In brief
- Germany has run the EU’s first legal psilocybin access program for just over a year, but only two facilities offer it: the public CIMH hospital in Mannheim and the private OVID clinic in Berlin.
- Mannheim already has nearly 700 interested patients on its waiting list while working to secure public healthcare coverage for outpatient treatment.
- Patients with private insurance—only about 10% of the German population—gain faster access through an expedited agreement with the country’s largest private insurer.
In July 2025, Germany became the first country in the European Union to establish a legal pathway to treat patients with treatment-resistant depression using psilocybin outside clinical trials. A year later, the two clinical directors overseeing the program on the ground detailed how it works in practice: dealing with limited beds, reimbursement bureaucracy, and a waiting list nearing 700 names at a single facility.
A pioneering program with just two points of entry
Germany’s federal drug regulator, the BfArM, approved the initiative under “compassionate use”: an exceptional pathway designed for severely ill patients who have exhausted standard therapies, not a broad commercial market authorization. Only two sites are permitted to administer it: the Central Institute of Mental Health (CIMH) in Mannheim, a public hospital, and the private OVID clinic in Berlin. The medicine used is PEX010, a standardized botanical psilocybin extract from Canada’s Filament Health. It is always administered in a day-hospital setting integrated into a psychotherapy protocol that includes preparatory and integration sessions.
The bottleneck is not the law, but insurance
Lea Mertens, a researcher and psychotherapist at CIMH in Mannheim (coauthor of the EPIsoDE study published in JAMA Psychiatry), and Andrea Jungaberle, medical director of Berlin’s OVID clinic alongside psychiatrist Gerhard Gründer, explain that the primary hurdle is funding rather than regulation. As a public hospital, CIMH would prefer to deliver outpatient care, but that route still awaits BfArM clearance; for now, it can only offer inpatient admissions, strictly limited by bed capacity at a facility serving an entire region. Demand already far outstrips capacity, with around 700 patient inquiries logged. In contrast, OVID, operating as a private day hospital, secured an agreement with Germany’s largest private health insurer that settles coverage approvals within a week, ensuring patients do not pay out-of-pocket for the experimental component. This distinction matters: only about 10% of Germans hold private health insurance, leaving that fast track out of reach for the vast majority.
What this means
Compassionate use does not mean psilocybin has gained standard drug approval: it remains a case-by-case exception restricted to treatment-resistant depression and subject to strict medical discretion. Across the EU, only esketamine holds marketing authorization for psychiatric care. What this first year in Germany reveals is far more practical and less discussed than the regulatory green light itself: once psychedelic therapy moves from clinical trials to the clinic floor, insurance coverage and private policies can matter just as much as the law in deciding who gets care first. This pattern echoes Switzerland’s compassionate use framework, running since 2014, and will likely recur in any European country opening a similar route in the coming years. In the meantime, harm reduction and honest education remain the most vital tools for anyone navigating these therapies, whether through an official program or beyond one.
Source
- Psychedelic Alpha. Psilocybin Compassionate Use in Germany: Lea Mertens and Andrea Jungaberle on the First Patients, Payers and Practicalities. Psychedelic Alpha, June 16, 2026.
Educational content written from a harm reduction perspective and with respect for individual freedom. It is not a substitute for advice from a healthcare professional and is not intended to encourage or condemn any drug use.
