The association of psychedelic use and opioid use disorders among illicit users in the United States

This survey study (2017; n=44,000) found that the use of psychedelics and cannabis was associated (but as always, this doesn’t imply causation) with a lower risk of opioid dependence and abuse in a large national survey.

Abstract

“Background: Preliminary studies show psychedelic compounds administered with psychotherapy are potentially effective and durable substance misuse interventions. However, little is known about the association between psychedelic use and substance misuse in the general population. This study investigated the association between psychedelic use and past year opioid use disorders within illicit opioid users.

Methods: While controlling for socio-demographic covariates and the use of other substances, the relationship between classic psychedelic use and past year opioid use disorders was analyzed within 44,000 illicit opioid users who completed the National Survey on Drug Use and Health from 2008 to 2013.

Results: Among respondents with a history of illicit opioid use, psychedelic drug use is associated with 27% reduced risk of past year opioid dependence (weighted risk ratio = 0.73 (0.60–0.89) p = 0.002) and 40% reduced risk of past year opioid abuse (weighted risk ratio = 0.60 (0.41–0.86) p = 0.006). Other than marijuana use, which was associated with 55% reduced risk of past year opioid abuse (weighted risk ratio = 0.45 (0.30–0.66) p < 0.001), no other illicit drug was associated with reduced risk of past year opioid dependence or abuse.

Conclusion: Experience with psychedelic drugs is associated with decreased risk of opioid abuse and dependence. Conversely, other illicit drug use history is largely associated with increased risk of opioid abuse and dependence. These findings suggest that psychedelics are associated with positive psychological characteristics and are consistent with prior reports suggesting efficacy in treatment of substance use disorders”

Authors: Vincent D. Pisano, Nathaniel P. Putnam, Hannah M. Kramer, Kevin J. Franciotti, John H. Halpern & Selma C. Holden

Summary

Introduction

Abuse of prescription and illicit opioids is an ongoing problem within the United States. Strategies to reduce illicit prescription opioid use have been implemented, but may have unintended consequences.

From 2008 to 2014, heroin use in the United States doubled, and the maintenance model treatment approach for opioid dependence is ineffective.

This study investigated the relationship between psychedelic use and substance misuse in illicit opioid users by controlling for socio-demographic covariates and the use of other substances.

The maintenance model of treatment for opioid dependence has remained conceptually static for almost a half century. However, a recent meta-analysis found that the addition of any psychosocial treatment compared with pharmacological maintenance alone is superior in terms of retention and reduced opiate use.

Serotonin – norepinephrine reuptake inhibitors (SNRIs) have shown some evidence in the treatment of physical pain with or without depression, diabetic neuropathy and other pain syndromes. Psychedelic compounds may be effective in treating substance use disorders, although use in opioid treatment has been minimal. A meta-analysis of 31 studies with over 1,100 alcohol dependent subjects demonstrated improvement in 75% of the lysergic acid diethylamide treatment group compared with 44% of the control group at 10 month follow-up.

22 of 24 respondents with substance abuse or dependence histories were in full remission, and 74 outpatients receiving general therapy were abstinent at six and 12 months after receiving LSD therapy.

Psychedelics have been shown to be associated with decreased recidivism and decreased odds of past month psychological distress, past year suicidality, suicidal planning and suicide attempt among people with substance abuse history.

The present study explored whether psychedelic use history was associated with decreased risk of past year opioid abuse and dependence.

Methods

The NSDUH is an annual, in person interview conducted to gain information on alcohol, tobacco, illicit and prescription drug use and mental health.

Data analysis

NSDUH data from 2008 to 2013 was appended to a new dataset and a subpopulation of individuals 18 or older who had used illicit opioids was defined. A new variable was created to denote a history of classical psychedelic use: LIFEHAL.

Observations were limited to adults that reported lifetime use of recreational pain killers or lifetime heroin use. Primary outcome variables included meeting criteria for past year PPK abuse or past year heroin abuse.

The NSDUH’s 10 dependence criteria were also analyzed for associations with psychedelic use. Respondents endorsing at least three criteria were coded positive for substance dependence.

A multivariate logistic regression was used to test the association between psychedelic use and outcome variables while controlling for demographic factors and use of other illicit substances.

Results

Of 228,556 adult respondents, 44,678 reported illicit pain killer or heroin use, of which 18,517 reported history of classic psychedelic use. Psychedelic use was concentrated in Whites, males and those more likely to engage in risky behaviors.

Psychedelic use was associated with reduced risk of past year opioid dependence and abuse, while marijuana use was also associated with reduced risk of past year opioid abuse. Age was not associated with a significant change in risk of past year opioid dependence or abuse.

Table 3 shows that psychedelic use was associated with reduced risk of reporting seven out of 10 dependence criteria, with risk ratios ranging from 0.65 to 0.78.

Discussion

Psychedelic use is associated with reduced risk of past year opioid dependence and abuse among respondents with a history of illicit opioid use.

Almost all drug use was associated with increased risk of opioid abuse and dependence, except psychedelics and marijuana. However, marijuana has been shown to decrease pain and states with medical marijuana laws have lower opioid overdose mortality.

Psychedelic use was associated with reduced risk of endorsing seven of NSDUH’s 10 dependence criteria. However, the three least endorsed criteria were not significantly associated with psychedelic use.

Psychedelic use outside of a structured therapy setting is associated with decreased abuse and dependence, despite uncontrolled settings and psychedelics of unknown dose and purity. The lack of a concrete mechanism raises safety concerns, especially in regard to vulnerable populations.

Psychedelic use causes rapid downregulation and desensitization of 5-HT2A receptors, which may be responsible for the ‘afterglow’ period of several weeks characterized by improved mood, energy and freedom from past guilt and anxiety. 5-HT2A receptors may also play a role in reducing stress-induced relapse to opioid use.

Serotonergic psychedelics may reduce opioid use by allowing for reflection and metamorphosis of personality traits, which may be facilitated by their potentially anti-nociceptive activity at 5-HT2A receptors.

This study uses self-reported data from a large population of illicit opioid users to analyze the association between classic psychedelic use history and opioid abuse and dependence. It finds that psychedelic use is associated with positive psychological characteristics and may be effective in treatment of substance use disorders.