July 02, 2007
Monday

SAN FRANCISCO -- Salvia divinorum is a bright, leafy green plant from Mexico that when chewed or smoked causes intense hallucinations comparable to LSD or "magic mushrooms."

And it's legal in most of America.

For $15 to $50 a hit, users get a high that sends them into a dream-like state for anywhere from a few minutes to an hour or two.

Unlike well-known illicit drugs such as marijuana or cocaine, salvia is not in widespread use. It hasn't caught the attention of state or local health departments.

But the U.S. Drug Enforcement Administration has taken notice, and the drug has been outlawed in at least five states: Louisiana, Missouri, Tennessee, Oklahoma and Delaware.

The fear is that salvia seems to be appealing to a growing group of young people, drawn to the drug by the fact that it's legal and natural.

"My friend told me he did cocaine, and salvia was more intense than that. And it's legal, so I figured it wasn't as dangerous," said Phuong, a 23-year-old from San Jose, Calif. who has tried salvia twice.

Phuong asked that her last name not be published because she didn't want people to know she had used the drug.

"Salvia could just be a flash in the pan, or it could turn into an important trend," said John Mendelson, a senior scientist at the Research Institute at California Pacific Medical Center, where he is studying potential health benefits of salvia. "This seems to be an aficionado drug right now, but the trajectory with things like that is it starts with a small group of adherents and spreads to larger groups with less controlled use.

"From my perspective, we have an incredibly unique opportunity to learn something before it hits widespread use."

But Mendelson might have to move fast to keep ahead of looming government restrictions of salvia.

The DEA is monitoring salvia to decide whether it should be regulated or banned outright. Not a lot is known about salvia and its long-term effects, but most medical researchers agree that there don't seem to be any immediate negative side effects of the drug, and they say it is highly unlikely that it is addictive.

The main concern of opponents to the drug is what people might do while they're hallucinating -- get in a car, for example, or react violently to their surroundings. A Rhode Island teenager claimed to be on salvia when he stabbed a friend, and the parents of a Louisiana teenager have said they believe their son killed himself because he was smoking salvia. But neither incident has been definitely linked to the drug.

In the meantime, some researchers say salvia could have beneficial effects -- including uses treating depression or bipolar disorder -- and they worry that a federal ban of the drug would make it difficult to study its effect on human subjects. Mendelson at California Pacific Medical Center is starting the first clinical trial of salvia next month, testing seven or eight people to see how much of the drug they must take before they start hallucinating. Nearly all medical researchers say there isn't enough evidence to determine whether salvia is safe or not.

"Certainly it sounds like it could have potential for harm," said Cathi Dennehy, a professor in the department of clinical pharmacy at UCSF. "If you have something that's causing people to have very intense, out-of-body experiences, that's pretty concerning."

But Jodie Trafton, an addiction specialist at Veterans Affairs Palo Alto Health Care System, said because the effects of salvia are brief -- often lasting just a few minutes, compared with LSD, which can cause hallucinations for many hours -- and because the drug is almost definitely nonaddictive, she doubts regulation will be necessary.

"People who use this aren't going to continue using it," Trafton said. "You're never going to get more than low-level use. And the effect is too short, so by the time somebody starts freaking out over the effects, it's over. It's not something that's going to bombard emergency rooms."

Salvia divinorum is a species of sage, but is the only plant in the salvia family to cause hallucinations. As a drug, it's usually just known as salvia but goes by a variety of other names, including "Sally D" and "magic mint."

The drug didn't reach the United States until the late 1980s or early 1990s, and even then it wasn't widely available until five or six years ago. It's now also grown in California and other states, but is mostly imported from Mexico and Central and South America, and it comes in the form of fresh or dried leaves, whole plants, seeds or sometimes just a salvia extract.

In a 2004 study out of UCSF, Salvia divinorum was the second most-popular ingredient in legal recreational drugs sold on the Internet, behind only ephedra, a stimulant and dietary supplement that has since been outlawed. Salvia is often sold on the Internet as the main ingredient in products that promise hallucinogenic effects, but it is more commonly used by itself.

A chemical found in salvia called salvinorin A causes hallucinations. It is considered the most potent known natural hallucinogenic and is unique in how it reacts with the brain's chemical receptors -- unlike most psychotropic drugs, salvinorin A does not react to serotonin receptors.

In fact, salvia's similarity with LSD and mushrooms ends with hallucinations. Even the hallucinogenic effect is different. Rather than interacting with their environment -- LSD is known to intensify colors, smells and sounds, for example -- salvia users often report out-of-body experiences, during which they feel as though they are in a different place or time.

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