A SALVIA DIVINORUM HORROR STORY

When mind-altering substances like psychedelics produce unpleasant
experiences - "bad trips" or worse - the real cause is often not so
much the drug itself, but "dosing." In street slang, "dosing" does
not refer to the normal medical administration of measured amounts of
a drug. Instead, the slang use of "dosing" is the dangerous and
stupid practice of covertly administering a drug to an unsuspecting
user. During the 1960s, some proponents of LSD usage were so
enthusiastic about its effects that they routinely offered strangers
spiked drinks containing the drug. But it's one thing for a fully
informed emotionally mature adult to voluntarily take a drug. It is
quite another when someone is "dosed," and has effects mimicking a
psychosis. The reckless abuse of LSD soon led to draconian criminal
laws and suppression of research into potential beneficial effects of
psychedelics. More recently, there has been concern about so-called
date rape drugs, GHB for example, slipped into a woman's drink to
facilitate sex (of course, the most common date rape drug is simply alcohol).

Salvia divinorum is a sage used for millennia by natives of Oaxaca
for its psychoactive properties. The active ingredient of the plant
is salvinorin A, which is similar in potency to LSD. The drug is now
available worldwide through the Internet and in head shops as leaves
for smoking, or as a liquid tincture. Salvia produces intense
short-lived psychedelic effects - longer effects when taken orally,
shorter when smoking the leaves. In most of the United States, salvia
is still sold legally. Users generally report pleasant experiences,
but some have reported the opposite result - fear, terror, panic and
worse. The September 2008 issue of the Journal of Clinical Psychiatry
reports a case of Salvia dosing that led to a near-fatal toxic psychosis.

An 18-year-old woman was admitted to a psychiatric hospital, after
reportedly smoking marijuana, with schizophrenia-type symptoms. She
was agitated, disorganized and hallucinating. Several days later, her
former boyfriend revealed that she had unknowingly smoked leaves and
leaf extracts of Salvia divinorum added to her marijuana joint. The
young woman had a long history of cannabis use with no untoward
effects, but had never before used salvia. After increasing
self-mutilating behavior in the hospital, she was involuntarily
admitted to a closed ward. Despite large doses of intravenously and
intramuscularly administered anti-psychotic drugs, she remained
highly psychotic, with disordered thinking, delusions, and slow
speech. A few nights later, she was transferred to an intensive care
unit because of "a marked decrease of alertness." She had developed a
toxic psychosis with stupor and catatonic excitement. Because the
anti-psychotic medications (Zyprexa and Haldol) were having no useful
effect, the young woman was given two series of electroconvulsive
treatments, but these were discontinued because she had recurrent
episodes in which her heart stopped for periods as long as 5 seconds.
Her erratic heartbeat required a temporary external cardiac pacemaker.

Then things started to turn bad .... Her agitation caused her to bite
off a 1/2-inch-by- 1/2-inch part of her tongue, which she aspirated,
requiring tracheal intubation and ventilation. She developed elevated
temperature, a drop in blood pressure and a rigid abdomen. An X-ray
showed signs of peritonitis. An exploration of her abdomen disclosed
several necrotic (dead, dying) areas of her small intestine and
colon, requiring surgical removal of the affected parts. After a long
hospitalization, which included decreasing doses of anti-psychotic
drugs, her psychotic symptoms resolved and she was discharged in a
psychiatrically stable condition. The young woman and her parents
have since instituted legal proceedings against her former boyfriend,
accusing him of dosing her with Salvia divinorum.

Few users of Salvia divinorum will ever undergo the horrors described
above. But psychedelic drugs are especially dangerous for individuals
who are psychologically unstable or not yet fully matured
emotionally, for example, teenagers. These dangers are multiplied
many times when a person is "dosed" and doesn't realize that the
resultant strange perceptual effects are drug induced. The "dosed"
victim may then experience a prolonged psychotic reaction, especially
if predisposed to mental illness.

Researchers are conducting human experiments with Salvia divinorum,
looking at potential benefits of the plant. But several states have
made Salvia sales and use illegal. Widespread abuse could lead to a
total ban and an end to legal research.