Lifetime psychedelic use and opioid use disorder severity in a National Survey: the roles of psychedelic type and mental health.
Sebastian Ehmann, Nathan M. Hager, Paul S. Regier, Grant Jones, John J B Allen
Addictive Behaviors June 1, 2026 DOI: 10.1016/j.addbeh.2026.108652 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Cross-sectional survey with structural equation modeling Peer reviewed |
|---|---|
| Sample size | 45,133 |
| Population | U.S. adults from the 2023 National Survey on Drug Use and Health |
| Topics | Addiction Mescaline |
| Keywords | Mental health impairment Psychedelics |
| Key findings | Mescaline or peyote use was associated with lower opioid use disorder severity, whereas use of LSD, psilocybin, MDMA, or DMT was associated with higher severity, with effects differing by level of mental health impairment. |
Abstract
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. 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. 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). 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.
In the evidence
This study is part of the evidence base for a synthesis in the library. Here is how each one recorded it.
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Mescaline/peyote use was associated with lower opioid use disorder severity, whereas LSD/psilocybin/MDMA/DMT use was associated with higher severity, with the mescaline association present only in the high mental health impairment group.
Synthesized
Comparable studies
Other cross-sectional and survey studies on addiction, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Persisting Reductions in Cannabis, Opioid, and Stimulant Misuse After Naturalistic Psychedelic Use: An Online Survey Online survey respondents | 2020 | Cross-sectional survey | |
| The users of Novel Psychoactive Substances: Online survey about their characteristics, attitudes and motivations International users of novel psychoactive substances recruited via bluelight.org | 2016 | Cross-sectional online survey | n = 619 |
| User perceptions of the benefits and harms of hallucinogenic drug use: A web-based questionnaire study Users of hallucinogenic drugs who completed a web-based questionnaire | 2010 | Cross-sectional survey | n = 600 |
| Psychological and neuropsychological assessment of regular hoasca users. Regular hoasca users from a U.S. branch of União do Vegetal and matched non-user controls | 2016 | Cross-sectional study | n = 57 |
| Client and counselor attitudes toward the use of medications for treatment of opioid dependence. Counselors and clients from outpatient, methadone, and residential drug treatment programs | 2007 | Cross-sectional survey | n = 1,459 |
Citations in the library
Cites 8
- Psychedelics and the essential importance of context. Journal of Psychopharmacology February 15, 2018
- Persisting Reductions in Cannabis, Opioid, and Stimulant Misuse After Naturalistic Psychedelic Use: An Online Survey Frontiers in Psychiatry January 22, 2020
- The epidemiology of mescaline use: Pattern of use, motivations for consumption, and perceived consequences, benefits, and acute and enduring subjective effects. Journal of Psychopharmacology March 1, 2022
- Associations between classic psychedelics and opioid use disorder in a nationally-representative U.S. adult sample Scientific Reports April 7, 2022
- The Native American Church, Peyote, and Health: Expanding Consciousness for Healing Purposes Contemporary Justice Review December 1, 2007
and 3 more in the library