Pubdate: Mon, 10 Nov 2008
Source: San Francisco Chronicle (CA)
Copyright: 2008 Hearst Communications Inc.
Contact:  http://www.sfgate.com/chronicle/
Details: http://www.mapinc.org/media/388
Author: Eugene Schoenfeld
Note: Dr. Eugene Schoenfeld practices psychiatry and addiction 
medicine in Sausalito. During the 1960s and 1970s, he provided 
information about psychoactive drugs through his Dr.Hip Pocrates 
newspaper columns and radio programs
Bookmark: http://www.mapinc.org/topic/Salvia
Bookmark: http://www.mapinc.org/hallucinogens.htm (Hallucinogens)

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.
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MAP posted-by: Richard Lake