A Report of Nausea and Vomiting with Discontinuation of Chronic Use of Salvia divinorum

A 51-year-old woman who smoked Salvia divinorum daily for 3–4 months developed nausea, vomiting, diarrhea, and abdominal discomfort about 48 hours after stopping. Laboratory tests were normal. The symptoms resolved with supportive care within a day. The authors suggest that the herb's active compound, salvinorin A, a kappa-opioid receptor agonist, may alter intestinal transit time and that this case represents the first reported gastrointestinal withdrawal syndrome from chronic Salvia use. As the herb is used widely, such withdrawal symptoms may become more common.

Study at a glance

Abstract

Introduction. This is the first reported case of gastrointestinal symptoms associated with withdrawal after chronic use of this substance. Case Presentation. A 51-year-old Caucasian woman was referred to a hospital with a 3-day history of nausea, vomiting, diarrhea, and abdominal discomfort. She reported no sick family members or contact with anyone who was ill. She did report smoking 3–5 cigarettes of the herb “Salvia” consistently for 3-4 months and quit approximately 48 hours before symptoms appeared. Her use of the herb had been consistent; she smoked several cigarettes each day. Laboratory results were essentially normal including the white blood cell count. She received symptomatic treatment and was released after one day. Discussion. Salvinorin A, a kappa-opioid receptor agonist, is the major active ingredient of S. divinorum. The unique opioid properties of this herb may explain its ability to cause changes in intestinal transit time. Conclusion. A 51-year-old woman possibly developed gastrointestinal manifestations suggestive of withdrawal from Salvia divinorum after smoking the substance consistently for 3 to 4 months. The widespread use of this herb will make the potential for withdrawal syndromes more commonplace.