Salvia Abuse

Over the past 5 years a number of teens and young adults in our program have reported using “salvia” during clinical interviews about their drug use history. Typically the user has a history with marijuana, alcohol, pills and other drugs. What has always been interesting though is that more often than not the salvia user would only try it once, not like and never return to that substance. However, in the last year we have had a number of clients who now use it on a regular basis which is what prompted the topic for this newsletter. It is difficult to pin point exactly why young people are using the drug more regularly, but the drug has had increasing publicity in the mainstream media, youtube and it is easily accessible for purchase at local smoke shops here in town and on the web. Clients report buying it in 5X, 10X or 20X doses, though there is video footage on the web of people claiming to have used 80X.
Salvia (Salvia divinorum) is an herb common to southern Mexico and Central and South America. The main active ingredient in Salvia, salvinorin A, is a potent activator of kappa opioid receptors in the brain.1,2 These receptors differ from those activated by the more commonly known opioids [mu receptors], such as [Oxycontin], heroin and morphine.

Traditionally, S. divinorum has been ingested by chewing fresh leaves or by drinking their extracted juices. The dried leaves of S. divinorum can also be smoked as a joint, consumed in water pipes, or vaporized and inhaled. Although Salvia currently is not a drug regulated by the Controlled Substances Act, several States and countries have passed legislation to regulate its use.3 The Drug Enforcement Agency has listed Salvia as a drug of concern and is considering classifying it as a Schedule I drug, like LSD or marijuana.
Health/Behavioral Effects
People who abuse Salvia generally experience hallucinations or delusional episodes that mimic psychosis.4,5 Subjective effects have been described as intense but short-lived; they appear in less than 1 minute and last less than 30 minutes. Effects include psychedelic-like changes in visual perception, mood, and body sensations; emotional swings; feelings of detachment; and importantly, a highly modified perception of external reality and the self, which leads to a decreased ability to interact with one’s surroundings.5 This last effect has prompted concern about the dangers of driving under the influence of salvia. The long-term effects of Salvia abuse have not been investigated systematically.

Extent of Use
There are no available estimates of Salvia abuse, but a recent increase in Salvia-related media reports and Internet traffic suggest the possibility of an increase in the level of Salvia abuse in the United States and Europe.4 Although information about the user population is limited, users appear to be mostly younger adults and adolescents who are influenced by promotions of the drug on Internet sites.3 Rather than being used as a party drug, Salvia seems to appeal to individual experimentalists.5
References

For more information on the effects of hallucinogenic drugs, see NIDA’s Research Report on Hallucinogens and Dissociative Drugs at www.nida.nih.gov/ResearchReports/hallucinogens/hallucinogens.html.

For more information on Salvia divinorum and the Controlled Substances Act, visit www.deadiversion.usdoj.gov/drugs_concern/salvia_d/salvia_d.htm.

For street terms searchable by drug name, street term, cost and quantities, drug trade, and drug use, visit www.whitehousedrugpolicy.gov/streetterms/default.asp.

1 Chavkin, C., Sud, S., Jin, W. et al. Salvinorin A, an active component of the hallucinogenic sage Salvia divinorum is a highly efficacious kappa-opioid receptor agonist: structural and functional considerations. J Pharmacol Exp Ther. 308:1197–203, 2004.

2 Harding, W.W., et al. Salvinicins A and B, new neoclerodane diterpenes from Salvia divinorum. Organic Letters. 7:3017–3020, 2005.

3 http://www.deadiversion.usdoj.gov/drugs_concern/salvia_d/salvia_d.htm. Accessed September 24, 2007.

4 Roth, B.L., et al. Salvinorin A: a potent naturally occurring non-nitrogenous kappa opioid selective agonist. Proc Natl Acad Sci. 99:11934–11939, 2002.

5 Gonzalez, D., et al. Pattern of use and subjective effects of Salvia divinorum among recreational users. Drug Alcohol Depend. 85:157–162, 2006.

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Jon Daily, LCSW, CADC II

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