Presented by Dr. S Harding.
Salvia Divinorum and Salvia Psychosis
(AKA Diviner’s Sage, Ska Maria Pastora, Seer’s Sage)
- Native to cloud forests in Oaxaca, Mexico
- Squared, hollow stems often with white flowers with violet calyces
- Historically used by Mazatec Shamans in religious ceremonies/divination
- “Salvinorin A”
- Member of the diterpenoid class – includes various aromatics, coloring agents, menthol, camphor, cannabinoids
- Potent k-opioid and D2 receptor agonist
- Similar effects reported to serotonergic agonists like mescaline and LSD
- Traditional/historical – tea can be made with crushed leaves
- Can also be chewed and swallowed (slower absorption, longer effect)
- Smoking is the more common modern use – requires a lower dose for effect
- 50mg to 172mg is the typical dose
- Various concentrations are available
– Peak effect in 1 minute; Lasts approximately 1-5 min, followed by the “afterglow”
– Return to baseline in 15-20 minutes
- Uncontrollable Laughter
- Past memories
- Sensing motion or pulling by unseen forces
- Merging with objects
- “Overlapping realities”
- Vivid hallucinations otherwise
- Synesthesia and glossolalia
- Per DEA: “perceptions of bright lights, vivid colors and shapes, as well as body movements and body or object distortions. Other effects include dysphoria, uncontrolled laughter, a sense of loss of body, overlapping realities, and hallucinations . . . adverse physical effects may include incoordination, dizziness, and slurred speech.”
Double blinded, randomized, crossover, counterbalanced study – 10 subjects, varying doses of salvia – “wide range of transient effects.” Intermittent use pattern explained by lack of euphoric effects and presence of perceptual altering effects.
– Several case reports
– Am J Psychiatry – 21 yo male no pmh, no psychiatric hx
- Smoked salvia – became suspicious, attempted to jump out of a moving car
- Echolalia, paranoia, flight of ideas, psychomotor agitation
- Transferred to psychiatric unit – continued to be agitated for 2d
- Attempted to barricade himself in his room
- Controlled with Risperdal
- After tapering and withdrawal of Risperdal, psychosis returned acutely
- Suspicion is that pt was genetically predisposed to schizophrenia and the dopaminergic effect of salvinorin A precipitated the psychosis
– Other case reports mention:
- paranoia, déjà vu experiences, and a blunted affect with thought blocking and slow speech that lasted for three days
- bizarre feelings of depersonalization
- 23 yo male – psychosis, paranoia, disorganized thinking , hypervigilance, mood lability
- several similar k-opioid agonists have shown promise as anti-addictive medication (esp for cocaine), antidepressant properties (afterglow)
- Salvinorin A is too short acting – improved pharmacokinetics in synthetics
1. Persistent psychosis associated with salvia divinorum use. Przekop P, Lee T. Am J Psychiatry. 2009 Jul;166(7):832. doi: 10.1176/appi.ajp.2009.08121759.
2. Salvia divinorum. Meyer EG, Writer BW. Psychosomatics. 2012 May-Jun;53(3):277-9. doi: 10.1016/j.psym.2011.07.003. Epub 2012 Jan 29.
3. From divination to madness: features of acute intoxication with Salvia use. Winslow M, Mahendran R. Singapore Med J. 2014 Apr;55(4):e52-3.
4. Dose-related behavioral, subjective, endocrine, and psychophysiological effects of the κ opioid agonist Salvinorin A in humans. Ranganathan M, Schnakenberg A, Skosnik PD, Cohen BM, Pittman B, Sewell RA, D’Souza DC. Biol Psychiatry. 2012 Nov 15;72(10):871-9. doi: 10.1016/j.biopsych.2012.06.012. Epub 2012 Jul 18.
5. Salvinorin A analogs and other kappa-opioid receptor compounds as treatments for cocaine abuse. Kivell BM, Ewald AW, Prisinzano TE. Adv Pharmacol. 2014;69:481-511. doi: 10.1016/B978-0-12-420118-7.00012-3.