Salvia: Good For Research, Bad For Recreation

Salvia is a powerful hallucinogen -- it must be regulated. But we don't know enough about it to say how it should be regulated.
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Parents who keep an eye on YouTube are likely aware of a recent viral video: The young actress and singer Miley Cyrus smoking an unknown substance leading to a fit of laughter and apparently extreme disorientation -- even hallucination. Some watchers have concluded that Cyrus' bong was likely packed with salvia divinorum, a psychedelic relative of sage that has become popular with young people in recent years for its intense but short-lived high. Another reason it's popular: In many states, it's totally legal.

The issue of salvia is as important as the drug is misunderstood. So I'd like to clear up some misconceptions and at the same time give you an idea why child and adolescent psychiatrists care about this drug. There are two reasons: We want to protect against its perils, and we want to protect its promise.

Salvia is a powerful hallucinogen that frankly terrifies many who try it, can cause loss of motor coordination, and often brings on overwhelming dissociative hallucinations. You probably wouldn't be OK with your child taking LSD or heroin; and yet because salvia is a leaf and is legal, some make snap judgments. Looking around the web for reactions, I stumbled on this comment about Cyrus, "Obviously she wasn't in her right frame of mind when this was filmed. Perhaps, she had a little more than that salvia."

More than that salvia? This sort of thinking unfortunately plagues the public consciousness. That blogger appears to think that Cyrus was actually smoking marijuana, because the legal herb salvia couldn't possibly have such an effect! Here's the real deal: Just because salvia is superficially similar to marijuana doesn't make it any safer than other hard drugs. (And, like other hallucinogens, it should be off limits for any child at risk for a psychiatric disorder.)

You can watch hundreds of salvia videos on YouTube that may elicit a chuckle, but a first person account in a comment on NPR's website gets closer to the heart of the matter. "I smoked this stuff once ... and only once," the commenter begins. "It scared the hell out of me."

I did see my mom and dad looking down at me and trying to tell me something, I couldn't hear them and realized I was dead and in a coffin. I also thought I was on a giant record player. Every time the record spun I saw a window into reality that became bigger and bigger as time went on. My friend told me I was spinning around in my chair yelling that my foot was on fire for about 10 minutes.

That is not just getting stoned. And it should be mentioned that salvia has been linked, if vaguely, to a handful of suicides. Which is not to say that the reckless and dissociative behavior that can be brought on by salvia isn't worrying in and of itself.

So why, you ask, is it legal? The DEA "schedules," or regulates, drugs and medications -- in part -- based on chemical similarities with already scheduled drugs. Salvia is legal because its method of action -- how it affects the brain -- is so novel that it is unrelated to any of the drugs currently regulated or outlawed by the federal government. But this is also why it should not be outlawed entirely -- because of the possible research benefits, which often, sadly, shrivel up when the government decides to outlaw instead of regulate.

The point is that this plant is telling us things we didn't know about how drugs interact with the brain. Its psychoactive ingredient, Salvinorin A, appears to target a single specific receptor in the brain that is implicated in a variety of psychiatric disorders. Down the road, this could lead to treatments for everything from depression and schizophrenia to addiction and even diarrhea. If the hallucinogenic side effects are removed or mitigated, derivatives of salvia or related chemicals could provide a path towards new psychopharmacological treatments for mental illness, and we must protect that promise.

In no way am I calling salvia a possible "medication" -- as it naturally occurs and is used to "trip," it is what we call a drug of abuse. But there is a possibility that research can yield valid, even life-saving medical treatments.

So it's important not to make a mistake here: Salvia is a powerful hallucinogen -- it must be regulated. But we don't know enough about it to say how it should be regulated. We must balance the need to keep our children safe with the imperative to explore its potential for breakthrough medications.

We must be reasonable, as we have not always been in the past, while still being vigilant.

Harold S. Koplewicz, M.D. is a leading child and adolescent psychiatrist and the president of the Child Mind Institute. For more on adolescents, drugs, and mental health research, go to our website, which offers parenting advice and a wealth of information on childhood psychiatric and learning disorders.

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