National survey links psychedelic use to opioid use disorder severity — in both directions

The question

Is having ever used psychedelics associated with how severe a person’s opioid use disorder is, and does that association differ depending on the type of psychedelic or on the person’s mental health?

What they did

Researchers analyzed data from the 2023 U.S. National Survey on Drug Use and Health, covering 45,133 adults. They used statistical modelling to group reported lifetime psychedelic use into two clusters: one for mescaline/peyote and one for LSD, psilocybin, MDMA and DMT. They then tested how each cluster related to opioid use disorder severity, adjusting for age, sex and income, and split the sample into higher and lower mental health impairment groups.

What they found

The mescaline/peyote cluster was associated with lower opioid use disorder severity (β = -0.34, p = 0.001), while the LSD/psilocybin/MDMA/DMT cluster was associated with higher severity (β = 0.60, p < 0.001). Greater mental health impairment was itself associated with higher severity (β = 0.21, p < 0.001). The link between mescaline/peyote and lower severity appeared only in the high mental health impairment group (β = -0.15, p = 0.041). The positive association for the LSD/psilocybin/MDMA/DMT cluster was somewhat smaller among those with high impairment (β = 0.38, p < 0.001) than among those with low impairment (β = 0.48, p = 0.004).

The fine print

This is a snapshot in time, so it cannot tell us whether psychedelic use changed opioid use disorder severity or whether people with more severe drug problems are simply more likely to have tried psychedelics. All drug use and symptoms were self-reported, and the analysis adjusted only for age, sex and income, leaving many other factors unaccounted for. The authors describe the work as exploratory, and this summary is based on the abstract alone.

What it means

In a large national survey, different psychedelics were linked to opposite patterns of opioid use disorder severity, which suggests that context and reasons for use may matter more than the drugs themselves. These findings are associations only and do not show that any psychedelic helps or harms people with opioid problems.

Evidence grade: Low. A cross-sectional analysis of self-reported survey data that can show associations at one point in time but cannot establish cause and effect.

This summary is based on the study’s published abstract.