Thousands of young adults have been showing up in Internet videos in recent years demonstrating the intense effects of salvia, a hallucinogenic drug used for centuries by Mexican shamans for spiritual healing. And in a video released Friday, pop star Miley Cyrus appears to be the latest.
While lawmakers in Maryland and other states have responded by banning or restricting the drug, Johns Hopkins researchers say the first scientific study on humans seems to show the brief mind alteration is not harmful — and salvia may eventually lead to new medicines.
"All kinds of decisions are being made about this drug, but it's so new on scene we have very little information about it," said Matthew W. Johnson, an assistant professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine and lead author of the study published online this month. "I'm interested in what it can tell us about the brain."
Johnson is not recommending anyone use the drug, but he said there is a unique makeup to salvinorin A. That's the active ingredient in Salvia divinorum, an herb in the mint family often used in gardens. Tweaking the molecules eventually could lead to new treatments for addiction, pain and brain disorders such as Alzheimer's and dementia.
Other researchers have had the same idea about salvia, but until now studies have focused on animals. Johnson and his team lined up four healthy, drug-experienced people for a scientifically controlled experiment.
Subjects reclined in a chair in a supervised lab while they smoked the drug in increasing concentrations over 20 sessions for the study, which was published online in the journal Drug and Alcohol Dependence. They rated the strength on a scale from 1 to 10.
The study, while small and in a tightly controlled environment, appeared to show that the drug could be surprisingly intense and disorienting — some rated the strength a 10. But the effects lasted only about 20 minutes and didn't cause blood pressure or heart rates to rise, and there was no apparent brain toxicity. Salvia also didn't appear addictive.
Johnson said salvia is unique because it targets the kappa opioid receptors in the brain, different from those targeted by addictive hallucinogens and opiates used to control pain, such as morphine and codeine.
Scientists may be able to generate a nonaddictive pain killer, for example, if they can alter salvia's makeup so its effects are not so brief and psychedelic. Or, they could learn enough about brain function to manufacture a new drug.
Still, Johnson said casual use of the drug can put users in dangerous situations. Users have reported feelings of fear, hopelessness and unhappiness while on the drug. And because they lose touch with reality, they are significantly impaired.
"We don't see a lot of emergency room visits, but that's likely because the effects are so brief," he said. "Someone who uses this while driving or operating machinery is likely to run into trouble."
Police said many young adults found that trouble in Ocean City, where salvia could be purchased on the boardwalk until last year, when the Town Council made it illegal.
Officer Michael Levy said some were acting strangely in public. And though he couldn't confirm that the incidents were related to salvia, he said one user blamed salvia use when he was caught smashing windows and another said she used it before making a false claim of rape.
Del. Jeannie Haddaway-Riccio, an Eastern Shore Republican, sought a statewide ban in 2009, but the effort failed. This year, she and other sponsors succeeded in prohibiting sales to minors in Maryland, but she said she always intended to exempt medical research.
"Our intent was never to interfere with scientific research," she said. "We were looking at it purely as a public health issue."
Around the country, the laws are spotty on salvia, which has likely already been used by millions. Other states ban sales to minors and some allow sales only for the garden. Thirteen states have outlawed salvia altogether.
The U.S. Drug Enforcement Administration lists it among "drugs and chemicals of concern," but hasn't prohibited it. Many websites and "head shops" offer a bag of dried leaves that can be smoked or chewed for about $20 to $40. Stronger concentrations are available.
Twig Harper, one of the subjects in the Hopkins study, advises caution to potential young users. The 34-year-old artist and musician, who acknowledges using the drug since he was 20, said its effects are too intense for recreational use — it won't get users high like marijuana or help them escape problems.
"It does just the opposite, and when young people have a bad experience, it's because they are using it in the wrong context," he said. "It throws you in the middle of all your problems and makes you deal with them."
He volunteered for the study because he wanted to show salvia can be safe. He also wanted to further the science behind how the drug works, especially if it could help with addiction and diseases.
Harper believes salvia helps him explore his spirituality by availing to him "extraordinary states of consciousness."
A video spreading on the Internet on Friday of the singer Cyrus showed her giggling, and later a source told TMZ she had inhaled salvia and not marijuana. But Harper said low doses of salvia only gave him a kaleidoscope-like vision.
Higher concentrations, unlike other hallucinogenic drugs, left him completely unaware of his surroundings. He said it "transported him into another dimension" filled with entities he said he couldn't quite see. They were "like angels or aliens hiding in the shadows" or behind scenes from his past, and they helped him see the scenes in a new way. The entities have been constructive for him, Harper said, but he knows they can also be aggressive and the experiences unpleasant.
In one session, he said, he felt his lymph nodes swell and his lungs become damaged. Harper, a smoker, said he realized he had to quit when the bad feelings returned each time he reached for a cigarette. Other sessions have helped him learn about what he can do to improve his relationships.
It's these descriptions that have intrigued scientists such as Johnson and botanist Daniel Siebert, who runs the Salvia divinorum Research and Information Center website.
Siebert said the shamans who have long used the drug for spiritual healing believe it works by helping users "gain access to the spirit realm where they have visions of divine entities coming to their aid." Some Americans want to emulate that and some just want to see what salvia does. Most, however, don't do the drug more than once because they don't like it.
Siebert said the drug isn't suitable for minors and supports regulation. But he said it may not be necessary because salvia's popularity has started to wane. (The latest craze is "spice," which is made of a group of chemicals sprayed on inert herbs, he said.)
But Siebert agrees salvia has medical potential and was encouraged by the Hopkins research on humans.
"It has pain-relieving qualities, but it's not very useful if you have to have a psychedelic experience to benefit," he said. "If scientists can fiddle with the molecules to find new compounds, that would be useful."