An increasing number of teenagers are taking salvia for its hallucinogenic effects. Salvia divinorum, a flowering plant in the mint family is also referred to as diviner’s sage, magic mint or purple sticky.1

Salvia is becoming so problematic in some areas of the country that one county in New York is considering a law to make it illegal for anyone younger than age 18 years to sell or possess the plant (it is already illegal in Delaware, Florida, Illinois, Kansas, Mississippi, Missouri, Nebraska, North Dakota, Ohio, Oklahoma, South Dakota, and Virginia).2 Salvia’s popularity among teens is due to its potent neuropsychiatric actions, which produce feelings of depersonalization, laughter, levitation, and self-consciousness.3

Background

Salvia divinorum was originally used in religious rituals by the holy men of the Mazetec Indian tribe in Mexico.3 Salvia is a perennial herb that grows to a height of about 3 ft, with ovule clustered leaves 10 to 12 in long. The plant’s flowers are strikingly white and purple.4 Unlike many ancient herbs, salvia does not thrive in the wild, only in cultivated settings in Mexico and (more recently) southern California.4,5

In addition to its ceremonial uses, Salvia divinorum was also used in its native culture to treat a wide variety of ailments, including diarrhea, headache, and rheumatism.1 Today, the substance is widely available internationally via the Internet, but it has been outlawed in Australia, Finland, Denmark, Spain, and Norway.3

Science

Although the data regarding the abuse and illicit use of this herb initially casts it in a very negative light, medical and neuropsychiatric researchers are keenly interested in its potential for the treatment of a wide variety of neurologic and mental illnesses.5

Current ongoing studies are exploring salvia’s ability to alter mental perception and cognition and whether it could be of use in cases of refractory depression, anxiety, Alzheimer disease, and schizophrenia.5

This interest is a result of salvia’s unique mechanism of action. Unlike marijuana and lysergic acid diethylamide (LSD), which act through serotoninergic pathways, salvia’s active metabolite—salvinorin A—is a potent but pure selective kappa-opioid receptor agonist.4 To date, animal studies have shown salvia to have a rapid onset of action with a short elimination half-life as well as a notable lack of evidence of toxicity.5 Most monitored cases of use show complete resolution of action within 30 minutes of ingestion.2

Medical proponents of the therapeutic potential of this herb are quick to point out that salvia’s specifically selective action means it is free of addictive properties and does not produce euphoria.6

Although large-scale clinical trials are currently lacking, interesting case reports abound. In one such report, a young adult woman with a long history of severe, refractory depression was studied while using salvia. Of note, this trial was somewhat accidental in that the patient obtained the salvia and discontinued pharmacologic therapy without informing her therapist.

During the woman’s routine therapy sessions, her Hamilton Depression Rating Scale (HAM-D) scores were consistently in the moderately depressed range (19-21).7 However, after six months of using small amounts of salvia three to four times per week, her HAM-D scores were down to 0-2, indicating near total reversal of symptoms.7

In another more formal experiment, salvia was used in an open-label trial for dementia therapy. Eleven patients aged 76 to 95 years with confirmed Alzheimer disease were enrolled. At the beginning of the study, all participants had Mini-Mental Status Examination scores between 10 and 26 and very low scores on the Neuropsychiatric Inventory (NPI). Current medications were continued but not adjusted during the trial period. At the end of six weeks, there had been no significant adverse effects, and statistically significant improvements in both the NPI and Clinical Dementia Rating cognitive assessment scores were noted.8

Safety, interactions, and dose

It should be noted that salvia in any form has a very rapid onset of action, crossing the blood-brain barrier almost instantaneously. Salvia may cause bradycardia, chills, and loss of muscle control, as well as hallucinations and perceptual distortions.9 Dizziness, slurred speech, nausea, and bizarre actions have also been documented.9

Interaction should be assumed with any other psychoactive medication, but specific drugs and herbs have not been studied. Allergic reaction is also possible. There is no established dose.

How supplied and cost

Salvia divinorum is usually supplied as dried plant matter, either as a powder for inhalation or leaves for smoking or chewing. Most purchases are made via the Internet.

Summary

While salvia may one day be proven as a lifesaving drug for people suffering from a variety of neurologic and psychiatric diseases, its use is currently a very dangerous experiment. From a professional standpoint, there are absolutely no valid reasons to use this substance.

References

1. Vortherms TA, Roth BL. Salvinorin A: from natural product to human therapeutics. Mol Interv. 2006;6:257-265. 

2. Sun-Edelstein C, Mauskop A. Alternative headache treatments: nutraceuticals, behavioral and physical treatments. Headache. 2011;51:469-483.

3. Singh S. Adolescent salvia substance abuse. Addiction. 2007;102:823-824.

4. Johnson MW, Maclean KA, Reissig CJ, et al. Human psychopharmacology and dose-effects of salvinorin A, a kappa opioid agonist hallucinogen present in the plant Salvia divinorum. Drug Alcohol Depend. 2011;115:150-155.

5. Grundmann O, Phipps SM, Zadezensky I, Butterweck V. Salvia divinorum and salvinorin A: an update on pharmacology and analytical methodology. Planta Med. 2007;73:1039-1046.

6. Brown DJ. Salvia on schedule: Law, medicine, and a hallucinogen. Scientific American. August 11, 2009. 

7. Hanes KR. Antidepressant effects of the herb Salvia divinorum: a case report. J Clin Psychopharmacol. 2001;21:634-635.

8. Perry NS, Bollen C, Perry EK, Ballard C. Salvia for dementia therapy: review of pharmacological activity and pilot tolerability clinical trial. Pharmacol Biochem Behav. 2003;75:651-659.

9. Natural Standard. Salvia divinorum.

All electronic documents accessed June 15, 2011.