MDMA-Assisted Therapy in Quebec

Quebec's relationship to MDMA-assisted therapy is shaped by two facts that often confuse patients: the Farzin/Stephan December 2022 RAMQ public-funding precedent was psilocybin-specific and has NOT extended to MDMA, and Bill 21 (loi 21, 2009) reserves psychotherapy as a regulated act in Quebec — meaning the psychotherapy component of any psychedelic-assisted therapy must be delivered by a physician, psychologist, or Ordre des psychologues du Québec (OPQ) permit holder. Quebec's psychedelic-medicine clinical landscape includes ATMA CENA's Montreal member clinic (Clinic Dr. Bita), Neurotherapy Montreal (which offers psychedelic-assisted psychotherapy services), the Jewish General Hospital and McGill psychiatry community (where Drs. Farzin and Stephan operate), and other Quebec providers with SAP-pathway experience. For Quebec MDMA-AT patients, the practical reality is SAP-pathway access with out-of-pocket payment unless they qualify through Veterans Affairs Canada (service-connected PTSD, case-by-case) or CNESST (workers' compensation, case-by-case for compensable PTSD). This article walks through the Quebec context honestly.

Key takeaways

• Quebec RAMQ precedent does NOT extend to MDMA. The December 2022 Farzin/Stephan billing precedent was psilocybin-specific. RAMQ has not modified billing codes for MDMA-AT at this time.
• Bill 21 (loi 21, 2009) reserves psychotherapy as a regulated act in Quebec. The psychotherapy component of MDMA-AT must be delivered by a physician, psychologist, or OPQ permit holder.
• Bill 96 (Charter of the French Language, 2022) has implications for healthcare communication; confirm clinic language capabilities.
• Quebec providers: Drs. Houman Farzin (Jewish General, McGill palliative psychiatry) and Jean-François Stephan; Neurotherapy Montreal psychedelic-assisted psychotherapy services; ATMA CENA's Montreal member clinic Clinic Dr. Bita; Quebec psychiatrists with SAP-pathway experience.
• Quebec MDMA-AT cost reality: SAP-pathway access with out-of-pocket payment (CAD $7,500–$15,000) unless VAC eligible (service-connected PTSD case-by-case) or CNESST eligible (compensable PTSD case-by-case).
• Quebec service-connected populations: CAF veterans, RCMP, Sûreté du Québec, municipal police, paramedics, firefighters — eligible for VAC or CNESST review pathways.

The RAMQ public-funding situation — psilocybin only, not MDMA

In December 2022, Drs. Houman Farzin (palliative psychiatrist, Jewish General Hospital, McGill) and Jean-François Stephan billed RAMQ for SAP-approved psilocybin-assisted psychotherapy delivered to a Quebec patient with end-of-life distress. RAMQ subsequently modified medical billing codes to permit further public claims for SAP-approved Quebec psilocybin-assisted therapy. This was the first publicly funded psychedelic therapy in Canada.

The precedent has not extended to MDMA. Reasons:

• Indication mismatch: the December 2022 precedent was for end-of-life distress (psilocybin's foundational SAP indication). MDMA-AT's foundational indication is PTSD, not end-of-life distress. Different clinical context, different applicability of existing RAMQ billing codes.
• No equivalent Quebec advocate has yet pursued an MDMA-AT RAMQ billing precedent at scale.
• Lower SAP volume: ~41 cumulative MDMA SAP approvals through February 2024 (versus ~176 psilocybin) means smaller potential population to drive a public-funding precedent.

The practical 2026 reality: Quebec MDMA-AT patients do not have access to a public-funding pathway analogous to the psilocybin Farzin/Stephan precedent. Out-of-pocket payment or coverage through VAC (service-connected PTSD), CNESST (compensable PTSD), or private insurance (limited) are the operational pathways.

For the Quebec psilocybin context, see Psilocybin Therapy in Quebec.

Bill 21 — psychotherapy as a reserved act

Quebec is the only Canadian province where psychotherapy is a reserved act under Bill 21 (loi 21, 2009, chapter 28). The implications for MDMA-assisted therapy:

Only the following may deliver psychotherapy in Quebec:

• Physicians
• Psychologists (members of OPQ)
• Members of designated professional orders holding a psychotherapy permit from OPQ — guidance counsellors, criminologists, occupational therapists, nurses, psychoeducators, social workers, family therapists

The OPQ psychotherapy permit requires graduate-level program, 765 hours of theoretical psychotherapy training, and 300 hours of supervised direct clinical work.

For MDMA-AT 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, counsellors, or therapists without OPQ authorization cannot deliver the psychotherapy component of MDMA-AT in Quebec.

This is particularly relevant for MDMA-AT given the two-therapist standard model in published trial protocols (Mitchell 2021/2023). Both therapists in the Quebec clinical setting must meet Bill 21 requirements.

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. Practical implications for MDMA-AT in Quebec:

• 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: ATMA CENA's Montreal member clinic Clinic Dr. Bita, Drs. Farzin and Stephan, and Neurotherapy Montreal historically operate bilingually.

Quebec's MDMA-AT provider landscape

The Quebec clinical landscape for psychedelic-assisted therapy is established for psilocybin and ketamine; MDMA-AT-specific Quebec capacity is more limited.

Drs. Houman Farzin and Jean-François Stephan

The Quebec physicians associated with the December 2022 RAMQ psilocybin precedent. Whether either or both have applied for MDMA SAP authorizations is a separate matter from their psilocybin work — confirm directly.

Jewish General Hospital — Department of Psychiatry, McGill

The Jewish General Hospital community has been at the centre of Quebec psychedelic medicine including:

• The Montreal Model of ketamine-assisted therapy (Dr. Kyle Greenway and team) — see Ketamine Therapy in Montreal
• Quebec's psilocybin SAP work (Farzin / Stephan)
• Possible MDMA SAP work — confirm with the institution

Neurotherapy Montreal

Neurotherapy Montreal offers psychedelic-assisted psychotherapy services. Their published service mentions PAT for depression, anxiety, and end-of-life care. Specific MDMA-AT scope should be confirmed at intake.

ATMA CENA's Montreal member clinic — Clinic Dr. Bita

ATMA CENA's Quebec member clinic is Clinic Dr. Bita (1255 Avenue Greene, Suite 410, Westmount, QC). Operating bilingually, the clinic supports preparation and integration via coordinated care in coordination with Quebec prescribing physicians. Specific MDMA-AT scope at Clinic Dr. Bita should be confirmed at intake.

For the broader ATMA CENA Montreal clinical context including ketamine therapy, see Ketamine Therapy in Montreal.

TheraPsil and MAPS Canada — pan-Canadian resources

Both organizations support Canadian MDMA-AT advocacy and provider matching. TheraPsil maintains a directory of trained Canadian clinicians; MAPS Canada supports Canadian MDMA-AT research and education distinct from Lykos (US).

Quebec service-connected populations

Quebec has substantial populations eligible for service-related PTSD coverage pathways:

• Canadian Armed Forces veterans in Quebec — VAC mental-health benefits apply (case-by-case for MDMA-AT where SAP-approved)
• RCMP: VAC-equivalent benefits framework
• Sûreté du Québec (provincial police), municipal police, paramedics, firefighters — CNESST workers' compensation; case-by-case for compensable PTSD
• Wildland firefighters: included in provincial workers' compensation; some emerging case-by-case

For the broader veterans pathway detail, see MDMA-Assisted Therapy for Veterans.

How ATMA CENA supports Quebec MDMA-AT patients

For Quebec SAP-pathway MDMA-AT patients, ATMA CENA's role is the same as elsewhere with Quebec-specific adaptations:

• The medical SAP application is initiated by the Quebec patient's prescribing physician — typically a Quebec psychiatrist or palliative-care physician with SAP-pathway experience.
• ATMA CENA supports preparation and integration through the three-phase psychedelic-assisted therapy model. For MDMA-AT specifically, this includes the more extensive integration phase (9 sessions across the program).
• The coordinated care 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.
• Bilingual service: ATMA CENA's Montreal member clinic (Clinic Dr. Bita) operates bilingually; confirm specific MDMA-AT pathway language preferences at intake.

Frequently asked questions

Does RAMQ cover MDMA-AT in Quebec? No. The December 2022 Farzin/Stephan RAMQ precedent was psilocybin-specific and has not extended to MDMA. Quebec MDMA-AT patients face standard out-of-pocket costs unless covered through VAC, CNESST, or private insurance.

Why does Quebec cover psilocybin but not MDMA? The Farzin/Stephan precedent was for end-of-life distress, where psilocybin had foundational SAP support. RAMQ modified billing codes for that specific clinical context. MDMA-AT's primary indication is PTSD, not end-of-life distress; no equivalent Quebec public-funding precedent has been established.

Does Bill 21 affect who can deliver MDMA-AT psychotherapy in Quebec? Yes. The psychotherapy component must be delivered by a physician, psychologist, or OPQ psychotherapy permit holder. Unregulated coaches or counsellors cannot deliver the psychotherapy component of MDMA-AT in Quebec.

Can I do MDMA-AT in French? Most Quebec psychedelic-medicine clinics operate bilingually. Confirm specific clinical-team language capabilities at intake.

Where can I access MDMA-AT in Quebec? SAP-authorized clinicians with PTSD/SAP experience. Resources: TheraPsil directory; MAPS Canada; Drs. Farzin and Stephan and Quebec colleagues at Jewish General / McGill; Neurotherapy Montreal; ATMA CENA's Montreal member clinic Clinic Dr. Bita; other Quebec psychiatrists with SAP-pathway experience.

What about CNESST coverage for first-responder MDMA-AT? CNESST reviews ketamine claims case-by-case; MDMA-AT case-by-case review may apply for compensable PTSD. No formal MDMA listing at this time. Verify with CNESST directly. Service-connected first responders in Quebec — Sûreté du Québec, municipal police, paramedics, firefighters — would pursue this pathway.

Does VAC cover MDMA-AT for Quebec veterans? VAC considers MDMA-AT case-by-case for service-related PTSD where SAP-approved — same framework as elsewhere in Canada. Quebec residency does not change the VAC pathway. See MDMA-Assisted Therapy for Veterans.

Can my regular Quebec therapist work with me through coordinated care? Yes — provided your therapist meets Bill 21 requirements (physician, psychologist, or OPQ psychotherapy permit holder). The coordinated care model lets your existing therapist remain the primary therapeutic relationship while ATMA CENA's clinical infrastructure provides the dosing-specific frame.

How does Quebec MDMA-AT cost compare to other provinces? The same SAP-pathway out-of-pocket cost (~CAD $7,500–$15,000 per program) applies in Quebec. The lack of RAMQ coverage means Quebec patients have no public-funding alternative analogous to the psilocybin pathway.

Is ATMA CENA Montreal member clinic delivering MDMA-AT? ATMA CENA's Montreal member clinic is Clinic Dr. Bita. Specific MDMA-AT scope at the clinic should be confirmed at intake with the clinic's clinical team. ATMA CENA's broader role is preparation and integration support via coordinated care.

Where can I learn more about Quebec psychedelic medicine more broadly? For psilocybin in Quebec, see Psilocybin Therapy in Quebec. For ketamine in Montreal including the Montreal Model, see Ketamine Therapy in Montreal.

Sources

1. ATMA CENA — coordinated care: https://psychedelic.healthcare/find-care
2. TheraPsil — Quebec first province to cover psilocybin therapy (December 2022): https://therapsil.ca/quebec-first-province-to-cover-costs-of-psilocybin-assisted-psychotherapy-done-by-two-physicians/
3. 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
4. Ordre des psychologues du Québec — psychotherapy permit: https://www.ordrepsy.qc.ca/web/english/who-practices-psychotherapy
5. 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
6. 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
7. ATMA CENA — Montreal member clinic: https://psychedelic.healthcare/
8. Veterans Affairs Canada — Mental Health Benefits: https://www.veterans.gc.ca/en/financial-programs-and-services/medical-costs/coverage-services-prescriptions-and-devices/mental-health-benefits

Related articles in this cluster

• MDMA-Assisted Therapy in Canada
• How to Access MDMA-Assisted Therapy in Canada (SAP)
• MDMA-Assisted Therapy Cost in Canada
• MDMA-Assisted Therapy for PTSD
• MDMA-Assisted Therapy for Veterans
• Psilocybin Therapy in Quebec
• Ketamine Therapy in Montreal
• Find care near you

Last updated: 2026-05-06