Khat Consumption Research Articles

Socio-economic effects of khat chewing in North Eastern Kenya

The khat habit is a widespread phenomenon which has in the past two decades spread to parts of Western Europe and North America from Eastern Africa and the Arabian Peninsula. Although khat has been identified as one of the most commonly abused substances in Kenya, restrictions on cultivation, trade and usage have been non-existent since its legalisation in 1977. To describe the socio-economic effects of khat chewing in Ijara District in the North Eastern Province of Kenya. Cross sectional study. Ijara District, North Eastern Kenya. Fifty respondents were interviewed. Eighty eight percent of the respondents were khat chewers, and the majority (80%) had family members who engaged in the khat habit. There was a general lack of education on the negative effects of khat chewing. Due to reported mood changes and withdrawal symptoms when not chewing khat, many respondents used more than half of their domestic budgets on khat, but few (28%) perceived this as a waste of resources. Fifty four percent of khat chewers typically started the habit during the day, implying a waste of time for productive work. However, only 40% of the persons interviewed admitted that the drug affected work performance negatively. The khat habit was associated with strain on family relationships, anti-social behaviour and health effects such as insomnia. In spite of the negative socio-economic impact of khat in Ijara District, khat consumption remains a widespread habit.

What harm? Kenyan and Ugandan perspectives on khat

What harm does khat actually do to users and the communities in which they live? In this article, the health-related, social, economic, and religious arguments of Kenyans and Ugandans for and against khat consumption are reported. The medical evidence for harm from khat is far from compelling, and the East African debate on khat is informed by local political discourses that often are closely connected to issues of ethnicity and the control of resources. As a result, the harm attributed to khat consumption is contested. The objective of most local efforts to curb the use of khat in East African towns is the reduction of social and economic ills. Yet, eliminating khat consumption would not reverse the problems that it is identified as causing.

A view from the refugee camps: new Somali khat use in Kenya

Catha edulis, known in the drugs literature as khat and in Kenya as gat, miraa, murungi, veve, gomba, abounds with paradoxes. One of the curious features of khat is that it has become so closely associated with Somalis, both at home and in the diaspora, that consumption of twigs and leaves of miraa are widely assumed to be part of Somali culture and tradition. Yet, khat consumption by Somalis only gained wide popularity in the second half of the twentieth century (Goldsmith, 1997). So, how did miraa use and distribution in Kenya come to be a marker of Somali identity?

Khat and alcohol use and risky sex behaviour among in-school and out-of-school youth in Ethiopia

BackgroundKhat (an evergreen plant with amphetamine-like properties) and alcohol are widely consumed among the youth of Ethiopia. However, their relationship to risky sexual behaviour is not well described. This study was conducted to describe the magnitude of risky sexual behaviour (unprotected sex and early initiation of sexual activity) and its association with Khat and alcohol consumption in Ethiopian youths.MethodsA probabilistic national sample of 20,434 in-school and out-of-school youths aged between 15 and 24 years of age was selected and interviewed regarding their sexual behavior and substance use.ResultsOver 20% of out-of-school youth had unprotected sex during the 12-month period prior to interview compared to 1.4% of in-school youth. Daily Khat intake was also associated with unprotected sex: adjusted OR (95% CI) = 2.26 (1.92, 2.67). There was a significant and linear association between alcohol intake and unprotected sex, with those using alcohol daily having a three fold increased odds compared to those not using it: adj. OR (95% CI) = 3.05 (2.38, 3.91). Use of substances other than Khat was not associated with unprotected sex, but was associated with initiation of sexual activity: adj. OR (95% CI) = 2.54 (1.84, 3.51).ConclusionA substantial proportion of out-of-school youth engage in risky sex. The use of Khat and alcohol and other substances is significantly and independently associated with risky sexual behaviour among Ethiopian youths.

Khat use as risk factor for psychotic disorders: A cross-sectional and case-control study in Somalia

BackgroundLittle is known about the prevalence of khat-induced psychotic disorders in East African countries, where the chewing of khat leaves is common. Its main psycho-active component cathinone produces effects similar to those of amphetamine. We aimed to explore the prevalence of psychotic disorders among the general population and the association between khat use and psychotic symptoms.MethodsIn an epidemiological household assessment in the city of Hargeisa, North-West Somalia, trained local interviewers screened 4,854 randomly selected persons from among the general population for disability due to severe mental problems. The identified cases were interviewed based on a structured interview and compared to healthy matched controls. Psychotic symptoms were assessed using the items of the WHO Composite International Diagnostic Interview and quantified with the Positive and Negative Symptoms Scale. Statistical testing included Student's t-test and ANOVA.ResultsLocal interviewers found that rates of severe disability due to mental disorders were 8.4% among males (above the age of 12) and differed according to war experiences (no war experience: 3.2%; civilian war survivors: 8.0%; ex-combatants: 15.9%). The clinical interview verified that in 83% of positive screening cases psychotic symptoms were the most prominent manifestations of psychiatric illness. On average, cases with psychotic symptoms had started to use khat earlier in life than matched controls and had been using khat 8.6 years before positive symptoms emerged. In most cases with psychotic symptoms, a pattern of binge use (> two 'bundles' per day) preceded the onset of psychotic symptoms, in contrast to controls of the same age. We found significant correlations between variables of khat consumption and clinical scales (0.35 to 0.50; p < 0.05), and between the age of onset of khat chewing and symptom onset (0.70; p <0.001).ConclusionEvidence indicates a relationship between the consumption of khat and the onset of psychotic symptoms among the male population, whereby not the khat intake per se but rather early onset and excessive khat chewing seemed to be related to psychotic symptoms. The khat problem must be addressed by means other than prohibition, given the widespread use and its role in Somali culture.

Effects of khat (Catha edulis) consumption on reproductive functions: a review.

To review research findings on the effects of khat (Catha edulis) chewing on reproductive functions. Retrieval and critical review of relevant articles and abstracts cited in international and local journals, literature searches on Medline and Medchem from 1961 to 2002. Analysis of published data and limited interviews of regular khat users revealed that khat chewing lowers libido in humans and may also lead to sexual impotence following long term use. In pregnant women, consumption of khat affects growth of foetus by inhibiting utero-placental blood flow and as a consequence, impairs foetal growth. Detailed studies on the effects of khat on reproduction are lacking. However, the limited available data reveal that chewing of khat has a negative impact on human reproductive health. Khat is genotoxic and has teratogenic effects on the foetus if regularly consumed by pregnant mothers. Since low birth weight is a well-established risk factor for both perinatal and young infant death, khat chewing during pregnancy may be one of the factors contributing to infant mortality in communities where khat is commonly chewed. Khat consumption affects the potency of male sexuality by affecting spermatogenesis and plasma testosterone concentration. However, the precise mechanisms by which khat may affect the male reproductive physiology have not been elucidated.

Effect of Catha edulis (khat) chewing on plasma lipid peroxidation

The effect of regular khat ( Catha edulis) chewing and the combination of khat chewing and smoking on plasma lipid peroxidation as a biomarker of oxidative stress and free radical activity (measured as plasma malondialdehyde, MDA), as well as on the lipid profiles were investigated. The fasting plasma levels of MDA were non-significantly higher in both groups (4% in khat chewers and 9.2% in khat chewers and smokers), whereas these levels were observed to be significantly increased at post meal and 2 h through the khat session. Post meal increase of plasma MDA could be attributed partially to the meal-induced oxidative stress and the possible decrease in the overall antioxidant capacity. This increase in plasma levels of MDA in both tested groups were found to be higher in the control group suggesting the presence of other contributing factors beside the meal-induced oxidative stress. Plasma levels of MDA were observed to fall slightly 2 h through the khat session over the post meal levels, suggesting a lack of additive effect of khat consumption. Plasma triglycerides, total cholesterol, and LDL-cholesterol were shown to be non-significantly affected in this study by khat chewing or by the combination of khat chewing and smoking.

Determination of cathinone, cathine and norephedrine in hair of Yemenite khat chewers

A sensitive and reproducible method for the quantitative determination of cathinone (CTN), norpseudoephedrine (NPE, cathine) and norephedrine (NE) from hair was developed. The compounds were extracted for 4 hours with phosphate buffer pH 2.0, followed by a standard solid phase extraction procedure on a mixed phase column, derivatization with heptafluorobutyric anhydride (HFBA) and GC–MS separation and quantification using D 3-ephedrine (D 3-E) and α-aminoacetophenone (AAP) as the internal standards. The diastereomers NPE and NE were satisfactorily separated. In the validation, the limits of detection and of quantification were determined at 0.03–0.08 ng/mg and 0.10–0.24 ng/mg, respectively and the interday standard deviation was between 10 and 15%. The method was applied to hair samples of 24 Yemenite khat chewers. All three compounds were detected in 23 of these cases. The concentrations ranged from 0.57 to 23.9 ng/mg for NPE, 0.19–25.0 ng/mg for NE and 0.11–22.7 ng/mg for CTN. A highly significant correlation was found between the self-reported data about the khat consumption habits of the volunteers (4–56 h chewing per week) and the concentrations of norephedrine and norpseudoephedrine in hair.

Psychosocial determinants of sexual activity and condom use intention among youth in Addis Ababa, Ethiopia.

Determinants of sexual activity and intentions for condom use were examined guided by the Attitude, Social influences, and Self-efficacy (ASE) model as a theoretical framework. A total of 561 in and out-of-school youth (15-24 years) in Addis Ababa completed a self-administered questionnaire. A third of them reported sexual intercourse in the past and half of the sexually active used condoms during recent intercourse. Being out-of-school, male, aged 20-24 years, alcohol use and khat (amphetamine-like substance) consumption predicted the likelihood of engagement in sexual activity. Of these variables, however, male sex was more associated with reported condom use during recent sexual intercourse. Self-efficacy, skills, and barriers predicted 23% of the variance in intentions to use condoms. Self-efficacy was also associated with past condom use. Psychosocial constructs predicted more variations in condom use intention for males than for females. In general, self-efficacy was found to be the strongest predictor of the constructs, whereas attitude and social influences were the weakest. The study implies that HIV/AIDS prevention programmes for young people in Ethiopia need to emphasize building assertive communication skills in sexual negotiations and condom use. Minimizing the gender gap in sexual relationships forms the cornerstone for such educational strategies.

Khat (Catha edulis) consumption causes genotoxic effects in humans.

We used the micronucleus (MN) test to determine the genetic damage caused by khat, a widely consumed psychostimulant plant, in exfoliated cells of volunteers who chewed the drug on a regular basis. In the first study in which we compared the frequency of MN in buccal and bladder mucosa cells in 20 khat consumers (10-160 g/day) and 10 controls, a pronounced (8-fold) increase in micronucleated buccal mucosa cells was seen among khat consumers; khat consumption did not lead to a detectable elevation of micronucleated bladder mucosa cells. Among heavy khat chewers, 81% of the MN had a centromere signal indicating that khat is aneuploidogenic. To investigate the effect of simultaneous consumption of tobacco and alcoholic beverages, we compared the MN frequency in buccal cells of 25 khat consumers (20-85 g/day) who smoked cigarettes (15-60/day) and drank alcoholic beverages (15-80 g of pure ethanol/day) with a control group (control group I) of 25 individuals matched for age, body weight, tobacco and alcohol consumption and with another control group of 25 individuals (control group II) not consuming any of the drugs. The frequency of buccal mucosa cells with MN was higher in control group I than in group II and the effect of khat, tobacco and alcohol was found to be additive. A time-kinetics study on khat-induced MN showed that the highest frequency of MN was observed during the fourth week after consumption. In light of the large body of evidence on the close association between genetic damage and cancer, these results suggest that khat consumption, especially when accompanied by alcohol and tobacco consumption, might be a potential cause of oral malignancy.

Periodontal status of a subject sample of Yemen.

From August to October 1991, the periodontal status of 1001 Yemenis representing the age groups 12-14, 15-19, 20-24 and 35-44 years was recorded and evaluated with reference to the CPITN, the calculus index and clinical attachment levels. The impact of chewing khat, the leaves of a cultivated, alkaloid shrub, and of using the traditional miswak chewing stick for oral hygiene purposes were investigated. The results show that 6.9% of the juvenile probands (15-19 years) had healthy periodontal tissue (CPITN 0), whereas bleeding on probing and calculus (CPITN 1 + 2) were registered in 86.2%. In the 35-44 year age group, 1.7% were periodontally healthy, whereas 84.5% displayed plaque retention or shallow pocketing (CPITN 2 + 3) and 12.5% deep pocketing (CPITN 4). The treatment needs in all age groups are confined primarily to calculus removal and instruction in oral hygiene. The clinical attachment level and the calculus index revealed age-related attachment loss and calculus formation, primarily among male probands. The higher khat consumption among the male population is reflected in its detrimental effect on the periodontal tissue, especially among younger probands. Oral hygiene aids have also an influence on periodontal status, with a toothbrush proving more efficient than the miswak. WHO efforts directed towards prophylactic programs need to be intensified but can be staffed by dental hygienists.

Chewing as a social act: cultural displacement and khat consumption in the East African communities of Melbourne

In this paper we present a review of practices surrounding the consumption of khat (Catha edulis) within recent migrant communities in Melbourne from East Africa. Cultures in East Africa and the Arabian Peninsular have used khat as a stimulant since the seventh century and the practice of coming together to chew the leaves of the khat plant has acquired unique cultural importance. Based on focus-group interviews the research examines transformations taking place in the meaning of khat for East African communities within their experiences of displacement and considers how the arrival of khat might be managed in the Australian context. Emphasis is given to indigenous models and the cultural context of practices surrounding khat. This anthropology of khat use in Melbourne summarizes issues such as who chews it, traditional settings for khat gatherings, culturally defined effects of the leaf, health effects, beliefs and attitudes, levels of use, gendered attitudes and questions of dependence. These issues raise questions regarding the reception of indigenous substance use within a state that claims to be multicultural.

Deleterious effects of khat addiction on semen parameters and sperm ultrastructure.

The semen parameters and sperm ultrastructural morphology have been described in semen samples from two groups of Yemeni subjects. The first 'exposed' group comprised 65 khat addicts, while the second control group included 50 non-khat addict subjects. The mean age was 39.94 +/- 13.85 and 35.72 +/- 11.35 years in the exposed and control groups respectively, without a significant difference. The mean duration of khat addiction among the addicts was 25.34 +/- 12.96 years (range 6.00-48.00). Statistically significant differences were detected between the semen parameters of the two groups. Such parameters, including semen volume, sperm count, sperm motility, motility index and percentage of normal spermatozoa, were lower among addicts. Significant negative correlation was also found between the duration of khat consumption and all semen parameters (r ranged from -0.30 to -0.74). At the transmission electron microscopy level, a counting system was incorporated to compare the numbers of normal spermatozoa with deformed and dead spermatozoa in ultrathin plastic sections. The total mean percentage of deformed spermatozoa was approximately 65%. Different patterns of sperm deformation were demonstrated, and included both the head and flagella in complete spermatozoa, aflagellate heads, headless flagella and multiple heads and flagella. Deformed heads showed aberrated nuclei with immature nuclear chromatin and polymorphic intranuclear inclusions; these were associated with acrosomal defects. The deformed flagella demonstrated numeric aberrations of the axonemal 9 + 2 configuration and structural defects of their associated elements. Persistent cytoplasmic droplets were observed frequently. This study has shown for the first time the deleterious effects of khat addiction on semen parameters in general and sperm morphology in particular of all addicts, especially those who have consumed khat for longer periods of time.

On the medico‐social aspects of khat (Catha edulis) chewing habit

AbstractRegular consumption of khat from Catha edulis seriously affects the social and economic life of the subject and therefore is hazardous both to the individual and the community.Increasing awareness of the prevalence of khat chewing, often together with other drugs such as alcohol and tobacco, it is essential to further assess the health and socio‐economic consequences of khat habituation in order to take further appropriate medical and social measures to limit its availability and use.

Chewing khat, an old drug habit that is new in Europe

Since ancient times, the khat bush has been grown in certain areas of East Africa and of the Arab Peninsula, and many people chew its leaves because of their stimulating effect. As khat use may be compulsive, the habit has been seen as a phenomenon of drug addiction, indeed, khat is known to induce a certain degree of psychic dependence and to contain an alkaloid with amphetamine effects. Due to the availability of air transport, this drug has now made its appearance in Western Europe and in the USA. This is worrying because khat consumption may induce toxic psychosis, several such cases have recently been observed in Great Britain. The present article therefore describes the habit and the effects of chewing khat, and it provides some background information together with a discussion of the advisability of prohibitive measures regarding this drug.

Khat consumption: a pharmacological review

The present review deals with the considerable body of evidence gathered in the last ten years on the clinical and experimental pharmacology of Khat. Khat effects are generally agreed to be of amphetamine-like type. In particular, Khat ingestion, like amphetamine ingestion, produces sympathetic activation, anorexia, euphoria, increased intellectual efficiency and alertness. These effects are mainly mediated by phenylalkylamines, such as cathinone and cathine, because the pharmacological actions of these agents and those produced by amphetamine almost overlap. In infra-human species cathinone is an effective positive reinforcer (i.e., it maintains self-administration). However, it would be inappropriate to infer from cathinone and cathine effects assessed in animals a high potential of abuse for Khat in humans; apart from other reasons the bulk volume of Khat leaves, limits the ingestion of high quantities of the active principles. Accordingly, in habitual consumers Khat dependence is probably mild, because craving and tolerance to the sympathomimetic and neuroendocrine effects of Khat are present, but there is no definite abstinence syndrome. Therefore, in our opinion, policies restricting the use of Khat should be adopted with caution, lest they simply change the pattern of drug abuse and increase the spread of more dangerous drugs.

Khat: scientific knowledge and policy issues.

Summary The chewing of khat leaves is common in certain countries of East Africa and the Arabian peninsula, and some khat users are subject to psychic dependence on this stimulant. Recently, important progress has been made in understanding the pharmacological basis for the effects of khat. It is now known that the CNS stimulation is mainly due to the presence of the alkaloid cathinone in the leaves, and the results of various in vitro and in vivo experiments indicate that this substance must be considered a ‘natural amphetamine’.The consumption of khat has strongly increased in recent years, and the drug has also made its appearance in Great Britain. In view of these developments, the socio‐economic and health aspects of the khat habit are discussed together with the political issues that they imply.

Subjective effects of Khat chewing in humans

The subjective effects of Khat ( Catha edulis) chewing were studied in 14 male somali, habitual khat users, by means of the Addiction Research Center Inventory (ARCI) questionnaire and of visual analogue scales concerning mood and appetite. Results show that euphoria, improved intellectual efficiency and alertness were associated with khat consumption in 10 subjects. In contrast, the remaining 4 subjects experienced only dysphoria and mild sedation. These latter effects were present in all the subjects in the post-chewing period. In spite of these subjective differences, blood pressure and pulse rate increased in all the volunteers studied. As a whole, these results are consistent with the presumed amphetamine-like action of khat, but suggest also a major role of environmental factors in the expression of these actions.

MECHANISM OF ACTION OF (−)CATHINONE, A NEW ALKALOID FROM KHAT LEAVES

A new alkaloid, (−)cathinone, has recently been isolated from khat leaves and has been shown to induce amphetamine-like behavioural effects. The actions of this alkaloid at the cellular level are discussed here and it is concluded that (−)cathinone resembles amphetamine in influencing catecholamine release both centrally and peripherally. As it is likely that the central and peripheral symptoms observed during khat consumption are due to these effects of (−)cathinone, it can be assumed that the widespread habit of khat chewing is pharmacologically analogous to amphetamine abuse.

The chewing of khat in Somalia

Khat ( Catha edulis Forsk.), known in Somalia as “qaad” or “jaad”, is a plant whose leaves and stem tips are chewed for their stimulating effect. From the Harar area, khat has been introduced at different times into the present day territories of Somalia, Djibouti, South and North Yemen, Kenya, Madagascar, Tanzania and down to south eastern Africa. The plant, which belongs to the Celestraceae family, grows wild at altitudes of 1500–2000 m above sea level. Among the various compounds present in the plant (more than forty alkaloids, glycosides, tannins, terpenoids, etc.), two phenyl-alkylamines, namely cathine ((+)-norpseudoephedrine) and cathinone ((−)S- o-aminopropiophenone) seem to account mostly for the effect. The consumers get a feeling of well-being, mental altertness and excitement. The after effects are usually insomnia, numbness and lack of concentration. The excessive use of khat may create considerable problems of social, health and economic nature. These problems have been summarily reviewed. Khat chewing started at different times in different parts of Somalia. Since World War II, the prevalence of the practice has continuously increased and no social group is excluded. An epidemiological research to compare Northern and Southern regions of Somalia and to obtain a rough estimate of prevalence, definition of social characteristics of the groups of consumers, specification of the motivations, patterns of use and effects during and after consumption has been conducted. Consumers and non-consumers (7485 people) were randomly interviewed in the two regions. Khat consumption in relation to sex, age, occupation and grade of education is presented.