Species Substitution in Medicinal Roots and Possible Implications for Toxicity of Herbal Remedies in Morocco

Abstract

Species Substitution in Medicinal Roots and Possible Implications for Toxicity of Herbal Remedies in Morocco. Herbal medicine is an integral part of health care in Morocco and is widely used by Moroccans. However, the efficacy and safety of traditional plant-based medicine in Morocco is threatened by insufficient knowledge about practices of adulteration and substitution. These issues are of particular importance when subterranean plant parts are employed. A combination of qualitative and quantitative methods was used to identify where and why confusion (accidental substitution) and intentional substitution occurs in root-based medicines sold in Marrakech. Additionally we examined local perceptions of the toxicological risks posed by substitution. We recorded a total of 20 species (34 unique cases) of roots for which substitution or confusion was reported by either herbalists or collectors. Substitution or confusion occurred in 54.6 % of the 33 most commonly sold medicinal roots, with herbalists reporting substitution in more species than collectors. Collectors and herbalists cited poor availability of roots (in part due to overexploitation of wild resources), high demand, high prices, and lack of knowledge as factors driving substitution and confusion. Roots for which substitution was reported were significantly more difficult for herbalists to identify. Moreover, profit was higher for roots for which intentional substitution was reported. Despite the detailed knowledge held by many herbalists and a long tradition of use of herbal medicine in Morocco, doctors and pharmacists had dismissive attitudes towards traditional medicine and expressed concern about both efficacy and safety of medicinal plant use. Given the high rates of substitution and confusion documented by this study, there is an urgent need for appropriate regulation of herbal remedies in Morocco, a conclusion embraced by herbalists and Western-trained medical practitioners alike.