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

Two distinct psychedelic factors were identified through factor analysis with divergent associations to OUD severity.

• Factor analysis of psychedelic substances yielded two factors: Psychedelic_F1 (mescaline/peyote) and Psychedelic_F2 (LSD/psilocybin/MDMA/DMT).
• The study used structural equation modeling of the cross-sectional 2023 U.S. National Survey on Drug Use and Health with n = 45,133 adults.
• Covariates included age, sex, and income.
• Mental health impairment was modeled as a latent construct.

Mescaline/peyote use (Psychedelic_F1) was associated with lower OUD severity.

• Psychedelic_F1 associated with lower OUD severity (β = -0.34, p = 0.001).
• This inverse association was statistically significant in the overall sample.
• The protective association was specific to the mescaline/peyote factor and not shared by other psychedelics examined.

LSD/psilocybin/MDMA/DMT use (Psychedelic_F2) was associated with higher OUD severity.

• Psychedelic_F2 associated with higher OUD severity (β = 0.60, p < 0.001).
• This positive association was stronger in magnitude than the inverse association found for Psychedelic_F1.
• The association persisted even after controlling for age, sex, income, and mental health impairment.

Mental health impairment was positively associated with OUD severity.

• Mental health impairment positively associated with OUD severity (β = 0.21, p < 0.001).
• Mental health impairment was modeled as a latent construct.
• Mental health impairment was used to define high vs. low impairment groups for moderation analyses.

The inverse association between mescaline/peyote use and OUD severity was present only in the high mental health impairment group.

• Psychedelic_F1 related to lower OUD severity only in the high mental health impairment group (β = -0.15, p = 0.041).
• The association was not statistically significant in the low mental health impairment group.
• This suggests a moderating role of mental health impairment on the relationship between mescaline/peyote use and OUD severity.

The positive association between LSD/psilocybin/MDMA/DMT use and OUD severity was attenuated among those with high mental health impairment.

• The positive association for Psychedelic_F2 was attenuated among those with high impairment (β = 0.38, p < 0.001) compared to those with low impairment (β = 0.48, p = 0.004).
• Despite attenuation, the association remained statistically significant and positive in both groups.
• The difference in effect sizes between high and low impairment groups suggests mental health impairment moderates this relationship.

The authors concluded that contextual and motivational factors underlying psychedelic use warrant further investigation.

• The study was described as exploratory and cross-sectional, limiting causal inference.
• The divergent findings across psychedelic types suggest that lumping all psychedelics together in research may obscure important distinctions.
• The authors noted that the differential associations by mental health impairment groups highlight the importance of considering psychiatric context in psychedelic research.