Holevn Health share articles about :Thuốc Salvia divinorum , side effects – dosage , Thuốc Salvia divinorum what disease treatment.Other noted issues. Please refer to the details below.
Scientific Name(s): Salvia divinorum Epl. & Jativa-M.
Common Name(s): Diviner’s sage, Hojas de Maria, Magic mint, Mystic mint, Purple sticky, Sally D, Ska Maria Pastora, yerba de la pastora, Yerba Maria
Medically reviewed by Holevn.org. Last updated on Sep 17, 2019.
Salvia divinorum is a hallucinogen and is illegal in some jurisdictions. Check individual state legislation. Clinical studies suggest Salvia divinorum to act via a potentiation of kappa opioid receptor activity.
200 to 500 mcg of salvinorin A, or several leaves, smoked or absorbed perorally, is sufficient to cause hallucinations.
S. divinorum should not be used in people with any mental disease.
Use during pregnancy or lactation is not recommended.
None well documented.
None systematically reported.
No toxicity was observed in a 2-week study in mice.
- Lamiaceae (mint)
S. divinorum is a species of sage native to the Sierra Mazateca in Oaxaca, Mexico. It is a perennial herb that grows 1 m in height, with ovate to acuminate leaves 12 to 15 cm long, and flowers with white corollas and purple calyces in a panicle. It has not been found in the wild and is only known from cultivated material in forest ravines in northeastern Oaxaca.Schultes 1973, PLANTS 2017
The plant has been used by the Mazatec people, who also employed a number of other psychotropic plants in extensively documented healing and divinatory rituals.Valdés 1983 The leaves of the plant typically were masticated or the expressed juice ingested. Because the plant is illegal in some jurisdictions, individual state statutes should be consulted. It is widely available through Internet sales.Babu 2008, Bücheler 2005, González 2006, Hoover 2008, Lange 2008, Singh 2007 A protein-coupled receptor method has been established for the identification of S. divinorum based on 5S-rRNA-NTS sequence.Bertea 2006
The psychotropic active agent in S. divinorum was identified as the diterpene salvinorin A, also known as divinorin A.Ortega 1982, Valdes 1984 Salvinorin A is the first example of a hallucinogenic agent that is not an alkaloid. Other diterpenes in the neoclerodane series have been isolated from the plant.Bigham 2003, Harding 2005, Kutrzeba 2009, Munro 2003, Shirota 2006, Valdés 2001 The lactone loliolide has also been isolated from S. divinorum.Valdes 1986 Reviews of the chemical constituents have been published. Casselman 2014
A detailed study of the tissue localization of salvinorin A found it in the peltate glandular trichomes of the leaves.Siebert 2004 Biosynthesis of salvinorin A utilizes the deoxyxylulose pathway, rather than the mevalonate pathway.Kutrzeba 2007
A preparative isolation procedure for salvinorin A using centrifugal partition chromatography has been published.Shirota 2007 Numerous reports describe analytical methods for salvinorin A in leaf material using high-performance liquid chromatography, thin-layer chromatography, and mass spectroscopy.Gruber 1999, Jermain 2009, Medana 2006, Tsujikawa 2008, Wolowich 2006 Similarly, methods using gas chromatography-mass spectrometry or liquid chromatography-mass spectrometry have been developed for the determination of salvinorin A in body fluids.McDonough 2008, Pichini 2005, Schmidt 2005 These methods have been used in initial pharmacokinetic studies in ratsTeksin 2009 and rhesus monkeys. Salvinorin A was rapidly eliminated with salvinorin B, the major metabolite.Schmidt 2005 It stimulated p-glycoprotein adenosine triphosphatase activity in cells, suggesting that it may be a substrate for P-glycoprotein, as well as for several cytochrome P450 enzymes.Teksin 2009
Uses and Pharmacology
The discovery of salvinorin A as responsible for the hallucinogenic activity of the leaves sparked interest in its mechanism of action. While lysergic acid diethylamide, mescaline, and psilocybin all act through serotoninergic pathways, salvinorin A acts as a potent agonist at the kappa-opioid receptorRoth 2002 while having no effect at the mu- and delta-opioid receptors. It was more effective than several other kappa agonists.Chavkin 2004 Analysis of activity with mutated kappa-receptors identified key binding sites on the receptor.Yan 2005
Salvinorin A was active in a mouse tail-flick analgesia model, and the effect was blocked by a kappa-opioid antagonist, but not by mu- or delta-antagonists.John 2006 Similarly, in a kappa-opioid knockout mouse, salvinorin A had no analgesic or hypothermic effects. The kappa-1 receptor subclass was affected in preference to kappa-2.Ansonoff 2006 Behavioral studies in mice using inverted screen climbing performance also found kappa-agonism involvement.Fantegrossi 2005
Salvinorin A produced reduction in striatal dopamine levels in mice, consistent with a kappa-opioid effect, and these reductions were linked to reduced locomotor activity and conditioned place aversion. Effects were blocked by the kappa-antagonist nor-binaltorphimine.Zhang 2005 In rats, extracellular levels of dopamine were decreased in the nucleus accumbens without affecting serotonin levels. Effects in forced-swimming tests and intracranial self-stimulation were found as well.Carlezon 2006
Like another kappa-opioid agonist, salvinorin A potentiated the effect of the dopamine D2/D3 agonist quinpirole in rats in high doses, but had an opposite effect at low doses.Beerepoot 2008 Rat studies demonstrated an effect on the cannabinoid reward system with salvinorin A, which was blocked by a cannabinoid receptor type 1 antagonist (rimonabant) and a kappa-opioid antagonist.Braida 2008
Salvinorin A modulated the behavioral and molecular effects of cocaine in rats, suggesting that it interfered with dopamine 1 receptor signaling in the striatum.Chartoff 2008 Other studies found that salvinorin A blocked cocaine-induced drug-seeking in rats, similar to other kappa-agonists.Morani 2009
Hallucinogens are extraordinarily difficult to study in animals; however, the measurement of discriminative stimulus effects is capable of sorting drugs into congruent categories. That is, experimental animals are trained to recognize the cues produced by a particular standard drug, and further experiments with other drugs can define the similarity in response to the standard. Thus, in rats, salvinorin A was a sufficient substitute for the kappa-opioid agonist U69593.Willmore-Fordham 2007 A second group found the same effect in rats with U69593 and U50488.Baker 2009 In rhesus monkeys, the same substitution was obtained with U69593 and salvinorin A.Butelman 2004 Biochemical studies by the same group found that salvinorin A and U69593 produced increases in serum prolactin levels, and these effects were blocked by kappa-antagonism. The effect was more robust in females than in males.Butelman 2007 The reported rapid onset and short duration of action of S. divinorum in humansSiebert 1994 was paralleled in baboons. Positron emission tomography showed rapid salvinorin A brain uptake and a clearance half-life of 8 minutes. The labeled drug was administered intravenously (IV), and the highest concentrations were found in the cerebellum and visual cortex.Hooker 2008 Unconditioned responses to IV salvinorin A in rhesus monkeys (facial relaxation, ptosis) were of a similarly rapid onset and short duration.Butelman 2009 Some of the previously mentioned effects have also been observed in zebrafish.Braida 2007
Observational studies of the plant and pure compound have been publishedSiebert 1994 while salvinorin A was detected in urine and saliva after plant consumption.Pichini 2005 Small double-blind, randomized, placebo-controlled trials have been conducted using the Hallucinogen Rating Scale and other similar scales. Marked changes in auditory, visual, and interoceptive sensory input are reported in addition to other effects as could be expected with a mechanism of opioid agonsim by salvinorin A.Addy 2015, MacLean 2013, Ranganathan 2012
Reviews of clinical trials conducted to date have been published.Butelman 2015, Casselman 2014
S. divinorum and pure salvinorin A inhibited cholinergic transmission in guinea pig ileum.Capasso 2006 This may account for traditional use as an antidiarrheal. Several recent reviews have appeared.Grundmann 2007, Prisinzano 2005, Vortherms 2006
The pure compound salvinorin A is estimated to be psychoactive at doses of 200 to 500 mcg when smoked. Several whole leaves are typically chewed or smoked for a similar effect; however, the leaves must be held in the mouth, because absorption through the oral mucosa is superior to GI absorption.Siebert 1994, Prisinzano 2005, Vortherms 2006
Pregnancy / Lactation
Use in pregnancy and lactation is not recommended.
Briggs Book Link
- Salvia Divinorum
The activation of numerous cytochrome P450 enzymes has been noted, but not explored, in herb-drug interactions.Teksin 2009
A case report was published showing persistent psychosis associated with S. divinorum use.Przekop 2009 A second report found that self-administered S. divinorum was effective in moderate depression.Hanes 2001 Potential for addiction is considered to be muted due to the lack of euphoric effects.Ranganathan 2012
Salvinorin A produced no toxicity in mice in a 2-week, subchronic toxicology study.Mowry 2003 Limited clinical studies suggest a low level of toxicity within certain dosages and a short duration of intoxication effect.Casselman 2014, Dueweke 2015
Addy PH, Garcia-Romeu A, Metzger M, Wade J. The subjective experience of acute, experimentally-induced Salvia divinorum inebriation. J Psychopharmacol. 2015;29(4):426-435.25691501Ansonoff MA, Zhang J, Czyzyk T, et al. Antinociceptive and hypothermic effects of salvinorin A are abolished in a novel strain of κ-opioid receptor-1 knockout mice. J Pharmacol Exp Ther. 2006;318(2):641-648.16672569Babu KM, McCurdy CR, Boyer EW. Opioid receptors and legal highs: Salvia divinorum and Kratom. Clin Toxicol (Phila). 2008;46(2):146-152.18259963Baker LE, Panos JJ, Killinger BA, et al. Comparison of the discriminative stimulus effects of salvinorin A and its derivatives to U69,593 and U50,488 in rats. Psychopharmacology (Berl). 2009;203(2):203-211.19153716Beerepoot P, Lam V, Luu A, Tsoi B, Siebert D, Szechtman H. Effects of salvinorin A on locomotor sensitization to D2/D3 dopamine agonist quinpirole. Neurosci Lett. 2008;446(2-3):101-104.18824069Bertea CM, Luciano P, Bossi S, et al. PCR and PCR-RFLP of the 5S-rRNA-NTS region and salvinorin A analyses for the rapid and unequivocal determination of Salvia divinorum. Phytochemistry. 2006;67(4):371-378.16426651Bigham AK, Munro TA, Rizzacasa MA, Robins-Browne RM. Divinatorins A-C, new neoclerodane diterpenoids from the controlled sage Salvia divinorum. J Nat Prod. 2003;66(9):1242-1244.14510607Braida D, Limonta V, Capurro V, et al. Involvement of κ-opioid and endocannabinoid system on salvinorin A-induced reward. Biol Psychiatry. 2008;63(3):286-292. 17920565Braida D, Limonta V, Pegorini S, et al. Hallucinatory and rewarding effect of salvinorin A in zebrafish: κ-opioid and CB1-cannabinoid receptor involvement. Psychopharmacology (Berl). 2007;190(4):441-448. 17219220Bücheler R, Gleiter CH, Schwoerer P, Gaertner I. Use of nonprohibited hallucinogenic plants: increasing relevance for public health? A case report and literature review on the consumption of Salvia divinorum (Diviner’s Sage). Pharmacopsychiatry. 2005;38(1):1-5.15706458Butelman ER, Harris TJ, Kreek MJ. The plant-derived hallucinogen, salvinorin A, produces κ-opioid agonist-like discriminative effects in rhesus monkeys. Psychopharmacology (Berl). 2004;172(2):220-224.14586540Butelman ER, Mandau M, Tidgewell K, Prisinzano TE, Yuferov V, Kreek MJ. Effects of salvinorin A, a κ-opioid hallucinogen, on a neuroendocrine biomarker assay in nonhuman primates with high κ-receptor homology to humans. J Pharmacol Exp Ther. 2007;320(1):300-306.17060493Butelman ER, Prisinzano TE, Deng H, Rus S, Kreek MJ. Unconditioned behavioral effects of the powerful κ-opioid hallucinogen salvinorin A in nonhuman primates: fast onset and entry into cerebrospinal fluid. J Pharmacol Exp Ther. 2009;328(2):588-597.19001155Butelman ER, Kreek MJ. Salvinorin A, a kappa-opioid receptor agonist hallucinogen: pharmacology and potential template for novel pharmacotherapeutics agents in neuropsychiatric disorders. Front Pharmacol. 2015;6:190.26441647Capasso R, Borrelli F, Capasso F, et al. The hallucinogenic herb Salvia divinorum and its active ingredient salvinorin A inhibit enteric cholinergic transmission in the guinea-pig ileum. Neurogastroenterol Motil. 2006;18(1):69-75.16371085Carlezon WA Jr, Béguin C, DiNieri JA, et al. Depressive-like effects of the κ-opioid receptor agonist salvinorin A on behavior and neurochemistry in rats. J Pharmacol Exp Ther. 2006;316(1):440-447.16223871Casselman I, Nock CJ, Wohlmuth H, et al. From local to global-fifty years of research on Salvia divinorum. J Ethnopharmacol. 2014;151(2):768-783.24315983Chartoff EH, Potter D, Damez-Werno D, Cohen BM, Carlezon WA Jr. Exposure to the selective κ-opioid receptor agonist salvinorin A modulates the behavioral and molecular effects of cocaine in rats. Neuropsychopharmacology. 2008;33(11):2676-2687.18185499Chavkin C, Sud S, Jin W, et al. Salvinorin A, an active component of the hallucinogenic sage Salvia divinorum is a highly efficacious κ-opioid receptor agonist: structural and functional considerations. J Pharmacol Exp Ther. 2004;308(3):1197-1203.14718611Dueweke JR. Towards evidence-based emergency medicine: best BETs from the Manchester Royal Infirmary. BET 3: what are the clinical features of Salvia divinorum toxicity? Emerg Med J. 2013;30(4):341-342.23511943Fantegrossi WE, Kugle KM, Valdes LJ ΙΙΙ, Koreeda M, Woods JH. κ-opioid receptor-mediated effects of the plant-derived hallucinogen, salvinorin A, on inverted screen performance in the mouse. Behav Pharmacol. 2005;16(8):627-633.16286814González D, Riba J, Bouso JC, Gómez-Jarabo G, Barbanoj MJ. Pattern of use and subjective effects of Salvia divinorum among recreational users. Drug Alcohol Depend. 2006;85(2):157-162.16720081Gruber JW, Siebert DJ, Der Marderosian AH, Hock RS. High performance liquid chromatographic quantification of salvinorin A from tissues of Salvia divinorum Epling & Jativa-M. Anal Chem. 1999;10(1):22-25.Grundmann O, Phipps SM, Zadezensky I, Butterweck V. Salvia divinorum and salvinorin A: an update on pharmacology and analytical methodology. Planta Med. 2007;73(10):1039-1046.17628834Hanes KR. Antidepressant effects of the herb Salvia divinorum: a case report. J Clin Psychopharmacol. 2001;21(6):634-635.11763023Harding WW, Tidgewell K, Schmidt M, et al. Salvinicins A and B, new neoclerodane diterpenes from Salvia divinorum. Org Lett. 2005;7(14):3017-3020.15987194Hooker JM, Xu Y, Schiffer W, Shea C, Carter P, Fowler JS. Pharmacokinetics of the potent hallucinogen, salvinorin A in primates parallels the rapid onset and short duration of effects in humans. Neuroimage. 2008;41(3):1044-1050.18434204Hoover V, Marlowe DB, Patapis NS, Festinger DS, Forman RF. Internet access to Salvia divinorum: implications for policy, prevention, and treatment. J Subst Abuse Treat. 2008;35(1):22-27.17931827Jermain JD, Evans HK. Analyzing Salvia divinorum and its active ingredient salvinorin A utilizing thin layer chromatography and gas chromatography/mass spectrometry. J Forensic Sci. 2009;54(3):612-616.19298461John TF, French LG, Erlichman JS. The antinociceptive effect of salvinorin A in mice. Eur J Pharmacol. 2006;545(2-3):129-133.16905132Kutrzeba LM, Ferreira D, Zjawiony JK. Salvinorins J from Salvia divinorum: mutarotation in the neoclerodane system. J Nat Prod. 2009;72(7):1361-1363.19473009Kutrzeba L, Dayan FE, Howell J, Feng J, Giner JL, Zjawiony JK. Biosynthesis of salvinorin A proceeds via the deoxyxylulose phosphate pathway. Phytochemistry. 2007;68(14):1872-1881.17574635Lange JE, Reed MB, Croff JM, Clapp JD. College student use of Salvia divinorum. Drug Alcohol Depend. 2008;94(1-3):263-266.18093751MacLean KA, Johnson MW, Reissig CJ, et al. Dose-related effects of salvinorin A in humans: dissociative, hallucinogenic, and memory effects. Psychopharmacology (Berl). 2013;226(2):381-392.23135605McDonough PC, Holler JM, Vorce SP, Bosy TZ, Magluilo J Jr, Past MR. The detection and quantitative analysis of the psychoactive component of Salvia divinorum, salvinorin A, in human biological fluids using liquid chromatography-mass spectrometry. J Anal Toxicol. 2008;32(6):417-421.18652747Medana C, Massolino C, Pazzi M, Baiocchi C. Determination of salvinorins and divinatorins in Salvia divinorum leaves by liquid chromatography/multistage mass spectrometry. Rapid Commun Mass Spectrom. 2006;20(2):131-136.16331747Morani AS, Kivell B, Prisinzano TE, Schenk S. Effect of kappa-opioid receptor agonists U69593, U50488H, spiradoline and salvinorin A on cocaine-induced drug-seeking in rats. Pharmacol Biochem Behav. 2009;94(2):244-249.19747933Mowry M, Mosher M, Briner W. Acute physiologic and chronic histologic changes in rats and mice exposed to the unique hallucinogen salvinorin A. J Psychoactive Drugs. 2003;35(3):379-382.14621136Munro TA, Rizzacasa MA. Salvinorins D-F, new neoclerodane diterpenoids from Salvia divinorum, and an improved method for the isolation of salvinorin A. J Nat Prod. 2003;66(5):703-705.12762813Ortega A, Bount JF, Manchand PS. Salvinorin, a new trans-neoclerodane diterpene from Salvia divinorum (Labiatae). J Chem Soc Perkin Trans 1. 1982;2505-2508.Pichini S, Abanades S, Farré M, et al. Quantification of the plant-derived hallucinogen salvinorin A in conventional and non-conventional biological fluids by gas chromatography/mass spectrometry after Salvia divinorum smoking. Rapid Commun Mass Spectrom. 2005;19(12):1649-1656.15915477Prisinzano TE. Psychopharmacology of the hallucinogenic sage Salvia divinorum. Life Sci. 2005;78(5):527-531.16213533Przekop P, Lee T. Persistent psychosis associated with salvia divinorum use. Am J Psychiatry. 2009;166(7):832.19570943Ranganathan M, Schnakenberg A, Skosnik PD, et al. Dose-related behavioral, subjective, endocrine, and psychophysiological effects of the κ opioid agonist Salvinorin A in humans. Biol Psychiatry. 2012;72(10):871-879.22817868Roth BL, Baner K, Westkaemper R, et al. Salvinorin A: a potent naturally occurring nonnitrogenous kappa opioid selective agonist. Proc Natl Acad Sci U S A. 2002;99(18):11934-11939.12192085
Salvia divinorum. USDA, NRCS. 2017. The PLANTS Database (http://plants.usda.gov, Sept 2017). National Plant Data Center, Baton Rouge, LA 70874-4490 USA.Schmidt MS, Prisinzano TE, Tidgewell K, et al. Determination of salvinorin A in body fluids by high performance liquid chromatography-atmospheric pressure chemical ionization. J Chromatogr B Analyt Technol Biomed Life Sci. 2005;818(2):221-225.15734162Schmidt MD, Schmidt MS, Butelman ER, et al. Pharmacokinetics of the plant-derived κ-opioid hallucinogen salvinorin A in nonhuman primates. Synapse. 2005;58(3):208-210.16138318Schultes RE, Hoffman A. The Botany and Chemistry of Hallucinogens. Springfield, IL: Charles C. Thomas; 1973:159-161.Shirota O, Nagamatsu K, Sekita S. Neo-clerodane diterpenes from the hallucinogenic sage Salvia divinorum [published correction appears in J Natr Prod. 2007;70(2):328]. J Nat Prod. 2006;69(12):1782-1786.17190459Shirota O, Nagamatsu K, Sekita A. Simple preparative isolation of salvinorin A from the hallucinogenic sage, Salvia divinorum, by centrifugal partition chromatography. J Liq Chromatogr Relat Technol. 2007;30(8):1105-1114.Siebert DJ. Localization of salvinorin A and related compounds in glandular trichomes of the psychoactive sage, Salvia divinorum. Ann Bot. 2004;93(6):763-771.15087301Siebert DJ. Salvia divinorum and salvinorin A: new pharmacologic findings. J Ethnopharmacol. 1994;43(1):53-56.7526076Singh S. Adolescent Salvia substance abuse. Addiction. 2007;102(5):823-824.17493110Teksin ZS, Lee IJ, Nemieboka NN, et al. Evaluation of the transport, in vitro metabolism and pharmacokinetics of Salvinorin A, a potent hallucinogen. Eur J Pharm Biopharm. 2009;72(2):471-477.19462483Tsujikawa K, Kuwayama K, Miyaguchi H, et al. Determination of salvinorin A and salvinorin B in Salvia divinorum-related products circulated in Japan. Forensic Sci Int. 2008;180(2-3):105-109.18768273Valdes LJ, Butler WM, Hatfield GM, Paul AG, Koreeda M. Divinorin A, a psychotropic terpenoid, and divinorin B from the hallucinogenic Mexican mint Salvia divinorum. J Org Chem. 1984;49(24):4716-4720.Valdes LJ ΙΙΙ. Loliolide from Salvia divinorum. J Nat Prod. 1986;49(1):171.3701340Valdés LJ ΙΙΙ, Chang HM, Visger DC, Koreeda M. Salvinorin C, a new neoclerodane diterpene from a bioactive fraction of the hallucinogenic Mexican mint Salvia divinorum. Org Lett. 2001;3(24):3935-3937.11720573Valdés LJ ΙΙΙ, Díaz JL, Paul AG. Ethnopharmacology of ska Maria Pastora (Salvia divinorum, Epling and Játiva-M.). J Ethnopharmacol. 1983;7(3):287-312.6876852Vortherms TA, Roth BL. Salvinorin A: from natural product to human therapeutics. Mol Interv. 2006;6(5):257-265.17035666Willmore-Fordham CB, Krall DM, McCurdy CR, Kinder DH. The hallucinogen derived from Salvia divinorum, salvinorin A, has κ-opioid agonist discriminative stimulus effects in rats. Neuropharmacology. 2007;53(4):481-486.17681558Wolowich WR, Perkins AM, Cienki JJ. Analysis of the psychoactive terpenoid salvinorin A content in five Salvia divinorum herbal products. Pharmacotherapy. 2006;26(9):1268-1272.16945049Yan F, Mosier PD, Westkaemper RB, et al. Identification of the molecular mechanisms by which the diterpenoid salvinorin A binds to κ-opioid receptors. Biochemistry. 2005;44(24):8643-8651.15952771Zhang Y, Butelman ER, Schlussman SD, Ho A, Kreek MJ. Effects of the plant-derived hallucinogen salvinorin A on basal dopamine levels in the caudate putamen and in a conditioned place aversion assay in mice: agonist actions at kappa opioid receptors. Psychopharmacology (Berl). 2005;179(3):551-558.15682306
This information relates to an herbal, vitamin, mineral or other dietary supplement. This product has not been reviewed by the FDA to determine whether it is safe or effective and is not subject to the quality standards and safety information collection standards that are applicable to most prescription drugs. This information should not be used to decide whether or not to take this product. This information does not endorse this product as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this product. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this product. This information is not specific medical advice and does not replace information you receive from your health care provider. You should talk with your health care provider for complete information about the risks and benefits of using this product.
This product may adversely interact with certain health and medical conditions, other prescription and over-the-counter drugs, foods, or other dietary supplements. This product may be unsafe when used before surgery or other medical procedures. It is important to fully inform your doctor about the herbal, vitamins, mineral or any other supplements you are taking before any kind of surgery or medical procedure. With the exception of certain products that are generally recognized as safe in normal quantities, including use of folic acid and prenatal vitamins during pregnancy, this product has not been sufficiently studied to determine whether it is safe to use during pregnancy or nursing or by persons younger than 2 years of age.
Copyright © 2019 Wolters Kluwer Health
The content of Holevn is solely for the purpose of providing information about Thuốc Salvia divinorum and is not intended to be a substitute for professional medical advice, diagnosis or treatment. Please contact your nearest doctor or clinic, hospital for advice. We do not accept liability if the patient arbitrarily uses the drug without following a doctor’s prescription.
Reference from: https://www.drugs.com/npp/salvia-divinorum.html