- Can you believe Salvia is legal?
- What Is Salvia Divinorum? Effects, Safety, and Legality
- What is Salvia Divinorum?
- Legal Status
- United States
- Other Countries
- How Does Salvia Work?
- Salvia Divinorum Effects
- Onset and Duration
- Health Risks
- 1) Psychosis
- 2) Impaired Memory and Attention
- 3) Withdrawal Symptoms
- Areas of Research (Animal Studies)
- Salvia Divinorum
- Case presentation
- Clinical manifestations
- Discussion of case questions
- Case conclusion
Can you believe Salvia is legal?
Marijuana, prostitution, artillery emplacements, there are certainly plenty of things the government has deemed illegal. For many this is a good thing, as most would agree that the world could do without a cocaine cowboy with a Howitzer.
However, there are still many surprising things Uncle Sam has yet to take away, such as Salvia Divinorum. Despite its potentially dangerous effects, salvia is still primarily legal in the eyes of the law.
Let’s dig deeper and find out more about why this dangerous plant can be found at the local grocery store and not on the government’s banned substance list.
What is Salvia?
Belonging to the Lamiacae family, salvia is a hard-working cousin of the mint plant.
The popular perennial herb is well-known for its wonderful taste and aroma, making it a regular in gourmet food magazines.
Commonly known as sage, salvia has long leaf-bearing stems and tall stalks that are typically covered with wonderful flowering buds. Amazingly, there are over 800 various kinds of salvias throughout the world.
However, some only grow in extremely tropical regions and others are sparse with few leaves. With that being said, there are still dozens of different types of ornamental salvias that are popularly found in flower beds and gardens across the country.
Most types of salvia are not particularly hardy, yet some varieties can survive in climates as cold as zone four. The most common of the hardy salvia varieties is the salvia nemerosas.
In 1997, a cultivar of this variety, the May Night, was given the crown of Perennial of the Year. The salvia’s vibrant purple stems overflow with violet and purple flowers each year from June through October.
The May Night reaches a plant height of 18 inches, and when mature, it spreads up to 25 inches.
In addition to its use in gardens and culinary creations, salvia also has a history of being used for medicinal purposes.
In fact, salvia used to be valued above tea by the Chinese who loved the plant for its healing properties. To this day, sage tea is still used to treat indigestion and sore throat.
Native Americans and others have also used it for aroma therapy and cleansing rituals for thousands of years.
Salvia as a Dangerous Drug
Although it has its merits, salvia can also be a dangerous, hallucinogenic drug.
When it’s properly prepared, many varieties of salvia can be smoked, resulting in incredibly intense hallucinations. The majority of salvia trips are quite jarring and powerful.
However, the high does not last long as most of the side effects are gone within one hour. Since salvia is legal in most states, it does not show up in most standard drug tests.
Depending on the amount of salvia that is smoked and inhaled, users may experience vivid hallucinations similar to those experienced by those on DMT or LSD. It is this intense high, however, that keeps salvia from becoming a popular party drug and getting on the radar of America’s anti-drug proponents.
Where is Salvia Purchased?
Salvia is still legal in the majority of states. Gardeners can pick up salvia varieties at nurseries, while others can find it at smoke shops or online. However, since salvia is illegal in Florida and a handful of other states, people should check the law in their area to see if they can legally purchase and possess salvia in their state.
Why is Salvia Legal?
As far as intoxicants go, salvia is rather harmless.
Of course, there have been a few cases in which the drug reportedly caused a suicidal mindset in those who smoked it, but evidence is lacking and it therefore cannot be labeled as a depressant.
In fact, some scientists believe salvia may act as an anti-depressant, in addition to having already been found effective in ending cocaine addiction.
Some experts believe the drug can potentially help Alzheimer’s patients and those suffering from schizophrenia as well, and have consequently urged the government not to ban the controversial drug. As a potential cure for Alzheimer’s, depression, cocaine addictions, and schizophrenia, it’s actually surprising the drug isn’t a staple in America’s high school cafeterias.
Salvia is a common plant that grows wild throughout the United States and much of the world, making it nearly impossible to ban as an illegal substance. However, due to its intense high and mind-altering abilities, it’s surprising the overlooked plant is still legal in nearly every state.
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What Is Salvia Divinorum? Effects, Safety, and Legality
The hallucinogenic mint Salvia divinorum is traditionally consumed by indigenous tribes in Mexico as a medicine and for spiritual purposes, but many states and countries have criminalized its use. Read on to learn more about how salvia works, the health risks, and the legality of its use.
Disclaimer: Salvia is illegal in many states in the U.S and is a controlled substance in several countries. We highly advise against the use of salvia until future studies determine its safety and efficacy in medically-supervised and safe settings. The only aim of this post is to outline the research findings.
What is Salvia Divinorum?
Salvia divinorum (also known as Sage of the Diviners, Seer’s Sage, Yerba de la Pastora, Ska Maria, or simply salvia) is a plant species known for its hallucinogenic effects due to psychoactive compounds in its leaves.
Native groups from Mexico have long used this plant in their rituals and as a traditional remedy .
Salvia has gained recent popularity as a recreational drug. Street names for this plant include Magic Mint, Purple Sticky, Lady Salvia, and Sally D .
Salvia is not considered a controlled substance in the United States, but it has been made illegal in several states. In many other countries, salvia is illegal .
The salvia plant is native to the sierras of Oaxaca, Mexico. The Mazatec tribe who are native to the region have long used the plant in religious ceremonies and as a medicine for various conditions including headaches, joint pain, and arthritis pain [4, 5].
In the 1970s, it was reported that young people from cities in Mexico were traveling to the Sierra Mazateca to purchase Salvia divinorum from the native tribes to make into cigarettes and smoke as a substitute for marijuana .
Use in the United States appears to have grown steadily during the 1990s. According to the National Survey on Drug Use and Health, the lifetime prevalence of salvia use increased from 0.7% to 1.3% from 2006 to 2008 .
The following section describes the legal status of salvia in different countries. Laws are complex and constantly changing, do not use this information as legal advice. Always verify your own local regulations.
Currently, in the United States, salvia is not a controlled substance on the federal level, although there have been multiple attempts to make salvia and its active compound a Schedule I substance .
However, 29 states have made salvia and/or salvinorin A (the active compound in salvia) illegal or have limited its use. In addition, a number of other states are currently considering legislation to ban salvia .
Even in states where salvia is not considered illegal, the use of the plant may still have legal repercussions. For example, a man in Nebraska was prosecuted for selling salvia even though it was not illegal in the state at the time. He was charged under a more general statute that bans the sale of products that induce an intoxicated condition .
Salvia is legal in most other countries.
Below are some countries where salvia is currently illegal or prohibited in some manner. However, this is not a comprehensive list, always verify your own local regulations .
- South Korea
- United Kingdom
Specific regulations vary widely depending on the country. For example, in some countries ( Denmark and Finland), salvia is only legal for medical purposes .
How Does Salvia Work?
The main component responsible for salvia’s hallucinogenic effects is a unique compound called salvinorin A .
The hallucinogenic dose of salvinorin A in humans is estimated to be around 250 to 500 μg, which makes it slightly less potent than LSD, a synthetic hallucinogen that is known for its high potency .
According to research, the primary mechanism of salvinorin A is the activation of kappa-opioid receptors (OPRK1). These receptors are linked to several roles in the body, including pain, hallucinations, bodily perception, motor control, mood, depression, and addiction [14, 15, 16].
Un classical hallucinogens such as LSD, DMT, psilocybin, or mescaline, salvia appears to have no effect on serotonin receptors (5-HT2A) .
However, LSD, salvia may activate dopamine receptors (D2 in the striatum) .
Research suggests that salvia also has indirect effects on the same receptor types that are activated by cannabis (CB1 and CB2) [18, 19].
Salvia Divinorum Effects
It is illegal to possess or consume salvia in many countries, including many parts of the U.S. It is unclear what the health risks are of taking salvia. Below is a summary of the reported effects of salvia, outlined for informational purposes and in no way supports the use of this substance.
The effects of taking salvia can vary depending on dose and the way it is taken (smoked, chewed, or as a tea) .
Psychological and sensory effects may include :
- Intense hallucinations
- Floating or flying sensations
- Sensations of traveling through time and space
- Feeling heavy or light
Physical effects may include :
- Slurred speech
- Reduced heart rate
- Lack of coordination
Users of salvia also sometimes report experiencing after-effects, which are sensations that last up to 24 hours or more after smoking. These effects can be positive (such as improved mood or calmness) or they can be negative (such as weird or racing thoughts) [20, 21].
Onset and Duration
There are 3 primary methods of consuming salvia: smoking, chewing the leaves, and brewing tea.
When smoked, the effects typically begin rapidly (within 30 seconds), but diminish within about 15 minutes [22, 23].
When chewing salvia leaves, the effects take approximately 20 minutes to begin and usually last between 1 to 2 hours .
In the case of infused tea, effects may last up to 3 hours, according to some reports. However, the effects may be milder because the active ingredient in salvia is deactivated by the digestive system before reaching the bloodstream [24, 25].
The safety of taking salvia is unclear due to a lack of clinical research. There is very little information on the health risks of salvia, especially potential long-term effects.
According to a review of reports from the California Poison Control System, only 18 cases due to salvia alone were reported over a 10-year period. Among these cases, some reported side effects include :
- Persistent anxiety
- Abdominal pain
In the sections below, we’ll detail some other potential health risks that have been described in case reports and small studies.
There are several case reports of salvia causing short-term and long-term psychosis [27, 28, 29].
For example, there is a report of one user being admitted to psychiatric emergency services after experiencing 3 days of paranoia, déjà vu, and other psychotic symptoms after consuming salvia .
In another case, an 18-year-old female was admitted to a psychiatric emergency room and then legally committed for involuntary treatment after escalating attempts at self-harm, disorientation, and other psychotic behaviors. These symptoms appear to have been triggered when salvia was put into her cigarette with her being unaware .
2) Impaired Memory and Attention
A placebo-controlled trial of 8 healthy hallucinogen-using adults found that salvia may cause dose-dependent impairment to recall and recognition memory. However, these effects did not appear to persist at a 1-month follow-up .
Animal research suggests that salvia may impair memory, attention, and reaction time [31, 32].
3) Withdrawal Symptoms
There is a case report of one woman who experienced 3 days of nausea, vomiting, diarrhea, and gut pain shortly after quitting salvia. Up to that point, she had been taking salvia on a regular basis for 3 to 4 months .
Areas of Research (Animal Studies)
It is illegal to possess or consume salvia in many countries, including many parts of the U.S. No clinical studies have evaluated the health effects of this substance. Below is a summary of animal research that has explored the potential positive effects of salvia, outlined for informational purposes and in no way supports the use of this substance.
Research in animals has explored some potential positive effects of salvia.
For example, several animal studies suggest that salvia may have pain-relieving and anti-inflammatory effects in rats and mice [34, 35, 36, 37, 38, 39].
Animal studies have also found that salvia may protect the brain against damage from oxygen deprivation in pigs and mice [40, 41, 42, 43, 44].
Salvia divinorum is a rare member of the mint family (Labiatae), endemic to a small region of Oaxaca, Mexico.
Shamans of the Mazatec Indians of Oaxaca have used the plant for centuries for religious purposes as well as in medicinal practices to treat diarrhea, headache, rheumatism, anemia, and a semi-magical disease known as panzón de Borrego, or a swollen belly, believed to be caused by an evil sorcerer. Similar to cannabis, S.
divinorum can be also cultivated indoors or in any humid and semitropical environment. Recently, S. divinorum (usually referred to as salvia) has received increasing attention for its recreational use due to its unique psychedelic effects.
It has gained popularity as a “legal high” due to its accessibility, legality in many areas, perception of relative safety, and lack of detectability upon routine drug screening. S. divinorum is frequently promoted as a safe and legal alternative to scheduled hallucinogenic drugs, such as cannabis, LSD, and mescaline.
Salvinorin A, the active component of salvia, is unique for several reasons, which include: 1) it is the first plant-derived molecule with selectivity for kappa-opioid receptors, 2) it is structurally unrelated to any known opioid receptor agonist, and 3) it is pharmacologically and mechanistically distinct from other known hallucinogens.
A 23 year-old male presented to the Emergency Department with anxiety. He admitted to smoking “Diviner’s Sage” shortly before arrival, which he purchased legally from the Internet. He reported having intense visual and auditory hallucinations including seeing furniture come alive and talk to him.
He felt that he had lost his identity and reported various sensations of motion, he was being pulled. On exam, he appeared anxious however had normal vital signs, and his physical exam including a neurologic exam was normal. Shortly after arrival, he felt better and was discharged from the Emergency Department.
His urine drug screen was negative.
- Is the mechanism of action of salvia similar to other hallucinogens, such as LSD?
- Do people under the influence of salvia commonly present to the Emergency Department for treatment?
- Is there an antidote to salvia poisoning?
Salvia divinorum is one of the most widely marketed recreational botanicals available via the Internet. Salvia divinorum is being used recreationally by both adults and adolescents worldwide.
In a recent study of adolescent drug users, 25% of the surveyed adolescents stated that they had used the Internet to obtain information about Salvia divinorum. Several features make Salvia divinorum attractive to young drug users.
First, plant material or extracts of salvinorin A may be purchased from “head” shops, record stores, online vendors, and even university campus stores. Whole plants, seeds, and tips for successful cultivation are available via the Internet.
The principal active component of S. divinorum is salvinorin A. Although a number of other compounds have been isolated from the plant, including salvinorins B–I, their biological activity remains to be elucidated.
The concentration of salvinorin A in leaves collected from separate plants, even genetically identical ones, can vary considerably.
In vitro and in vivo studies have demonstrated that salvinorin A is a selective and potent agonist of k-opioid receptors (KOR), and has no structural resemblance to any known hallucinogens, such as LSD.
Of particular importance is the fact that salvinorin A has no affinity for other known receptors for psychoactive compounds, such other opioid receptors, cannabinoid receptors, cholinergic receptors, glutamate receptors, and serotonin (5-HT) receptors, including 5-HT2A, which represent the main molecular target for classical hallucinogens, such as LSD, psilocybin, and mescaline.
Taken orally, salvinorin A is minimally absorbed through the mucosa, and most of the dose is degraded in the gastrointestinal tract. On the other hand, when inhaled, salvinorin A exerts psychoactive effects within seconds that last only minutes.
Inhalation (of either vaporized salvinorin A extract or smoked dried leaves) produces psychoactive effects within seconds, which last up to 20 to 30 minutes. Threshold doses of Salvia divinorum required to produce hallucinations depend on the route of administration.
Two hundred micrograms of salvinorin A has been described as the threshold dose for hallucinations after inhalation, while doses of 10 mg failed to produce hallucinations after ingestion.
The intravenous administration of salvinorin A is not described in humans, although it has been performed in an animal model.
The KOR mediates diverse behavioral functions including mediation of reward and aversion, mood, anxiety, memory, and higher cognitive functions as well as neuroendocrine effects and pain/analgesia.
KOR are localized in most major dopaminergic areas in the CNS.
KOR activation by exogenous compounds such as salivorum A tends to result in a decrease in dopaminergic activation, an effect opposite to that of diverse drugs of abuse including cocaine and other psychostimulatns.
Inhalation of the vaporized smoke of salvinorin A is considered as the most efficient method for achieving its psychoactive effects.
Salvinorin A induces intense, but short-lived, psychedelic- changes in visual perception and mood, and somatic sensations, which appear in less than 1 min and last for 15 min or less.
Importantly, the rapid onset and high intensity of the effects of salvia can be disorienting and potentially dangerous to a new user, who may have expected a marijuana- experience.
Characteristic vivid visual hallucinations include mainly perceptions of changes in bodily form, merging with objects in the environment, being relocated to a different setting, strong dissociate states in which the passage of time is altered, and colorful visions of objects and designs. Some users describe confusion of senses, called synesthesia, such as seeing sounds and hearing colors. Others report an “ body experience.”
Most of the reported effects of S. divinorum are pleasant. Effects of salvia could be also negative including loss of control over the experience, a feeling of heaviness in the head, fatigue, dizziness, confusion, anxiety, social withdrawal, amnesia, dysphoria, temporary language impairment, and increased perspiration.
At present, neither salvinorin A nor its metabolites can be detected by standard and extended drug tests. However, because S.
divinorum is controlled in several countries, including Australia, Belgium, Canada, Italy, Japan, Poland, Russia, Spain, and Sweden, and in several USA states, various highly advanced methods for forensic analysis of suspected products and biological fluids have been developed in recent years. Salvia divinorum cannot be distinguished from other Salvia species on the basis of morphological features. However, as salvinorin A is present only in S. divinorum. Common methods of salvinorin A detection in the plant material are gas chromatography–mass spectrometry and liquid chromatography–mass spectrometry. These tests are typically performed for forensic purposes only and are not useful in acute management of a poisoned patient.
In comparison to other hallucinogens, the physiological and neuropsychiatric effects produced by Salvia divinorum are relatively mild, but agitated delirium and confusion are reported.
Symptoms severe enough to require treatment in the emergency department are thought to be uncommon, ly due to the short duration of effects. The greatest risk may be trauma in the context of complex activity, driving. To date, no cases of Salvia divinorum deaths from overdose have been reported.
Theoretically, naloxone (a non-specific opioid receptor antagonist) may reverse the physiological and psychiatric effects of salvinorin A at the kappa opioid receptor.
A selective kappa opioid receptor antagonist, norbinaltorphine, demonstrated complete reversal of the analgesic effects of salvinorin A in mice. Otherwise, treatment is supportive and benzodiazepines may be used for anxiety if needed.
Discussion of case questions
- Is the mechanism of action of salvia similar to other hallucinogens, such as LSD?
Salvinorin A, the active component of salvia, is a selective and potent agonist of k-opioid receptors (KOR), and has no structural resemblance to any known hallucinogens, such as LSD.
Salvinorin A has no affinity for other known receptors for psychoactive compounds, most importantly serotonin (5-HT) receptors, including 5-HT2A, which represent the main molecular target for classical hallucinogens, such as LSD, psilocybin, and mescaline.
- Do people under the influence of salvia commonly present to the Emergency Department for treatment?
Symptoms severe enough to require treatment in the emergency department are thought to be uncommon, ly due to the short duration of effects.
Unless a patient presents with trauma, the psychedelic effects of salvia have worn off by the time the patient presents to a health care facility.
- Is there an antidote to salvia poisoning?
Theoretically, naloxone (a non-specific opioid receptor antagonist) may reverse the physiological and psychiatric effects of salvinorin A at the kappa opioid receptor, however this is typically not indicated due the short duration of effects of salvia.
The patient was admitted to the intensive care unit and given vigorously hydrated with normal saline to treat hypotension with systolic blood pressures in the 80-90’s mmHg overnight. Acidosis and lactic acid levels cleared over the next 24 hours and creatinine levels remained normal. She was discharged on hospital day 2 after being cleared by psychiatry.