by Joshua Goldman, MD, MBA | email@example.com
Miley Cyrus’ documented celebration of her entry into adulthood has transformed a shaman’s sacred herb into one of the hottest new drugs (and legal one at that) on the market. Since the YouTube leak of Miley Cyrus smoking Salvia divinorum from a bong on her 18th birthday hit the internet, Google searches for “salvia” in the United States spiked 600% (even Saturday Night Live took a jab at Cyrus for her Salvia indulgence). What is this wacky Mexican herb that has suddenly found its way to the main stream thanks to Cyrus’ accidental celebrity endorsement? Is it really as safe is people make it out to be? We dive into the ancient roots of the herb, its affects on the body and, most importantly, its potential health risks.
What is it?
Salvia divinorum, Latin for Salvia of the Ghosts and commonly known as Diviner’s Sage, is a perennial herb that comes from the mint family of plants. The plant is indiginous to the Sierra Mazateca cloud forest in Oaxaca, Mexico but has become much more ubiquitous as it has grown in popularity. The herb was originally discovered by the Mazatec people living in the area and was used by Mazatec shaman to stimulate hallucinogenic visions during spiritual healing and divination (maybe that’s what Miley was up to). The shaman also used the plant medicinally in smaller doses for the treatment of diarrhea, anemia, headaches and rhematism (which, it turns out, was a pretty darn good guess on their part; maybe Miley had diarrhea). The plant’s slang names (Ska Maria Pastora, La Maria, etc.) come from the fact that the shaman thought the plant was an incarnation of the Virgin Mary. The plant does not readily reproduce but can be propagated via vegetative reproduction. This is done by taking small cuttings, from a mother plant and placing them in plain tap water. The sprig will then root within two or three weeks and can be transplanted to soil.
In modern history, Salvia has gained popularity among teenagers and young adults because it is both legal and readily available. The National Survey on Drug Use and Health from 2006 estimated that about 1.8 million persons aged 12 or older had used Salvia divinorum in their lifetime with the annual number of users increasing from 750,000 in 2006 to 1 million in 2007. Plants, leaves, and extracts are now readily available over the internet, where it is marketed as a “legal and safe hallucinogen” (1).
How does it work?
The active ingredient in the herb is salvinorin A, a diterpene alkaloid and kappa opioid agonist (this will not be on the final exam) (2). This is unique because Salvia is the only hallucinogen to act on opioid receptors in your body. The exact mechanism underlying classic hallucinations is not known but a property common to most hallucinogens is their ability to bind 5-HT2A receptors (a specific seratonin receptor in the brain), especially those expressed in one specific type of cell in the brain (neocortical pyramidal cells) (3). Salvia is the only hallucinogen that does not act on this receptor.
The plant is the most potent naturally occuring hallucinogen, triggering its charcteristic effects at doses as low as 200 micrograms (in contrast, LSD, a synthetic hallucinogen, causes effects at doses of only 20-30 micrograms). What do people do with it? The herb is both smoked (usually via a water pipe or bong) and chewed with the onset and duration of the effects varying by method of ingestion. The “usual dose” (if there is such a thing when referring to a recreational hallucinogen) is 10 to 20 fresh leaves chewed or 2 to 5 dried leaves smoked. The hallucinogenic effects of Salvia divinorum normally last about one to two hours when chewed and about 15 minutes when smoked.
In terms of other medicinal effects, Salvinorin A has also been shown to inhibit gut motility in an inflamed intestinal tract by acting on the opiod receptors there (it appears the Mazatec shamen were on to something) but has no effect on an intact gut (i.e. it only works if your gut is irritated). Additionally, one small study showed that it provides some analgesic effects although we don’t recommend replacing your go-to analgesic with a hallucinogenic herb (4). Your uncontrollable giggling would be hard to explain to your boss or teacher.
What are these hallucinogenic effects we keep hearing about?
Research into the hallucinogenic effects of Salvia divinorum revealed a myrid of unique experiences including uncontrollable laughter, conjuring of past memories, sensations of motion, visions of membranes, merging with or becoming objects, and overlapping realities, such as the perception of being in several locations at once (6). Users also commonly report a sense of calm, elevated mood, and introspection. In a survey of salvia users, 38% described the effects as unique in comparison to other methods of altering consciousness and 23% said the effects were like yoga, meditation or trance (maybe we’ve been doing yoga incorrectly all these years, but we have yet to hallucinate while perfecting the downward dog).
While the hallucinogenic effects are short-lived, there are some documented lasting effects. A study of 500 Salvia users performed by the University of California and California Pacific Medical Center Research Institute (i.e. your tax dollars at work) investigated the effects of the herb other than the classic hallucinogens it’s known for (5). They found the following effects in users (the percentage of respondents noting each particular symptoms is included):
- Increased insight: 47%
- Improved mood: 44.8%
- Feelings of calmness: 42.2%
- Weird thoughts: 36.4%
- Things seeming unreal: 32.4%
- Increased sweating: 28.2%
- Mind racing: 23.2%
- Feeling lightheaded: 22.2%
- Increased self-confidence: 21.6%
- Increased concentration: 19.4%
- Difficulty concentrating: 12%
Worsened mood: 4%
What if someone has a bad experience? How long is it going to last?
Salvia divinorum was the subject of the first drug-behavioral research project utilizing YouTube. Scientists at San Diego State University reviewed a collection of YouTube videos documenting Salvia users under the influece to study their degree of impairment (7). They found that the most profound effects of smoking Salvia, including speech and coordination loss, occur almost immediately and last about eight minutes. Essentially, if you have a bad reaction, it will all be over soon.
Is it dangerous?
The simple answer is: Not really. There are some documented adverse effects including dysphoria, lack of coordination, dizziness, and slurred speech. The typical sympathomimetic symptoms seen with hallucinogens are mild with Salvia (this is a fancy medical way of describing a constellation of symptoms caused by your sympathetic nervous system which include a fast heart rate, fever, high blood pressure, and dilated pupils). Severe vital sign abnormalities are uncommon with hallucinogens in general. No deaths or cases of severe toxicity have been reported. There also appears to be little potential for addiction. The previously mentioned study by the University of California found that only 0.6% of respondents felt addicted to or dependent on salvia at some point and 1.2% reported strong cravings (5). As with all smoked substances, the inhaled smoke can cause irritation to your respiratory tract and, if smoked repeatedly, can increase your risk of lung cancer.
Although Salvia divinorum is not a federally controlled substance in the US, the US Drug Enforcement Agency has listed it as a Drug of Concern (8). It is currently categorized as a controlled substance in Australia and several European countries.
The Take Home Message:
Salvia divinorum, like all hallucinogenic substances, brings with it risks, albeit few in number. As long as it is used safely and not used in excess, it seems to have few adverse effects and minimal if any long-terms consequences. As a result of its mind-altering properties, it remains on the DEA’s Drug of Concern list but is completely legal for adults in California where Miley shot her home video. While we, as physicians, hate to say that drug use is acceptable, Salvia divinorum seems to be more acceptable than almost any substance we’ve studied. Maybe those ancient shaman were on to something. If you, like Miley Cyrus, insist on taking Salvia for a spin around the block, remember these parting words from the most prolific Salvia researcher to date, Daniel Siebert, “If you try to party with salvia you probably will not have a good experience. Salvia is a consciousness-changing herb that can be used in a vision quest, or in a healing ritual…It is an herb with a long tradition of sacred use. It is useful for deep meditation. It is best taken in a quiet, nearly dark room; either alone, or with one or two good friends present.” A little too zen for our tastes but we think he’s headed in the right direction.
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1. Boyer, EW, Shannon, M, Hibberd, PL. The Internet and psychoactive substance use among innovative drug users. Pediatrics 2005; 115:302.
2. Roth, BL, Baner, K, Westkaemper, R, et al. Salvinorin A: a potent naturally occurring nonnitrogenous kappa opioid selective agonist. Proc Natl Acad Sci U S A 2002; 99:11934.
3. Fantegrossi WE, Murnane KS, Reissig CJ. “The behavioral pharmacology of hallucinogens.” Biochemical Pharmacology. 2008;75(1):17-33.
4. Turner, D.M. “Effects and Experiences”. Salvinorin—The Psychedelic Essence of Salvia Divinorum. San Francisco, CA: Panther Press. August 1996
5. Baggott, Matthew; Erowid, E. & F. “A Survey of Salvia divinorum Users”. Erowid Extracts 6: 12–14. June 2004.
6. Prisinzano, Thomas E. (2005). “Psychopharmacology of the hallucinogenic sage Salvia divinorum”. Life Sciences 78 (5): 527–531.
7. Lange, J. E.; Daniel, J.; Homer, K.; Reed, M. B.; Clapp, J. D. (2010). “Salvia divinorum: Effects and use among YouTube users”. Drug and Alcohol Dependence 108 (1-2): 138–140.
8. Drug Enforcement Administration, US Department of Justice. Drugs and Chemicals of Concern, 2007.