Epidemiology of adolescent Salvia divinorum use in Canada
Cheryl L. Currie
Drug and Alcohol Dependence, 2012, 128, (1-2)
a b s t r a c t
Background : Salvia divinorum is a potent, naturally occurring hallucinogen gaining popularity as a recreational drug in North America. To date, detailed epidemiologic information about the use of this substance among adolescents living outside the United States has been limited. This study provides information on the prevalence and correlates of Salvia divinorum use among adolesecents in Canada using a nationally representative sample.
Methods : Data were obtained from a representative sample of 42,179 Canadian adolescents aged 12–17
years living across all 10 provinces who completed the Youth Smoking Survey in 2008–09.
Results : Overall, 3.8% of adolescents reported using Salvia in the past year and 6.2% had used the substance in their lifetime. A conservative estimate suggests 23.2% of youth were repeat users. Salvia use was highest among youth in British Columbia and Quebec. Comparatively, the prevalence of 12-month Salvia use was higher than 12-month cocaine and amphetamine use but lower than 12-month ecstasy, cannabis, and other hallucinogen use. Correlates of Salvia use included older age, male gender, high available spending money, binge drinking, illicit drug use and smoking in fully adjusted models. Findings suggest low selfesteem may be an important correlate specific to the use of this substance among youth.
Conclusions : Salvia divinorum use is prevalent among Canadian adolescents. Salvia may be a significant public health issue in Canada given it is readily available, under limited regulation, and little is known about the abuse liability of the substance, interactions with other substances, and potential complications from use.
Keywords : Salvia divinorum, Hallucinogen, Adolescent, Prevalence, Correlates, Canada
Salvia divinorum is a potent naturally occurring hallucinogen gaining popularity as a recreational drug in North America. This species of sage was traditionally used in Mexican shamanistic ceremonies for its potent visionary effects (Babu et al., 2008). The active component of the plant, salvinorin A, is pharmacologically distinct from other hallucinogenics, with effects mediated by the kappa opioid (KOP) receptor in the spinal cord and brain rather than serotonin 2-A receptors (Roth et al., 2002; Cunningham et al., 2011).
Salvinorin A is absorbed through the buccal mucosa quickly, with effects occurring in seconds or minutes and persisting up to 1 h (Roth et al., 2002). Salvinorin A has pharmacological activity consistent with other KOP agonists including aversion, inhibition of GI transit and depressant effects; sweating, tachycardia, and nausea have also been reported, among other symptoms (González et al., 2006; Vohra et al., 2011). Although extended psychotic-type reactions
are uncommon they are not unknown, with several reported in published case studies (Singh, 2007; Przekop and Lee, 2009; Breton et al., 2010).
Dose-response relationships have not been established as laboratories are seldom equipped to detect Salvinorin A and historical accounts are often unreliable due to the distribution of Salvia in concentrations (5×, 10×, 50×) subjectively determined by manufacturers without listed milligramme equivilants (Vohra et al., 2011).
Products containing S. divinorum or salvinorin A meet the definition of natural health products in Canada, are not licenced for sale, and subject to enforcement under the Food and Drugs Act (Health Canada, 2011a). Similar to governments in other countries, Health Canada (2011b) has announced intentions to move Salvia and salvinorin A to a category of the Controlled Drugs and Substances Act
to protect the health and safety of Canadians. Currently Health Canada recommends products containing Salvia or its active ingredient Salvinorin A be avoided as little is known about the damage these substances may cause the body, including the brain (Health Canada, 2011a).
The recreational abuse liabilities of Salvia are unknown. Theoretically, they may be limited given KOP receptor agonists generally produce dysphoria rather than the euphora often produced by-opioid receptor agonists (Cunningham et al., 2011). However, research suggests that about half all youth who try Salvia plan to continue use (Albertson and Grubbs, 2009). Ease of access to Salvia through shops that sell drug use paraphernalia (i.e., head shops) and via the Internet increase the likelihood for experimention and ongoing use. In the US, less than 1% of youth aged 12–17 report past year Salvia use, while 1.7% report lifetime use (Ford et al., 2011; Wu et al., 2011). There is little published information on the use of Salvia by youth outside the US. The purpose of this paper is to provide information on the prevalence and correlates of Salvia use among Canadians aged 12–17 using nationally representative data.