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What are the Signs and Symptoms of Salvia Abuse?

A YouTube search of Salvia will yield videos of people lying on the floor, thrashing, getting into strange positions, laughing maniacally, mumbling slurred gibberish, waving their arms and grabbing at things only they can see, or even diving through a closed window.

What is Salvia?

Salvia Divinorum is a leafy green plant of the sage family. It has green leaves, and purple and white flowers, with square stems, and can grow to a height of about three feet. It grows naturally in a mountain area in northern Mexico, but has been cultivated in other areas including the United States. When burned, the smell is putrid, and described as “burnt rotten fish”. Salvia Divinorum contains the chemical compound salvinorin A. Salvinorin A is one of the most potent naturally occurring psychedelic1 substances. Psychedelic substances, commonly but erroneously referred to as hallucinogens, produce an altered sense of perception and distort reality. As of 2018, the DEA (Drug Enforcement Administration) has not scheduled Salvia as a controlled substance, but rather a “substance if concern”. The DEA is contemplating making it a Schedule I controlled substance, meaning it has a high abuse potential and no approved medical uses. As of 2018, 12 states have made the possession, sale or use of Salvia a crime. However, Salvia is readily available for purchase on line, or at smoke shops, where it is sometimes called legal weed. Despite this name, Salvia is not related to Cannabis Sativa, commonly referred to as marijuana

 

How Salvia is Used?

Salvia leaves are dried and can be smoked in a joint or bowl, or bong. The leaves can also be infused in hot water to make tea, infused in alcohol to make a tincture, or concentrate, or shredded and crushed, and held between the cheek and gum, where the psychoactive compounds are absorbed gradually.  

 

What are the Effects of Salvia on the User?

Salvia produces a brief psychoactive experience when smoked and a longer lasting experience when chewed or the infusion is drank, or drops of the tincture are swallowed. When smoked, the duration of the experience will only be about 10 or 15 minutes. The other methods of use will produce a longer lasting effect of about three hours. 

The effects of salvia vary between individuals, but include: 

  • Hysterical laughter
  • Visual hallucinations of bright lights, colors, and shapes
  • Tactile hallucinations or the sense of being touched, or something crawling on or under your skin.
  • A panic response
  • Inability to move or difficulty moving
  • Loss of muscle coordination
  • Vertigo, or a spinning sensation.
  • Tunnel vision
  • Profoundly altered sense of self and ones surroundings
  • The feeling of being buried underground or being underwater
  • The feeling of becoming an inanimate object.

Short-Term and Long-Term Risks of Using Salvia

The short term risks of smoking salvia are unknown, and the long term risks are also uncertain, and unclear. The use of Salvia in the United States has risen since 2002, but much of the information about it is more anecdotal than scientific in nature. There is research being done on Salvia for potential medical uses of the psychoactive compound it contains, but relatively little is known about the effects when abused, which are highly variable between users. On a positive note, there are no reported deaths from Salvia, and the very brief duration of action; which is only about ten minutes when smoked means that medical management of acute symptoms is probably not needed, as the symptoms will rapidly resolve on their own without intervention. With any perception altering drug, an ever present danger is that someone will injure themselves accidently while under the influence. For this reason, many users of psychedelic drugs recommend use of a sitter, or designated driver. This is a person who is not under the influence, but who is experienced with the effects of the drug who will safeguard the person under the influence. 

Salvia does not appear to have addictive potential, as the research that has been done on it has revealed how it affects the brain. Salvinorin A binds to kappa opiate receptors in the brain, which are different than the mu-opiate receptor activated by heroin and other opiates. When mu-opiate receptors are activated, addiction results, while addiction is not seen with activation of kappa opiate receptors. The foul smell when smoked and the general unpleasantness of the salvia experience also preclude it from being addictive. The reward from smoking salvia is so limited that there is little incentive to go back and do it again. 

Conclusion

As with all newly introduced psychoactive drugs, more information is needed, and it is important not to overreact in the fit of moral hysteria which too often accompanies the rise in popularity of new drugs. A sane and reasonable approach needs to be taken to understand the effects of the drug, warn the public accordingly with accurate information, and clinically treat users who have difficulty discontinuing use. If it is determined Salvia is a threat to public health, it may be regulated or controlled at both the state and federal level. 

1 A Psychedelic compound is specifically a chemical compound which primarily alters perception, while a psychoactive compound is any chemical compound which alters thoughts, feelings, perception, or behavior.