At a glance — ibogaine treatment for New York City residents, April 2026 update:
- Federal status: Schedule I; no New York clinic can administer ibogaine
- New York legislative posture: S1817 / A1522 / A9583 / A628 — none passed yet
- 2024 NYC overdose: 2,192 deaths (down 28%); fentanyl involved in 73%
- Regulated treatment pathway: Brazil, ANVISA-permitted, medically supervised
- Travel from NYC: JFK / EWR → São Paulo (GRU), ~10 hours nonstop on LATAM, Delta, American, United
Ibogaine is a plant medicine studied for opioid dependence, substance abuse, prescription medications, behavioral addictions, and trauma. At Nekawa it is given as natural ibogaine treatment, with spiritual guides and medical oversight. For New York City residents, the regulated pathway runs through Brazil, and Nekawa is the wellness academy that supports US students through it.
New York City recorded 2,192 unintentional drug overdose deaths in 2024, a 28% decline from 3,056 in 2023, the first meaningful drop after nearly a decade of climbing numbers. Fentanyl was involved in 73% of those deaths. The Bronx continues to carry the highest absolute rate of any borough, more than double Manhattan's, and Black and Latino New Yorkers die at roughly twice the rate of white residents despite seeing comparable percentage reductions. The scale of the crisis, even in a year of improvement, tells you something about the limits of what the existing system can do.
There are 350+ SAMHSA-licensed substance use programs within 25 miles of central New York City. For many families, that number is both reassuring and hollow. Conventional treatment (methadone, buprenorphine, residential rehab) works for some people. For those with chronic, treatment-resistant dependence, or for whom every prior attempt has ended in relapse, the standard menu of options hasn't been enough. That's the population that finds this page.
This page covers:
- What ibogaine is and how treatment actually works
- Why the medically supervised pathway runs through Brazil rather than the United States
- How Nekawa's program is structured around the work the medical team does
- What the trip from New York City to Paraty involves, from flight to integration
Nekawa is a wellness education academy. It is a wellness and education program and does not provide medical services or sell or dispense ibogaine. The work the medical team does happens under medical oversight; Nekawa builds the preparation, environment, and integration around it.
Why New York City residents are looking outside the US for ibogaine
The 2024 overdose numbers carry a complicated message. Mayor Adams's office announced a 28% single-year drop, the result of scaled-up harm reduction, expanded treatment access, and naloxone saturation citywide. That progress is real. But 2,192 deaths in a single year, with xylazine present in 21% of them, is not a solved problem. It is a system working hard against a supply that keeps shifting.
For chronic, treatment-resistant opioid dependence (the kind where someone has been through multiple rounds of medication-assisted treatment, residential programs, and outpatient care) conventional pathways in New York have a ceiling. The 350+ SAMHSA-licensed programs within 25 miles of the city are largely structured around maintenance and harm reduction, rather than the kind of neurological reset that families in this situation are searching for.
Fentanyl-contaminated counterfeit pills and polysubstance combinations (fentanyl with cocaine, fentanyl with xylazine) have made the pharmacology of addiction in New York harder to treat with tools designed for a different era. That's part of why families from the Upper East Side, Williamsburg, Harlem, and the Bronx are reaching out to Nekawa. Many have already cycled through the academic medical centers along the East River and the outpatient programs in their own neighborhoods. They're not rejecting the local system. They've already been through it.
What ibogaine actually does
Ibogaine is not a substitute drug and it is not a sedative. It is a psychoactive compound derived from the root bark of the Tabernanthe iboga plant, and its mechanism of action is unlike anything in the existing addiction pharmacopeia. It works simultaneously on opioid receptors, NMDA receptors, serotonin and dopamine systems, and sigma-1 receptors, a combination that can interrupt physical dependence and reset the neurological patterns that drive compulsive use.
For families watching someone they love cycle through relapse, what matters most is this: ibogaine has shown the ability to dramatically reduce or eliminate acute opioid withdrawal symptoms and to quiet the craving signals that make early recovery so fragile. It is not a cure. It is a reset, and what happens in the weeks after treatment determines how durable that reset becomes.
The period immediately following treatment is called the Window of Wonder, roughly 2 to 12 weeks of elevated neuroplasticity during which the brain is unusually receptive to new patterns. This is the window Nekawa's integration program is built to fill. Integration on campus, followed by at-home coursework, is designed specifically around this window. For a deeper look at the peer-reviewed evidence, see our ibogaine research page. If you want to understand the science of ibogaine more completely, visit our ibogaine science page.
The medical protocol: what medical oversight actually means
Ibogaine carries real cardiac risk if administered without proper screening. It can prolong the QT interval, a measure of cardiac electrical timing, which in a small percentage of patients can trigger a dangerous arrhythmia. This is why ibogaine is not something that can be safely given in a retreat setting without medical oversight, and it is why the medical team conducts a thorough workup before any patient is cleared for treatment.
Before the medical team clears a patient for ibogaine, the workup includes:
- EKG
- QT-interval check
- Comprehensive blood panel
- Liver function test
- Magnesium loading
Treatment itself takes place with medical oversight throughout. The medical team provides continuous cardiac monitoring during and after each dose. The intense visionary phase lasts 6 to 12 hours, followed by roughly 12 hours of quieter mental processing, then 24 to 48 hours of physical recuperation.
The full program structure is:
- 10 days of preparation and natural detox before any ibogaine
- Natural ibogaine treatment with spiritual guides, medical oversight and continuous cardiac monitoring
- Structured integration on the property
- Integration coursework and community after returning home
Longer on-site programs of up to 90 days are available for students seeking deeper transformation work. Nekawa structures the preparation curriculum and integration coursework; the cardiac protocol and cardiac monitoring belong to the medical team. See our cardiac safety overview for the full QT-interval, EKG, and screening protocol the medical team follows.
Why Brazil and not somewhere else
Ibogaine is a Schedule I controlled substance in the United States. No clinic in New York, public or private, can legally administer it. That is the federal floor, and pending state research bills do not change it for individual patients today.
Mexico and Costa Rica have become well-known alternatives, and some operations there are run by serious people. But the regulatory environment is not equivalent. In Brazil, ibogaine treatment is delivered with medical oversight and continuous cardiac monitoring. That is a different category of oversight than a private retreat operating in a regulatory gray zone.
In Brazil, Nekawa is a leader in fully integrated ibogaine care, not just ibogaine treatment. The medical team provides the emergency response capability and the medical oversight that the cardiac risk profile of ibogaine actually requires. Nekawa is a wellness education academy built around the medical oversight that ibogaine treatment requires. For the full picture of ibogaine's legal status across the US and globally, see our ibogaine legal status page.
| Brazil (Nekawa pathway) | New York rehabs | Mexico clinics | |
|---|---|---|---|
| Is ibogaine available? | Yes, with medical oversight | No (Schedule I); S1817 / A1522 / A9583 / A628 pending — none passed | Yes — but unregulated |
| Regulatory framework | Medical oversight and cardiac monitoring | FDA + DEA (federally illegal) | No formal framework |
| Cardiac monitoring | Continuous cardiac monitoring, EKG, QT screening | N/A (no ibogaine) | Varies |
| Program length | 28+ days | 30 days typical | 5–10 days typical |
| Setting | Medical oversight + wellness program | Treatment facility | Retreat / private clinic |
| Aftercare structure | Integration coursework, mentors and lifelong community | Outpatient varies | Rare |
| Cost / insurance | $750/day; insurance N/A | $300–$2,000/day; insurance available | $1,000–$1,800/day; insurance N/A |
Travel from New York City to Paraty
Getting from New York City to Paraty is a straightforward two-leg journey. From JFK, there is nonstop service to São Paulo–Guarulhos (GRU) on LATAM, Delta, and American, with a block time of roughly 10 hours. JFK also has nonstop service to Rio de Janeiro–Galeão (GIG) on American and LATAM. From Newark (EWR), United operates nonstop service to GRU with comparable block time. Most of these flights leave from JFK Terminal 4 or Terminal 8 in the evening and land in Brazil the following morning. Both GRU and GIG are the right arrival airports; from either one, it is a 4-hour drive along the BR-101 coastal highway to Paraty, on Brazil's Costa Verde coast. Nekawa arranges private ground transport from both airports, so students arrive directly without navigating Brazilian transit.
Paraty sits at the edge of the Atlantic rainforest (Mata Atlântica), one of the most biodiverse ecosystems on earth. What students arrive to is old-growth jungle, waterfalls, a protected lagoon, and a bay scattered with more than 300 forested islands. The colonial port town itself is a UNESCO World Heritage Site. This is not a clinical setting. It is a place designed, by its geography, for the kind of interior work that integration requires. More detail on the property, the rooms, and the route in is on our location page.
As of January 1, 2026, US travelers need an approved Brazilian eVisa to enter Brazil. Apply online at brazil.vfsevisa.com.
- Cost: US$80.90
- Processing time: about 72 hours
- Validity: 10 years, multiple entries of up to 90 days per stay
- Passport: US passport with at least 6 months of remaining validity
Our intake team walks every student through this during onboarding.
New York's legal and policy context for ibogaine
New York State has multiple ibogaine bills pending in the legislature as of April 2026, but none have passed. S1817 (Senate) and A1522 (Assembly) are companion bills that would direct New York's Office of Addiction Services and Supports (OASAS) to encourage and facilitate clinical research into ibogaine for heroin, methamphetamine, and cocaine addiction. S1817 is currently in the Senate Finance Committee.
Assembly Bill A9583, introduced in January 2026, would establish a research grant program funding clinical trials of ibogaine for veterans with post-traumatic stress disorder. Assembly Bill A628 takes a broader posture, calling for the legalization of ibogaine and other entheogenic substances for adults 21 and older. None of these bills change what is available to a New York resident today.
At the federal level, the April 2026 Trump Executive Order directed a major federal effort on ibogaine research, particularly for veterans. That accelerates the FDA's clinical trial framework but does not open a legal pathway for individual patients in New York in the near term. The Americans for Ibogaine state legislation tracker shows where New York's bills stand. For a full breakdown of ibogaine's current legal status, see our ibogaine legal status page.
What aftercare looks like back in New York City
The at-home integration coursework that follows the program on campus is not a supplement, it is the second half of the treatment. The Window of Wonder, the period of elevated neuroplasticity after treatment, closes over 2 to 12 weeks. What a student does inside that window shapes whether the neurological reset holds.
For students returning to New York City, that means returning to the pressures (the pace, the density, the professional demands of industries like finance, media, and technology) that often surrounded the addiction in the first place. A student stepping back onto a 6 train at rush hour the week after returning is walking back into the same sensory environment they left. The at-home coursework Nekawa provides is structured to meet that reality. It is not a generic aftercare checklist. It is a curriculum built around the specific psychological and behavioral work treatment opened up.
Students from New York also have access to a network of therapists, psychiatrists, and integration specialists across the city who are familiar with psychedelic-assisted work. Nekawa's intake team can speak to that landscape during the discovery call. For students whose primary concern is opioid dependence, our opioid recovery program page covers what the full arc of preparation, treatment and integration looks like for that track.
How to start: what the discovery call covers
The first step is a discovery call with our intake team. This is a candidacy and program-fit conversation; we are trying to understand whether Nekawa's program is genuinely the right fit for you or your loved one, and whether you are ready to commit to the full arc of preparation, treatment and integration that the program requires. We cover your history, your goals, the program structure, the travel logistics, and what to expect from each phase.
Clinical screening (the cardiac workup, the blood panel, the QT-interval assessment) is conducted separately by the medical team after program fit has been established. Nekawa does not perform clinical screening and does not make medical determinations.
If you are a family member calling on behalf of someone in active addiction, that is a conversation we have regularly. The discovery call is the right place to start. Book a discovery call and our intake team will follow up within one business day.
Where the jungle meets the sea
Nekawa sits in the Atlantic rainforest just outside the colonial port town of Paraty. Old-growth jungle, waterfalls, natural swimming pools, and a bay scattered with more than 300 forested islands. After New York City, this is a different world.
Frequently asked questions
More questions? See our full FAQ.
Definitions
Plain-language definitions of the terms used on this page.
- Schedule I
- A US federal classification under the Controlled Substances Act for substances with no accepted medical use and high abuse potential. Ibogaine has been Schedule I since 1970, which means no clinic in the United States — public or private — can administer it.
- ANVISA
- Brazil's federal health agency, the Agência Nacional de Vigilância Sanitária — the functional equivalent of the US FDA. Ibogaine enters Brazil through its import rules for medicines that are not available locally.
- Window of Wonder
- The 2- to 12-week period of elevated neuroplasticity following ibogaine treatment, during which the brain is more receptive to new patterns and integration work. Nekawa's integration work, on campus and at home, are structured around this window.
- eVisa (Brazilian)
- An electronic visa required for US travelers entering Brazil since January 1, 2026. Applied at brazil.vfsevisa.com, costs US$80.90, processes in roughly 72 hours, valid 10 years with multiple entries up to 90 days per stay.
- QT-interval
- A measurement on an electrocardiogram (EKG) of the time between ventricular depolarization and repolarization. Ibogaine prolongs the QT interval, which is why the medical team screens every patient with EKG and a comprehensive workup before clearing them for treatment.
- Medically supervised
- Refers to ibogaine treatment given with medical oversight and continuous cardiac monitoring, after EKG and QT screening. Distinct from retreat-style settings in countries without a federal regulatory pathway.
New York City's 2024 overdose numbers reflect real progress, and they also reflect 2,192 people who didn't make it, in a city with 365 licensed treatment programs within 25 miles of its center. For families who have already been through those programs, the medically supervised pathway through Brazil is not a last resort. It is a different category of intervention, built around a different mechanism, inside a regulatory and medical framework that takes the cardiac risk seriously. If that is where you are, book a discovery call and our intake team will walk you through whether Nekawa's program is the right fit.
A medical program in a setting that matters
Medical oversight is the foundation. The setting is the second medicine. See the property, the rooms, the team, and the route in.