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By now, nearly every parent has heard about -- or seen -- the clip of 18-year-old Miley Cyrus, giggling and sounding confused and disoriented as she allegedly smoked salvia, an herb with hallucinogenic properties.
What do parents need to know? WebMD consulted experts in the field, asking them the questions on the minds of most parents.
It's a perennial herb in the mint family, according to the Drug Enforcement Administration (DEA). It is native to certain areas of the Sierra Mazateca region of Oaxaca, Mexico.
Salvia, technically Salvia divinorum, has large green leaves, hollow square stems, and white flowers.
Users can chew the fresh leaves, drink the extracted juices, or smoke the dried leaves as a joint. It can be consumed in water pipes or vaporized and inhaled.
This depends on where you live. According to the National Conference of State Legislatures, at least 21 states have passed laws regulating or controlling the substance since 2006.
In California, for instance, where Cyrus allegedly used the herb, the law prohibits selling to anyone under 18 years old. Cyrus had already turned 18 when the alleged incident occurred.
"It's been around a while, but it really came on the radar about three years ago," says Harris Stratyner, PhD, co-chair of the medical-scientific committee of the National Council on Alcoholism and Drug Dependence Inc.
He can't point to a single incident that triggered its use back then, other than young users were videotaping themselves and posting the videos on the Internet, where they were seen by other young people.
Salvia is widely sold online. Tobacco or smoke shops may also carry it.
Prices range. Online, one company offers a "starter pack" for first-time customers. It includes an ounce of leaves and 2 grams of extract of two concentrations, for $43 (about $66 with shipping).
Another company sells a 1-gram vial for $11 plus shipping and tax.
Charles Sophy, MD, medical director of the Department of Children and Family Services for Los Angeles County and a psychiatrist, says he has counseled children as young as 10 or 12, and even an 8-year-old, who used salvia.
Stratyner finds the typical range for users is about age 12 through college.
''It's a hallucinatory experience," says Sophy.
Users feel giddiness, he says, along with some disorientation. In the widely circulated video of Cyrus allegedly using the herb, she is heard giggling and expressing confusion.
The effects can be felt, Stratyner says, for an hour or up to two hours. It's sometimes used in combination with other substances, such as alcohol.
Loss of physical coordination can occur, Stratyner says, as well as a variety of responses, such as a feeling of floating, or a feeling that you are lost in a tunnel.
''Salvia is very similar to other psychoactive substances," Stratyner says. "It cannot be considered a party drug in a sense. In essence people usually under the influence of salvia don't interact a lot."
A typical scenario, he says, is for a young person to use it with a friend and have the friend film the salvia use, then post it on the Internet.
"It's something to be concerned about. It activates opioid receptors in the brain," Stratyner says, but different opioid receptors from the ones activated by heroin, for instance. "It's very dangerous. Because of the hallucinogenic properties you don't know what's going to happen. We would consider it a hallucinogen like LSD or mushrooms."
"It has the potential to be addictive physically," he says. And it can be psychologically addictive, he says.
For many users, salvia use is a phase, Sophy says. If a young person has no serious family or personal issues, he says, ''a kid will typically do it once or twice." But a child with issues, he says, will be more likely to stick with it as a bandage against their problems, to not feel the pain.
Side effects can include dizziness, lack of coordination, and slurred speech, according to the DEA. But Stratyner says experts are still studying other side effects, such as cardiovascular effects.
"I think it will go up," Stratyner says.
Salvia has made inroads in the teen population, according to the latest “Monitoring the Future Survey,” released Dec. 14 by the National Institute on Drug Abuse and the University of Michigan.
In its 2009 survey, the researchers found that 5.7% of 12th-graders said they have used salvia in the 12 previous months; in the 2010 survey, 5.5% said they did. So use does not appear to be growing, the researchers say. This year, 3.7% of 10th-graders and 1.7% of eighth-graders admitted to using salvia at least once.
The DEA has termed it a ''drug of concern," but it is not controlled under the federal Controlled Substances Act.