Adolescent salvia substance abuse case report

[occidentalis]

Addiction

Volume 102 Issue 5 Page 823 - May 2007

To cite this article: Sundeep Singh (2007)

Adolescent salvia substance abuse

Addiction 102 (5), 823–824.

doi:10.1111/j.1360-0443.2007.01810.x

ABSTRACT

Background Salvia divinorum is a non-water-soluble hallucinogen that is becoming increasingly popular among adolescents. Salvia is a highly selective full agonist of primate and cloned human cerebral kappa-opioid receptors, although its psychotomimetic effects are similar to serotonergic agonists and NMDA glutamate antagonists. Salvia has been associated with depersonalization, laughter, feelings of levitation and self-consciousness. These effects resolve within 30 minutes following use. Salvia has been banned in many countries, although it remains legal and easily assessable over the internet in the United States.

Case description A 15-year-old man with a history of salvia and marijuana use presented to psychiatric emergency services with acute onset of mental status changes characterized by paranoia, déjà vu, blunted affect, thought blocking and slow speech of 3 days' duration.

Conclusion There is limited literature discussing the clinical effects of salvia use. Based on this case presentation, salvia use may be associated with many undocumented long-term effects such as déjà vu. The ease of use and increasing popularity of salvia requires further investigation into the clinical effects of salvia use.

Mr M, a 15-year-old man, presented to the psychiatric emergency services in May 2006 with an acute onset of mental status changes characterized by paranoia, déjà vu, blunted affect, thought blocking and slow speech of 3 days' duration. He had no previous medical history, but there was a family history of major depressive disorder in his mother and brother, who required in-patient hospitalization. The parents described a period beginning in early spring 2005, during which they became concerned about an episode characterized by anhedonia, depressed mood, declining academic performance and numerous absences from school. During May 2005, the mother considered seeking care from a psychologist for Mr M; however, his mood had improved significantly by late June without professional consultation. The temporal relationship of the subsequent events was difficult to ascertain, because the patient was a poor historian and resided on alternate weeks with each of his divorced parents. In July 2005, Mr M began using marijuana on a regular basis, along with a one-time use of mushrooms, presumed to contain psilocybin. In October, he placed an order online for Salvia divinorum, which he then smoked on multiple occasions over an unknown period of time. He described experiencing visual hallucinations involving vivid colors and objects when consuming salvia. When interviewed, neither he nor his family were able to recall the last time he engaged in the use of salvia. His family was able to confirm the use of marijuana several hours before his initial onset of paranoia 3 days prior to hospitalization. Before this admission, except for the depressive symptoms noted above, he had had no previous behavioral abnormalities noted by family and teachers.

During his hospitalization, he complained regularly of déjà vu without other concurrent visual or auditory hallucinations and paranoia towards those who informed him that he had not previously experienced events or conversations. His presentation was also notable for mental slowing, with poor short-term memory, attention and cognition. During his hospitalization all these symptoms improved significantly, although the feelings of déjà vu remained. The differential diagnosis for the cause of his déjà vu included salvia use, temporal lobe tumors or temporal lobe seizures. A magnetic resonance imaging (MRI) scan and electroecephalogram (EEG) obtained upon consulting with neurology found no notable abnormalities. The absence of any abnormalities in thesestudies and improving mental status during hospitalization were consistent with substance-induced mental status changes. Because marijuana has not been documented to be a cause of déjà vu, salvia was considered the most probable cause of déjà vu in Mr M.

S. divinorum, also known as magic mint or Diviner's Sage, was used by the shamans of Mazatec Indians in Oaxaca, Mexico for ritualistic purposes [1]. Recently, it is becoming an increasingly popular hallucinogen among adolescents. At least six different compounds (salvinorin A–F) have been extracted from the plant leaves with salvinorin A (Divinorin A) being the most psychoactive compound [2]. Salvinorin A is a non-water-soluble compound that is absorbed primarily by the respiratory tract and to a lesser extent by the oral mucosa when users chew or smoke dried leaves [3]. Salvinorin A is a highly selective full agonist of primate and cloned human cerebral kappa-opioid receptors, although its psychotomimetic effects are similar to serotonergic agonists (LSD) and NMDA glutamate antagonists (PCP) [4,5]. This association between psychotomimetic effects and kappa-agonists has been documented with other substances [6]. Users typically describe experiencing depersonalization, hysterical laughter, transforming into people or animals, being in multiple places at the same time, levitation and increased sense of self-consciousness [7]. Users also indicate that these effects start within 5 minutes of consuming salvia and subside within 30 minutes [8]. Currently, there are no records of long-term side effects of salvia use.

Although this substance is available easily over the internet, it has been outlawed in Australia, Finland, Denmark, Spain and Norway. Similar to our patient, users are typically adolescent experimenters seeking a safe method for meditative introspection. Analogous to Bucheler et al.'s case report [1], our patient indicated that he felt he was well informed, and he thought salvia was a safe alternative to marijuana after reading websites citing many scientific articles. Although Mr M perceived that salvia's drug safety was well studied, only three studies and two case reports involving a total of 56 people discuss the effects of salvia in human subjects. Bucheler notes that the user may experience amnesia of the event, thus potentially contributing to our patient's inability to recollect his last use. As a non-water-soluble hallucinogen, salvia could potentially have long-term consequences associated with re-experiencing hallucinations or other neuropsychiatric sequelae such as déjà vu. By being accessible easily over the internet and becoming increasingly popular among adolescents around the world, salvia introduces a new substance about which health-care workers should be informed, and the long-term effects should be evaluated.

Informed consent by the patient was obtained prior to publication of this case report.

REFERENCES

1.

Bucheler R., Gleiter C. H., Schwoerer P., Gaertner I. Use of non-prohibited hallucinogenic plants: increasing relevance for public health? Pharmacopsychiatry 2005; 38: 1–5.

2.

Ortega A., Blount J. F., Machand P. S. Salvinorin: a new trans-neoclerodane diterpine from Salvia divinorum. J Chem Soc Perkin Trans 1982; 1: 2503–8.

3.

Valdes L. J. III. Salvia divinorum and the unique diterpine hallucinogen salvinorin. J Psychoact Drugs 1994; 26: 277–83.

4.

Roth B. L., Baner K., Westkaemper R., Siebert D., Rice K. C., Steinberg S. et al. Salvinorin A: a potent naturally occurring nonnitrogenous opioid selective agonist. Proc Natl Acad Sci USA 2002; 99: 11934–9.

5.

Butelman E. R., Harris T. J., Kreek M. J. The plant derived hallucinogen, salvinorin A, produces κ-opioid agonist-like discriminative effects in rhesus monkeys. Psychopharmacology 2004; 172: 220–4.

6.

Pfeiffer A., Brantl V., Herz L., Emrich H. M. Psychotomimesis mediated by κ opiate receptors. Science 1986; 233: 774–6.

7.

Gonzalez D., Riba J., Bouso J. C., Gomez-Jarabo G., Barbanoj M. J. Pattern of use and subjective effects of Salvia divinorum among recreational users. Drug Alcohol Depend 2006; 85: 157–62.

8.

Siebert D. Salvia divinorum and salvinorum A: new pharmacologic findings. J Ethnopharmacol 1994; 43: 53–6.

[Jesus On Peyote]

sounds a little over exaggerated but gives more reason for people to do more research into long term use. altho anyone who respects the plant and uses it as a tool rather then a high would have none of the problems mentioned in that article.

and the bollox it says about depression is total sh!t,i had minor depression (still do sometimes) and salvia (leaf) did nothing but help me. (when it was legal)

I can understand some people having bad experience but those are the fools that go and buy 20x extracts without the slightest clue on what salvia is ment for.

--------edit--

And addictive my ass. someone should sue the jurno that stated that or they should loose their jobs for printing blatant misinformation

Edited May 15, 2007 by Jesus On Peyote

[reptyle]

People dont just post articles to show how little the medical observers know about such things.

whats is strange however is that they attribute his symptoms largely to the salvia.

replacement for marijuana is strange thing to have been claimed about it.

i would posit that the paranoia has more to do with social climate than anything else.

also i wonder what the circumstances and experinces of deja vu where in relation to. the assumption of mental illness in case seems based on investigators personal experinces of Deja vu rather than a culturally appropriated view of functional circumstancial rememberance used and understood by some traditions as phenomenonlogically significant. This individual could be treated using an expanded reality therapy, which actually enables patient to incorperate their symptoms into newly defined approach to interacting within society.

Depression would more than likely be based upon inability to reconcile personal experince with that of accepted norm of local area, which in no way negates validity of experince but instead requires doctor/case worker to research a variety of globally significant approaches to understanding experinces and transfer this new format to the patient such that they can understand their own situation and adapt lifestyle accordingly.

[chilli]

@JoP

the bollox it says about depression is total sh!t,i had minor depression (still do sometimes) and salvia (leaf) did nothing but help me. (when it was legal)

Yeah, but just because it didn't make you depressed doesn't make this guy's depressive symptoms "total shit," ie they may still be attributable to the chronic Salvia use, especially if he is genetically or environmentally predisposed.

@reptyle

I would posit that the paranoia has more to do with social climate than anything else.

So you haven't interviewed this guy, but you read the case history written by trained professional who has, and say he is wrong about his conclusions? Don't you know marijuana and salvia can both cause massive paranoia?

Don't get me wrong guys, I'm not trying to be nasty, I'm just wary about what sounds like a lot of rationalization... the report sounds pretty reasonable to me... these drugs CAN fuck your head up, it sounds like this guy was using powerful salvia extract as a recreational drug, which it most definitely is not.

[ThunderIdeal]

i can't understand why it i used recreationally, i don't find it pleasant in the least.

[Auxin]

From what I've seen recreational use usually aims for threshold or low dose effect with only the minority using it at full dose for recreational effect.

addictive my ass. someone should sue the jurno that stated that or they should loose their jobs for printing blatant misinformation

Dude, Addiction is the name of the journal- not the subject of the paper.

[Jesus On Peyote]

IB

Yeah, but just because it didn't make you depressed doesn't make this guy's depressive symptoms "total shit," ie they may still be attributable to the chronic Salvia use, especially if he is genetically or environmentally predisposed.

Hey IB, yea no nastyness taken.

Its not that it dident make me depressed, it helped with my depression. When i used salvia tho, i dident use it recreationally for fun. i used it more as a tool to help me get over depression that was their before i had even heard of salvia. I used it sparingly, like once or twice a week, like i said in leaf form, so no extract(i can see how chronic use of extracts could cause problems). personally i wouldent touch anything over 5x, simply because i dont think that is what it is ment to be used for.

Like Thunder said, i dont see why people would want to use it as a "drug" of fun recreationally ( my definition of recreationally is pretty much high doses,multiple daily hits) which i can see causing mental effects, which is why i also said there needs to be more official research on it. and you also cant rule out the guys cannabis use, and the fact that he was 15.

hope that cleared that up.

Ah auxin, musta been a reaction to the title lol. salvia and addiction in the same sentence got me Kind of suggestive

Edited May 15, 2007 by Jesus On Peyote

[MORG]

altho anyone who respects the plant and uses it as a tool rather then a high would have none of the problems mentioned in that article.

I think you're dreaming dude. If you're predisposed to having a poor reaction to something, or just get downright unlucky no amount of "plant-spirit-goodwill-love-I'm searching for the inner truth" is going to stop reactions occurring. We're dealing with a substance, the effects of which are still poorly understood. What will happen will happen.

And addictive my ass. someone should sue the jurno that stated that or they should loose their jobs for printing blatant misinformation

As Auxin said, the "Journal" is called addiction, and these are written not by journalists but experts in the field. Most likely a psychologist or psychiatrist here.

Interesting article but I think the importance of Sally in the symptoms might be overstated. I think it's likely the regular MJ use played a big part.

It's common for adolescent males with a history of mental illness in the family to suffer onset of psychological disorder with cannabis use. It's happened to 3 people I know.

Just because one symptom: de ja vu, hasn't been typically associated with cannabis-induced mental health problems doesn't mean it is has to be the sally. It could simply be variation in individual reaction.

[Jesus On Peyote]

youve known 3 people who have mental illness due to cannabis, as i know a few also (me included ). but i dont know anyone whos gotten those symptoms from salvia, and havent really read any recorded info long term pyscosis ,apart from this article. which again is why i reacon there needs to be more research

I think you're dreaming dude. If you're predisposed to having a poor reaction to something, or just get downright unlucky no amount of "plant-spirit-goodwill-love-I'm searching for the inner truth" is going to stop reactions occurring. We're dealing with a substance, the effects of which are still poorly understood. What will happen will happen.

Agreed, but what i was trying to say is that this person was a chronic salvia smoker and most likely an online extract buyer.

Im not saying having a "plant-spirit-goodwill-love-I'm searching for the inner truth" feeling will help, but i was saying that its effects do have an anti depressive nature to it. giving if you respect the plant (in the sense of not using a 20x daily,speculating that he was using an extract)

Interesting article but I think the importance of Sally in the symptoms might be overstated. I think it's likely the regular MJ use played a big part.

Just because one symptom: de ja vu, hasn't been typically associated with cannabis-induced mental health problems doesn't mean it is has to be the sally. It could simply be variation in individual reaction.

Yea, thats what i think. it may have been a mix of both even,too many veribilities to single it out on anything, but still is a usefull start article to get things rolling on more real actual research about its use.

I think where saying the same things.. i should have worded it better.

Edited May 16, 2007 by Jesus On Peyote

[chilli]

"Just because one symptom: de ja vu, hasn't been typically associated with cannabis-induced mental health problems doesn't mean it is has to be the sally. It could simply be variation in individual reaction."

True, but one of the recurring things I've noticed in Salvia trip reports is strong deja vu.

[SaBReT00tH]

I thought I had read Salvia has anti-depressant effects, unlike Marijuana which has depressant effects

[occidentalis]

I thought I had read Salvia has anti-depressant effects, unlike Marijuana which has depressant effects

There is one reported case of antidepressant activity, or at least reduction in symptoms of depression, following salvia use. There are many anecdotal reports of similar effects. This is something that requires further study - Like everything else about this plant drug.

[Jesus On Peyote]

2 reported cases if you included my experience.

at least reduction in symptoms of depression

That sounds about right,no cure but helped.

[occidentalis]

Yours is an anecdotal report. There are many anecdotal reports as I said. By reported case, I meant reported in the medical literature.

[Guest Øskorei]

JoP, how much are you really the journeyman into your being ? A lot of what you write sounds like piss & wind.

[Jesus On Peyote]

wtf did i say now? Please explain ( or dont,ittle ruin the thread)

Unless your argumentative minded, you would have seen i was adding to Creaches response to SaBReT00tHs question with personal experience.

arnt i allowed to talk about something which you seem to have no input on? go post some evil looking picture of that gardener you hate so much.btw how did you get 165 posts in 33 days since you signed up?

Edited May 20, 2007 by Jesus On Peyote

[chilli]

What's the problem Osk? I don't really get why you're having such a go at him.

"...go post some evil looking picture of that gardener you hate so much."

LMAO