Salvia Divinorum

Health Care Professional Information

Scientific Name
Salvia divinorum
Common Name

Salvia, Diviner’s sage, magic mint, Maria Pastora, sherpherdess’ herb

Clinical Summary

Salvia divinorum, a type of sage, has been cultivated by the Mazatec people of Mexico for centuries for use as a hallucinogen during religious ceremonies.
Chewing or smoking the leaves can cause depersonalization, visual changes, altered perceptions, and feelings of metamorphosis into objects (1). The plant was also reported to have antidepressant effects (4).
Salvinorin A, a hallucinogenic compound found in the plant, is a potent kappa-opioid receptor agonist (6). It was shown to have deleterious effects on learning and memory (13) (14).

Salvia divinorum has also gained popularity as a recreational drug and is widely available through the internet (2) (3). Analysis of the 2006-2008 United States National Surveys on Drug Use and Health indicates an 83% increase in the number of salvia users; its use was common among active drug users (11). Salvia was also among the top five products marketed via the Internet in the UK in 2009 (12).

There are adverse effects reported due to abuse. Some states have considered legislation to ban consumption of this herb and it is illegal in Australia, Finland and Denmark. Salvia divinorum should not be confused with the other sages used for cooking and medicinal purposes, such as Salvia officinalis, the common sage.

Purported Uses
  • Recreational use
  • Depression
  • Drug addiction
  • Stress management
Constituents
  • Salvinorin A
  • Salvinorin B
  • Sugars
  • Fatty acids
  • Sterols
  • Vitamins
    (2)
Mechanism of Action

Salvinorin A, the active ingredient in Salvia divinorum, is a kappa opioid receptor agonist. It is a naturally occurring psychoactive compound and is being investigated as a treatment for diseases that produce hallucinations, such as schizophrenia and dementia (1). Salvinorin A can regulate dopamine levels and has been suggested as a potential treatment for stimulant abuse (5). Salvia divinorum may help to alleviate depression (4).

Pharmacokinetics

In vivo, Salvinorin A was shown to be eliminated quickly with a half-life of 75 min and a clearance of 26 L/h/kg. The distribution was extensive (Vd of 47.1 L/kg); however, the brain to plasma ratio was 0.050 with the half-life being 36 min. Salvinorin A was rapidly eliminated after i.p. dosing (15).

Adverse Reactions
  • Use of Salvia by itself or in combination with alcoholic beverages and other drugs can cause neurologic, cardiovascular, and gastrointestinal effects (7).
  • Psychosis (8)
  • A 15-year-old man with a history of salvia and marijuana use needed emergency psychiatric service following acute onset of mental status changes characterized by paranoia, blunted affect, thought blocking and slow speech (9).
  • Smoking salvia has been implicated in the death of a 21-year-old man (10).
Literature Summary and Critique

Gonzales D, Riba J, Bouso JC, et al. Pattern of use and subjective effects of Salvia divinorum among recreational users. Drug and Alcohol Dependence 2006 Nov 8;85(2):157-62
Descriptive data was gathered from self-report questionnaires given to 32 users of Salvia divinorum. History of drug use, history and pattern of use of Salvia, and subjective descriptions of the experience were examined. The vast majority of volunteers reported using multiple recreational drugs including alcohol (93.7%); cannabis (96.9%); ecstasy (88%); cocaine (84%); amphetamines (69%); opiates (56%); benzodiazepines (36%); and GHB (9%). Most had begun taking Salvia recently (88% within the last year). Smoking was the preferred method for delivery (75%). When describing the experience following use of Salvia, 88% felt onset of effects within one minute. In written descriptions of the best and worst aspects of using Salvia, 40% described entering another reality, 28% laughed and felt happy; 6.4% felt out of control.

References
  1. Siebert DJ. Salvia divinorum and salvinorin A: new pharmacologic findings. J Ethnopharmacol, 1994;43(1): 53-6.
  2. Giroud C, Felber F, Augsburger M, et al. Salvia divinorum: an hallucinogenic mint which might become a new recreational drug in Switzerland. Forensic Sci Int, 2000;112(2-3): 143-50.
  3. Gonzalez D, Riba J, Bouso JC, et al. Pattern of use and subjective effects of Salvia divinorum among recreational users. Drug Alcohol Depend, 2006.
  4. Hanes, K. R. Antidepressant effects of the herb Salvia divinorum: a case report. J Clin Psychopharmacol, 2001; 21(6): 634-5.
  5. Prisinzano TE, Tidgewell K, Harding WW. Kappa opioids as potential treatments for stimulant dependence. AAPS J, 2005;7(3): E592-9.
  6. 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, 2004;308(3): 1197-203.
  7. Vohra R, Seefeld A, Cantrell FL, Clark RF. Salvia divinorum: exposures reported to a statewide poison control system over 10 years. J Emerg Med. 2011 Jun;40(6):643-50.
  8. Przekop P, Lee T. Persistent psychosis associated with salvia divinorum use. Am J Psychiatry. 2009 Jul;166(7):832.
  9. Singh S. Adolescent salvia substance abuse. Addiction. 2007 May;102(5):823-4.
  10. Wills K, Paddock B. NY Daily News. http://www.nydailynews.com/ny_local/2011/03/08/2011-03-08_smoked_salvia_before_leaping_to_death.html. Updated March 8, 2011. Accessed December 13, 2013.
  11. Wu LT, Woody GE, Yang C, Li JH, Blazer DG. Recent national trends in Salvia divinorum use and substance-use disorders among recent and former Salvia divinorum users compared with nonusers. Subst Abuse Rehabil. 2011 Apr;2011(2):53-68.
  12. Schmidt MM, Sharma A, Schifano F, Feinmann C. “Legal highs” on the net-Evaluation of UK-based Websites, products and product information. Forensic Sci Int. 2011 Mar 20;206(1-3):92-7.
  13. Braida D, Donzelli A, Martucci R, Capurro V, Sala M. Learning and memory impairment induced by salvinorin A, the principal ingredient of Salvia divinorum, in wistar rats. Int J Toxicol. 2011 Dec;30(6):650-61.
  14. MacLean KA, Johnson MW, Reissig CJ, Prisinzano TE, Griffiths RR. Dose-related effects of salvinorin A in humans: dissociative, hallucinogenic, and memory effects.Psychopharmacology (Berl). 2013 Mar;226(2):381-92.
  15. Teksin ZS, Lee IJ, Nemieboka NN, et al. Evaluation of the transport, in vitro metabolism and pharmacokinetics of Salvinorin A, a potent hallucinogen. Eur J Pharm Biopharm. 2009 Jun;72(2):471-7.

Consumer Information

How It Works

Bottom Line: Salvia divinorum is a mind-altering herb that has major adverse effects. It is illegal in some states and recreational use should be discouraged.

The active component of Salvia divinorum is a compound known as Salvinorin A. This has been shown to act on the nervous system to produce altered mental states. In laboratory and animal studies, Salvinorin A has been shown to affect certain pain receptors in the nervous system.

Purported Uses
  • Mind-altering effects
    This is only supported by anecdotal reports.
  • Depression
    There is one report of Salvia divinorum's effectiveness in treatment-resistant depression. More studies are needed.
  • Drug addiction
    Based on the chemistry of Salvia divinorum, some scientists have suggested using the herb to treat addiction to other drugs, such as cocaine and amphetamines. Large scale clinical trials have yet to be conducted to support this use.
Research Evidence

In a survey of 32 Salvia divinorum users, mind-altering symptoms, such as “entering another reality”, “laughed and felt happy”, and “felt out of control” were reported.

Side Effects
  • Use of Salvia by itself or in combination with alcoholic beverages and other drugs can cause neurologic, cardiovascular, and gastrointestinal effects.
  • Psychosis
  • A 15-year-old man with a history of salvia and marijuana use needed emergency psychiatric service following acute onset of mental status changes characterized by paranoia, blunted affect, thought blocking and slow speech.
  • Smoking salvia has been implicated in the death of a 21-year-old man.
E-mail your questions and comments to aboutherbs@mskcc.org.