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CORK Bibliography: Khat

69 citations. January 2003 to present

Prepared: March 2012

Acuda W; Othieno CJ; Obondo A; Crome IB. The epidemiology of addiction in sub-saharan Africa: A synthesis of reports, reviews, and original articles. (review). American Journal on Addictions 20(2): 87-99, 2011. (67 refs.)

Use of alcohol and other psychoactive substances is associated with serious social and public health problems, but the extent of the problem in Sub-Saharan Africa is not well known. We set out to review epidemiological publications on alcohol and other psychoactive substances in Sub-Saharan Africa by performing a systematic search of electronic databases and paper records. Ten Sub-Saharan African countries are among the 22 in the world with the highest increase in per capita alcohol consumption. Cannabis, tobacco, and khat are widely used, and use of cocaine, stimulants, and heroin is increasing. More epidemiological research and implementation and evaluation of interventions is needed. Collaboration between African researchers and those in developed countries could help.

Copyright 2011, Wiley-Blackwell

Ai-Dubai W; Al-Habori M; Al-Geiry A. Human khat (Catha edulis) chewers have elevated plasma leptin and nonesterified fatty acids. Nutrition Research 26(12): 632-636, 2006. (46 refs.)

In this study, the effect of regular khat (Catha edulis Forsk) chewing (200 and 400 g) in humans on plasma leptin, nonesterified fatty acid, triacyglycerol, and total cholesterol levels was investigated. The results presented show that khat chewing increases plasma leptin concentration particularly in individuals who chew 400 g of khat leaves. The significance of increased plasma leptin is in explaining the underlying mechanism of the observed effects associated with khat chewing such as loss of appetite, decreased body weight, and hyperthermia. The decreased body weight was evident from the significantly lower body mass index of the khat leaves chewers group as compared to the non-khat leaves chewers group (control). Moreover, like leptin, the plasma levels of nonesterified fatty acids were significantly higher in those chewing 400 g of khat leaves. On the other hand, the plasma levels of triacylglycerol were significantly lower in the 2 khat-chewers groups (200 and 400 g of khat leaves), whereas plasma cholesterol levels were not affected by the 2 levels of khat leaves used in this study. The significance of these results may suggest that khat leaves may contain a component(s) that has the ability to reduce body weight via decreasing appetite.

Copyright 2006, Elsevier Science

Alem A; Kebede D; Kullgren G. The prevalence and socio-demographic correlates of khat chewing in Butajira, Ethiopia. Acta Psychiatrica Scandinavica 100(Supplement 7): 84-91, 1999. (33 refs.)

A house-to-house survey was carried out in a rural Ethiopian community to determine the prevalence and socio-demographic correlates of khat use. A total of 10 468 adults were interviewed. Of these, 58% were female, and 74% were Muslim. More than half of the study population (55.7%) reported lifetime khat chewing experience and the prevalence of current use was 50%. Among current chewers, 17.4% reported taking khat on a daily basis; 16.1% of these were male and 3.4% were female. Various reasons were given for chewing khat; 80% of the chewers used it to gain a good level of concentration for prayer. Muslim religion, smoking and high educational level showed strong association with daily khat chewing.

Copyright 1999, Munksgaard International Publishers, Ltd. Used with permission

Al-Hadrani AM. Khat induced hemorrhoidal disease in Yemen. Saudi Medical Journal 21(5): 475-477, 2000. (19 refs.)

Objectives: The aim of this study was to evaluate the potential association between the habit of khat chewing and the development of hemorrhoidal disease. Method: Four hundred and seventy four individuals (373 men and 101 women) with ages ranging from 17 to 80 years were divided into 2 groups. Group 1 (n=247) chronic khat chewers. Group 2 (n=200) non- khat chewers. Data was collected regarding chewing habits, colorectal symptoms, abdominal, proctoscopic, and operative findings. Results: The key difference between the 2 groups was the incidence of hemorrhoids and hemorrhoidectomy. In the chronic khat chewers group: 169 (62%) had hemorrhoids. Of these 124 (45.4%) underwent hemorrhoidectomy. In the control group there is 8 (4%) had hemorrhoids and one patient underwent hemorrhoidectomy (0.5%). P- value (0.05). Conclusion: The study demonstrated a significant association between the habit of khat chewing and the development of hemorrhoidal disease.

Copyright 2000, Riyadh Al-Kharj Hospital Programme

Al-Hebshi NN; Skaug N. Effect of khat chewing on 14 selected periodontal bacteria in sub- and supragingival plaque of a young male population. Oral Microbiology and Immunology 20(3): 141-146, 2005. (33 refs.)

Background/aims: The habit of chewing khat (Catha edulis) for its amphetamine-like effects is highly prevalent in Yemen and east Africa, and has expanded to Western countries. The purpose of this study was to estimate and compare the prevalence and levels of 14 periodontal bacteria in gingival plaque of khat chewers and khat nonchewers, as well as of khat chewing sides and khat nonchewing sides. Methods: A total of 408 sub- and supragingival plaque samples were collected from 51 young males (29 khat chewers and 22 khat nonchewers; age range 19-28 years) and analyzed using whole genomic DNA probes and checkerboard DNA-DNA hybridization. Clinical parameters were recorded for all teeth at six sites per tooth. Results: Streptococcus intermedius and Veillonella parvula were significantly more prevalent in the subgingival plaque of chewers, which also showed significantly higher levels of V. parvula and Eikenella corrodens. Similar results were found for the subgingival plaque of the chewing sides compared to the nonchewing sides. However, there was a significantly higher prevalence and higher levels of Tannerella forsythia in the subgingival plaque of the nonchewing sides. No significant differences were observed for the supragingival plaque between the two study groups. There was a significantly lower prevalence of Capnocytophaga gingivalis and Fusobacterium nucleatum in the khat chewing sides, and higher levels of V. parvula and Actinomyces israelii. Conclusion: The data suggest that khat chewing induces a microbial profile that is not incompatible with gingival health.

Copyright 2005, Blackwell Munksgaard

Al-Hebshi NN; Skaug N. Khat (Catha edulis): An updated review. (review). Addiction Biology 10(4): 299-307, 2005. (112 refs.)

The habit of chewing fresh leaves and twigs of khat (Catha edulis) for their stimulating amphetamine-like effects is highly prevalent in East Africa and southwest on the Arabic peninsula. There is an extensive literature on khat providing information about its history, botany, production, geographical distribution, chemistry and pharmacology, and exploring the social, economic, medical., psychological and oral aspects related to its use. Some of this literature dates as early as the 11th century; however, most of it appeared after the first scientific description of khat by Peter Forskal in 1775. This review provides a panorama of khat and the various aspects of its use. A non-technical description of the plant chemistry and pharmacology is included. The medical, psychological and oral aspects are emphasized, and the current knowledge about the microbiological effects of khat is also presented.

Copyright 2005, Taylor and Francis Ltd.

Ali WM; Zubaid M; Al-Motarreb A; Singh R; Al-Shereiqi SZ; Shehab A et al. Association of khat chewing with increased risk of stroke and death in patients presenting with acute coronary syndrome. Mayo Clinic Proceedings 85(11): 974-980, 2010. (49 refs.)

OBJECTIVE To evaluate the prevalence and significance of khat chewing in patients with acute coronary syndrome (ACS). PATIENTS AND METHODS: From January 29, 2007, through July 29, 2007, 8176 consecutive patients presenting with ACS were en roiled In a prospective, multicenter study from 6 adjacent Middle Eastern countries. RESULTS: Of the 8176 study patients, 7242 (88 6%) were non-khat chewers, and 934 (11 4%) were khat chewers, mainly of Yemeni origin Khat chewers were older (57 vs 56 years, P= 01) and more likely to be men (85 7% vs 74 5%) compared with non khat chewers Non khat chewers were more likely to have diabetes mellitus, hypertension, dyslipldemia, obesity, and prior history of coronary artery disease and revascularization. Cigarette smoking was more prevalent in khat chewers, and they were more likely to present greater than 12 hours after onset of symptoms compared with non-khat chewers. At admission, khat chewers had higher heart rate, Killlp class, and Global Registry of Acute Coronary Events risk scores. Khat chewers had a significantly higher risk of cardiogenic shock, stroke, and mortality After adjustment of baseline variables, khat chewing was an independent risk factor for in hospital mortality (odds ratio, 1 9, 95% confidence interval, 1 3-2 7, P< 001) and stroke (odds ratio, 2 7, 95% confidence interval, 135 9, P= 01). CONCLUSION: in this large cohort of patients with ACS, khat chewing was prevalent and was associated with increased risk of stroke and death in the context of increasing global migration, a greater awareness of potential widespread practices is essential

Copyright 2010, Mayo Clinic Proceedings

Al-Motarreb A; Baker K; Broadley KJ. Khat: Pharmacological and medical aspects and its social use in Yemen. (review). Phytotherapy 16(5): 403-413, 2002. (61 refs.)

Fresh leaves of the khat tree (Catha edulis Forsk.) are chewed for their euphoric properties in East Africa and parts of the Middle East, such as The Yemen. This review describes the history, cultivation and constituents of khat, and the social aspects of khat chewing in Yemen. The major pharmacologically active constituent of the fresh leaves is (-)-S-cathinone. The pharmacology of (-)-S- Cathinone in the central nervous system and the peripheral effects are described. (-)-S-Cathinone is regarded as an amphetamine-like sympathomimetic amine and this mechanism of action is discussed in relation to the central stimulant actions and the cardiovascular effects of increasing blood pressure and heart rate. The risk factors associated with khat chewing are described, with emphasis on the reported increased incidence of acute myocardial infarction.

Copyright 2002, John Wiley & Sons, Ltd.

Anderson D; Beckerleg S; Hailu D; Klein A. The Khat Controversy: Stimulating the Debate on Drugs. Oxford: Berg Publishers, 2007

Khat is a natural stimulant that, in the Middle East, is as common as coffee is in the West. It is popular in a number of African and Arab populations. This book examines the use of khat, its increasing availability and introduction to areas beyond those where it has been used historically. Included in this discussion is the role of globalization, ethnicity and culture. With its popularity escalating in large metropolitan areas from London to Rome, Toronto and Copenhagen, khat is fast being viewed as a problem in the West. Warning voices have been raised about its addictive properties and potential for being the next drug fad. This book is drawn from research efforts conducted by the authors to discern the trade in khat, the nature of related policy, and related policy issues. Following an introductory chapter which outlines the nature of khat use, discussion turns in Part I to khat Ethiopia and the Somaliland, the role of khat production, the role in export and foreign change. Part II turns to East Africa, with attention to Kenya, Meru and Uganda, their the khat trade, the impact of colonial controls, and campaigns against the drug. Part III reviews the global emergence of khat, the international trade, related social issues, and incorporates two case studies, the experience of control efforts in Canada and Sweden. The concluding chapter addresses the policy debates and the case for and against prohibition.

Copyright 2006, Project Cork

Anderson D; Carrier N. Khat in Colonial Kenya: A history of prohibition and control. Journal of African History 50(3): 377-397, 2009. (50 refs.)

Efforts to institute a system for the control and prohibition of khat in Kenya are examined in this article. Prohibition was introduced in the 1940s after an advocacy campaign led by prominent colonial officials. The legs legislation imposed a racialized view of the effect of khat, seeking to protect an allegedly 'vulnerable' community in the north of the country while allowing khat to be consumed and traded in other areas, Including Meru where 'traditional' production and consumption was permitted. Colonial policy took little account of African opinion, although African agency was evident in the failure and ultimate collapse of the prohibition in the face of Wwdespread smuggling and general infringement. Trade in khat became ever more lucrative, and in the final years of colonial rule economic arguments overcame the prohibition lobby. The imposition of prohibition and control indicates the extent to which colonial attitudes towards and beliefs about cultural behaviour among Africans shaped policies, but the story also illustrates the fundamental weakness of the colonial state in Its failure to Uphold the legislation.

Copyright 2009, Cambridge University

Apps A; Matloob S; Dahdal MT; Dubrey SW. Khat: An emerging threat to the heart in the UK. (editorial). Postgraduate Medical Journal 87(1028): 387-388, 2011. (12 refs.)

Bamashmus M; Othrob NY; Mousa A; Al-Tay W. Effect of khat (qat) consumption on pain during and after local anesthesia for patients undergoing cataract surgery. Medical Science Monitor 16(8): SR29-SR33, 2010. (37 refs.)

Background: The leaves of the Khat (Qat) plant (Catha edulis), which contain amphetamine-like compounds, are widely chewed in Yemen and East Africa for their pleasurable stimulant properties and for their psychostimulative effects. Khat consumption has a number of unwanted side-effects. This study investigates effects of Khat consumption on the quality of local anesthesia with peribulbar injection and patient perception of pain after administration of local anesthesia for routine cataract extraction. Material/Methods: This single-center, prospective trial included 323 consecutive patients undergoing routine cataract extraction for senile cataract. Cataract surgery was performed within 10 minutes of the administration of local anesthesia. The patients were divided into 2 groups: Group A for those who are consuming Khat on a regular basis and Group B for those who had not consumed Khat within the last 3 months. To assess pain experience during injection, intraoperatively, and postoperatively, each patient was asked to use a 10-point pain score chart. Results: The study included 164 males and 159 females. There were 121 patients (37.5%) in Group A and 202 patients (62.5%) in group B. All patients had peribulbar local anesthesia by 2-site injections. Group A had significantly greater pain scores during injection (p=0.000821) and intraoperatively (p=0.000001), but there was no difference in pain score postoperatively. Conclusions: Khat consumption decreases pain threshold and affects patients' comfort during local anesthesia and during surgery in routine cataract surgery. Patients consuming Khat need more care during local anesthesia to make the surgery comfortable.

Copyright 2010, International Scientific Literature

Beckerleg S. 'Idle and disorderly' khat users in Western Uganda. Drugs: Education, Prevention and Policy 17(4): 303-314, 2010. (23 refs.)

Aims: To describe and analyse patterns of khat consumption and the response of the authorities to such drug use in Western Uganda. Methods: Participant-observation and key informant interviews were carried out in Western Uganda during 2007, 2008 and 2009. Findings: Khat is legal in Uganda but its use, especially when combined with alcohol and cannabis, is linked with violent crime by many Ugandans. In Western Uganda local government authorities have attempted to crack down on khat: in Bushenyi District they have introduced a by-law; in other districts khat traders and consumers face arrest and charges of being 'idle and disorderly'. Conclusion: The authorities, by clamping down on khat, because they perceive it to be a cause of violent crime, are targeting a substance that is widely reported in the academic literature to cause apathy, not violence.

Copyright 2010, Taylor & Francis

Beckerleg S. Khat chewing as a new Ugandan leisure activity. Journal of Eastern African Studies 3(1): 42-54, 2009. (27 refs.)

A culture of hedonism that attaches a high value to leisure has prevailed in much of Uganda. Having in the past been associated only with Somali and Yemeni migrants, khat consumption has spread among all ethnic groups and to all parts of Uganda. The locus of consumption has moved from the living room to video halls, alleyways and the ghettos of both urban and rural areas. Khat chewing, which takes several hours if the full sequence of effects is to be achieved, is viewed as idling by mainstream society, and as an affront to the core Ugandan values of hard work and education. There are two types of consumer: 1) the traditional users, maqatna, who chew khat accompanied by soft drinks; 2) the mixers who combine khat sessions with alcohol and/or cannabis use. The mixers have abandoned the rules and rituals of consumption that pertain in other khat-using settings. Many Ugandans confuse cannabis and khat, condone alcohol use, and brand khat chewers as, at best, idlers, and at worst violent criminals.

Copyright 2009, Taylor & Francis

Bekele AB; van Aken MAG; Dubas JS. Sexual violence victimization among female secondary school students in Eastern Ethiopia. Violence and Victims 26(5): 608-630, 2011. (79 refs.)

Behavioral, lifestyle, and relationship factors have all been identified as risk factors that increase a woman's vulnerability to sexual violence victimization. However, it remains unclear which risk factors most strongly increase young women's vulnerability to sexual violence victimization because most studies only examine a few factors simultaneously. Using a cross-sectional sample of 764 female secondary school students from eastern Ethiopia, multivariate analyses revealed that high-rejection sensitivity, having multiple sexual partners, the frequent watching of pornography, and use of alcohol or other soft drugs (Khat or shisha) are factors associated with higher levels of sexual violence victimization. The overall rates of victimization is high in this group, with 68% of the young women studied having experienced at least one instance of sexual violence victimization. Based on type of sexual perpetration, 52% of the young women were victimized by at least one instance of sexual offence, 56% by sexual assault, 25% by sexual coercion, and 15% by sexual aggression. Qualitative data gathered from interviews of extracurricular club members and school officials and focus group discussion with students were used to further augment and illustrate results from the quantitative data. Several suggestions for intervention are presented in light of these results.

Copyright 2011, Springer

Belew M; Kebede D; Kassaye M; Enquoselassie F. The magnitude of khat use and its association with health, nutrition and socio-economic status. Ethiopian Medical Journal 38(1): 11-26, 2000. (21 refs.)

Although the literature on khat (Catha edulis Forsk) is fairly extensive, and several authors have stated the potential-adverse effects of habitual use of khat on mental, physical and social well- being, very few population based studies exist to substantiate those statements in Ethiopia. A house-to-house survey of a representative sample of 1200 adults from a rural Ethiopian community was conducted from January to September of 1997 to determine the prevalence of khat use and its association with health, nutritional status, mental distress, substance use, family and social functioning and economic well-being. The current prevalence of khat chewing was found to be 31.7%. Muslims more than Christians, males more than females, these between the ages 15 and 34 years more than other age groups were habitual users. The following factors were found to be significantly associated with khat use: physical illness, (OR=1. 52, 95% CI=1.14- 2.02); injuries (OR=2.31,95%CI=1.42-3.79), undernutrition (OR =1.76,95% CI = 1.24-2.48), mental distress (OR=8.30,95% CI=5.20-13.31). Family functioning among current khat users was significantly higher than non users (OR-56,95%-CI=1.04-2.28). Social functioning and economic well-being were not significantly associated with khat use. It is concluded that a fairly large proportion of the population consumes khat and that this is related to physical and mental ill- health, although family and social functioning, and economic well- being seem to be unrelated to khat use.

Copyright 2000, Ethiopian Medical Association

Belhadj-Tahar H; Sadeg N. Methcathinone: A new postindustrial drug. Forensic Science International 153(1): 99-101, 2005. (15 refs.)

Methcathinone, a methyl derivative of cathinone, is an illicit drug also known as ephedrone. It is a stimulant found in the "khat" plant, Catha edulis, which can easily be synthesized from pseudoephedrine. Its intoxication is difficult to diagnose and cure properly for two reasons: (i) target consumers are usually "well-educated people" aware of the risks and precautionary measures and (ii) intoxication by cathinone derivatives of synthetic or natural (derived from the khat) origin induce misleading symptoms. As a result, documented reports of methcathinone intoxication that are based on reliable analyses are rare. This paper describes a case of reiterated coma due to an overdose of methcathinone dissolved in alcohol that was taken with bromazepam. A 29-year-old woman was admitted to an emergency department for a coma of toxic origin. Medical files showed that it was her second such episode to occur that month. Moreover, the family indicated signs of depression, incoherent behaviour and intake of "amphetamine-like" drugs. Clinical examination revealed a Glasgow coma score of 9, symmetrical reactive pupils with mydriasis and no convulsions. The patient presented with rapid respirations and her blood pressure was 93/53 mmHg. The ionogram and the blood gas analyses were normal, while the blood alcohol level was 0.167 g/dL. Urinalysis revealed the presence of benzodiazepines and a high concentration of amphetamines (methcathinone: 17.24 mg/L, ephedrine: 11.60 mg/L and methylephedrine: 11.10 mg/L). In addition, serum analysis revealed bromazepam (8.89 mg/L), methcathinone (0.50 mg/L) and methylephedrine (0.19 mg/L). This case showed that the consumption of bromazepant and alcohol altered the typical clinical symptoms of cathinone derivative intoxication, namely hypertension and convulsions. Methylephedrine, an impurity resulting from the alkylation of a primary amine, can be considered a chemical tag indicating fraudulent synthetic origin of the drug. This case describes a documented example of new addictive behaviour of "well-educated" people involving the intake of methcathinone, a postindustrial psychostimulant intentionally combined with an anticonvulsant benzodiazepine. However, this specific case suggests that in spite of a very high bromazepam concentration in presence of the potentiator alcohol, the vital respiratory function would be probably maintained, thanks to the association with methcathinone.

Copyright 2005, Elsevier Ireland Ltd.

Bhana A; Parry CDH. The South African Community Epidemiology Network on Drug Use (SACENDU): Findings, implications and future directions. IN: Community Epidemiology Work Group, eds. Epidemiologic Trends in Drug Abuse. Volume II: Proceedings of the Community Epidemiology Work Group. June 2000. Bethesda MD: National Institute on Drug Abuse, 2000. pp. 373-385. (2 refs.)

This chapter summarizes information from the most recent administration of this project. As in the six previous surveys, alcohol was the most frequently reported substance of abuse in each of five sites. Trauma unit indicators highlight the heavy burden associated with alcohol abuse. Cannabis and methaqualone (Mandrax) either alone or in combination are the most frequently reported illicit drugs use. There has been a rise in requests for treatment for cannabis abuse. Cocaine/crack have shown an upward trend, and crack seizures have increased in three sites. In three sites, 9 percent of persons arrested on housebreaking and murder charges tested positive for cocaine. Heroin indicators remained fairly stable; however, there are concerns about the increased quality of heroin. Ecstasy use continues to be reported among young persons in the club scene, alone or in combination other amphetamines, LSD, and methamphetamine. Other substances that have entered the market include gamma hydoxybutyrate (GHB), and Khat (a plant with stimulant properties grown mostly in East Africa.

Public Domain

Bono JP. Criminalistics. IN: Karch SB, ed. Drug Abuse Handbook. Boca Raton FL: CRC Press, 1998. pp. 1-76. (90 refs.)

This chapter provides an overview of factors related to drug testing and forensic considerations related to controlled substances. It begins with a definition of the scheduling of drugs, and the analogue enforcement act of 1986. There is discussion of the major controlled substances, both illicit drugs -- heroin, cocaine, marijuana, peyote, psilocybin mushrooms, LSD, Peyote, fentanyl, methcathinone, Khat, anabolic steroids and pharmaceutical preparations -- stimulants, narcotic analgesics, and CNS stimulants. For each of these, there is a review of production and manufacture process, and laboratory analysis. and comparative analysis. There is also a discussion of the clandestine laboratories.

Copyright 2003, Project Cork

Borelli S. Social aspects of drug use in Djibouti: The case of the leaf of Allah. Journal of African Economies 18(4): 555-591, 2009. (37 refs.)

In Djibouti the chewing of qat leaves is a widespread habit of the male population that has a profound socio-cultural importance, credited with fostering amity and building social relationships. This paper uses a sample of Djiboutian male adult household heads to test for the presence of peer effects in qat consumption choices in the context of the African society of Djibouti. We use multiple empirical strategies to assess the importance of peer effects in qat consumption. The results contribute to provide some suggestive evidence about the importance of social determinants in qat use.

Copyright 2009, Oxford University Press

Bruce-Chwatt RM. Intoxication with Qaat, Catha edulis L. Journal of Forensic and Legal Medicine 17(5): 232-235, 2010. (10 refs.)

The increasing use of Qaat, Catha edulis L in immigrants from the Horn of Africa to the UK is a matter of concern and may yet become a problem in the UK diaspora. Although it is not illegal in the UK to import sell, buy transport or consume, Qaat is a drug of addiction and demotivation. It is legal, in the unprepared plant form, in the UK and the Netherlands, but is a controlled substance and illegal in the USA, Canada, Australia, New Zealand, Denmark, Finland, Germany, Norway, and France. As long ago as 1980 the World Health Organization classified khat as a drug of abuse that can produce mild to moderate psychological dependence. This view continues to be born out and would suggest a re-evaluation of the legal classification of Qaat in the UK and placing it into class C under the Misuse of Drugs Act 1971.

Copyright 2010, Elsevier Science

Chappell JS; Lee MM. Cathinone preservation in khat evidence via drying. Forensic Science International 195(1/3): 108-120, 2010. (23 refs.)

A primary concern with the forensic analysis of the khat plant (Catha edulis) has been the need to preserve the principle psychoactive component, cathinone, which converts to the less-active substance, cathine, after harvesting. The loss of cathinone has serious legal implications since it is a Schedule I controlled substance under federal regulations in the United States, while cathine is Schedule IV. A common misconception is that cathinone is highly unstable once the plant is harvested, and may be undetectable upon drying and prolonged storage. However, drying the plant material will preserve cathinone. Numerous seizures of a dried form of khat (referred to as "graba" in the United States) have been made in recent years, suggesting that drying the plant material is a viable approach to preserve khat evidence for both storage and reanalysis. A qualitative and quantitative study of the composition of khat samples seized as dried plant material has found the khat alkaloids to be relatively stable for a monitored period of 3 years, and cathinone has remained identifiable while stored at room temperature for over 10 years. Studies of green khat (received moist) have also determined that drying the moist leaves at either room temperature or by the application of heat are suitable methods to preserve cathinone in the dried material. These findings demonstrate that cathinone persists in dried khat for a time frame of several years, and simple drying techniques are an effective means to preserve seized khat evidence for long-term storage.

Copyright 2010, Elsevier Science

Colzato LS; Ruiz MJ; van den Wildenberg WPM; Hommel B. Khat use is associated with impaired working memory and cognitive flexibility. PLoS ONE 6(6): e20602, 2011. (54 refs.)

Rationale: Khat consumption has increased during the last decades in Eastern Africa and has become a global phenomenon spreading to ethnic communities in the rest of the world, such as The Netherlands, United Kingdom, Canada, and the United States. Very little is known, however, about the relation between khat use and cognitive control functions in khat users. Objective: We studied whether khat use is associated with changes in working memory (WM) and cognitive flexibility, two central cognitive control functions. Methods: Khat users and khat-free controls were matched in terms of sex, ethnicity, age, alcohol and cannabis consumption, and IQ (Raven's progressive matrices). Groups were tested on cognitive flexibility, as measured by a Global-Local task, and on WM using an N-back task. Result: Khat users performed significantly worse than controls on tasks tapping into cognitive flexibility as well as monitoring of information in WM. Conclusions: The present findings suggest that khat use impairs both cognitive flexibility and the updating of information in WM. The inability to monitor information in WM and to adjust behavior rapidly and flexibly may have repercussions for daily life activities.

Copyright 2011, Public Library of Science

Corkery JM. Crying wolf? A response to Corkery et al. 'Bundle of fun' or 'bunch of problems'? Case series of khat-related deaths in the UK Response. (editorial). Drugs: Education, Prevention and Policy 18(6, special issue): 431-432, 2011. (6 refs.)

Corkery JM; Schifano F; Oyefeso A; Ghodse AH; Tonia T; Naidoo V et al. 'Bundle of fun' or 'bunch of problems'? Case series of khat-related deaths in the UK. Drugs: Education, Prevention and Policy 18(6, special issue): 408-425, 2011. (94 refs.)

Twenty million people worldwide use khat (Catha edulis). Previously confined to Eastern Africa and Arabia, consumption is spreading to other regions. Chewing khat leaves releases the stimulants cathinone and cathine. Khat consumption has adverse health consequences including myocardial infarction, liver failure, depression, psychoses and dependence. Literature regarding khat-related mortality is scant: only one death (in 1945) due to physiological complications, and a small number of fatalities due to psychological problems associated with long-term khat use have been reported. However, deaths associated with khat do occur. Thirteen deaths in the UK occurring in 2004-2009 associated with khat consumption are described. All decedents were males (mean age 35). Four deaths resulted from the physiopathological consequences of long-term khat use; liver failure (3), left ventricular failure and pulmonary oedema (1). In a further case, the deceased died of a cardiovascular event precipitated by khat use causing either an infarction or electrical instability (arrhythmia) leading to death. Three confirmed and one possible suicide occurred of individuals with psychoses caused and/or exacerbated by long-term khat consumption. An accidental overdose of an anti-psychotic occurred where schizophrenia was exacerbated by khat use. Impaired judgment due to khat and alcohol led to two fatalities in road accidents. One fatality resulted from heroin intoxication, but khat was also present. Khat-consuming communities and health professionals need to be aware of the physiological and psychological effects of khat, together with the risks for mortality associated with its use.

Copyright 2011, Taylor & Francis

Deressa W; Azazh A. Substance use and its predictors among undergraduate medical students of Addis Ababa University in Ethiopia. BMC Public Health 11: article 660, 2011. (32 refs.)

Background: Substance use remains high among Ethiopian youth and young adolescents particularly in high schools and colleges. The use of alcohol, khat and tobacco by college and university students can be harmful; leading to decreased academic performance, increased risk of contracting HIV and other sexually transmitted diseases. However, the magnitude of substance use and the factors associated with it has not been investigated among medical students in the country. This study was conducted to determine the prevalence of substance use and identify factors that influenced the behavior among undergraduate medical students of Addis Ababa University in Ethiopia. Methods: A cross-sectional study using a pre-tested structured self-administered quantitative questionnaire was conducted in June 2009 among 622 medical students (Year I to Internship program) at the School of Medicine. The data were entered into Epi Info version 6.04d and analyzed using SPSS version 15 software program. Descriptive statistics were used for data summarization and presentation. Differences in proportions were compared for significance using Chi Square test, with significance level set at p < 0.05. Multivariate logistic regression analyses were used to assess the magnitude of associations between substance use and socio-demographic and behavioral correlates. Results: In the last 12 months, alcohol was consumed by 22% (25% males vs. 14% females, p = 0.002) and khat use was reported by 7% (9% males vs. 1.5% females, p < 0.001) of the students. About 9% of the respondents (10.6% males vs. 4.6% females, p = 0.014) reported ever use of cigarette smoking, and 1.8% were found to be current smokers. Using multiple logistic regression models, being male was strongly associated with alcohol use in the last 12 months (adjusted OR = 2.14, 95% CI = 1.22-3.76). Students whose friends currently consume alcohol were more likely to consume alcohol (adjusted OR = 2.47, 95% CI = 1.50-4.08) and whose friends' use tobacco more likely to smoke (adjusted OR = 3.89, 95% CI = 1.83-8.30). Khat use within the past 12 months was strongly and positively associated with alcohol consumption (adjusted OR = 15.11, 95% CI = 4.24-53.91). Similarly, ever use of cigarette was also significantly associated with alcohol consumption (adjusted OR = 8.65, 95% CI = 3.48-21.50). Conclusions: Concordant use of alcohol, khat and tobacco is observed and exposure to friends' use of substances is often implicated. Alcohol consumption or khat use has been significantly associated with tobacco use. While the findings of this study suggest that substance use among the medical students was not alarming, but its trend increased among students from Year I to Internship program. The university must be vigilant in monitoring and educating the students about the consequences of substance use.

Copyright 2011, Biomed Central

Douglas H; Boyle M; Lintzeris N. The health impacts of khat: A qualitative study among Somali-Australians. Medical Journal of Australia 195(11-12): 666-669, 2011. (24 refs.)

Objectives: To identify patterns of khat use among Somali-Australians in Australia and to explore their views about the links between khat use and personal health. Design, setting and participants: Qualitative study using semistructured focus groups among adult members of Somali communities in Brisbane, Sydney, Melbourne and Perth who volunteered to attend focus groups in January and December 2010. Main outcome measures: Emergent themes related to Somali-Australians' understanding of the links between khat use and personal health. Results: Nineteen focus groups included 114 participants. Khat use was reported to be common among the Somali community, and more common among men than women. Khat was usually chewed in prolonged sessions, producing mild psychostimulant effects such as increased energy, enhanced mood, reduced appetite and reduced sleep. Khat was widely perceived to be a food, not a drug, and as harmless, or even beneficial, to the user's health. Many users reported discontinuation effects such as lethargy, sleep disturbances and mood problems after sessions of heavy khat use, and some reported self-medicating with alcohol to cope with such problems. Problems of addiction to khat were identified by some participants, but not all believed it is addictive. Many khat users reported visiting their health professionals for treatment of adverse effects and failing to disclose their khat use. Conclusions: Health professionals require greater awareness of khat use and related health problems. Health promotion activities targeting communities with high levels of khat use are required to increase understanding of the potential risks of regular khat use, to promote harm-reduction strategies, and to increase awareness of services available for those experiencing harm. Health professionals should consider targeted screening for khat use among individuals from Horn of Africa communities who present to health services.

Copyright 2011, Australasian Medical Publishin Co Ltd

Dupont HJBH; Kaplan CD; Verbraeck HT; Braam RV; van de Wijngaart GV. Killing time: Drug and alcohol problems among asylum seekers in the Netherlands. International Journal of Drug Policy 16(1): 27-36, 2005. (30 refs.)

In the Netherlands, procedures for obtaining eventual refugee status normally take several years. This long period of uncertainty has been identified as a significant variable in psychological health complaints related to post-migration stress. Drug and alcohol problems were examined in a convenience sample of key figures in asylum seeker communities (N = 21) selected from three Dutch Asylum Seeker Centres (AZCs). A qualitative analysis of drug and alcohol use drawn from semi-structured, cross-sectional interviews was conducted to provide a description and explanations of variations in the drug use careers and drug use patterns of asylum seekers. Drug and alcohol use patterns were found to be often a continuation of standards, values and traditions from the country of origin and four types of drug culture emerged: abstinence, opium, khat and alcohol. Although psychological expectations and cultural background differed, our main finding was a hypothetical causal mechanism where use patterns have a similar function across groups as a means of "killing time". "Killing time" involved countering the psychosocial distress of the asylum-seeking process and uncertainties about the future as well as past trauma. Several possible education and policy interventions were identified. We hypothesise post-migration and cultural expectation factors that continue between the country of origin and the host country are more significant than past trauma in accounting for drug and alcohol use patterns in the asylum seeker population.

Copyright 2005, Elsevier Science

Eckersley W; Salmon R; Gebru M. Khat, driver impairment and road traffic injuries: a view from Ethiopia. (editorial). Bulletin of the World Health Organization 88(3, special issue): 235-236, 2010. (6 refs.)

Copyright 2010, World Health Organization

Falkowski CL. Drug abuse trends in the Minneapolis/St. Paul metropolitan area. IN: Community Epidemiology Work Group, eds. Epidemiologic Trends in Drug Abuse. Volume I: Proceedings of the International Epidemiology Work Group on Drug Abuse. June 1999. Bethesda MD: National Institute on Drug Abuse, 1999. pp. 127-130. (0 refs.)

Cocaine and marijuana prominent positions as illicit drugs of abuse in the Minneapolis/St. Paul metro area, although cocaine overdose deaths decreased in 1998, as did treatment admissions for both cocaine and marijuana. For the fourth consecutive year, marijuana treatment admissions outnumbered those for cocaine, and half of the patients were younger than 18. Marijuana abuse increased among Minnesota youth: in 1998, 30 percent of 12th graders and 24 percent of 9th graders reported past-year marijuana use. As in other midwestern cities, methamphetamine abuse, manufacture, and distribution escalated in 1998. All law enforcement agencies reported substantial growth in the methamphetamine-related activity, and for some metro law enforcement agencies, methamphetamine seizures and arrests surpassed those for cocaine. Dextromethorphan (DXM), gamma-hydroxybutyrate (GHB), ketamine, and khat continued to surface as new, emerging drugs of abuse. Injecting drug use was the soul contributing factor in 12 percent of the adult and adolescent AIDS cases diagnosed in Minnesota in 1998.

Public Domain

Getahun W; Gedif T; Tesfaye F. Regular Khat (Catha edulis) chewing is associated with elevated diastolic blood pressure among adults in Butajira, Ethiopia: A comparative study. BMC Public Health 10: article 390, 2010 , 2010. (33 refs.)

Background: Fresh leaves and buds of the Khat plant (Catha edulis) contain Cathinone, an amphetamine like alkaloid responsible for its pharmacological action. Chewing of Khat has been associated with a transient rise in blood pressure and heart rate in experimental studies. Few studies examined the effect of regular or frequent Khat chewing on blood pressure at the population level. This study was conducted to examine the association of regular Khat chewing with blood pressure among adults. Methods: We compared systolic and diastolic blood pressure of adults 35-65 years of age who reported regular chewing of Khat during the preceding five years to those who never chewed Khat during the same period. Study participants were recruited from purposively selected urban and rural villages of Butajira District in Ethiopia. The comparative groups, chewers (334) and non-chewers (330), were identified from among the general population through a house-to-house visit using a screening questionnaire. They were frequency-matched for sex and age within a five-year range. Data were collected through structured interviews and physical measurements including blood pressure, weight and height. Results: The prevalence of hypertension was significantly higher among Khat chewers (13.4%) than non-chewers (10.7%), odds ratio (OR) = 1.66 (95% confidence interval (CI) 1.05, 3.13). A considerably high proportion of chewers (29.9%) than non-chewers (20.6%) had sub-optimal diastolic blood pressure (> 80 mmHg). The mean (sd) diastolic blood pressure was significantly higher among Khat chewers [75.0 (11.6)] than non-chewers [72.9 (11.7)], P < 0.05. Similarly, Khat chewers had significantly higher mean (sd) heart rate [76.3 (11.5)] than non-chewers [73.9 (12.6)], P < 0.05. There was no significant difference in mean systolic blood pressure between the two groups. Conclusion: Regular chewing of Khat is associated with elevated mean diastolic blood pressure, which is consistent with the peripheral vasoconstrictor effect of Cathinone. Regular Khat chewing may have sustained effects on the cardiovascular system that can contribute to elevated blood pressure at the population level.

Copyright 2010, BioMed Central Ltd.

Griffiths P; Gossop M; Wickenden S; Dunworth J; Harris K; Lloyd C. A transcultural pattern of drug use: Qat (khat) in the UK. British Journal of Psychiatry 170(3): 281-284, 1997. (12 refs.)

Background: This study investigates patterns of qat use among 207 Somalis living in London. Method: Subjects were recruited using privileged access interviewing. Somalian interviewers were recruited who shared the same culture as the subjects. Data were collected by means of a structured interview. Results: One hundred and sixty-two subjects (78%) had used qat. The majority (76%) used more qat than in Somalia. Some users reported moderate dependence; a minority reported severe problems. Adverse psychological effects included sleep problems, anxiety and depression. Medical problems associated with qat use were rare. Conclusions: Qat users who continue to use this drug when transplanted from a traditional context may experience difficulties. Qat use can also be seen as playing a positive role in supporting the cultural identity of the Somalian community. Severe problems were rarely reported. Qat consumption should be considered when addressing health-related topics with patients from those communities in which qat use is common.

Copyright 1997, Royal Society of Medicine

Griffiths P; Lopez D; Sedefov R; Gallegos A; Hughes B; Noor A et al. Khat use and monitoring drug use in Europe: The current situation and issues for the future. Journal of Ethnopharmacology 132(3, special issue): 578-583, 2010. (26 refs.)

Aim of the study: To review the information available on the use of khat (Catha edulis) in the EU, and to assess the future use of this drug and related substances. Material and methods: Khat is not controlled by international law and it has not been systematically included in the list of illicit drugs monitored in the EU. The current principal source of information on khat use in Europe is the early-warning system set up to monitor new and emerging drugs. Further information was obtained from official national reports to the EMCDDA and from the scientific literature. Results: Across Europe, the use of khat is low. Khat use is limited to countries with immigrant communities from countries where khat use is common (such as Ethiopia, Somalia and Kenya). Information on the prevalence of khat use in the general population is scarce. Data on seizures provide an insight on the situation, though these may be difficult to interpret. The most recent estimates suggest that Europe accounts for about 40% of the khat seized worldwide. Conclusion: The shortage of data on the use and patterns of use of khat in Europe does not allow an evaluation of the needs for health and social interventions in communities in which the drug is used. But seizures of the plant are increasing in the EU, and more synthetic derivatives of the pharmacologically active ingredients of the plant (cathine and cathinone) are appearing on the market. Some of these, like mephedrone, have significant potential for future diffusion, and are likely to play a greater role on the European drug scene of the future.

Elsevier Science

Hassan NA; Gunaid AA; El-Khally FM; Murray-Lyon IM. The effect of chewing Khat leaves on human mood. Saudi Medical Journal 23(7): 850-853, 2002. (24 refs.)

Objective: Chewing fresh leaves of the Khat plant (Catha edulis), represents a widespread habit with a deep-rooted sociocultural tradition in Yemen. Khat is chewed for its central stimulant properties and to dispel feeling of fatigue and its use is believed to be associated with disturbance of mood. We studied the effect of chewing Khat leaves on human mood by using a standard questionnaire method, the Hospital Anxiety and Depression scale. Methods: A prospective study was conducted in the Faculty of Medicine and Health Sciences, University of Sana'a during the period January to June 2000. It comprised of 200 healthy volunteers, interviewed on 2 occasions a week apart. Subjects either chewed Khat at least 3 hours daily for 3 days or abstained from chewing for at least 7 days prior to mood assessment using the Hospital Anxiety and Depression scale. Subjects were studied in random order. Results: Using the Hospital Anxiety and Depression scale, there was a significant increase (P < 0.0001) of median score on the scale indicating mood disturbance during the Khat-arm of the study as compared to the control-arm. The effect was particularly evident shortly after the Khat session. Reactive depression symptoms were predominant. Conclusion: Khat chewing did result in functional mood disorder. This effect is believed to be caused by the sympathomimetic action of cathinone on the central nervous system. The clinical implication of this study is that Khat-chewing might exacerbate symptoms in patients with pre-existing psychiatric disease.

Copyright 2002, Riyadh Al-Kharj Hospital Programme

Hassan NAGM; Gunaid AA; El Khally FMY; Murray-Lyon IM. The subjective effects of chewing Qat leaves in human volunteers. Annals of Saudi Medicine 22(1-2): 34-37, 2002. (14 refs.)

Background: Chewing the leaves of the Qat plant (Catha edulis) for their pleasurable central stimulant effect is a habit that is widespread in Yemen and certain areas of East Africa. The use of the Qat leaves is believed to cause a variety of gastrointestinal and genito-urinary symptoms as well as sleep disturbance. We studied the subjective effects of chewing Qat leaves in human volunteers. Subjects and Methods: This prospective study included 1600 healthy adult male subjects who chewed Qat, and a similar number of 1600 subjects who never chewed Qat serving as control. Subjects in the Qat group chewed Qat for at least four hours daily for three successive days before answering a questionnaire. Results: The study revealed that the prevalence of gastrointestinal (GI) symptoms (epigastric bloating, belching and abdominal distension) and genito-urinary symptoms (weak stream of micturition, post-chewing urethral discharge) were significantly higher (P<0.0001) among Qat-chewing subjects than controls. Similarly, central nervous system (CNS) symptoms such as anorexia, insomnia (delayed bedtime), late wake-up the next morning and low work performance the next day, were significantly higher in Qat chewers (P<0.0001). Stepwise multivariate logistic regression analysis revealed that GI symptoms which were significant in univariate analysis were no longer significant, whereas CNS and genito-urinary symptoms remained significant (P<0.0001). Conclusion: This study confirms that Qat chewing induces anorexia, weak stream of micturition, post-chewing urethral discharge and insomnia (delayed bedtime), which result in late wake-up next morning and low work performance the next day. These effects are believed to be caused by the central and peripheral actions of cathinone and cathine in the Qat leaves.

Copyright 2002, King Faisal Specialist Hospital and Research Centre and King Saud University College of Medicine

Kassim S; Islam S; Croucher RE. Correlates of nicotine dependence in UK resident Yemeni Khat chewers: A cross-sectional study. Nicotine & Tobacco Research 13(12): 1240-1249, 2011. (73 refs.)

Khat chewing is often associated with tobacco use with impacts on health. This cross-sectional study aimed (a) to explore and validate aspects of self-reported tobacco smoking and whether objective measures of tobacco smoking differ in different situations among khat chewers who smoked and (b) to assess the social factors correlated with nicotine dependence among khat chewers who smoked regularly. This study recruited a purposive sample of 204 U.K. resident Yemeni khat chewers during random visits to Khat sale outlets. Data were collected via a face-to-face scheduled interview. Data analyses included descriptive tests and a hierarchical linear multiple regression. Of 133 self-reported tobacco smokers, 68% were regular smokers with a mean (SD) carbon monoxide (CO) score (20.53 +/- 12.12 ppm) and 32% were episodic smokers with a mean (SD) CO score (16 +/- 15.66 ppm). Tobacco smoking as an enhancement of the impacts of khat chewing was reported by 65% and 69% of regular and episodic smokers, respectively. In both groups, higher CO scores were recorded during khat chewing. Hierarchical linear multiple regression modeling showed that increases in levels of severity of dependence on khat chewing were correlated positively with increase in levels of nicotine dependence (beta = .27, p = .006, 95% CI = 0.05, 0.29), whereas social participation was correlated inversely (beta = -.34, p = .001, 95% CI = -0.06, -0.02). In this study, smoking prevalence was high. Smoking increased during khat chewing. Nicotine dependence levels correlated positively with khat dependence levels, while higher social participation reduced nicotine dependence.

Copyright 2011, Oxford University Press

Kebede D; Alem A; Mitike G; Enquselassie F; Berhane F; Abebe Y et al. Khat and alcohol use and risky sex behaviour among in-school and out-of-school youth in Ethiopia. BMC Public Health 5: ar109, 2005. (34 refs.)

Background: Khat (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. Methods: A 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. Results: Over 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). Conclusion: A 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.

Copyright 2005, Biomedical Central Ltd.

Kelly JP. Cathinone derivatives: A review of their chemistry, pharmacology and toxicology. (review). Drug Testing and Analysis 3(7-8, special issue): 439-453, 2011. (164 refs.)

The purpose of this review is to evaluate what is currently known about the pharmacology of cathinone derivatives. Cathinone is the principal active constituent of khat responsible for the stimulant effects that have led khat to be known as a 'natural amphetamine'. Synthetic derivatives have been abused for their amphetamine-like stimulant effects, most notably methylone, methcathinone (ephedrone), and 4-methlymethcathinone (mephedrone). To date, cathinone and methcathinone have been studied most, demonstrating amphetamine-like effects in a range of in vitro and in vivo investigations, albeit less potently than amphetamines. In humans, cathinone derivatives are usually administered orally, and in some cases by insufflation. Methcathinone has a longer history of abuse, being produced from readily available starting materials, and administered by injection. Mephedrone has become the best publicised cathinone derivative, amid considerable media and public concern about its legal status, its ready availability, and reports of serious toxicity and deaths following its use. As a consequence, there has been a clampdown on cathinone derivatives, dramatically changing their legal status in a number of countries. However, little objective evidence-based comparative experiments have been conducted to date between these compounds and their related amphetamines in order to make clear risk judgements. Such assessments have largely been predictive in nature, based on their structural similarity to amphetamines. It can be assumed that, despite their illegal status, cathinone-related compounds will continue to be prevalent drugs of abuse for the foreseeable future.

Copyright 2011, Wiley-Blackwell

Klein A. Khat deaths - or the social construction of a non-existent problem? A response to Corkery et al. 'Bundle of fun' or 'bunch of problems'? Case series of khat-related deaths in the UK. (editorial). Drugs: Education, Prevention and Policy 18(6, special issue): 426-427, 2011. (9 refs.)

Khat is a benign substance with an excellent medical safety record. The paper by Corkery et al. seeks to present it as a 'killer drug' but can only do so by redefining the term drug related deaths from one of causality to a loose association. In the process, scientific rigour is sacrificed and both the evidence on khat use as a cause of harm, and khat as a culturally integrated psychoactive substance, are grossly misrepresented

Copyright 2011, Taylor & Francis

Klein A; Beckerleg S; Hailu D. Regulating khat: Dilemmas and opportunities for the international drug control system. International Journal of Drug Policy 20(6, Special Issue): 509-513, 2009. (27 refs.)

Background: The regulation of khat, one of the most recent psychoactive drugs to become a globally traded commodity, remains hotly contested within different producer and consumer countries. As regimes vary, it has been possible to compare khat policies in Africa, Europe and North America from different disciplinary perspectives. Methods: Field research was conducted in East Africa and Europe, using a combination of semistructured interviews, participant observation and the analysis of trade statistics. Results: The research established the significance of khat for rural producers, regional economies, as a tax base and source of foreign exchange. At the same time, khat as a psychoactive substance is associated with health and public safety problems that in turn are met with often ill-informed legislative responses. Bans have in turn lead to the criminalisation of users and sellers and illegal drug markets. Conclusion: The empirical work from Africa provides a strong argument for promoting evidence-based approaches to khat regulation, harnessing the positive aspects of the khat economy to develop a control model that incorporates the voices and respects the needs of rural producers. Ultimately, the framework for khat may provide both a model and an opportunity for revising the international treaties governing the control of other plant psychoactive-based substances.

Copyright 2009, Elsevier Science

Kroll J; Yusuf AI; Fujiwara K. Psychoses, PTSD, and depression in Somali refugees in Minnesota. Social Psychiatry and Psychiatric Epidemiology 46(6): 481- 493, 2011. (57 refs.)

Introduction: Initial clinical observation of Somali patients seen at a busy inner-city community clinic (CUHCC) suggested that, in addition to the expected pictures of Posttraumatic Stress Disorder (PTSD) and depression previously seen in the clinic's Southeast Asian refugee population from 1980 to 2000, there was an unusually high number of young Somali men presenting with acute psychotic disturbances. Objectives The aim of this study of health care utilization of Somali refugees (N = 600) seen in the mental health unit of the clinic from 2001 to 2009 was to investigate the major patterns of psychiatric disorders in this outpatient population and compare these findings with a cohort of non-Somali patients (N = 3,009) seen at the same outpatient clinic during the years 2007-2009. If the results supported the initial clinical observations that the rate of psychoses was higher among young Somali men than non-Somali men attending CUHCC clinic, then several areas of further research would recommend itself. First, since this study was not a study of prevalence of mental illness in the Somali community, the next step would be to undertake a study of community prevalence of mental illness among different age and gender cohorts. Second, further research should look into likely causative and contributory risk factors to explain the development of psychoses among Somali young men. Methods: Somali and non-Somali patients were diagnosed according to DSM-IV-R criteria. Main outcome measures (diagnoses, age cohort, sex) were analyzed by Chi-square tests. Patterns of illness and adjustment varied significantly by age and gender cohorts, reflecting the relevance of age and gender at time of trauma on different trauma and loss experiences and cultural and religious shaping of subsequent adjustment and symptoms. Results: The study confirmed that almost half of the Somali male patients are under age 30, 80% of whom presented with psychoses, compared with the rate of psychosis (13.7%) in the non-Somali control group of same-aged males at the clinic. The older male, and the majority of Somali female patients, show predominantly depressive and PTSD symptomatology. Conclusions: War trauma experienced in childhood, early malnutrition from famines, head trauma, and excess Khat use in male adolescents provide partial explanations for the large number of young psychotic Somali men seen in the clinic from 2001 to 2009.

Copyright 2011, Springer

Lamina S. Khat (catha edulis): The herb with officio-legal, socio-cultural and economic uncertainty. (review). South African Journal of Science 106(3-4): 28-31, 2010. (51 refs.)

Khat (Catha edulis) is a plant of uncertain and highly controversial status grown in the countries around the Red Sea and on the eastern coast of Africa. The chewing of khat leaves has a deep-rooted religious and socio-cultural tradition. Khat is considered a cash crop and its cultivation is a source of economic value to the societies and nations involved. There have, however, been reports of negative economic effects on the individuals engaging in the habit of khat chewing. The increasing use of khat worldwide, along with the negative international attention that this has garnered, has led to the present status of uncertainty of the once indigenous practice of khat chewing. Scientists, mostly western Europeans, have tended to focus on problems related to khat with little attention to the positive role of khat chewing in society and the world at large. In addition, no report has directly associated khat with any organised crime, violence or antisocial activity, particularly in countries where khat is legalised. This paper reviewed the various areas of uncertainty and controversy relating to khat. Based on the findings of the review, further qualitative and quantitative research is required and a positive international approach to khat use at economic, religious and socio-cultural levels is advocated.

Copyright 2010, Academy of Science of South Africa

Laussmann T; Meier-Giebing S. Forensic analysis of hallucinogenic mushrooms and khat (Catha edulis FORSK) using cation-exchange liquid chromatography. Forensic Science International 195(1-3): 160-164, 2010. (17 refs.)

Hallucinogenic mushrooms (e. g. Psilocybe and Panaeolus species) as well as leaves and young shoots of the khat tree (Catha edulis FORSK) are illicit drugs in many countries. The exact concentration of the hallucinogenic alkaloids psilocin and psilocybin in mushrooms and the sympathomimetic alkaloids cathinone and cathine in khat is usually essential for jurisdiction. Facing an increasing number of mushroom and khat seizures by German customs authorities, a convenient comprehensive quantitative HPLC method based on cation-exchange liquid chromatography for these rather "exotic'' drugs has been developed which avoids time-consuming multi-step sample preparation or chemical derivatization procedures. Using this method a number of different hallucinogenic fungi species and products that are mainly distributed via the internet have been analysed (dried and fresh Psilocybe cubensis SINGER as well as P. cubensis collected from "grow boxes'', Panaeolus cyanescens BERKELEY AND BROOME and so-called "philosopher stones'' (sclerotia of Psilocybe species)). Highest total amounts of psilocin have been detected in dried P. cyanescens reaching up to 3.00 +/- 0.24 mg per 100 mg. The distribution of khat alkaloids in different parts of the khat shoots has been studied. High concentrations of cathinone have not only been detected in leaves but also in green parts and barks of stalks. Additionally, the sample treatment for fresh mushroom and khat samples has been optimised. Highest amounts of alkaloids were found when fresh material was freeze-dried.

Copyright 2010, Elsevier Science

MacDonald D. Drugs in Southern Africa: An overview. (review). Drugs: Education, Prevention and Policy 3(2): 127-144, 1996. (61 refs.)

This article presents an overview of the availability and supply of various types of drug and patterns of drug use in southern Africa, a region of the developing world currently experiencing a marked period of transition. The socioeconomic diversity and multi-faceted cultural dualism so characteristic of the region are reflected in patterns and levels of drug consumption. While alcohol, both licit and illicit, is still the major drug of abuse, others including methaquolone, solvents, khat and pharmaceuticals are reported to be increasingly abused, and illegal drugs in transit through the regions, such as cocaine and heroine, are more likely to be consumed locally. Available data suggest that the cultivation of cannabis as an export commodity is also increasing. Traditional cultural uses of this drug, however, illustrate the problem of controlling drugs and preventing their abuses within the context of modernizing post-colonial societies. The development of relevant community-led drug prevention strategies, social policies and legislation needs to be attuned to the cultural complexities and socioeconomic realities of rite region, rather than to northern paradigms of drug control based predominantly on legal prohibitionism.

Copyright 1996, Carfax Publishing Co.

Manghi RA; Broers B; Khan R; Benguettat D; Khazaal Y; Zullino DF. Khat use: Lifestyle or addiction? (review). Journal of Psychoactive Drugs 41(1): 1-10, 2009. (131 refs.)

The khat plant contains psychoactive alkaloids with psychostimulant properties, and has been used for centuries as a recreational and religious drug, mainly in some African and Middle Eastern countries. With changing migration patterns, epidemiological and clinical outcomes may have changed. The aim of this article is to review current knowledge on pharmacological, epidemiological and clinical aspects of khat use. Khat use is still highly prevalent in the countries mentioned, and in African and Yemeni emigrant groups. Preclinical and clinical data confirm its addictive potential as well as possible psychological, psychiatric and medical consequences related to stimulant use; however, existing epidemiological studies do not focus on the prevalence of problematic use or dependence. There are no indications of high prevalence of khat use in other cultural and ethnic groups. Data are lacking on possible increased psychotogenic risks when khat is used outside of the original cultural context. As with alcohol use in many countries, khat use can be considered as a lifestyle in some specific countries, covering the spectrum from nonproblematic use to problematic use and dependence. Khat dependence is associated with high morbidity and societal and economical costs.

Copyright 2009, Haight-Ashbury Publishing

Marker P; Krogdahl A. Plasma cell gingivitis apparently related to the use of khat: Report of a case. British Dental Journal 192(6): 311-313, 2002. (15 refs.)

Plasma cell gingivitis (PCG) is characterized by massive infiltration of plasma cells into the subepithelial tissue. It is a rare condition; the cause of which is still not fully understood. A case of PCG is reported in the mandibular gingiva probably caused by chewing khat. This report is the first, as far as we know, that relates PCG to the use of khat. The histological examination revealed infiltration of polyclonal plasma cells without signs of fungus, tuberculosis or malignancy. It is concluded that the changes were compatible with an allergic-like reaction. The patient, a 30-year-old immigrant from Somalia, revealed in a subsequent consultation that he regularly used khat. The leaves are placed in the buccal sulcus. The PCG disappeared within two weeks of the use of khat being discontinued. Dental surgeons (periodontists) in Europe and the New World will, due to increasing immigration from Africa and the Arabian Peninsula, meet more patients who regularly use khat. This means that PCG and other khat related intraoral changes will become more common in the future.

Copyright 2002, British Dental Association

Mateen FJ; Cascino GD. Khat chewing: A smokeless gun? (editorial). Mayo Clinic Proceedings 85(11): 971-973, 2010. (23 refs.)

Nabuzoka D; Badhadhe FA. Use and perceptions of Khat among young Somalis in a UK city. Addiction Research 8(1): 5-26, 2000. ( 21 refs.)

This study examined patterns of use, perceptions, associated effects and problems of using Khat by a sample of young Somalis (N=94) in Sheffield, UK. Findings indicate that khat chewing has a social dimension, occupies a significant proportion of one's time and may be associated with other drugs. Most respondents considered khat to be a problem among Somalis with some negative health and social effects but rationalised usage citing personal pressures, socio-cultural and emotional problems faced as a result of dislocation from the country of origin, and need for recreation. Social intervention including counselling, health education and advice about khat was seen as necessary. It is suggested that excessive khat consumption among Somalis in UK should be seen in the wider context of a people dislocated from their country of origin as facilitating a deviant pattern of drug abuse. The findings are preliminary but have implications for future research and intervention.

Copyright 2000, Harwood Academic Publishers GmbH

Ndetei DM. Dental complications of chewing khat. (editorial). Substance Abuse 31(1): 74-75, 2010. (0 refs.)

Nielen RJ; van der Heijden FMMA; Tuinier S; Verhoeven WMA. Khat and mushrooms associated with psychosis. World Journal of Biological Psychiatry 5(1): 49-53, 2004. (41 refs.)

Objective: This paper describes two cases with khat- and two with psilocybin-induced psychoses and draws attention to the medical and social consequences of the use of these drugs. Method: Two male patients are presented who developed relapsing and short-lasting psychotic episodes after chewing khat leaves. In addition, two male patients are reported who showed an acute exacerbation of psychosis after ingestion of psilocybin mushrooms. In addition, a review of the literature is presented. Results: The khat-induced psychotic symptoms disappeared without any treatment within one week. One of the patients with a psilocybin-induced psychosis was treated with risperidone. In the other, symptomatology subsided in a few days. No somatic medical complications occurred. Conclusion: Adequate psychiatric diagnosis and treatment of the psychoses and the negative social consequences of the use of these drugs are stressed as well as the delineation from functional psychoses in cases of chronic use. The latter applies to patients with psychiatric comorbidity in particular.

Copyright 2004, World Federation of Socbiological Psychiatry

Numan N. Exploration of adverse psychological symptoms in Yemeni khat users by the Symptoms Checklist-90 (SCL-90). Addiction 99(1): 61-65, 2004. (46 refs.)

Aim: The present study was aimed at assessing associations between psychological symptoms and khat use in the Yemeni population. Setting: The survey was performed in 2000/2001, in different zones including three urban and three rural areas. Participants: The survey was carried out in 800 Yemeni adults (15-76), both male and female, representing mainly urban populations of students, state employees and housewives. Design: A cross-sectional survey was undertaken using face-to-face interviews and no preset selection criteria regarding profession, socio-economic status, age or gender. Measurement: The Symptoms Checklist-90 (SCL-90) was used containing 90 items, which cover nine scales of the following domains: somatization, depression, anxiety, phobia, hostility, interpersonal sensitivity, obsessive-compulsive, hostility, interpersonal sensitivity, paranoia and psychoticism. Details of khat use and socio-demographic data were also collected. Findings: At least one life-time episode of khat use was reported in 81.6% of men and 43.3% of women. Male users tended to use more frequently. The incidence of adverse psychological symptoms was not greater in khat users; in fact, there was a negative association between the incidence of phobic symptoms and khat use. Conclusions: Khat use is very common in the Yemeni population, particularly men, but it is not associated with adverse psychological symptoms.

Copyright 2004, Society for the Study of Addiction to Alcohol and Other Drugs

Odejide AO. Status of drug use/abuse in Africa: A review. International Journal of Mental Health and Addiction 4(2): 87-102, 2006. (51 refs.)

The history of psychoactive substance use in Africa is relatively short except for the reports on the use of traditional substances such as alcohol, cannabis and khat. The introduction of prescription drugs to Africa drastically increased the availability and use of psychoactive substances. This notwithstanding, alcohol, cannabis and khat still remain the most common substances of abuse in Africa. More recently, trafficking in heroin and cocaine has made narcotic drugs easily available across Africa despite the existing legal control measures. Complications arising from the use/abuse of psychoactive substances often draw public attention to their deleterious effects, which culminate in drug control policy formulation. This paper highlights the contribution of poverty, political instability, social unrest and refugee problems to the rapid spread of psychoactive substance use/abuse in Africa particularly among the youth. The review also points to a possible linkage between psychoactive drug use and HIV infection. At present in Africa, systematic evidence-based drug information is sparse. Also, drug policies are skewed towards formal control measures that may not encourage community participation. Poor funding, insufficient skilled health personnel, poor laboratory facilities, inadequate treatment facilities, and lack of political will are some of the impediments to controlling substance use/abuse in Africa. The paper argues that well-coordinated civil society participation is necessary in the control of drug problems in Africa in order to achieve a balance between supply and demand reduction efforts.

Copyright 2006, Springer

Odenwald M; Hinkel H; Schauer E; Neuner F; Schauer M; Elbert TR et al. The consumption of khat and other drugs in Somali combatants: A cross-sectional study. PLoS Medicine 4(12): 1959-1972, 2007. (74 refs.)

Background: For more than a decade, most parts of Somalia have not been under the control of any type of government. This "failure of state'' is complete in the central and southern regions and most apparent in Mogadishu, which had been for a long period in the hands of warlords deploying their private militias in a battle for resources. In contrast, the northern part of Somalia has had relatively stable control under regional administrations, which are, however, not internationally recognized. The present study provides information about drug abuse among active security personnel and militia with an emphasis on regional differences in relation to the lack of central governmental control-to our knowledge the first account on this topic. Methods and Findings Trained local interviewers conducted a total of 8,723 interviews of armed personnel in seven convenience samples in different regions of Somalia; 587 (6.3%) respondents discontinued the interview and 12 (0.001%) were excluded for other reasons. We assessed basic sociodemographic information, self-reported khat use, and how respondents perceived the use of khat, cannabis (which includes both hashish and marijuana), psychoactive tablets (e. g., benzodiazepines), alcohol, solvents, and hemp seeds in their units. The cautious interpretation of our data suggest that sociodemographic characteristics and drug use among military personnel differ substantially between northern and southern/central Somalia. In total, 36.4% (99% confidence interval [CI] 19.3%-57.7%) of respondents reported khat use in the week before the interview, whereas in some regions of southern/central Somalia khat use, especially excessive use, was reported more frequently. Self-reported khat use differed substantially from the perceived use in units. According to the perception of respondents, the most frequent form of drug use is khat chewing (on average, 70.1% in previous week, 99% CI 63.6%-76.5%), followed by smoking cannabis (10.7%, 99% CI 0%-30.4%), ingesting psychoactive tablets (8.5%, 99% CI 0%-24.4%), drinking alcohol (5.3%, 99% CI 0%-13.8%), inhaling solvents (1.8%, 99% CI 0%-5.1%), and eating hemp seeds (0.6%, 99% CI 0%-2.0%). Perceived use of khat differs little between northern and southern Somalia, but perceived use of other drugs reaches alarmingly high levels in some regions of the south, especially related to smoking cannabis and using psychoactive tablets. Conclusions: Our data suggest that drug use has quantitatively and qualitatively changed over the course of conflicts in southern Somalia, as current patterns are in contrast to traditional use. Although future studies using random sampling methods need to confirm our results, we hypothesize that drug-related problems of armed staff and other vulnerable groups in southern Somalia has reached proportions formerly unknown to the country, especially as we believe that any biases in our data would lead to an underestimation of actual drug use. We recommend that future disarmament, demobilization, and reintegration (DDR) programs need to be prepared to deal with significant drug-related problems in Somalia.

Copyright 2007, Public Library Science

Osman FA; Soderback M. Perceptions of the use of khat among Somali immigrants living in Swedish society. Scandinavian Journal of Public Health 39(2): 212-219, 2011. (30 refs.)

Aims: The aim of this study was to gain a better understanding of Somali immigrants' perceptions of the use of khat when living in Swedish society. Using khat is illegal in Sweden. Methods: A phenomenographic design was used to capture different perception of using khat. Fourteen interviews were conducted with both men and women. The information was subjected to phenomenographic analysis. Results: Perceptions of the habit of chewing khat among Somalis living in Sweden vary. The use of khat is perceived as a kind of food or as a drug. To use khat is perceived as having a physical impact on individual health, as well as an impact on social and family life. Using khat also has an impact on people's time, because time is needed to indulge the habit. Furthermore, using khat is perceived as a medium for cultural and community cohesiveness. The Somalis preferred preventive measures in place to counter the use of khat in Sweden. Conclusions: The use of a phenomenographic design which captured the variation in perceptions of the habit of using khat among Somali immigrants' living in Swedish society is helpful in guiding individual strategies in health promotion activities.

Copyright 2011, Sage Publications

Patel NB. Mechanism of action of cathinone: The active ingredient of khat (Catha edulis). East African Medical Journal 77(6): 329-332, 2000. (28 refs.)

Objective: To review the current understanding of the mechanism of action of cathinone, the active ingredient of khat, Data source: Published experimental studies on the nature and action and effect of cathinone on the central nervous system both in animals and humans, Data extraction: Data was taken from work published on the mechanism of action of cathinone and also from work where the action of cathinone and amphetamine was compared. Data synthesis: Data from various studies on cathinone was compared for common themes with regards to its action and similarity with the known mechanism of action of amphetamine. Conclusion: The experimental work shows that cathinone is a liable substance, structually related to amphetamine, and similarly to amphetamine, increases the levels of dopamine in the brain by acting on the cathecholaminergic synaspes, Hence the psychostimulant effect of khat can be accounted for by the mechanism of cathinone, which is considered to be its main active ingredient.

Copyright 2000, Medical Association of East Africa

Rassool GH. An overview of psychoactive drugs. IN: Rassool GH, ed. Substance Use and Misuse: Nature, Context and Clinical Interventions. London: Blackwell Science, 1998. pp. 38-53. (6 refs.)

This chapter in a textbook for nurses offers an overview of the nature and effects of psychoactive substances. The chapter is organized by drug class --- opiates, cannabis, stimulants, hypnosedatives, hallucinogens, ecstasy, anabolic steroids, inhalants, over-the-counter preparations, as well as khat, ketamine, GHB. There is a brief description of each drug, its therapeutic and illicit uses, legal status, acute and chronic effects.

Copyright 1998, Blackwell Science

Royal Canadian Mounted Police. Drug Situation Report 2005. Ottawa: Royal Canadian Mounted Police, 2006. (0 refs.)

This report deals provides a strategic overview of the illicit drug trade in Canada. Separate sections are directed to cocaine, heroin, opium, cannabis derivatives, ecstasy/MDMA, methamphetamine, other synthetic drugs (ketamine and GHB, and other controlled drugs), khat. It also includes a section on precursor chemicals, concludes with a summary of drug offenses. Drug seizure data is provided in an appendix. For each of the sections on drugs, key findings related to the substances are outlined, along with the level of demand, the drug source, the means of smuggling, trafficking patterns within the country, and major seizures.

Copyright 2007, Project Cork

Scheifele C; Nassar A; Reichart PA. Prevalence of oral cancer and potentially malignant lesions among shammah users in Yemen. Oral Oncology 43(1): 42-50, 2007. (32 refs.)

The purpose of this study was to assess the prevalence of oral precancerous lesions and squamous cell carcinoma (OSCC) in Yemeni users of shammah, a traditional smokeless tobacco habit known in the Arabian Peninsula. The study group comprised 199 male and one female shammah users who were interviewed via a standardised questionnaire and clinically examined in 48 Yemeni villages and cities. Cases with oral leukoplakia (OL) or mucosal burns (MB) were compared with users without any lesion. MB were detected in 31%, of which 46.8% were located on the tongue or floor of the mouth, and OL in 27%, of which 59.2% were located in the same region. In addition, two cases (1%) of apparent OSCC were identified. Statistically significant increased OR (95% CI) of OL were (a) 6.91 (2.66-17.95) for an average duration of the respective shammah application > 5 min.; (b) 4.90 (1.99-12.08) for a daily frequency of those applications > 10; and (c) 4.22 (1.43-12.43) for a daily duration > 6 h of chewing qat, also a traditional habit in Yemen. Likewise, decreased OR were (a) 0.39 (0.18-0.85) for rinsing the mouth after the shammah application; (b) 0.36 (0.17-0.78) for successful attempts to stop the use in the past; and (c) 0.26 (0.09-0.72) for existing knowledge about the carcinogenicity of shammah that was present in only 19% overall. In conclusion, evidence was shown for a significant association between the prevalence of OL and the daily duration of shammah application in a dose-dependent manner. An appropriate public health program might help to reduce this potential OSCC burden in shammah users.

Copyright 2007, Elsevier Science

Singleton N. Crying wolf? A response to Corkery et al. 'Bundle of fun' or 'bunch of problems'? Case series of khat-related deaths in the UK. (editorial). Drugs: Education, Prevention and Policy 18(6, special issue): 428-430, 2011. (6 refs.)

Stevenson M; Fitzgerald J; Banwell C. Chewing as a social act: Cultural displacement and khat consumption in East African communities of Melbourne. Drug and Alcohol Review 15(1): 73-82, 1996. (19 refs.)

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.

Copyright 1996, Australian Medical and Professional Society on Alcohol and Other Drugs

Teferra S; Hanlon C; Alem A; Jacobsson L; Shibre T. Khat chewing in persons with severe mental illness in Ethiopia: A qualitative study exploring perspectives of patients and caregivers. Transcultural Psychiatry 48(4): 455-472, 2011. (27 refs.)

People with severe mental illness (SMI) in Ethiopia chew khat despite advice from their physicians to desist. We wanted to better understand their reasons for khat chewing, including any benefits that they might gain. A qualitative study was conducted involving patients with SMI and their caregivers in Butajira. Reasons given by patients as well as caregivers were more or less congruent: social pressure, a means for survival by improving function, combating medication side effects, to experience pleasure and curbing appetite. These findings will be of value to health workers, caregivers and policymakers alike in improving care and understanding for this patient group. Furthermore, our study indicates a role for future research to explore potentially beneficial effects of khat in this population.

Copyright 2011, Sage Publications

Thickett A. Khat use - What direction for policy? (editorial). Drugs: Education, Prevention and Policy 18(6, special issue): 405-407, 2011. (13 refs.)

Ageely HM. Prevalence of khat chewing in college and secondary (high) school students of Jazan region, Saudi Arabia. Harm Reduction Journal 6(11), 2009. (31 refs.)

Background: Khat is widely consumed among the youth of Jazan region of Saudi Arabia. However, its prevalence is not well documented. Objective: This study was conducted to assess the prevalence and associated risk factors of khat chewing among college and secondary school students in Jazan region. Methods: The study was conducted in May 2006 in the colleges and secondary schools in Jazan region. A sample of 10,000 students aged between 15 and 25 years was randomly selected. Students in each year of study were selected by systematic random sampling technique. Self-administered questionnaire was used for data collection. Results: The overall prevalence of khat chewing in all the studied population was 21.4% (colleges 15.2% versus schools 21.5%). There were 3.8% female khat chewers and 37.70% male Khat chewers. Significant differences were found between khat chewers according to age, gender and residence (p < 0.05). The prevalence was different in different colleges and in different provinces of Jazan region. Conclusion: The prevalence of khat chewing seems to be high among male students and not remarkable among female students. The use of khat is significantly associated with age, gender, residence and school and college education (p < 0.05) among students of Jazan region. Strong measures need to be taken for greater awareness among school and college students to reduce its prevalence.

Copyright 2009, BioMed Central

Titeca K. The 'Masai' and miraa: Public authority, vigilance and criminality in a Ugandan border town. Journal of Modern African Studies 47(2): 291-317, 2009. (43 refs.)

Recent studies on vigilante groups show how they often begin as popular schemes for imposing order, before degenerating into violent militias which contribute in turn to social and political disorder. The Masai, a group of khat sellers and consumers in the Ugandan border town of Bwera, represent a more complex case. By using vigilance tactics in the provision of security, the Masai actually help to shape public authority within Bwera town instead of creating institutional chaos. They also provide a range of services, imposing a degree of order on illegal cross-border activities in the area. However, a closer look at the Masai shows that their vigilance activities are mainly performed out of self-interest, as a quid pro quo enabling them to continue their illegal activities of smuggling, general criminality outside town and illegal drug use. Therefore they straddle the 'crime or social order' dynamic, representing a criminal gang of illegal drug traffickers which also provides services for public community interests. As such, they contribute to both order and crime.

Copyright 2009, Cambridge University Press

Toennes SW; Kauert GF. Driving under the influence of khat-alkaloid concentrations and observations in forensic cases. Forensic Science International 140(1): 85-90, 2004. (25 refs.)

The use of the herbal stimulant khat (Catha edulis FORSK) is maintained by immigrants from countries where it is part of their cultural life (Arabian Peninsula and eastern Africa). In western countries the drug and its effects are largely unknown and no experience in evaluating impairment symptoms due to the khat-alkaloids, e.g. cathinone, cathine and norephedrine exists. Blood and urine samples from khat users involved in 19 cases of suspected driving under the influence of drugs were analysed and correlated with the results of medical examination and police officer reports. In 3 cases impaired driving and in 10 cases marked impairment of psychophysical functions was observed such as effects on the nervous system (slow pupil reaction to light, dry mouth, increased heart-rate), trembling, restlessness/nervousness, daze/apathy/dullness, impairment of attention, walking and standing on one leg. However, the alkaloid concentrations assayed in blood did not correlate with the impairment symptoms. Apart from an acute phase of indirect sympathomimetic action the development of habituation and withdrawal symptoms must also be considered in explaining the diversity of effects observed. From these results it can be concluded that chewing khat may severely impair driving ability, but may also be without noticeable effects.

Copyright 2004, Elsevier Science Ireland, Ltd

Toennes SW; Kauert GF. Excretion and detection of cathinone, cathine, and phenylpropanolamine in urine after kath chewing. Clinical Chemistry 48(10): 1715-1719, 2002. (21 refs.)

Introduction: The stimulating herbal drug kath is uncommon in most countries, and information on its detection and interpretation of analytical results is limited. Therefore, a study with kath was carried out to compare the efficiencies of different analytical techniques used to detect drug use. Methods: Four volunteers chewed kath leaves for 1 h; urine samples were collected up to 80 It afterward and analyzed by the Abbott fluorescence polarization immunoassay (FPIA), the Mahsan-AMP300 on- site immunoassay, the Bio-Rad Remedi HS HPLC system with photodiode array detection (DAD), and gas chromatography-mass spectrometry (GC- MS). Results: FPIA gave negative results, whereas positive results were obtained with the Mahsan test during the first day. With HPLC, one peak could be observed up to 50 It, but its DAD spectrum could not be identified by the system. Further investigations indicated that the kath alkaloids coeluted and produced a mixed DAD spectrum. With GC- MS, the specific kath ingredient cathinone was detected up to 26 h, whereas cathine and norephedrine were still detectable in the last samples. Maximum concentrations of cathinone, cathine, and norephedrine in urine samples from the study were 2.5, 20, and 30 mg/L, respectively, whereas in authentic cases the concentrations were much higher. Conclusion: GC-MS is superior to the screening techniques Mahsan- AMP300 and Remedi with respect to specificity and sensitivity for the detection of kath use in urine.

Copyright 2002, American Association for Clinical Chemistry, Inc.

Wedegaertner F; al-Warith H; Hillemacher T; Wildt BT; Schneider U; Bleich S et al. Motives for khat use and abstinence in Yemen - a gender perspective. BMC Public Health 10: e-article 735, 2010. (28 refs.)

Background: Khat consumption is widespread in Yemeni society and causes problems both in economic development and public health. Preventive measures have been largely unsuccessful and the cultivation continues to proliferate. The gender-specific motives for khat use and abstinence were studied to create a toe-hold for more specific interventions. Methods: In a quota sample with equal numbers of males, females, abstainers and consumers, 320 subjects were interviewed on their specific opinions about khat and its impact on subjective and public health, and on social and community functioning. Strata were compared in their acceptance and denial of opinions. Notions that could predict abstinence status or gender were identified with multivariate logistic regression analysis. Results: Male khat users had a strong identification with khat use, while females were more ambivalent. The notion that khat consumption is a bad habit (odds ratio (OR) 3.4; p < 0.001) and consumers are malnuorished (OR 2.2; p = 0.046) were associated with female gender among khat users. Among the females worries about health impact (OR 3.2; p = 0.040) and loss of esteem in the family (OR 3.1; p = 0.048) when using khat predicted abstinence. Male abstainers opposed khat users in the belief that khat is the cause of social problems (OR 5.1, p < 0.001). Logistic regression reached an accuracy of 75 and 73% for the prediction of abstinence and 71% for gender among consumers. (All models p < 0.001.) Conclusions: Distinct beliefs allow a differentiation between males, females, khat users and abstainers when targeting preventive measures. In accordance to their specific values female khat users are most ambivalent towards their habit. Positive opinions scored lower than expected in the consumers. This finding creates a strong toe-hold for gender-specific public health interventions.

Copyright 2010, BioMed Central

WHO Expert Committee on Drug Dependence. WHO Expert Committee on Drug Dependence. Thirty-Third Report by WHO. Geneva Switzerland: World Health Organization, 2003. (14 refs.)

This report provides an overview of the review criteria for scheduling, essentially established in 1961, that serve as a classification schema for psychoactive substance. It then provides a critical review of amfepramone; amineptine; buprenorphine, delta-9-tetrahydrocannabinol, and tramadol. It also offers a "pre-review" of ketamine, zaleplon, zopiclone, butorphanol; oripavine; and khat. For each of these there is summary of pharmacology, therapeutic use, abuse potential, similarity to known substances and effects on the central nervous system.

Copyright 2003, Project Cork

Zaghloul A; Abdalla A; El Gammal H; Moselhy H. The consequences of khat use: A review of literature. (review). European Journal of Psychiatry 17(2): 77-86, 2003. (42 refs.)

Khat is an evergreen tree, which grows in certain areas of East Africa and the Arabian Peninsula. The leaves of the khat have stimulating effect, and therefore chewed habitually by many people living in the area where it grows. Due to the availability of air transport, this drug has made its appearance in Western Europe and in the USA. In this article we will review all the issues related to khat consequences and its use and abuse in different areas of the world.

Copyright 2003, European Journal of Psychiatry, Inc