An 18-year-old woman was admitted to a psychiatric hospital, after reportedly smoking marijuana, with schizophrenia-type symptoms. She was agitated, disorganized and hallucinating. Several days later, her former boyfriend revealed that she had unknowingly smoked leaves and leaf extracts of Salvia divinorum added to her marijuana joint. The young woman had a long history of cannabis use with no untoward effects, but had never before used salvia. After increasing self-mutilating behavior in the hospital, she was involuntarily admitted to a closed ward. Despite large doses of intravenously and intramuscularly administered anti-psychotic drugs, she remained highly psychotic, with disordered thinking, delusions, and slow speech. A few nights later, she was transferred to an intensive care unit because of "a marked decrease of alertness." She had developed a toxic psychosis with stupor and catatonic excitement. Because the anti-psychotic medications (Zyprexa and Haldol) were having no useful effect, the young woman was given two series of electroconvulsive treatments, but these were discontinued because she had recurrent episodes in which her heart stopped for periods as long as 5 seconds. Her erratic heartbeat required a temporary external cardiac pacemaker.
Then things started to turn bad .... Her agitation caused her to bite off a 1/2-inch-by- 1/2-inch part of her tongue, which she aspirated, requiring tracheal intubation and ventilation. She developed elevated temperature, a drop in blood pressure and a rigid abdomen. An X-ray showed signs of peritonitis. An exploration of her abdomen disclosed several necrotic (dead, dying) areas of her small intestine and colon, requiring surgical removal of the affected parts. After a long hospitalization, which included decreasing doses of anti-psychotic drugs, her psychotic symptoms resolved and she was discharged in a psychiatrically stable condition. The young woman and her parents have since instituted legal proceedings against her former boyfriend, accusing him of dosing her with Salvia divinorum.
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