Salvinorin A

Individuals with a personal or family history of schizophrenia, schizoaffective disorder, or other psychotic disorders are at elevated risk. KOR agonism produces intense reality distortion and dissociation that may precipitate or exacerbate psychotic symptomatology. Two published case reports associate Salvia divinorum use with the development of psychotic disorders.

The intense dysphoric and affective states produced by salvinorin A may destabilize mood episodes in individuals with bipolar disorder. This is a theoretical contraindication based on the pharmacological profile of KOR agonism; no case data specific to bipolar disorder and salvinorin A have been published.

Combination with opioid receptor agonists introduces concurrent KOR and potentially MOR agonism, with unpredictable additive or synergistic effects. Severity and clinical significance have not been characterized in published literature. All interaction assessments are mechanistically inferred.

The extreme rapidity of onset (15–60 seconds to peak effects) and complete motor and cognitive incapacitation at common-to-strong doses create acute physical danger in any environment containing fall hazards, open flames, bodies of water, or other environmental risks. A sober sitter is essential at common dose and above. This is a practical/situational contraindication supported by the pharmacological profile and clinical observation data.

Salvinorin A produces complete motor control impairment and cognitive incapacitation during peak effects. Users should not drive or operate machinery for at least 1 hour after use. Motor and cognitive impairment may persist beyond subjective resolution of effects.