Lifetime psychedelic use and opioid use disorder severity in a National Survey: the roles of psychedelic type and mental health.

Abstract

<h4>Background</h4>Opioid use disorder (OUD) remains a major public health crisis in the United States, with mental health disorders substantially increasing risk severity. Emerging evidence suggests psychedelics may relate to reduced OUD risk. This exploratory study examined associations between lifetime psychedelic use and OUD severity and tested whether these associations varied by mental health impairment.<h4>Methods</h4>Structural equation modeling of the cross-sectional 2023 U.S. National Survey on Drug Use and Health with multiple-group moderation (n = 45,133 adults). OUD severity was the primary outcome. Independent variables were two psychedelic factors derived from factor analysis: mescaline/peyote (Psychedelic_F1) and LSD/psilocybin/MDMA/DMT (Psychedelic_F2). Mental health impairment was modeled as a latent construct and used to define high vs. low impairment groups. Covariates included age, sex, and income.<h4>Findings</h4>Psychedelic_F1 associated with lower OUD severity (β = -0.34, p = 0.001), whereas Psychedelic_F2 associated with higher severity (β = 0.60, p < 0.001). Mental health impairment positively associated with OUD severity (β = 0.21, p < 0.001). Moderation analyses indicated Psychedelic_F1 related to lower OUD severity only in the high mental health impairment group (β = -0.15, p = 0.041), while the positive association for Psychedelic_F2 was attenuated among those with high impairment (β = 0.38, p < 0.001, vs. β = 0.48, p = 0.004).<h4>Conclusions</h4>Psychedelic use patterns showed divergent associations with OUD severity. Mescaline/peyote use was linked to lower severity, whereas LSD/psilocybin/MDMA/DMT use was linked to higher severity, with effects differing by mental health impairment. Contextual and motivational factors underlying psychedelic use warrant further investigation.

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