SALVIA DIVINORUM

OFFICIAL NAMES: Salvia divinorum (Epling and Jativa-M.), salvinorin A, divinorin A

STREET NAMES: Hierba Maria (the Virgin Mary's herb), ska Maria Pastora (the leaves of Mary, the shepherdess), semilla de la Virgen (the Virgin's seed), salvia, diviner's sage

DRUG CLASSIFICATIONS: Not scheduled, hallucinogen

OVERVIEW

Salvia divinorum is an herb of the mint family indigenous to the highlands of the Sierra Mazateca of Oaxaca, Mexico. The plant grows about 24–36 in (61–91 cm) in height, with leaves about 6 in (15 cm) long. For centuries, the leaves of the plant have been used by the natives of that region as a hallucinogen in rituals of divination and healing. It is one of several hallucinogenic plants which have been used for these purposes. Other plants are peyote (peyotl), psilocybin mushrooms (teonanactl), and morning glory (ololiuqui).

Reports of the use of psychotropic plants in Mexico date back to the Spanish invasion in the sixteenth century. Following the Spanish conquest, ritual practices involving these plants were banned throughout most of Mexico by the Catholic clergy, who were following the dictates of the Inquisition. However, knowledge of the plants and the traditions connected with them persisted among isolated groups in central Mexico. In the 1930s, expeditions to Oaxaca by Richard Schultes and others studied the hallucinogenic plants and the associated rituals, which had continued among the Mazatec Indians of northeastern region of the state. One such plant was Salvia divinorum. Around 1960, R. Gordon Wasson and Albert Hoffman brought samples of the plant to the United States, where it was identified as a new species of Salvia (sage).

When used by Mazatec shamans for divination or healing, the foliage of Salvia divinorum is collected as needed. Only the leaves are used. They are squeezed, crushed, or ground, and brewed as a tea of extremely bitter taste. A dose of four or five pairs of fresh or dried leaves is used to restore regularity to elimination, relieve headaches, and function as a tonic for generalized weakness, aches, and pains. The herb is deemed a cure for swollen belly, an illness known as panzon de barrego, which is believed to be due to a sorcerer's curse. In doses of 20–60 leaves, the plant causes the user to experience hallucinations.

Shamans make use of Salvia divinorum to induce hallucinatory experiences for several purposes. When someone suffers from an unknown illness, the plant may be used as an aid in diagnosis. A shamanic healer, known in Spanish as a curandero, ascends a mountain where the plants grow to obtain some leaves. Before harvesting the plant, he kneels in prayer. Then, returning to the patient, the curandero prepares a dose of 50 leaves. If the patient suffers from alcoholism, the dose is doubled. They go to a quiet place, along with one other person, who serves as a helper. The patient drinks an elixir of water in which the leaves have been squeezed. In 15 minutes, intoxication sets in and the patient enters a trance. During the trance, he speaks out, and it is believed that his words describe the true nature of his illness. Afterward the patient throws off his clothes, as if to free himself, and then goes to sleep. The next morning, the curanderobathes the patient. It is believed that as a result of this treatment, the patient is cured.

Another use of the hallucinatory experience is to help the victim of a crime find the perpetrator. For example, if a robbery has occurred, the curandero listens while another person ingests the plant. It is believed that the intoxicated person will divine the nature of the deed that was done. Shamans also use Salvia divinorum to find lost animals and objects. After taking a dose under the supervision of a curandero, the person who has lost something goes to sleep in the presence of one other person, who stays awake. The sleeper speaks in his sleep, while the other listens. It is believed that the sleeper will tell the other one the location of the lost item. The next day they go to find it.

Practices such as these also occur among other indigenous peoples of this region, and other hallucinogenic plants are also used in these ways.

The Mazatec curanderos believe that the hallucinogenic trance induced by Salvia divinorum allows them to travel to heaven and learn from God or the Saints. For this purpose, the herb is used to train new curanderos. Because Salvia is considered a weaker hallucinogen than morning glory seeds or mushrooms, it is usually the first of these three hallucinogens to be employed in the training program.

Originally, Salvia divinorum grew naturally only in the remote mountainous regions the Sierra Mazateca. However, the Mazatec shamans transferred the plant to lower elevations near their villages, where it has continued to grow in cultivated plots and in the wild. After Salvia divinorum was brought to the United States, it was first grown in university greenhouses for research. In recent years it has been cultivated in California and Hawaii by persons interested in its effects. There have also been reports that the plant has been spotted growing in the wild in California.

The psychotropic effects of Salvia divinorum have generated interest among psychopharmacologists and other scientists. Chemical analysis of the plant has succeeded in identifying the active substance, which is now known as salvinorin A. Research on animals and human volunteers indicates that the psychoactive effects of salvinorin A are comparable to those of mescaline. As little as 200–500 mcg of salvinorin A will reliably produce hallucinations in people, when the crystallized substance is vaporized over a flame and inhaled. On the basis of effective dose, salvinorin A is the most potent natural hallucinogen known. The leaves have been determined to contain 1–4 mg of salvinorin A per gram of dry weight.

At the present time, Salvia divinorum is a legal plant in the United States, and no federal laws apply to its possession or use. It is grown for sale by cultivators in Mexico, Hawaii, and California. In recent years, Salvia has gained some popularity as a legal psychedelic drug. A wide range of people has used the plant for recreation, as an aid in meditation, or for herbal healing. As information about Salvia has spread on the Internet, the notoriety of the plant has increased. The psychedelic potential of salvinorin A has become the subject of numerous websites and chat rooms.

The leaves and other components of Salvia divinorum are available for sale on the Internet. Users may obtain fresh or dried leaves, an extract of the leaves in alcohol and water, or an extra-strength leaf product fortified with the extract. Pure crystallized salvinorin A, which is sold for use in scientific experiments, may also be obtained. Prices currently range from around $100 per 1 oz (28 g) for the leaves to $20 per mg for purified crystals of salvinorin A.

Although most hallucinogenic drugs are believed to induce their effects by acting on the serotonin receptors of nerve cells in the brain, Salvia divinorum does not act in this way. At present, the mechanism of the hallucinogenic activity of the plant is completely unknown. Salvinorin A has been tested on more than 40 different receptors in the brain and other tissues, including serotonin receptors. So far, no activity has been detected on any of these receptors.

The Drug Enforcement Administration (DEA) is currently aware of Salvia divinorum, and the agency is monitoring the plant's increasing availability and use. The agency states, "There has been a growing interest among young adults and adolescents to re-discover ethnobotanical plants" that can induce hallucinations or "mystical" experiences. The agency explains, "Salvia is being smoked to induce hallucinations" that are similar to those caused by tetrahydrocannabinol (THC). The DEA states that it has no plan to classify Salvia divinorum as a controlled substance at the present time.

CHEMICAL/ORGANIC COMPOSITION

The active principle of Salvia divinorum, salvinorin A, is derived from the leaves of the plant. Chemically, salvinorin A is a neoclerodane diterpene, one of a group of nitrogen-containing terpene compounds that have psychotropic properties. Two other such compounds are tetrahydrocannabinol and absinthe. Purified salvinorin A can be obtained from an ether extract of the leaves, which is then concentrated by chromatography and repeated crystallization.

INGESTION METHODS

Salvinorin A is destroyed in the gastrointestinal tract, and therefore is almost completely inactive if swallowed. For that reason, Salvia divinorum is usually consumed in some manner other than by eating it, in order to allow absorption of the intact compound.

Among the Mazatec Indians, it is the practice to chew four or five fresh leaves thoroughly, while retaining them in the mouth, in the manner of chewing a cud of tobacco or coca leaves. After many minutes of mastication, the leaves are swallowed. Chewing the leaves as a cud permits absorption of salvinorin A through the mucous membranes of the mouth. This method is reported to induce long-lasting visions. However, Daniel Siebert, who has studied Salvia divinorum and has become one of the plant's popularizers in the United States, has remarked that chewing the leaves can be an arduous task, since it takes time to achieve the effect and the taste is extremely bitter.

Alternatively, the fresh leaves can be squeezed and the juices drunk. The amount of salvinorin A ingested by this method depends on the length of time the user holds the juices in his mouth. Most often when the juices are drunk, the effect is mild, since the substance remains in contact with oral tissues for only a short time. If the juice is kept in the mouth as long as possible, the effect will be stronger.

A third method utilizes fresh leaves, which are crushed and soaked in water to make an extract. A tea prepared from four or five fresh leaves is reported to act as a tonic. A tea made from 20–60 leaves will induce hallucinations.

The leaves may also be dried and smoked like a marijuana joint. Five or six deep puffs are reported to produce an effect similar to marijuana and last one or two hours.

The most efficacious means of ingesting salvinorin A is to vaporize the crystalline form and inhale. A dose of 200–500 mcg produces intense hallucinations.

In an experimental investigation in 20 human volunteers, Siebert studied the effects of salvinorin A administered through different routes of ingestion. The subjects reported no perceptible effects when 10 mg was encapsulated and swallowed. In contrast, when 2 mg was prepared as an alcohol extract, which was sprayed on the subjects'oral tissues, the subjects noted some effects, but the activity of the extract was inconsistent. However, when 200–500 mcg of crystallized salvinorin A were vaporized by heat and inhaled through a tube, hallucinatory effects were consistently experienced, with an intensity similar to those induced by fresh leaves.

THERAPEUTIC USE

There are no recognized therapeutic uses of Salvia divinorum. However, tribal shamans in Oaxaca, Mexico have used the plant to restore regularity of elimination, relieve headache, and function as a tonic for generalized weakness, aches, and pains.

Karl Hanes, Ph.D., a cognitive-behavioral therapist in Australia, has described one case of a 26-year-old woman who had been moderately depressed without remission since adolescence. After six months of cognitive-behavioral therapy, she was only slightly improved. Previous treatment with the antidepressant sertraline for three months had produced no benefit. Despite being cautioned against its use, the woman experienced relief of her symptoms after smoking leaves of Salvia divinorum. She continued to ingest the herb, chewing two to three leaves as a cud for 15–30 minutes three times a week. While consuming the herb in this way, she remained in remission for at least six months.

Siebert claims that Salvia divinorum has healing properties, and cites its use in one case of depression that was reported on the Internet. In the 1960s, however, there were many claims that the leading hallucinogen of that era, LSD, also provided in a self-healing experience. There were attempts to study LSD when used as an adjunct to psychotherapy. The claims for LSD, however, did not pass the test of time. There is no recognized therapeutic role for LSD today. Statements by Siebert and others appear to make a similar case for Salvia divinorum. It remains to be seen whether such assertions are proven true.

USAGE TRENDS

Scope and severity

Salvia divinorum is a newcomer to the drug scene in the United States. In the middle of the last century, specimens of the plant were brought to the United States from Mexico by botanists and pharmacologists, who studied the plant because of its hallucinogenic properties and the associated traditions of shamanic use. Knowledge of Salvia divinorum remained mostly confined within these academic and scientific circles until recent years. Toward the end of the twentieth century, however, information about Salvia became more widely known, and people interested in experiencing of the hallucinogenic herb's effects transplanted it from academic sites to homes and greenhouses throughout California and other parts of the country.

Salvia divinorum is currently being used as a legal hallucinogen. While the users are still relatively few, the number of persons consuming the plant may be growing. Several developments in the last year or two suggest that Salvia use has begun to spread more rapidly. Growers of the herb in Mexico, California, and Hawaii have been selling their produce for personal consumption on the Internet. A Texas company recently tried to market Salvia divinorum at a trade show for tobacco and head shop supplies in Las Vegas.

Details, a trendy publication for young men, ran a feature on the plant in December 1999, titling the article "The New Ecstasy: It's not illegal." In the summer of 2001, information about Salvia divinorum and its increasing use was reported by the New York Times, the Los Angeles Times, the Associated Press, and other news organizations. In April 2002, a story appeared on the ABC News website. Salvia divinorum has spread to other parts of the world as well. In 2000, live specimens of the plant were discovered by Swiss authorities growing in a large illegal hemp farm in that country. Subsequently, the Swiss found the plant growing in several horticultural greenhouses.

Despite its current vogue, the availability of Salvia divinorum in the United States has not aroused great alarm among law enforcement agencies. At the present time, federal officials have not received any reports of emergency room visits or health problems resulting from its use. Moreover, in 2001, the federal Center for Substance Abuse Treatment reported that there was no information that use of Salvia was increasing. Although they are collecting information on the use of the plant, the federal agencies are not intending to take any action in regard to it.

For several reasons, Salvia divinorum is not considered a substance with a high potential for abuse. The taste of the leaves is extremely bitter, and it is necessary to chew many leaves for many minutes to achieve the desired effect. These properties would probably discourage many potential users. One supplier of the herb in the United States explained that Salvia divinorum does not act like a party drug that causes users to become expansive and sociable. In contrast, the Salvia experience is directed inward, and users tend to withdraw into themselves. The effects of a Salvia experience are often profound or bizarre, but not much fun. He reports that only 10% of first-time purchasers place a second order for the plant. The peculiar, introspective nature of the hallucinogenic experience induced by Salvia divinorum suggests that it is unlikely that the plant or its active substance, salvinorin A, will become popular.

Age, ethnic, and gender trends

No statistical information about the use of Salvia divinorum exists. As of 2002, use of the plant is so uncommon that reliable estimates cannot be made. Nevertheless, Salvia divinorum is a hallucinogen, and the appeal of the plant seems motivated by the same kinds of interests as that of other hallucinogens. If it does become more popular and widely consumed, the pattern of its usage may be analogous to that of other hallucinogenic drugs.

The National Household Survey on Drug Abuse (NHSDA), which is conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA), provides statistical data on illegal drug use in the United States. For the purpose of the survey, hallucinogenic drugs were defined to include lysergic acid diethylamide (LSD), phencyclidine (PCP), psilocybin, peyote, and ecstasy.

As estimated in the NHSDA, about one million Americans were current users of hallucinogenic drugs in the year 2000. This number comprised 0.4% of the U.S. population age 12 or older. Users of hallucinogens tended to be younger than users of most other illicit drugs. Hallucinogen use is most common among young adults. About half of all illicit drug users were under the age of 26, as opposed to 83% of all hallucinogen users. Moreover, about 15% of people aged 18–34 report having used hallucinogens at least once during their lifetime. This rate is twice the frequency of adolescents in the 12–17 age group or people older than 34.

Gender and ethnic data from the study show disproportionate distributions. Adult males are twice as likely as adult females to have used hallucinogens. Furthermore, whites use these drugs more frequently than Hispanics, who use them more frequently than blacks.

Use of hallucinogens may be increasing. The number of persons who used hallucinogens for the first time at least once hallucinogen in 1999 was 1.4 million, the largest number ever. Rates of first hallucinogen use have risen steadily since the 1990, and by 1999, these rates had more than doubled. Moreover, the rate of first use is rising most quickly among the youngest group surveyed, adolescents aged 12–17.

MENTAL EFFECTS

The hallucinatory experience induced by Salvia divinorum has been described by users as unique and more intense than that of other hallucinogens, which often simply distort perceptions rather than cause true hallucinations. Salvia, however, dramatically alters consciousness, producing all-encompassing hallucinations and a complete loss of contact with reality. Users often report that the experience is not entirely pleasant. One person said it was like calling in some kind of presence. The intense effects last from several minutes to an hour or more. Experienced users caution others that the herb should not be taken while alone.

Several graphic descriptions of the Salvia experience were provided by L. J. Valdes, an ethnopharmacologist who visited the Mazatecs in 1983. The scientist recorded his personal experience of two hallucinogenic trips induced by the plant, which he ingested under the guidance of a curandero. Before his first experience, Valdes drank a liquid prepared by crushing 20 leaves in water. About 45 minutes later, he felt himself rushing through black space past brightly colored objects. Approaching one of them, he saw a Mazatec village, as viewed from above. The houses of the village were flanked by pillars of Kaleidoscopic color.

On a second occasion, the scientist drank a liquid prepared from 50 leaves at about 9 p.m. one evening. Within an hour, he experienced visions of elaborate scenes. Shapes appeared and grew into the forms of plants and flowers. This was followed by a vision of a flaming cross that began to emit light. Humanoid figures appeared in clothes covered with gold. A church appeared around the figures, and they began to pray before a jeweled cross that changed into a sword. The images then began to change rapidly. Visions of animals, plants, and people flew by. Valdes' last visions were of a castle, which then changed into a Byzantine church, along with a procession of hooded monks who were marching around it.

Valdes emphasized that one should consume the plant in a dark, quiet environment. This is essential if visions are to occur, since light and noise interfere with the effects. The hallucinations that develop include visual, auditory, and tactile sensations. Sensations of floating, spinning, twisting, flying through space, and bodily lightness or heaviness may be experienced. An audiotape recording made during Valdes' second experience revealed that the scientist slurred his speech and spoke in unusual patterns. Although the hallucinations were most intense at about an hour after taking the drug, a few hours later, Valdes again hallucinated an elaborate vision of himself in broad meadow, where he talked to a man in a white robe, and also touched the figure and held onto him. He continued to experience visions intermittently for about four hours until he went to sleep.

The effects of Salvia are extremely variable and depend on the dose and the environment in which the plant is consumed. Visions of people, objects, and places occur frequently. There have been reports of out-of-body experiences, loss of the sense of one's body and one's identity, being in several locations at once, becoming one with objects, and visiting places from the past. A common experience is the feeling that one has become a two-dimensional

surface or membrane, which is being pulled or twisted. Users may also laugh uncontrollably.

Salvia users in the United States have reported that smoking the leaves or chewing them in a cud induces an experience that can be more intense than one from LSD, but much shorter in duration. While an "acid trip" can last for many hours, the Salvia experience usually goes on for about an hour, peaking around 20 minutes after consumption.

When salvinorin A is consumed, a dose of 200–500 mcg will induce an elaborate hallucinatory experience lasting one-half to two hours. Doses greater than 500 mcg may cause the subject to lose awareness of surroundings and become delirious. The effect can be frightening. Users may be disoriented, babble incoherently, and stagger about. Accidental injuries may occur. Since so little salvinorin A is needed for an overdose, it would be easy for an inexperienced user to ingest more than intended. For this reason, it would be foolhardy for most users to try to obtain and consume pure crystals of this substance.

Adverse reactions affecting the user's mental state have been associated with hallucinogenic drugs, and it is likely that Salvia divinorum could produce similar reactions. Since few scientific studies of the effects of Salvia on human beings have been reported, there is very little known about adverse effect related to this herb. However, anecdotal reports by users of the plant have described episodes of uncoordinated, purposeless movement, which may have the potential for causing injuries; Siebert has described the delirious state that can result from a large dose of salvinorin A.

Acute adverse mental effects that have been associated with other hallucinogens include anxiety states, panic reactions, paranoid ideation, confusion, and delirium. Longer-lasting adverse mental effects have included a variety of persistent disorders of mood, anxiety, and perception. In some cases, prolonged hallucinatory states and other forms of loss of contact with reality have resulted. These long-term adverse mental effects have been classified in the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-IV) as hallucinogen-induced mood disorder, hallucinogeninduced anxiety disorder, hallucinogen persisting perception disorder, and hallucinogen-induced psychotic disorders.

A striking form of persistent mental effect of hallucinogen use is called the flashback. This disorder is properly called hallucinogen persisting perception disorder. In a flashback experience, the drug-induced state is re-experienced, along with the perceptual distortions and loss of contact with reality. These episodes occur during the weeks or months following the initial experience. They may occur spontaneously, in response to stressful situations, or during a later instance of drug use. Flashbacks have also been reported to occur as an adverse effect of antidepressant drug treatment. Although they have been widely reported, flashbacks are rare; few hallucinogen users actually have such experiences.

PHYSIOLOGICAL EFFECTS

The actions of Salvia divinorum on the physiology of the body have not been studied as of 2002 and are thus unknown. However, other hallucinogenic substances have substantial effects on the autonomic nervous system, the part of the nervous system that governs bodily functions. These effects may include dilation of the pupils, blurred vision, tremors, uncoordination, elevated heart rate, heart palpitations, elevated body temperature, and sweating.

Pharmacological studies of the effects of salvinorin A on mice have shown that the substance acts similarly to mescaline. The animals cease to scamper about as usual. While they appear sedated, the effect is not true sedation, since they are easily stimulated to move by a noise or light touch. The mice also maintain their righting reflex.

In the laboratory, receptor studies have shown no significant activity at more than 40 receptor sites on nerve cells and other tissues, including the monoamine receptors usually involved in producing the effects of hallucinogenic substances. Thus the mechanism of hallucinogenic activity of Salvia divinorum remains unknown.

Harmful side effects

Neither animal nor human toxicity studies of Salvia divinorum have been done. Very little scientific data exist in regard to adverse effects of the substance on the functioning of the human body. However, hallucinogens have been associated with harmful mental effects.

Long-term health effects

As of 2002, no scientific data exist on the long-term effects of Salvia divinorum on human health. Other hallucinogenic substances have been associated with long-term adverse mental effects.

REACTIONS WITH OTHER DRUGS OR SUBSTANCES

There is no scientific data on the interactions of Salvia divinorum with medicines or other illicit substances. Reports of the use of Salvia divinorum indicate that this substance is usually consumed without other drugs.

TREATMENT AND REHABILITATION

Acute mental reactions to Salvia divinorum may require treatment. Panic reactions, confusion, delirium, and other acute adverse mental effects are usually managed by means of the reassuring presence of a counselor who has knowledge of the drug's effects. In addition to "talking the person down," a counselor can observe the user and prevent any injurious behavior until the effects of the drug have worn off. Among the Mazatec Indians, the curandero functions in this manner, by preparing the initiate and guiding him or her through the experience. Since the effects of Salvia divinorum are short-lived, lasting less than two hours, the presence of a reassuring counselor should almost always be sufficient.

In rare cases, it may happen that a user develops extremely intense anxiety or loses contact with reality and becomes acutely psychotic. Such conditions might require pharmacological intervention. For severe anxiety or panic, a tranquilizer, such as lorazepam, may be administered. For a psychotic state, an antipsychotic drug, such as haloperidol or chlorpromazine, may be given. If a user becomes extremely agitated, both a tranquilizer and antipsychotic agent can be administered together. The combination of lorazepam and haloperidol is often used by emergency room personnel to calm agitated or belligerent patients. Administration of medicines should only be done by qualified practitioners.

It is not known whether the use of Salvia divinorum is associated with long-lasting adverse mental effects in some users. However, such disorders have resulted from the use of other hallucinogenic substances, and it would be reasonable to expect that long-term mental disorders could also develop in certain individuals as a consequence of Salvia consumption.

Such disorders are described in the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-IV). They include hallucinogen persisting perception disorder, hallucinogen-induced anxiety disorder, hallucinogen-induced mood disorder, and hallucinogen-induced psychotic disorders. These mental disorders may necessitate treatment by qualified mental health practitioners.

Hallucinogen persisting perception disorder is commonly called the flashback. While flashbacks are brief, usually lasting only a few seconds, these experiences often cause considerable anxiety and distress, due to the sudden, unanticipated onset of the episodes and the inability of the sufferer to control their occurrence. Psychotherapy is often sufficient treatment for anxiety and distress associated with flashbacks. Occasionally treatment with a long-acting tranquilizer, such as clonazepam, may be required. Anticonvulsant drugs, such as valproic acid and carbamazepine, have also been used to control flashbacks. However, antipsychotic drugs have been reported to exacerbate flashbacks and should not be prescribed.

With time flashbacks usually become shorter, less intense, and less frequently. Most subside eventually with or without treatment. About half of those experiencing flashbacks cease having such experiences within five years.

Hallucinogen-induced anxiety disorder and hallucinogen-induced mood disorder may also be adequately treated by psychotherapy. When necessary, pharmacotherapy may be employed as an adjunct to such treatment.

Hallucinogen-induced psychotic disorder is a continuing loss of contact with reality long after the hallucinogenic drug has been eliminated from the body. It is uncertain whether hallucinogen use can actually cause a persisting psychotic illness de novo, or whether it simply precipitates the onset of a psychosis in a person who would have developed such a condition in any case. Psychotic episodes in reaction to hallucinogens tend to occur in individuals who had previously been functioning poorly.

A continuing psychosis triggered by hallucinogen use should be treated in the same manner as any other ongoing psychotic disorder. Hospitalization may be required to stabilize the patient's condition, to initiate treatment, or to prevent injury to the patient or others. Long-term use of antipsychotic medications may be necessary, as well as continuing involvement in programs of mental health treatment and rehabilitation.

Long-term use of hallucinogenic drugs has been associated in some individuals with changes in personality and withdrawal from social relationships. Both psychotherapy and pharmacological treatment may be necessary to help some chronic users reintegrate into society and resume normal functioning. In addition to medical treatment, participation in self-help groups can be effective. Twelve-step programs such as Narcotics Anonymous and reality-oriented groups such as Smart Recovery may be particularly helpful in allowing a user to limit or completely give up the use of illicit drugs and begin to participate in society.

PERSONAL AND SOCIAL CONSEQUENCES

As it only recently became widely known in the United States, Salvia divinorum has had limited use. There have been no reports of hospital or emergency room treatment of users for adverse reactions. Negative personal or social consequences of its use have so far gone undetected. Nevertheless, if use of Salvia becomes more widespread, these facts may change.

It is worthwhile to recall that the use of hallucinogens in the United States has had marked social and personal consequences in the past. In the 1960s, hallucinogen use became widespread, especially on college campuses. Promoted by Timothy Leary, a psychology instructor at Harvard, and others, LSD was hailed as the source of psychic awakening, happiness, fulfillment, creativity, and other good things. Other hallucinogens such as peyote and mescaline were also employed in the service of attaining allegedly greater insight and understanding. However, Leary lost his position at Harvard, and other frequent voyagers on "acid trips" found that their supposedly expanded awareness and understanding did not translate into greater success in the everyday world.

"Turn on, tune in, drop out" became the mantra of those who preferred the reality found through hallucinogen use to that of participation in ordinary social life. A subculture of users emerged. Terms such as hippie, flower child, acid head, and others came to describe those mostly young people who withdrew from mainstream society. Centers of the subculture arose in East and West Coast cities. Many of these youths joined protest movements, such as those in support of civil rights and against the Vietnam War.

Eventually, a number of negative repercussions of this social ferment became evident. Hospitals and emergency rooms began reporting adverse reactions to hallucinogen use. Accounts of users becoming permanently psychotic or suicidal were publicized and sometimes sensationalized in the press. In certain individuals, repeated use of hallucinogenic drugs resulted in changes in personality. Some developed a passive, noncompetitive attitude and withdrew from participation in various aspects of society. Such behavior was often associated with involvement in the subculture, in which values and behavior differed from the social norm and drug use was common. Many users began to abuse other drugs besides hallucinogens, including marijuana, hashish, methamphetamine, and heroin. Young people without means of support wandered on the streets of New York, Chicago, San Francisco, and other cities. Some went through periods of poverty and even starvation. Some became victims of crime. Others became criminals themselves. Parents feared that those of their children who had become involved in the subculture would remain permanently dysfunctional and fail to obtain education and gainful employment.

Although many young people who joined the hallucinogen subculture went on to hold jobs, marry, create families, and be responsible adults, there is little doubt that many young people were harmed and their lives permanently set back. In consequence, LSD was classified as a Schedule I substance, and its possession and distribution were made crimes. The National Institute of Drug Abuse (NIDA) was created to promote scientific research into drug abuse and addiction.

In the decades following the 1960s, the use of hallucinogens subsided. The American economy went through difficult times, and the concerns of youth turned away from protest and toward finding good jobs and achieving financial stability. In the 1990s, however, there were signs that interest in hallucinogens may have emerged again. The National Household Survey on Drug Abuse has indicated that usage of hallucinogens is again on the rise.

It is too soon to know whether Salvia divinorum will play a role in a new wave of hallucinogen abuse. That this will not be the case is suggested by reports by Siebert and others that the effects of the substance are often unpleasant and users do not seek to repeat the experience. Still it is useful to recall the upheavals that once took place, in order that knowledge of the past may help to prevent the repetition of it.

LEGAL CONSEQUENCES

Salvia divinorum is presently a legal substance. The DEA has not placed Salvia on its list of controlled substances. Various forms of the substance are available for purchase, and users may grow their own plants. If the use of Salvia becomes more widespread or if negative consequences of its use appear, this situation may change.

See also LSD; Mescaline; Psilocybin

RESOURCES

Books

Pechnick, R. N., and J. T. Unger. "Hallucinogens." In Substance Abuse: A Comprehensive Textbook. 3rd ed. Baltimore: Williams & Wilkins, 1997.

Periodicals

Jones, R. L. "New Cautions Over a Plant With a Buzz." New York Times 9 July 2001, late edition—final.

Siebert, D. J. "Salvia divinorum and Salvinorin A: New Pharmacologic Findings." Journal of Ethnopharmacology 43 (1994): 53–56.

Valdes, L. J., III. "Salvia divinorum and the Unique Diterpene Hallucinogen, Salvinorin (Divinorin) A." Journal of Psychoactive Drugs 26 (1994): 277–283.

Other

Diversion Control Program, Drug Enforcement Administration,U.S. Department of Justice. "Salvia Divinorum, ska Maria Pastora, Salvia (Salvinorin A, Divinorin A)." <http://www.deadiversion.usdoj.gov/drugs_concern/salvia_d/summary.htm>.

Siebert, D. J. "Salvinorin A: Notes of Caution." <http://www.sagewisdom.org/caution.html>.

Substance Abuse and Mental Health Services Administration. 2000 National Household Survey on Drug Abuse.<http://www.health.org/govstudy/nhsda2000>.

Organizations

National Clearinghouse for Alcohol and Drug Information (NCADI), P.O. Box 2345, Rockville, MD, USA, 20847-2345,(800) 729-6686, [email protected], <http://www.health.org>.

National Drug Intelligence Center (NDIC), 319 Washington Street, 5th Floor, Johnstown, PA, USA, 15901-1622, (814) 532-4601, (814) 532-4690, [email protected], <http://www.usdoj.gov/ndic/>.

National Institute on Drug Abuse (NIDA), National Institutes of Health, 6001 Executive Boulevard, Room 5213, Bethesda, MD, USA, 20892-9561, (301) 443-1124, (888) 644-6432, [email protected], <http://www.nida.nih.gov>.

Substance Abuse and Mental Health Services Administration (SAMHSA)/Center for Substance Abuse Treatment (CSAT), 5600 Fishers Lane, Rockville, MD, USA, 20857, (301) 443-8956, [email protected], <http://www.samhsa.gov>.

Richard M. Kapit, M.D.