Salvia Divinorum: Exposures Reported to a Statewide Poison Control System Over 10 Years

Department of Emergency Medicine, Olive View-UCLA Medical Center, Los Angeles, California, USA.
Journal of Emergency Medicine (Impact Factor: 0.97). 09/2009; 40(6):643-50. DOI: 10.1016/j.jemermed.2009.05.019
Source: PubMed


Salvia divinorum, a hallucinogenic herb, has in recent years become popular among teenagers and young adults. Salvia is presently marketed as a "legal" alternative to other drugs of abuse, but little is known about the clinical toxicity of this substance.
The purpose of this study is to describe the clinical and demographic features of this emerging substance of recreational abuse using data obtained from the records of a poison control center.
We performed retrospective review of exposures to the herbal hallucinogen Salvia divinorum as reported to the California Poison Control System (CPCS) over the last 10 years. Demographic and clinical data were collected and compiled from the computerized records of the CPCS for the search terms "salvia" and "sage."
There were 37 exposures to S. divinorum and 96 exposures to non-hallucinogenic Salvia species. Eighteen (49%) of the exposures were to S. divinorum alone. Intentional Salvia exposures resulted in a variety of neurologic, cardiovascular, and gastrointestinal effects. Notably, the use of concomitant substances of abuse was associated with a high rate of complications and psychomotor disturbances.
Intentional use of S. divinorum, whether alone or in combination with alcoholic beverages and other drugs, causes neurologic, cardiovascular, and gastrointestinal effects. This poison-center-based review helps to characterize the clinical toxicity of S. divinorum, but more clinical and pharmacologic research is warranted for this rapidly emerging substance of abuse.

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    • "However, prior personal and family psychiatric and drug use history, purity and potency of SD used, and long-term outcomes in these cases are under-reported. A review of the California Poison Control System (CPCS) found 37 cases where the CPCS had been contacted regarding patient exposure to SD in a 10-year period (Vohra et al., 2011). The most commonly reported symptoms were alteration in mental state (e.g. "
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    ABSTRACT: This study examined the overall psychological effects of inebriation facilitated by the naturally-occurring plant hallucinogen Salvia divinorum using a double-blind, randomized, placebo-controlled trial. Thirty healthy individuals self-administered Salvia divinorum via combustion and inhalation in a quiet, comfortable research setting. Experimental sessions, post-session interviews, and 8-week follow-up meetings were audio recorded and transcribed to provide the primary qualitative material analyzed here. Additionally, post-session responses to the Hallucinogen Rating Scale provided a quantitative groundwork for mixed-methods discussion. Qualitative data underwent thematic content analysis, being coded independently by three researchers before being collaboratively integrated to provide the final results. Three main themes and 10 subthemes of acute intoxication emerged, encompassing the qualities of the experience, perceptual alterations, and cognitive-affective shifts. The experience was described as having rapid onset and being intense and unique. Participants reported marked changes in auditory, visual, and interoceptive sensory input; losing normal awareness of themselves and their surroundings; and an assortment of delusional phenomena. Additionally, the abuse potential of Salvia divinorum was examined post hoc. These findings are discussed in light of previous research, and provide an initial framework for greater understanding of the subjective effects of Salvia divinorum, an emerging drug of abuse. © The Author(s) 2015.
    Journal of Psychopharmacology 02/2015; 29(4). DOI:10.1177/0269881115570081 · 3.59 Impact Factor
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    • "The pharmaceutical delivery method may also impact the potency delivered to the patient. The dosage form is particularly pertinent in the case of the current patient who was smoking the herb and inhaling it [12]. The half-life of Salvia has been reported to range from 40 minutes to 1.5 hours [3]. "
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    ABSTRACT: Introduction. This is the first reported case of gastrointestinal symptoms associated with withdrawal after chronic use of this substance. Case Presentation. A 51-year-old Caucasian woman was referred to a hospital with a 3-day history of nausea, vomiting, diarrhea, and abdominal discomfort. She reported no sick family members or contact with anyone who was ill. She did report smoking 3-5 cigarettes of the herb "Salvia" consistently for 3-4 months and quit approximately 48 hours before symptoms appeared. Her use of the herb had been consistent; she smoked several cigarettes each day. Laboratory results were essentially normal including the white blood cell count. She received symptomatic treatment and was released after one day. Discussion. Salvinorin A, a kappa-opioid receptor agonist, is the major active ingredient of S. divinorum. The unique opioid properties of this herb may explain its ability to cause changes in intestinal transit time. Conclusion. A 51-year-old woman possibly developed gastrointestinal manifestations suggestive of withdrawal from Salvia divinorum after smoking the substance consistently for 3 to 4 months. The widespread use of this herb will make the potential for withdrawal syndromes more commonplace.
    Case Reports in Medicine 05/2012; 2012:543747. DOI:10.1155/2012/543747
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    • "Data on the potential adverse effects and toxicity of S. divinorum are limited. Over 10 years, 37 cases were reported to the California Poison Control System after intentional exposure to S. divinorum (Vohra et al., 2009). Just under half of these were associated with ingestion of S. divinorum alone, and the most common symptoms were confusion or disorientation, hallucinations, dizziness, and gastrointestinal disturbances. "
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    ABSTRACT: Salvia divinorum is a hallucinogenic plant with ethnopharmacological and recreational uses. It differs from classic serotonergic hallucinogens such as LSD and psilocin in both phenomenology and potent agonist activity of the active component salvinorin A at κ-opioid receptors. Awareness of S. divinorum has grown recently, with both an increase in its public representation and concern over its potential harmful effects. This discussion is particularly relevant as S. divinorum is legal to use in many countries and regions and easily available through online retailers. Drawing upon previous investigations of S. divinorum and other hallucinogens, this study surveyed 154 recent users and questioned them on their use behaviours, consequences of use and other attitudinal measures. Although reporting an extensive substance use history, and considering the limitations of online surveys, there was little evidence of dysfunctional S. divinorum use, and few reports of troubling adverse consequences of use. Furthermore, there was no evidence that users exhibited increased schizotypy. Respondents reported that S. divinorum produced mixed hallucinogenic and dissociative effects, which lends support to assertions that it phenomenologically differs from other hallucinogens with primary serotonergic activity. The functions of use changed with greater experiences with the drug, and although many respondents reported use of S. divinorum as an alternative to illegal drugs it, was apparent that legal proscription would be unlikely to dissuade them from use. These results are discussed with reference to psychopharmacologically informed public health responses to substance use.
    Journal of Psychopharmacology 10/2010; 25(11):1496-507. DOI:10.1177/0269881110385596 · 3.59 Impact Factor
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