Salvia Divinorum

Feb. 16, 2010
Chewing the leaves of salvia divinorum is one form of usage of this legal recreational drug that should concern dental professionals.

by Stephanie Wall, RDH, MSDH, MEd

Most of us have heard of marijuana, LSD, mushrooms, and ecstasy, but how about salvia divinorum? I hadn’t heard of it until I watched a daytime TV talk show host discussing its use among today’s young adults. It is legal in most states even though it’s considered a hallucinogen. For that reason alone it warrants a closer look.

Salvia divinorum is a plant from the mint family and a species of sage that is used for its psychoactive effects. It can grow to over three feet tall, has large green leaves, hollow square stems, and white flowers with purple calyces. Salvia, along with its active ingredient salvinorin-A, is difficult to pharmaceutically categorize as it doesn’t fit into any specific class. It is primarily found in the Mazateca region of the Sierra Madre Mountains in Oaxaca, Mexico; however, it has been grown successfully in other regions. The Mazatec Indian shamans use it during healing and divination ceremonies.

Salvia divinorum produces a hallucinogenic state that can range from very mild to very extreme. It is not considered a party drug but is used primarily by individuals to get high. Those who want to explore deep meditative states, spiritual realms, mysticism, and the nature of consciousness and reality also use it. Many people report that the effects of salvia become stronger after using it a couple of times. Some people become more sensitive and reach a higher level of effects with repeated use. When using salvia, especially the first time, someone should act as a “sitter.” The reaction to the substance may induce an experience that can be overwhelming to the novice, so a sitter is a necessary precaution. The duration of a salvia-induced experience varies from person to person and depends on the amount consumed and the method of ingestion. The most common methods include smoking, chewing, or taking orally as a liquid extract.

Dry leaves are usually smoked in a pipe with water added to cool the smoke. The temperature required to activate the substance is quite high at 464° F (240° C). A regular flame will work; however, a butane torch lighter is recommended to reach the required temperature. When smoked, untreated salvia leaves produce unnoticeable or very light effects. Maximum intensity is usually reached within a minute and lasts from one to five minutes. At five to 10 minutes the effects taper off, and a return to normalcy occurs in 15 to 20 minutes. Concentrated forms of salvia have become more widely available and are preferred over the plain leaf. An enhanced leaf is followed by the multiplier “x” (such as 5x, 10x, etc.), that refers to the relative amounts of leaf used in the preparation. These numbers are often representative of the concentration of the active ingredient, salvinorin-A, but cannot be assumed as exact in measure. Potency depends on the varying strength of the untreated leaf and the efficiency of the extraction process.

When chewed, the leaf mass, called a “quid,” is held within the cheek area, similar to that of tobacco, with absorption occurring across the lining of the oral mucosa. Any juice that is swallowed is considered to be inactive as the active ingredient is deactivated when it enters the gastrointestinal system. Chewing produces a longer-lasting experience since more of the leaf is consumed. The effects come on more slowly, usually over a 10 to 20 minute period. The experience can last from 30 minutes to 1.5 hours.

The third method is in the form of a tincture, usually taken sublingually using a glass dropper. The substance is often diluted with water to reduce the intensity of the effects, as well as decrease the stinging sensation from the alcohol presence. Tinctures vary in potency, and the effects range from a mild meditative state to a more intense visionary one. The experience duration is similar to that of the other methods.

Salvia, also known as “magic mint,” “Ska Maria Pastora,” or “Sally D,” is readily available on the Internet, at some tobacco and head shops, and at stores that sell herbal remedies. There are also several YouTube accounts of salvia use that clearly show the effects that can occur as part of a salvia experience. The average cost of the mild extract is about $5 a gram, with the more potent form going for about $50 a gram. In 2008, the federal government published its first estimates of salvia use: nearly 1.8 million people had tried it, including 750,000 the previous year. Among males 18 to 25, where use is the heaviest, nearly 3% reported using salvia during the previous year, making it twice as prevalent as LSD and nearly as popular as ecstasy.

States taking steps

As of November 2008, many states placed regulatory controls on the use of salvia and its active ingredient, salvinorin-A. Delaware, Florida, Illinois, Kansas, Mississippi, Missouri, North Dakota, Oklahoma, and Virginia have placed salvia into Schedule I of state law. California, Louisiana, Maine, and Tennessee have enacted other forms of legislation restricting the distribution of salvia. States that attempted legislation but failed are Alabama, Alaska, Hawaii, Indiana, Iowa, Minnesota, Nebraska, Oregon, South Carolina, and Utah. Current legislation proposing regulatory controls are in Michigan, New Jersey, New York, Ohio, Pennsylvania, Texas, and Wisconsin. There are also regulatory controls in Australia, Belgium, Denmark, Estonia, Finland, Italy, Japan, Spain, and Sweden.

Many are concerned that misuse of the substance and any associated negativity will undermine its possible use in medicine. Medical researchers believe salvia shows great promise in the treatment of addiction, depression, Alzheimer’s, schizophrenia, and chronic pain. Salvinorin-A seems to have absolute specificity for a single receptor site on the brain called the kappa opioid receptor. Studies have shown that it works in the same place in the brain as morphine and related pain reducers known as opioids. It is unique in that many other substances in the hallucinogen category act on many brain receptors, which makes it difficult to isolate effective uses. Research has been completed using rodents, and it is still unknown when and if studies can be duplicated in humans.

For those of you with teenage and young adult children, know what your child is ingesting or using. Ask your child outright about usage, just as you would ask him or her about drug use. As mentioned, there are many sites on the Internet that offer salvia for purchase. Whether or not there is a minimum age requirement to order the substance, I do not know; I didn’t investigate the sites to that length. For the dental and dental hygiene practitioner, there is no report of what the oral side effects might be. Since it is often used in the form of a “quid,” the oral mucosa may show changes similar to those associated with chewing tobacco. Gaining information from research would be extremely valuable; however, gaining access to enough chronic users might not make this possible.

The effects of salvia
Salvia is often grouped with other hallucinogenic psychoactives; however, its effects are unique. It is sometimes marketed as a legal form of cannabis even though the effects are in no way similar. Psychedelic experiences associated with salvia, as stated by users, include:

• Uncontrollable laughter

• Revisiting past memories

• Sensations of motion

• Loss of physical coordination

• Visual alterations or visions

• Experiencing multiple realities

• A sense of total confusion or madness

• Becoming an inanimate object

• A feeling of being underwater or underground

• Seeing or becoming part of a tunnel

• Appearing to travel to other places or times

Little is known about the long-term effects but it is believed that salvia is not addictive nor its users prone to overdose or abuse. There is also no evidence of any deaths associated with its use; however, there is some speculation based on individual incidences.

Stephanie Wall, RDH, MSDH, MEd, has been a dental hygienist for 22 years. She is an author, speaker, and owner of Visual Dynamics, a presentation design company. You can view her Web site at or contact her at [email protected].