Khat qat

This perennial shrub, indigenous to Yemen, Ethiopia, and surrounding areas, is used in cultures where alcohol is prohibited. Outside its area of propagation, khat is most commonly used among immigrant Somali communities in the United Kingdom, and elsewhere in Europe and the United States. Concern has grown over recent years regarding possible adverse effects that use of this stimulant herb may have upon both individuals and their societies. For a review of the literature and use in the United Kingdom see Griffiths. (41)

The fresh bitter leaves are usually chewed for their stimulant effect with the extracted juices swallowed and the residue kept within the cheek for some time after. This is a relatively slow mode of administration, requiring prolonged chewing to provide a relatively mild stimulant effect. Less often the leaves may be smoked or infusions prepared. Khat is primarily a social drug and its mild stimulant effects appear to promote social interaction. Users report loquacity, disinhibition, and improved concentration. As with other stimulants, use is associated with anorexia and reduced need for sleep. Although originally used more commonly by men, its use is becoming more common among women.

Khat is a central stimulant, considerably less potent that amphetamine, although it has a similar mechanism of action through the release of presynaptically stored catecholamines. The main stimulant psychoactive components, cathine and the more potent cathinone (both phenylpropylamines), are found in combination with other alkaloids and tannins. Because cathinone is very unstable, fresh leaves are used within a day or two of harvesting.

In the countries in which it is used, assessment of the impact on health is confounded by the poor socio-economic status of many users, and the anorexic effects of use. Reported adverse physical effects include oral problems, constipation, and hepatic and cardiac disturbances. Accidents may occur whilst intoxicated. Khat use has been associated with compulsion to use and dependence, but there does not appear to be a physically characterized withdrawal syndrome. There have been several case reports of short-lived amphetamine-like psychoses among users of khat, although there is little to suggest longer-term psychiatric morbidity among users.

Cathine and cathinone are controlled in the United Kingdom under the Misuse of Drugs Act 1971, as well as under international conventions. However, sale of unprepared khat is not prohibited in the United Kingdom and where legislation does exist it has been difficult to enforce.

Because cathinone decomposes rapidly, the effects are modest, and the drug is usually taken by chewing, unprepared khat is unlikely to enter Western drug use. Cheaper more potent synthetic preparations are better suited and more familiar to groups not culturally associated with its use. A refined preparation of cathinone could be used and there has been an isolated outbreak of use associated with localized manufacture of the derivative methylcathinone in the United States.

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