The leaves of the plant have been used by Mazatec Indians for hundreds of years without any reported health risks and no evidence of addiction. Salvia divinorum's popularity amongst contemporary psychonauts increased slowly through the 1980s and early 1990s and then more rapidly since the first 'X' extracts began to be marketed in 1997. Although there have undoubtedly been tens of thousands of people who have now tried S. divinorum (if not more), many people only try it once or a few times, and decide that they don't need to experiment further or just dislike the effects. This sort of experimental use is not very likely to have any serious detrimental effects caused directly by the plant's compounds, regardless of how it is ingested.

Problems of Smoking People who smoke the plant on a regular basis might have some concern about potentially detrimental effects on the lungs. There is increasing evidence that any inhaled particulate matter is unhealthy. However, such use is extremely unlikely to cause damage comparable to chronic cigarette smoking. We have never heard of a 'daily' smoker of S. divinorum, let alone someone who smokes it many times per day. Those who use the concentrated 'X' extracts may benefit from not having to inhale as much smoke; the more potent the extract, the less smoke that needs to be inhaled. Perhaps the biggest problem with more potent extracts is that users are more likely to accidentally smoke a stronger dose than they intend to. Overly large doses can be extremely frightening, can cause one to stumble around unaware of one's surroundings, or may cause black outs. Clearly it could be dangerous to do such doses alone and particularly if one is near busy streets, swimming pools, fire, large bodies of water, glass objects, etc. It is always better to take S. divinorum at 'ground level' (we heard of one person lunging toward a balcony in a second-story hotel room, who had to be restrained by the sitters).

Accidents The most common adverse events reported so far associated with using Salvia divinorum are simply accidents such as bruises, cuts, and burns from falling or dropping a lighter or pipe.

Traumatic Experience Perhaps the second most likely adverse effect of using Salvia divinorum is having a difficult psycho-spiritual experience. As with any strong psychoactive, acute anxiety reactions from unexpected or unwanted experiences can lead to lasting feelings of dysphoria in a small number of users. Although lasting anxiety is uncommon, the primary treatment is discontinuing use of Salvia divinorum and other entheogens and symptomatic treatment for anxiety such as relaxation, rest, regular excercise, sleeping well, and talking about one's feelings.

Oral Toxicity If one drinks an infusion or chews the leaves, it is more difficult to take an overly large dose. There are no reports yet of physically toxic reactions (hospitalizations or serious problems due to pharmacological reactions). The current view is that the leaves are effectively 'non-toxic' and that it would be difficult to eat or chew enough to cause serious injury or lasting adverse health reactions. Generally, no lasting side-effects are reported from consuming S. divinorum. On rare occasions people get mild nausea from oral consumption. The acute effects can cause people to be dizzy and uncoordinated.

Addiction There is no evidence that the plant or its primary active compound in isolation, salvinorin A, are habit forming or physically addictive. Those who use S. divinorum as a tool for spiritual or psychological insight have reported the difficult to quantify 'health benefits' of stress reduction, centering, a greater understanding of the world and their place in it, and/or a feeling of connectedness to the universe. One psychologist wrote an article for the Journal of Clinical Psychopharmacology (2001; 21: 634–635) about how his patient who was using S. divinorum found it to be useful for combating the symptoms of her depression. Visit this link. A religious group in Canada has been using low doses of S. divinorum as an aid to their meditations. Visit this link and this link and this link.