Salvia, more specifically salvia divinorum, is an herb in the mint family that is generally found in southern Mexico and used by the Mazatec tribes in divination rituals.
According to the National Institute on Drug Abuse, the active ingredient, salvinorin A, can cause hallucinations, as it changes the chemistry in the brain. This happens when salvinorin A attaches to parts of certain nerve cells, kappa opioid receptors. These receptors are not the same receptors involved in the use of opioid drugs, such as heroin.
Salvia is known by many different names, including:
- Shepherdess’s herb
- Diviner’s sage
- Seer’s sage
- Ska Maria pastora
- Magic mint
- Lady salvia
Ingestion Methods and Effects
There are many different ways that salvia can be ingested. The fresh leaves can be chewed or their juices can be extracted. The leaves can also be dried, so that, similar to marijuana, they may be smoked in cigarettes or joints, inhaled via hookahs, or vaporized and inhaled.
According to NIDA, the effects of salvia can appear in less than one minute, peak in 10-15 minutes, and last less than a half-hour. A study conducted by the Center for Substance Abuse Research states that the physical effects can include, but are not limited to:
- Decreased heart rate
- Lack of coordination
- Slurred speech and awkward sentence patterns
- Uncontrollable laughter
There are also multiple psychological effects, including intense hallucinations, which are often frightening and mimic psychosis; changes in vision; mood and body sensations; feelings of detachment and dissociation from surroundings; and emotional swings, including depression and anxiety. There are also reports of salvia altering the user’s perception of reality, creating dangerous outcomes when the user participates in seemingly harmless activities, such as driving or swimming. In fact, salvia has been linked to several deaths in the United States, although not from overdose.
Many people, after their first experience with salvia, never use the drug again. The New York Times stated in a 2008 article that salvia-related emergency room visits are rare, due to the drug’s short period of effects. A survey group’s lifetime use of salvia jumped from 0.7 percent in 2006 to 1.3 percent in 2008, according to a survey supported by NIDA. The same NYT article reported that the federal government published estimates of salvia use in 2008, and approximately 1.8 million people had tried salvia in their lives.
The United States Drug Enforcement Agency has listed salvia as a “drug of concern,” and is looking to determine if it should be listed in the same category as heroin; multiple countries have done the same. Salvia is often bought and sold on the Internet or in tobacco and head shops. Many states now criminalize salvia, but until the drug is criminalized at a federal level, each state must decide on the appropriate laws regarding its possession and use.
Salvia Dependence in Adults
It may be difficult to note salvia abuse, since the high from the drug can be so short-lived. However, some common signs of abuse will also apply to salvia use, including:
- Cravings and urges to use salvia
- Unable to stop or cut down use of salvia
- Taking increased amounts of salvia to achieve the desired effect
- Spending more time and money to obtain, use, or recover from salvia
- Being unable to manage responsibilities at home, work, and school
- Continued use of salvia, even if it is causing problems with relationships
- Missing work, school, or social activities because of salvia use
- Continued use of salvia, even after harmful consequences
- Continued use of salvia, even if it aggravates physical or psychological issues
- Experiencing withdrawal symptoms when going without salvia
According to a National Survey on Drug Use and Health report from 2006, young adults aged 18-25 were more likely than youths aged 12-17 or adults aged 26 or older to be past-year users of hallucinogens, including salvia, with young adult males being more likely than females to be past-year users.
Salvia Dependence in Teens
Salvia use can be prominent with teens; according to a brief provided by the New Hampshire State government, young users often upload videos of themselves during their experiences with the drug. Some of the videos on sites such as YouTube suggest, when users are taking the drug (especially the first time), they have a “sitter” nearby – someone who is sober, keeping a watchful eye to make sure users are safe while using the drug. Many of the videos feature the user laughing hysterically, hallucinating, and losing awareness of the surroundings. Singer Miley Cyrus filmed such a video in 2006, later stating that she had “made a bad mistake.”
In a study by NIDA from 2014, groups of 8th graders, 10th graders, and 12th graders were interviewed about their salvia use within the past year. In the 8th grade group, 0.6 percent of the age group stated that they had used salvia in the past year. The 10th and 12th grade groups had both 1.8 percent of interviewees state that they had used salvia in the past year.
As with adults, it may be difficult to detect use in teens due to the short duration of the high associated with salvia. At times, the only way a parent or guardian will know of salvia abuse is when told by the user or a friend. Teens, however, may show these signs of abuse, as listed by NIDA:
- Withdrawing from family and friends
- Acting depressed
- Hostile behavior
- Having problems with family and friends
- Hanging out with a different group of friends
- A drop in grades
- Lack of personal hygiene
- Not caring about appearance
- Skipping classes or school
- Change in eating and sleeping habits
- Getting in trouble at school, at home, or with the law
- Losing interest in favorite activities
Unfortunately, there isn’t an abundance of research in regards to salvia to know if this particular drug can cause withdrawal symptoms. However, it is very possible to be psychologically addicted to salvia, even if the user does not experience any physical withdrawal symptoms. To be psychologically addicted means that the user may experience symptoms that are more emotional in nature – for example, feeling anxiety if unable to use the drug.
Drug dependence is categorized as a mental health disorder by NIDA, because dependence changes the way people think, turning normal thought processes into ones that are associated with obtaining and using a drug. Drug dependence means that users have extremely strong urges to use the drug, and, even if they want to stop, they cannot. If there is a dependence issue, either for an adult or a teen, there is a need for treatment.
Finding Treatment for Teens
Parents may take their teen for a physician consult, where a screen can be completed to assess for signs of drug use, so parents should ensure that the physician is comfortable with the topic of salvia dependence. (f the physician has reason to believe that the teen needs to see another physician, the parents should ask for a referral to a physician who handles teen drug dependence. The physician will also be able to order blood and urine testing; Medical Laboratory Observer reports that there are tests that can detect salvia in a urine sample. The screening will consist of certain questions as well, regarding drug use and certain drug-related behaviors.
Should the physician decide that the teen needs treatment, the parents then need to find an appropriate facility. Many facilities can accommodate the teen population, and either the physician or an addiction specialist can provide referrals.
If the teen does not wish to seek treatment, the parents should avoid interventions if possible. Research has shown that these interventions are not effective, and this may cause the teen to lash out. Instead, parents should speak with the teen about seeing a physician, as the teen may accept the option of treatment better if it is suggested by a professional.
Finding Treatment for Adults
In the case of an adult user needing treatment, the first step may also be to speak with the user about seeing a physician. A loved one may offer to accompany the user, especially if the user has confided in the loved one and asked for help. If the user does not wish to see a physician, the loved one may leave information with the user regarding drug dependence and treatment. Loved ones may reassure the user that recovery is possible, and that treatment will be the first step toward recovery.
If the user agrees to begin treatment, it is important to locate a treatment facility that is familiar with salvia abuse and addiction. As stated above, it is unknown if salvia causes any physical withdrawal symptoms, therefore, the user should be monitored around the clock by medical staff. If psychological withdrawal symptoms such as anxiety occur, staff may be able to provide medication to help the client through this period of discomfort.
Specifics of Treatment
When individuals enter inpatient treatment, they will be monitored around the clock by medical staff. Since it is unknown if salvia causes long-term effects or withdrawal symptoms, there is no evidence to state whether or not medical detox is necessary. However, should the person experience psychological withdrawal symptoms, medical staff may provide medication to ease discomfort.
As previously stated, a treatment plan must suit the person’s dependence. For example, those who have severe psychological dependence on salvia would not be suited for an outpatient program, as they need specialized care to guide them through any symptoms that may occur. These individuals would also benefit from the safe and secure environment of inpatient care, where clients don’t have access to any drugs of abuse, reducing the risk of relapse significantly.
Treatment should focus on the person as a whole, not just the person’s salvia dependence. There are many factors that may play into drug dependence, such as mental health disorders like depression, anxiety, attention deficit hyperactivity disorder, and oppositional defiant disorder. Issues such as abuse should be immediately addressed as well. Support should also be provided for any medical, wellbeing, and psychiatric needs, as well as any issues that may arise with school, work, housing, legal aid, and transportation.
Treatment times – if residential or inpatient – may vary, depending on the client’s withdrawal symptoms and progress in recovery. If the client has a severe psychological dependence or long-term addiction, it may take a longer period of time for the client to work through the drug-related behaviors and make changes. Also, if clients experience physical withdrawal symptoms, time will be needed to assist them with the medical detox process. In the case of medical detox, it is vital that medical staff members continuously monitor clients.
NIDA offers suggestions for five questions individuals and/or loved ones should ask when searching for a treatment facility and/or program:
- Does the program use treatments backed by scientific evidence? The facility should use behavioral therapy methods and, if necessary, medications.
- Does the program tailor treatment needs to each client? One treatment plan does not fit all clients. Ensure that the facility will give all clients treatment plans that fits their unique situations.
- Does the program adapt as the client’s needs change? As clients change their thoughts and behaviors, treatment plans will need to change. The facility should periodically review each client’s treatment plan.
- Is the duration of treatment sufficient? As with the treatment plan, the duration of treatment is different with each client. Clients should be assured that they will not be discharged from treatment before they are ready, and that they will have support in the event of relapse.
- How do 12-Step or similar recovery programs fit into the treatment plan? Self-help groups can help guide the client through the recovery process by offering peer support. These meetings and groups can also offer ongoing support once clients exit formal treatment programs.
Factors in Choosing Treatment
If individuals have a severe dependence on salvia, they may achieve a greater benefit from inpatient – or residential – treatment. In this situation, loved ones should search for a facility and program that offers the physical, psychiatric, and medical care that is needed for that person.
Outpatient programs are also available, either for the client who must attend school or work and take care of other responsibilities while in treatment, or for the client who has progressed through inpatient treatment but is not ready for total discharge. These programs may meet anywhere from once a week to daily, and may decrease as the client’s needs change. There are also intensive outpatient or partial hospitalization programs available. These programs may last for a set amount of hours during the day, allowing the client to tend to other responsibilities as well. In the case of teens, this option may not work with school; however, there may be the option of a tutor to help the teen stay up to date with their studies.
Geographical location is an important factor in treatment as well. It may be difficult to find a facility or program in a location that is convenient to the client’s home. In such case, the client and loved ones must decide which option will provide the greatest benefit – sending the person to a facility that may be further from home, or having the person participate in a different program so it is possible to stay close to home. The individual and loved ones must ask many important questions at this point: How severe is the person’s salvia dependence? If the person stays closer to home, will the treatment be of the same benefit? If the person chooses to attend a facility further from home, will insurance benefits cover treatment? An admissions coordinator at the specific treatment facility can answer these questions, as well as others the individual and loved ones may have.
If budget is a concern, an admissions coordinator will be helpful in this situation as well. This specialist will be able to check if a client’s insurance policy will cover the treatment option of choice. If not, the specialist may be able to provide financing options for treatment. These financing options are essentially payment plans, where the treatment costs are covered upfront and the individual then makes monthly payments against that bill.