Can Education Compensate for Poor Healthcare? Racial Inequalities in Psychedelic-Associated Psychological Distress

Abstract

Abstract While prior research suggests that healthcare context shapes the mental health correlates of psychedelic use, it remains unclear whether education can mitigate these disparities—particularly across racial and ethnic groups. This study examines whether educational attainment moderates the association between lifetime psychedelic use, health insurance context (public vs. private), and psychological distress, and whether these patterns vary by race/ethnicity. Using nationally representative data from the National Survey on Drug Use and Health (2008–2018; N = 484,732), we estimate ordinary least squares regression models stratified by racial and ethnic group. Results indicate that higher education is associated with lower psychological distress among psychedelic users primarily when paired with private insurance, a pattern observed most consistently among White respondents. In contrast, among individuals relying on public insurance, educational attainment offers little protection against elevated distress. A notable exception emerges among Native Hawaiian and Pacific Islander respondents, for whom higher education is associated with reduced distress despite public insurance coverage. Taken together, these findings suggest that education alone is insufficient to offset structurally patterned inequalities in healthcare and that the mental health correlates of psychedelic use remain contingent on institutional context.