The main risk of salvia is what happens while you have lost control: a fall, a bump against furniture, walking into traffic or panic. UK government information notes that most injuries come from people hurting themselves while under the influence (FRANK), and the Trimbos Institute calls a bad trip the biggest risk (DRUGSinfo). A sober sitter, a safe room and a low dose prevent most of it.
Data gap. Controlled human studies used small groups of healthy, experienced adults. Little is known about long-term effects or about use outside that group (Casselman et al., 2014).
Who should not use salvia
- Anyone with a personal or family history of psychosis. Drugs can trigger a psychosis in people who are susceptible, and the risk is greater when a parent, brother or sister has had one (DRUGSinfo; FRANK). The Dutch RIVM lists psychosis among the possible effects (RIVM, 2022).
- Anyone who does not feel well or is going through a stressful period. That stress can surface during the effect (DRUGSinfo).
- People with heart problems or high blood pressure. One study measured a rise in systolic blood pressure (Maqueda et al., 2016).
- Anyone pregnant or breastfeeding. We found no studies on safety in this group.
- Anyone under 18.
What a sitter does
A sitter is a trusted person who stays sober, stays nearby and pays attention. That alone makes a difficult moment less likely, because the person using salvia feels safe (DRUGSinfo). With salvia the sitter has a few concrete jobs:
- Know the plan. Which product, how much, and that there will be no second dose.
- Take the lighter and pipe from the user's hands right after the inhale. People can move without realising it (DRUGSinfo).
- Stay within arm's reach and keep the user seated or lying down. If they try to stand or walk, guide them back gently.
- Say little and stay calm. Short sentences, a quiet voice. Touch only when needed to prevent a fall, and agree beforehand whether touch is welcome at all.
- Watch the clock. When smoked, the strongest part is usually over within minutes. Knowing that helps both of you.
A sitter does not film. Being recorded or watched by people you do not trust can cause shame or fear, which can quickly turn into a bad trip (DRUGSinfo).
Trip sitter. Recommended by both the Trimbos Institute and the Australian ADF.
Setting up the room
- A familiar, quiet place at home is better than a party or a public space (DRUGSinfo).
- Sit on a sofa or on cushions on the floor, so that nobody can fall from a height.
- Clear the area of glass, sharp corners, candles and anything hot. Keep away from stairs, balconies, open water and roads.
- Dim light and no loud music. Close doors so nobody walks in unexpectedly.
- The Trimbos Institute advises vaporising rather than smoking.
Dose and combinations
Start low and use one product. Extract strengths vary widely, even under the same label, so read what the x means first. Weigh doses on a milligram scale and decide in advance that you will not take a second portion.
Do not combine salvia with alcohol, cannabis, other drugs or medication. The Trimbos Institute calls combinations dangerous because salvia is already unpredictable (DRUGSinfo). In ten years of California poison control records, cases where salvia was taken with other substances had a high rate of complications (Vohra et al., 2011). Alcohol adds nausea and cannabis makes the effect less predictable (ADF).
Do not drive, cycle or operate machinery for the rest of the day. In the Netherlands, driving while under the influence of a substance that you know or should know impairs your driving is an offence (Road Traffic Act, art. 8), and most countries have similar rules.
When it gets difficult
- The sitter repeats, calmly, that this is the salvia and that it will pass within minutes.
- Keep the person seated or lying in a safe spot. Do not try to hold them down unless they are about to hurt themselves.
- Lower the light, turn off the music, open a window.
- Afterwards, let them talk about it or rest.
Call the emergency number (112 in the EU, 999 in the UK, 911 in North America) if someone is injured, has trouble breathing, has a seizure, does not come round after the expected time, or is a danger to themselves or others. Tell the ambulance staff what was taken. In the Netherlands the Drugs Infolijn of the Trimbos Institute answers questions without an emergency on 0900-1995.
Read on: effects and duration, legal status.