Psychedelic Retreats Abroad:
The Medicine May Be Real, but the Safeguards Often Are Not
By Thomas Lee Abshier, ND | 15 September 2026
Interest in psychedelic medicine has moved from the fringe to the center of American health policy in only a few years. In April 2026 the President signed an executive order directing the FDA to speed its review of psychedelic therapies, and the Secretary of Health and Human Services has spoken openly about veterans who travel abroad because the treatments they seek are not legal at home. Meanwhile, a market has grown up to meet that demand. Clinics and retreats in Mexico, Costa Rica, Peru, and elsewhere now offer ibogaine, ayahuasca, 5-MeO-DMT, psilocybin, and other substances, often in packages costing $5,000 to nearly $20,000 before airfare.
Two recent sources give a sober picture of what a patient may actually encounter there. The first is an investigation by The New York Times (August 26, 2026, updated September 14), built on interviews with more than two dozen patients and researchers. The second is a peer-reviewed study in JAMA Network Open (January 2026) by Amy McGuire and colleagues at Baylor College of Medicine, who interviewed representatives of 49 publicly advertised psychedelic retreat organizations across North and South America about how they protect their clients.
Read together, they make one point clearly: the question is rarely whether a given plant or compound has therapeutic value. The question is whether the person administering it is practicing medicine responsibly.
What the reporting found
The Times describes a field in which some operations are staffed by credentialed physicians in clinical settings, while others are run by self-styled shamans who book clients through messaging apps. The newspaper counted at least 40 clinics and wellness centers in Mexico offering ibogaine, where a decade ago there were almost none.
The harms it documents fall into a few recurring categories.
Deaths. An American social worker died of a heart attack after taking ibogaine at a Costa Rican retreat in 2024; a patient died during drug detoxification at a Mexican psychedelic clinic in 2025; and an Alabama man died of multiple organ failure after drinking ayahuasca at a Peruvian retreat this year. No agency keeps an official count of such events.
Poor screening and careless prescribing. Patients reported that they were not routinely evaluated for conditions that make psychedelics dangerous, that sedatives such as Xanax were offered without regard to their history, and that they were encouraged to stop psychiatric medications abruptly or to combine substances in risky ways.
Weak informed consent. At least one clinic initially declined to tell patients what dose of ibogaine they were receiving, information both Mexican and U.S. law treat as the patient’s right. The clinic’s chief executive said it prefers to disclose the dose afterward so that clients will not pressure practitioners to change it.
Exploitation of an altered state. Some patients said staff tried to sell them additional services while they were still under the influence. A psychiatrist who went to one Cancún clinic for his own PTSD objected to the practice of recording promotional-style interviews with patients shortly after dosing; the clinic says those recordings follow a rest period and are for training. Most gravely, a Florida woman seeking treatment for a long opioid addiction reported that a physician at a different Cancún clinic sexually assaulted her after giving her 5-MeO-DMT, a drug the clinic says its own protocols did not permit. The doctor has been arrested and charged with rape. A Peruvian nonprofit that assists people harmed at retreats reports handling eight to ten such cases a year from a single region.
The problem is not confined to other countries. In July, a Miami Beach doctor was charged with manslaughter after a woman given ketamine and MDMA was found unresponsive in a sauna; he has pleaded not guilty.
What the JAMA study found
The McGuire study adds data to these stories. Its findings are more measured than a news investigation, and in some respects more troubling, because they describe the ordinary practice of organizations willing to advertise publicly and speak with researchers.
Most of the 49 organizations collected a medical history before a client attended. But every one of them relied on the client’s own report of that history. None described independent verification such as records review, an electrocardiogram, or a physician’s clearance. As Dr. McGuire has observed in interviews, a desperate person has every incentive to leave out the one condition that might disqualify him.
Screening criteria varied widely. About half excluded people with schizophrenia or psychosis, and about a third excluded bipolar disorder. Only about a third excluded people with cardiovascular conditions. For substances like ibogaine, which is known to disturb the heart’s electrical rhythm, that last figure deserves attention.
Medication “washout” was nearly universal and poorly grounded. Close to nine in ten organizations required or recommended stopping certain prescription drugs, most commonly antidepressants, before a psychedelic session. The required interval ranged from a single day to more than six weeks, and only seven organizations said they had consulted medical professionals in setting those rules. Some retreat staff also reported taking psychedelics themselves alongside participants, which leaves no clear head in the room if something goes wrong.
The authors also note an older and instructive finding: of 58 deaths reported during ayahuasca ceremonies between 1994 and 2022, none of those with a determined cause was attributed to the brew’s direct toxicity. The causes were heart attack, suicide, drowning, homicide, and contaminants added to the preparation. In other words, most of those deaths were failures of screening, supervision, and setting, which means most were preventable.
A physician’s reading of the evidence
From the standpoint of clinical practice, three lessons stand out.
First, the substance and the setting cannot be separated. Proponents are right that many people report profound benefit from these medicines, including some of the same patients who described poor care. One legal advocate quoted by the Times put the matter well: “The substance is not the problem.” A compound that opens a person’s deepest memories and suspends his ordinary defenses is, by that very property, a compound that places him in the practitioner’s hands. That is exactly the situation in which the traditional duties of medicine, namely screening, informed consent, monitoring, and restraint, matter most. A clinic that relaxes those duties because the substance is “natural” or “sacred” has misunderstood both medicine and the traditions it borrows from.
Second, stopping psychiatric medication is itself a medical intervention. There are real pharmacological reasons for caution. Some antidepressants can interact with certain psychedelics to produce dangerous serotonin excess, and ayahuasca contains compounds that inhibit the enzyme that breaks serotonin down, which makes that combination especially hazardous. But the answer is not to have a retreat coordinator tell a patient to quit his medication a few days before arrival. Discontinuing an antidepressant safely commonly takes weeks and requires supervision, and the patient faces a real risk that his depression, anxiety, or other condition will return in the meantime, just before he enters an intense and destabilizing experience. There is also a less flattering motive for washouts, which Dr. McGuire has named: medications can blunt the experience a paying customer came for.
Third, the patient’s heart must be evaluated, not merely asked about. Ibogaine can cause life-threatening heart rhythm disturbances, and several of the deaths described above were cardiac. Self-reported history is not a cardiac workup. Any program offering ibogaine without objective cardiac screening and continuous monitoring during the session is accepting a risk on the patient’s behalf that the patient cannot properly weigh.
Questions to ask before going anywhere
For readers considering this path, and for family members trying to help someone who is, these questions follow directly from the evidence. None of them tells you whether a particular treatment is right for you, which is a matter for you and a physician who knows your history. They are meant to separate programs that practice medicine from those that merely resemble it.
Ask who is medically responsible for your care, what his credentials are, and whether he is present during dosing rather than on call. Ask whether the program independently reviews your medical records and performs its own examination, including an ECG and bloodwork where the substance warrants it, or relies only on a questionnaire. Ask how the program decides whether and how you should change your current medications, and insist that any change be planned with your own prescribing physician well in advance. Ask whether you will be told exactly what you are receiving and in what amount, before you receive it. Ask whether staff have emergency medical training and resuscitation equipment on site, how far the nearest hospital is, and how you would get there. Ask whether staff ever use substances during sessions. Ask what preparation and follow-up support is provided, since the research suggests that counseling before and after a session contributes substantially to good outcomes. And ask whether you may bring a trusted companion who remains sober throughout.
A reputable program will welcome these questions. A program that evades them has answered them.
The larger picture
Psychedelic medicine may well earn a lasting place in the treatment of addiction, trauma, and depression. The present enthusiasm, however, has outrun the institutions that normally protect patients. Americans who cannot obtain these treatments at home are traveling to jurisdictions where the regulations are looser and legal remedies after harm are limited. The people most drawn to these programs are often the most vulnerable: veterans with PTSD, people with long addictions, and survivors of trauma. Those are precisely the patients who most need careful screening, honest consent, and protection while they are incapacitated.
The encouraging part is that the harms documented here are largely preventable. They do not come from some mysterious property of the medicines. They come from skipped examinations, casual advice about prescriptions, undisclosed doses, untrained staff, and practitioners who take advantage of a person in a defenseless state. Those are problems medicine already knows how to solve. Until the field solves them consistently, the burden of vetting falls on the patient, and he should carry it seriously.
Sources
- Daly N, Jacobs A. [Report on overseas psychedelic clinics and ibogaine in Mexico]. The New York Times. August 26, 2026; updated September 14, 2026.
- McGuire AL, Neitzke-Spruill L, Robinson JO, et al. Reported Safety Practices of Publicly Advertised Psychedelic Retreats. JAMA Network Open. 2026;9(1):e2552505. doi:10.1001/jamanetworkopen.2025.52505
- “What to know about psychedelic retreats, a booming business with few safety guardrails.” Associated Press, via The Boston Globe. April 20, 2026.
This article is for general information and is not medical advice. Anyone considering psychedelic treatment, or any change to prescribed medication, should consult a qualified physician who knows his full history.