4th Anniversary of Brett's Passing-Gone, but Never, Ever Forgotten

Today Brett has been gone from our lives for 4 years. It is still uncomprehensible to us all. His spirit still shines and we are often made aware that he is still with us, if only in that spiritual realm. The light and love that was Brett can somehow still be felt. He will never be gone from our lives, his memory lives on forever.

I know he would be proud of the progress I've made in having the drug that caused him to lose his life regulated across the nation. I am most proud of my work in California, and most recently Ocean City, MD. OC is the first town to go outside of state law and form their own law outlawing salvia. The council members there were very courageous as they weren't sure if what they were doing was actually legal, and whether it would end up being a complete waste of time. Fortunately they were correct in going forward, salvia is now banned in OC and I'll no longer be receiving phone calls from angry parents asking me what they can do to get it out of the boardwalk stores.

And, on this 4th anniversary of Brett's passing, I would like to address something that has bothered me for these four years. When Brett passed away I immediately joined a suicide support group. I had no experience of any kind with suicide or mental illness. There had been nothing like this in either side of the family so I was consumed with finding out how it could be possible. How could a boy who was at the pinnacle of happiness take his own life? I knew, beyond a doubt, it was his salvia use, but I still wanted to reach out to others who had experienced this and some how learn more. One thing that was drummed into me from day 1 that was you must be suffering from depression to commit suicide. I always had a problem with this because there were absolutely NO signs of depression in Brett. I knew this and all his friends confirmed it, including the love of his life, Lauren. Even so, I was told over and over again, he had to be depressed, no question about it. So, without much thought, I told everyone he had to be depressed, even though I had subsequently learned the signs of depression and he exhibited none of those. That one statement was to haunt me for all the years to come and has been reported all over the internet and in the media. So, I will come clean, and say with no hesitation now:

BRETT DID NOT SUFFER FROM DEPRESSION.

I know he would want people to know the truth, as I do. I left the support group fairly quickly afterwards as I soon realized Brett's case had absolutely zero in common with what these other unfortunate people had experienced. Two mothers who had lost their sons admitted to me that they first saw signs of mental illness and depression in their child as early as eight years old!! They fought for years to maintain a normal, healthy lifestyle. I had none of this. I can say with all honesty that Brett was the absolute best son ever, and his only shortcoming was being completely fearless and way too inquisitive. He had no fear of salvia and wasn't in least concerned of the long range effects. Those effects would cause his life.

Several months ago I received the article (see below) that put everything I knew and felt about what happened to Brett in perspective. I always knew on his last day he had to be experiencing complete and total psychosis after smoking salvia for the last time. This article confirms the severity of salvia and it's devastating, life altering effects. If only Brett had been able to read this, he may still be here today. RIP sweet, dear Brett.

PERSISTENT PSYCHOSIS ASSOCIATED WITH SALVIA DIVINORUM USE

TO THE EDITOR: We present a case in which salvia precipitated persistent psychosis.
“Mr. J” was a 21-year-old man with no family or personal
psychiatric history or laboratory abnormalities. He
was reported to have normal social interactions, behavior,
and cognitive skills. He was transferred to our psychiatric
unit for acute psychosis and paranoia, which occurred
shortly after smoking salvia. In transport, the patient became
suspicious and attempted to jump from the vehicle.
Upon presentation, he demonstrated echolalia, paranoia,
flight of ideas, and psychomotor agitation. The patient remained
agitated for the first 2 days of hospitalization. He
attempted to barricade himself in his room. Risperidone
(3 mg by mouth/three times per day) was administered,
and the patient was eventually stabilized. The dosage,
however, resulted in the parkisonian features of rigidity,
bradykinesia, and masked facies.
Mr. J was transferred to the chemical dependency unit
for further treatment. He was stabilized, and treatment
with risperidone was slowly tapered. During the taper
from risperidone, the patient continued to improve and
manifested better insight and logical thought processes.
He participated in group therapy and interacted with
peers, and the parkinsonian features subsided. One day
after risperidone was withdrawn, the patient’s symptoms
abruptly returned. He became agitated, paranoid, and aggressive
and believed he was able to project and receive
thoughts. He returned to the inpatient psychiatry unit
where risperidone (3 mg by mouth/twice daily) was reinstated.
He was once again stabilized and transferred to
the referring psychiatric facility for further treatment. At
the 4-month follow-up, the patient exhibited no perceptible
improvement.
To the best of our knowledge, this is the first reported case
of a persistent negative outcome from the use of salvia. We
suspect that our patient was genetically predisposed to
schizophrenia, and salvia precipitated the clinical manifestations.
This may relate to the drug’s ability to influence dopamine
levels in the brain and potentiate plastic changes in
frontal lobe networks (3).
Previous studies have cited salvia as a potential treatment
option for CNS illnesses (2). This is surprising, considering the
paucity of research regarding its efficacy. Salvia’s ability to increase
dopamine levels in the nucleus accumbens increases
its potential for dependence. Consistently, patients at our
clinic who have used the drug report that its psychological effects
are abrupt and frightening. Clinicians should be aware
that salvia use can be associated with psychiatric illness.
References
1. Prisinzano T: Psychopharmacology of the hallucinogenic sage
Salvia divinorum. Life Sci 2005; 78:527–531
2. Grudmann O, Phipps SM, Zadezensky I, Butterweck V: Salvia divinorum
and salvinorin A: an update on pharmacology and
analytical methodology. Planta Med 2007; 10:1039–1046
3. Braida D, Limonta V, Capurro V, Fadda P, Fadda P, Rubino T,
Mascia P, Zani A, Gori E, Fratta W, Parolaro D, Sala M: Involvement
of kappa-opioid and endocannabinoid system on salvia
A-induced reward. J Biol Psychiatry 2008; 3:286–292
PETER PRZEKOP, D.O., PH.D.
TIMOTHY LEE, M.D
Loma Linda, Calif.
The authors report no competing interests.
This letter