Clinical and Pharmacological, Forensic and Pharmaceutical Profile of Hallucinogenic Sage Salvia Divinorum: Regulatory Restrictions, Internet Accessibility to Consumers, Risks to Public Health in Italy

Abstract

Salvia divinorum and Salvinorin A are an example of herbal psychoactive substances that combine high toxicological risk, rapid psychotropic action, and complexity of legal control. Their specific pharmacological profile, availability through online and informal markets, and perception as “natural” products create additional challenges for public health, forensic practice, and regulatory authorities. The extremely rapid onset of psychoactive effects, the potential for unpredictable behavioral reactions, and the difficulty of detecting use through routine toxicological screening further increase the relevance of these substances for medico-pharmaceutical law and forensic pharmacy. Italy's experience and the new EUDA mandate confirm that effective counteraction to such substances must be based on a combination of legislative control, forensic pharmaceuticals, monitoring of digital markets, prevention, early-warning mechanisms, public education, and preparedness of the health system. Particular attention should be paid to cross-border distribution, internet-based promotion, and the misleading marketing of psychoactive plants as harmless herbal products. Such an integrated approach is essential to reduce misuse, improve detection, support timely risk assessment, and strengthen cooperation between healthcare professionals, law-enforcement bodies, forensic experts, and regulatory institutions.