently in active crisis may not be in a position to engage with this frame.

This creates a pathway that looks like: stabilize first, then assess for psychedelic-assisted therapy as an adjunct or next-step intervention. For OUD specifically, that means opioid agonist therapy must be in place and stable before a psychedelic-assisted therapy course is considered. Interrupting OAT to pursue psychedelic-assisted therapy is not appropriate and could be dangerous.

The emerging model is one of sequencing: standard-of-care treatment is first-line; psychedelic-assisted therapy is evaluated as a complement or next-step option for patients who have engaged with standard care, have achieved some degree of stabilization, and whose clinical picture suggests that a psychedelic-assisted therapy course might address elements of the SUD that first-line treatments have not fully addressed. For patients with comorbid TRD and AUD, the comorbid depression may itself open a Health Canada approval pathway.

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Comparing options: what is approved, what is investigational

Condition	Substance	Evidence level	Access in Canada	Contraindication notes
Alcohol use disorder	Psilocybin	Phase 2 RCT (n=93) [Bogenschutz 2022]	Health Canada approval required; investigational, off primary uses	Active AUD usually requires stabilization first
Alcohol use disorder	Ketamine	Pilot RCT (n=40) [Dakwar 2020]	Off-label; physician-supervised	Active/unstable AUD is a contraindication; misuse potential
Cocaine use disorder	Ketamine	Single RCT (n=55) [Dakwar 2019]	Off-label; physician-supervised	Active use a contraindication; stimulant history screening required
Tobacco use disorder	Psilocybin	Open-label (n=15) [Garcia-Romeu 2014]	Health Canada approval required; investigational
OUD	Any psychedelic	No published RCT	Not a current pathway	OAT must remain primary; do not interrupt
Any SUD	MDMA	Smaller emerging signal	Health Canada approval required; primarily for PTSD
Any SUD	Spravato	No evidence	Not applicable	Health Canada-approved for TRD only

Standard-of-care options that should remain primary:

• OUD: methadone, buprenorphine/naloxone (Suboxone), provincially funded via OAT programs
• AUD: naltrexone, acamprosate, disulfiram, provincially covered in most provinces
• Tobacco: varenicline (Champix), NRT, bupropion, provincially covered
• All SUDs: CBT, contingency management, 12-step programs, SMART Recovery

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How ATMA CENA works with patients who have SUDs

ATMA CENA's approach to patients with SUD history or active SUD involves a clinical assessment designed to establish whether psychedelic-assisted therapy can safely proceed, and if so, in what sequence relative to existing addiction treatment.

Information call (15 minutes). ATMA CENA's clinical team discusses the patient's SUD history, current treatment, and what psychedelic-assisted therapy might realistically offer. This call is educational and not a commitment.

Comprehensive intake. Includes full SUD history, prior addiction treatments, current OAT or other medications, comorbid conditions, and screening for contraindications including current substance use, psychotic-disorder risk, and cardiovascular risk. ATMA CENA delivers ketamine by intranasal, intramuscular, or oral routes; it does not provide intravenous (IV) ketamine.

Coordination with the addiction medicine team. Through our CoCare program, ATMA CENA can partner with a patient's existing therapist, if they have the appropriate training, through a service agreement, so that established relapse-prevention work continues. For OAT patients, the OAT prescriber must be informed and engaged before any psychedelic-assisted therapy proceeds. Learn more about our addiction treatment approach and about CoCare.

Pricing. ATMA CENA's ketamine-assisted therapy is $1,590 for the initial treatment and $800 for each additional medicine session, with a $300 non-refundable deposit to begin intake. This price is inclusive of assessment and prescription, preparation therapy, intention-setting therapy, the medicine session, integration therapy, and follow-up care. For a full breakdown, see Ketamine Therapy Cost in Canada.

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Getting started: what to ask at an information call

If you are considering psychedelic-assisted therapy and have a substance use disorder, the information call is the right first step. Questions worth bringing:

• Does my current SUD situation require stabilization before psychedelic-assisted therapy can be considered?
• Should I stay on my current OAT or other addiction medications while pursuing psychedelic-assisted therapy?
• Is my AUD or SUD likely to qualify for a psilocybin application, or is ketamine the more accessible pathway?
• What does coordination with my existing addiction medicine team look like?
• What is the realistic cost and timeline?

ATMA CENA's clinical team is experienced with these questions and can give you an honest assessment of your situation. Book a free 15-minute information call to start that conversation.

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Frequently asked questions

What is the strongest psilocybin evidence for SUD?

Bogenschutz et al. 2022 (JAMA Psychiatry, PMID 36001306) is the current benchmark. This phase 2 double-blind RCT (n=93) compared psilocybin-assisted therapy against diphenhydramine placebo, both combined with psychotherapy, in adults with alcohol use disorder. At 32 weeks, the psilocybin group showed 9.71% heavy-drinking days versus 23.57% in the placebo group, a statistically significant difference of 13.86 percentage points. This is the most rigorous published RCT of a psychedelic for any SUD to date. No phase 3 trial for psilocybin in any SUD indication has been completed as of 2026.

Can I access psilocybin therapy for alcohol use disorder in Canada?

Possibly, but it is difficult. Legal access to psilocybin in Canada requires Health Canada approval on a case-by-case basis, initiated by a physician. That approval is granted primarily for adults with treatment-resistant MDD or distress associated with a life-threatening illness. An application for an AUD-primary indication would sit outside those primary uses and be considered investigational. Approval is case-by-case and cannot be assumed. A prescribing physician must initiate the application. Patients with comorbid treatment-resistant MDD alongside AUD may have a more straightforward path, as the MDD can be the primary indication.

Does ketamine work for addiction?

Early evidence is positive but not conclusive. Dakwar et al. 2019 (Am J Psychiatry) reported an RCT signal for cocaine use disorder (n=55), and Dakwar et al. 2020 (Am J Psychiatry) reported a pilot RCT signal for alcohol use disorder (n=40). Both were single-infusion studies with small samples. Ketamine is more accessible than psilocybin in Canada because it is off-label, but it carries its own complications: active or unstable SUD is typically a contraindication requiring stabilization first, and ketamine itself has misuse potential.

Can psychedelic therapy replace methadone or Suboxone for opioid use disorder?

No. This is one of the most important things to understand about this topic. Opioid agonist therapy with methadone or buprenorphine/naloxone is foundational for OUD and saves lives in the context of Canada's opioid-toxicity crisis. No published clinical trial has tested psychedelic-assisted therapy as a replacement for OAT, and the standard clinical position is that OAT must remain primary. Patients should not interrupt OAT to pursue psychedelic-assisted therapy without close coordination with their OAT prescriber.

I have an SUD and I am currently using. Can I still access psychedelic-assisted therapy?

Generally, not immediately. Active or unstable SUD is a standard contraindication for psychedelic-assisted therapy. This includes active physiological dependence where there is withdrawal risk, active heavy alcohol use, and active stimulant use where ketamine is being considered. Stabilization is typically required first. The information call is the right place to discuss your specific situation honestly.

What about MDMA for addiction?

MDMA has a smaller emerging evidence base for SUD. Most MDMA-assisted therapy evidence and approvals are for PTSD. MDMA is a Schedule I substance in Canada; access requires Health Canada approval on a case-by-case basis and is not guaranteed. MDMA-assisted therapy for AUD or other SUD indications is at an earlier research phase than psilocybin for AUD. The comorbidity angle (PTSD plus SUD) is where MDMA may ultimately have the most clinical relevance for patients with substance use disorders.

Should I stop going to AA or other 12-step programs?

No. Twelve-step and other peer-support programs are foundational community-based recovery resources. Psychedelic-assisted therapy is an adjunct that may complement existing recovery work, not a reason to leave it. Published psilocybin trials for AUD have been conducted alongside, not instead of, psychosocial support.

Is SUD covered under insurance for psychedelic-assisted therapy?

SUD-specific psychedelic-assisted therapy coverage through private insurance is not generally available in Canada as of 2026. Standard-of-care addiction treatments (OAT, naltrexone, acamprosate, CBT programs) receive provincial and private coverage. Workers' compensation coverage for psychedelic-assisted therapy may be available on a case-by-case basis for compensable injuries with SUD comorbidity. ATMA CENA's information call can walk through your specific coverage situation.

Does ATMA CENA treat any SUD directly?

ATMA CENA's intake process assesses each patient's SUD history and coordinates with existing addiction medicine teams. Which SUD presentations can be accepted, and the stabilization requirements that apply, are determined case-by-case at intake. Patients with active or medically unstable SUD are typically referred for stabilization before a psychedelic-assisted therapy course can be offered.

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Compliance disclaimer

Psilocybin and MDMA are restricted drugs under Canada's Controlled Drugs and Substances Act. Patient access to psilocybin- or MDMA-assisted therapy is available only through Health Canada approval, granted on a case-by-case basis and initiated by a physician, and is not guaranteed. That approval is granted primarily for adults with treatment-resistant major depressive disorder or distress associated with a life-threatening illness; for MDMA, it is granted primarily for adults with PTSD. Use of psilocybin for alcohol use disorder or any SUD indication is investigational and sits outside those primary uses.

Ketamine is approved by Health Canada as an anaesthetic. Use for substance use disorders and other psychiatric indications is off-label, regulated by provincial medical regulators. Ketamine carries misuse potential; active or unstable SUD is a standard contraindication requiring clinical assessment and typically stabilization before a ketamine course can proceed.

Spravato (esketamine) is Health Canada-approved for treatment-resistant depression (TRD) only. It is not approved for any SUD indication.

Nothing in this article constitutes a clinical recommendation for any individual patient. Clinical decisions belong with a qualified prescribing physician. Psychedelic-assisted therapy does not replace standard-of-care addiction treatment, including opioid agonist therapy for opioid use disorder.

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About the author

Reverdi Darda, RN, BScN - Reg #61707 | CEO & Founder, ATMA CENA

Reverdi Darda, RN is CEO & Founder of ATMA CENA and a Registered Nurse with over three decades of experience in healthcare operations, community engagement, policy development, and strategic planning. A recognized leader in mental health access, Reverdi has dedicated her career to advancing evidence-based treatment models and advocating for policy change that prioritizes effective care. She founded ATMA CENA to expand practitioner and public access to psychedelic-assisted therapy across Canada.

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Sources

1. Bogenschutz MP, Ross S, Bhatt S, et al. (2022). Percentage of Heavy Drinking Days Following Psilocybin-Assisted Psychotherapy vs Placebo in the Treatment of Adult Patients With Alcohol Use Disorder: A Randomized Clinical Trial. JAMA Psychiatry, 79(10):953-962. PMID: 36001306. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2795625
2. Bogenschutz MP, Forcehimes AA, Pommy JA, et al. (2015). Psilocybin-assisted treatment for alcohol dependence: a proof-of-concept study. J Psychopharmacol, 29(3):289-99. PMID: 25586396.
3. Garcia-Romeu A, Johnson MW, Griffiths RR. (2014). Psilocybin-occasioned mystical experiences in the treatment of tobacco addiction. Curr Drug Abuse Rev, 7(3):157-64. PMID: 25563443.
4. Johnson MW, Garcia-Romeu A, Griffiths RR. (2017). Long-term follow-up of psilocybin-facilitated smoking cessation. Am J Drug Alcohol Abuse, 43(1):55-60. PMID: 27441452.
5. Dakwar E, Nunes EV, Hart CL, et al. (2019). A Single Ketamine Infusion Combined With Mindfulness-Based Behavioral Modification to Treat Cocaine Dependence: A Randomized Clinical Trial. Am J Psychiatry, 176(11):923-930. PMID: 31272208.
6. Dakwar E, Levin F, Hart CL, et al. (2020). A Single Ketamine Infusion Combined With Motivational Enhancement Therapy for Alcohol Use Disorder: A Randomized Midazolam-Controlled Pilot Trial. Am J Psychiatry, 177(2):125-133. PMID: 32340401.
7. Krupitsky EM, Burakov AM, Romanova TN, et al. (2002). Ketamine psychotherapy for heroin addiction. J Subst Abuse Treat, 23(4):273-83. PMID: 12495781.
8. Andrashko V et al. (2020). Benzodiazepine doses attenuate ketamine antidepressant effects. Front Psychiatry, 11:844. PMID: 33005153.
9. Health Canada - access to 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
10. Public Health Agency of Canada - Opioid- and Stimulant-related Harms in Canada (2024). https://health-infobase.canada.ca/substance-related-harms/opioids-stimulants/
11. Canadian Research Initiative in Substance Misuse (CRISM) - National Clinical Practice Guideline for OUD. https://crism.ca/projects/opioid-use-disorder-national-guideline/
12. Statistics Canada - Canadian Community Health Survey (CCHS). https://www.statcan.gc.ca/en/survey/household/3226

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Last updated: 2026-08-06. This article is reviewed every 6 months or whenever material regulatory or clinical evidence changes.