In this article, I document contemporary highland Maya use of traditional tobacco (Nicotiana tabacum) preparations among the highland Maya (Tzeltal-Tzotzil) of Chiapas, Mexico. Among the Ancient Maya, Nicotiana was considered a sacred plant, closely associated with deities of earth and sky, and used for both visionary and therapeutic ends. The contemporary Tzeltal and Tzotzil Maya of Highland Chiapas are bearers of this ethnobotanical inheritance, preserving a rich and varied tradition of Nicotiana use and folklore. The entire tobacco plant is viewed as a primordial medicine and a powerful botanical “helper” or “protector.” Depending on the condition to be treated, whole Nicotiana leaves used are used alone or in combination with other herbs in the preparation of various medicinal plasters and teas. In its most common form, fresh or “green” leaves are ground with slaked lime to produce an intoxicating oral snuff that serves as both a protective and therapeutic agent. Despite its historical and cultural significance, traditional tobacco use is declining in favor of smoked tobaccos. The article closes with a discussion of the social transformations responsible for this decline, reviewing research that suggests tobacco powder snuffs may be less dangerous to health than smoked tobaccos, despite their addictive potential.