Salvia toxicity

Background

• Historically used by shamans in rituals
• Active ingredient: Salvinorin A
• Kappa opiod receptor agonist and D2 agonist
• Hallucinogen
• Dissociative effects similar to ketamine 
• Tea: 10 min onset, duration 30-90 min
• Smoked: 1-2 minute onset, tapers over 10-20 min
• Does not appear on typical tox screens

Clinical Features

• Uncontrollable laughter
• Intense hallucinations
• Diaphoresis
• Sensations of motion, lights, visions, overlapping realities
• Low toxicity, little hangover, low abuse potential
• Few reports of psychosis and suicide associated with use

Treatment

• Supportive
• Benzodiazepines as needed
• Most patients will have symptoms resolve prior to ED arrival given short duration of action

Source

David Burbulys, MD lecture 9/2012