Khat (Catha edulis)-an updated review

Here today, gone tomorrow…and back again? A review of herbal marijuana alternatives (K2, Spice), synthetic cathinones (bath salts), kratom, Salvia divinorum, methoxetamine, and piperazines

Despite their widespread Internet availability and use, many of the new drugs of abuse remain unfamiliar to health care providers. The herbal marijuana alternatives, like K2 or Spice, are a group of herbal blends that contain a mixture of plant matter in addition to chemical grade synthetic cannabinoids. The synthetic cathinones, commonly called "bath salts," have resulted in nationwide emergency department visits for severe agitation, sympathomimetic toxicity, and death. Kratom, a plant product derived from Mitragyna speciosa Korth, has opioid-like effects, and has been used for the treatment of chronic pain and amelioration of opioid-withdrawal symptoms. Salvia divinorum is a hallucinogen with unique pharmacology that has therapeutic potential but has been banned in many states due to concerns regarding its psychiatric effects. Methoxetamine has recently become available via the Internet and is marked as "legal ketamine." Moreover, the piperazine derivatives, a class of amphetamine-like compounds that includes BZP and TMFPP, are making a resurgence as "legal Ecstasy." These psychoactives are available via the Internet, frequently legal, and often perceived as safe by the public. Unfortunately, these drugs often have adverse effects, which range from minimal to life-threatening. Health care providers must be familiar with these important new classes of drugs. This paper discusses the background, pharmacology, clinical effects, detection, and management of synthetic cannabinoid, synthetic cathinone, methoxetamine, and piperazine exposures.

The health impacts of khat: a qualitative study among Somali-Australians

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.

Reproductive parameters are differentially altered following subchronic administration of Catha edulis F. (Khat) extract and cathinone in male rats

AIMS OF THE STUDY

Controversy surrounds on the effect of khat, a widely chewed herb for its stimulant effect on sexuality. This study investigated the effect of fresh Catha edulis F. (Khat) extract, synthetic cathinone and vehicle on reproductive parameters, including sexual motivation and performance, serum testosterone and cortisol levels, epididymal sperm count, and histoarchitecture of testis in male rats.

OBJECTIVE

This study investigated the effect of fresh Catha edulis Forsk (Khat, Celastraceae) extract, synthetic cathinone and vehicle on reproductive parameters, including sexual motivation and performance, serum testosterone and cortisol levels, epididymal sperm count, and histoarchitecture of testis in male rats.

MATERIALS AND METHODS

Rats were treated with either Tween 80 (3%, v/v) in water, khat extract (100mg/kg, K100; 200mg/kg, K200; and 300mg/kg, K300 doses) or cathinone (5mg/kg, CAT5) intragastrically for four weeks and subjected to a battery of behavioral tests. Three days following the last administration, blood was drawn for hormonal analysis and the animals were sacrificed for sperm count and morphologic-pathology studies.

RESULTS

K100 significantly decreased mount latency (ML) (p<0.05) and intromission latency (IL) (p<0.01) compared to controls. K200 whilst significantly reduced IL (p<0.01) and intromission frequency (IF) (p<0.01), increased postejaculatory latency (PEL) (p<0.01). K300 significantly reduced IF (p<0.01) and ejaculatory latency (EL) (p<0.01), but increased mount frequency (MF), IL, PEL, and ML (p<0.01, in all cases). With CAT5, MF (p<0.05) and IL (p<0.01) were significantly greater but EL and IF were lower (p<0.05, in both cases) than controls. Serum levels of testosterone were doubled in K100 (p<0.01), but a significant decrease was recorded in both K200 (18%, p<0.01) and K300 (50%, p<0.01) rats. Whereas K100 did not have any effect on cortisol levels, K200 and K300 significantly increased by 83% (p<0.05) and 164.5% (p<0.01), respectively. CAT5 affected neither serum testosterone nor cortisol levels. Khat extract demonstrated a dose-dependent decline in epididymal sperm count: 50% with K100 (p<0.05), 78% with K200 (p<0.01) and 89% with K300 (p<0.01). CAT5 did not, however, produce any significant change in sperm count. Khat extract and cathinone did not produce any discernible damage on testis.

CONCLUSION

Mild dose of khat improves sexual motivation, without much effect on performance. With increasing dose, however, both motivation and performance are reduced. Although testosterone levels correlated well with motivation, there was dissociation with sperm count, indicating optimum level might be required for normal spermatogenesis.

The impact of khat use on East African communities in Melbourne: a preliminary investigation

INTRODUCTION AND AIMS

Catha Edulis Forsk (khat) is a plant-reported to have a stimulant effect similar to that of amphetamines-grown and used by eastern African communities worldwide. Khat can be legally consumed in many parts of the world, including Victoria, Australia. Recent concerns have been raised about the social and economic impacts of khat consumption among Victoria's East African community members. This study explores khat use and the social impact it has on East African families and communities in Melbourne, Australia.

DESIGN AND METHODS

Focus groups and individual interviews were conducted in 2009 with 29 members of Melbourne's East African community recruited via community leaders and snowball sampling. Fifty-five per cent of the sample reported khat use and the remainder reported only having experience of other people's use of the drug.

RESULTS

Participants who did not report chewing khat were mainly concerned with the negative social impacts of its use, such as the extended time men spent away from their families while consuming the drug. These participants (mainly women) expressed their hope that khat would be prohibited in Victoria. Participants who reported the use of khat (mainly men) reported that any social problems existed independently of khat consumption.

DISCUSSION AND CONCLUSIONS

This study found only limited evidence that khat use has been impacting directly on people's health and well-being. Any moves to prohibit khat use may further marginalise already vulnerable groups of people.

Khat Use and Trait Anger: Effects on Affect Regulation during an Acute Stressful Challenge

Khat (Catha edulis) is a widely used stimulating drug often consumed in daily routine in Yemen and East African countries. Chewing khat acutely elicits states of euphoria and feelings of well-being which later shift into emotional instability and low mood. Little is known about emotional regulation in habitual khat chewers. In this study, we compared self-reports on trait anger as well as positive and negative affect responses to a mental arithmetic challenge. Participants included 135 men and women from Yemen who chew khat regularly, occasionally or not at all. Participants attended a laboratory session that involved resting periods and performing a math challenge. Analyses of variance and regression show that regular khat chewing is associated with higher trait anger, more pronounced negative responses during stress and less pronounced positive emotional states. These results suggest that regular khat chewing is associated with disturbances in emotion regulation processes.

Effect of khat chewing on periodontal pathogens in subgingival biofilm from chronic periodontitis patients

AIMS

Existing in vitro and in vivo data suggest that khat may have a favorable effect on periodontal microbiota. The purpose of this study was to assess the effect of khat chewing on major periodontal pathogens in subgingival plaque samples from subjects with chronic periodontitis.

MATERIALS AND METHODS

40 subgingival plaque samples were obtained from periodontitis and healthy sites of 10 khat chewers (40 y median age) and 10 khat non-chewers (37.5 y median age) with chronic periodontitis. Absolute and relative counts of 6 periodontal pathogens were determined in each sample using highly sensitive and specific Taqman real-time PCR assays. Data were analyzed using an ordinal regression model.

RESULTS

Significantly more total bacteria were detected in samples from the periodontitis sites of the khat chewers (OR=20). Treponema denticola was present at significantly higher absolute counts at the healthy as well as periodontitis sites of the khat chewers (OR=3.13 and 13, respectively). However, the khat chewers harbored significantly lower absolute counts of Porphyromonas gingivalis at the healthy sites (OR=0.07). Furthermore, khat chewing was significantly associated with lower relative counts of Porphyromonas gingivalis, fusobacterium ssp., prevotella ssp. and Parvimonas micra-like species in subgingival plaque samples from both healthy and periodontitis sites (OR=0.11-0.33). Only Treponema denticola was found in higher relative counts at the healthy sites of the khat chewers (OR=2.98).

CONCLUSIONS

Overall, there was a lower burden of pathogens in the khat chewers. Findings from the current study are suggestive of a potential prebiotic effect for khat on periodontal microbiota.

Concurrent sexual and substance-use risk behaviours among female sex workers in Kenya's Coast Province: findings from a behavioural monitoring survey

While many studies confirm the association between HIV, alcohol and injecting drug use by female sex workers (FSWs), little is known about their use of marijuana, khat and other substances and the association of these substances with HIV, risky sexual behaviour, and sexual violence. To better understand this association, data were analysed from a cross-sectional, behavioural survey of 297 FSWs in Mombasa, a well-known tourist destination and the second largest port in Africa and capital city of the Coast Province in Kenya. Among the FSWs, lifetime use of different substances was reported by 91% for alcohol, 71% for khat, 34% for marijuana, and 6% for heroin, cocaine, glue or petrol. The majority (79%) used more than one substance, and multiple-substance use was reported by all respondents who ever used marijuana, heroin, cocaine, glue and petrol. The risk of HIV acquisition was perceived as medium to high by 41% of respondents, 75% of whom attributed this risk to multiple partners. Sexual violence was reported by 48% of respondents, and 30% indicated that this happened several times. Despite HIV prevention programmes targeting FSWs in Mombasa, most of them continue to engage in risky sexual behaviours. This suggests that harm reduction strategies for substance use should be coupled with efforts to promote consistent condom use and partner reduction.

Concentration levels of essential and non-essential metals in Ethiopian khat (Catha edulis Forsk)

The levels of essential (Ca, Mg, Mn, Fe, Zn, Cr, Cu, and Co) and non-essential (Cd and Pb) metal in six different varieties of Ethiopian khat (Catha edulis Forsk, an evergreen stimulant plant) commonly consumed in the country and exported to the neighboring countries were determined by flame atomic absorption spectrometry. Known weight of oven-dried khat samples were wet-digested using 2 mL of (69-72%) HNO(3) and 2 mL of (70%) HClO(4) for 2 h and 30 min at variable temperature (120-270°C). The mineral contents in the digests were analyzed using flame atomic absorption spectrometer. The following concentrations ranges in fresh-weight basis were recorded in decreasing order: Ca (1,038-2,173 µg/g) > Mg (478.2-812.3 µg/g) > Fe (53.95-82.83 µg/g) >Zn (5.18-9.40 µg/g) >Mn (6.98-8.66 µg/g) >Cu (1.85-5.53 µg/g) > Cr (0.66-3.47 µg/g) >Co (0.41-0.80 µg/g). A wide variation in the mineral contents of khat from different region of Ethiopia was noticed. The toxic metals (Pb and Cd) were not detected in all the samples analyzed.

Cytological study of exfoliative buccal mucosal cells of Qat chewers in Yemen

Prevalence of oral cancer is relatively increasing in Yemen in recent years, which is ascribed to Qat with other carcinogens. Since the establishment of a simple and reliable method for the detection of oral cancerous and precancerous lesions is essential, exfoliative cytology (EC) was applied to a case-control study to appraise the presence and severity of oral epithelial atypia in 300 subjects (150 were Qat chewers and 150 were non-Qat users) without prior knowledge of the subjects' Qat exposure. Ten patients with oral squamous-cell carcinoma (OSCC) were included as internal controls. Cytological atypia and hyperkeratosis were demonstrated in six and 24 subjects, respectively, and could not be ascertained in the remaining 294 and 276 correspondingly. All of the 30 (six atypia and 24 hyperkeratosis) were among the 150 Qat chewers. Cytological atypia was found in all the 10 control cases with OSCCs (eight with severe degree and two with mild atypia). For the Qat among those with atypia and hyperkeratosis, the adjusted OR and the 95% confidence level were found to be 1.6 (0.8-7.2) and 3 (10.1-21.9), respectively. In view of these findings, we suggest the use of EC for detection and assessment of oral cytological atypia. Qat use contributes to the occurrence of cytological atypia that might develop to oral precancerous or cancerous lesions.

Oral health status and treatment needs among school children in Sana'a City, Yemen

Data on the oral health status and treatment needs among Yemeni children are lacking.

OBJECTIVES

To assess caries prevalence, treatment needs and gingival health status among school children in Sana'a City and to examine how these are affected by age, gender and khat chewing.

METHODS

1489 children (6- to 14-year old) were randomly selected from 27 schools representing all nine districts of Sana'a City. Dental caries and treatment needs were evaluated using standard WHO oral survey methods. The plaque index (PI), calculus index (CI) and the gingival index (GI), recorded at the six Ramfjord's teeth, were used to assess gingival health status.

RESULTS

4.1% of the study subjects were caries-free. Prevalence of these was significantly higher among the males. Overall, mean dmfs, dmft, DMFS and DMFT scores were 8.45, 4.16, 3.59 and 2.25 respectively. The decayed component accounted for >85% of the scores. The highest dmfs/dmft means were found among the 6-8 years age group, while the highest DMFS/DMFT means were scored by the 12-14 years age group. The need for restorative treatment and extractions was high; the former was significantly higher among the females. All subjects had gingivitis; the mean PI, CI and GI were 1.25, 0.3 and 1.36 respectively. Khat chewing did not affect caries experience; however, it was significantly associated with higher PI, CI and GI scores.

CONCLUSIONS

The prevalence of caries, gingivitis and treatment needs among children in Sana'a city is high. More surveys in other Yemeni cities to generate comprehensive data are required.

Regular Khat (Catha edulis) chewing is associated with elevated diastolic blood pressure among adults in Butajira, Ethiopia: a comparative study

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.

Khat - a controversial plant

Khat (Catha edulis) is a shrub or tree whose leaves have been chewed for centuries by people who live in the Eastern part of Africa and the Arabian Peninsula. It has recently turned up in North America and Europe, particularly among emigrants and refugees from countries such as Somalia, Ethiopia and Yemen. Khat contains a number of chemicals, among which are two controlled substances, cathinone (Schedule I) and cathine (Schedule IV). Both chemicals are stimulant drugs with effects similar to amphetamine. Chewing the leaves makes people feel more alert and talkative, and suppresses appetite. Chewing khat leaves releases cathinone, a stimulant that produces the feeling of euphoria. When cathinone is broken down in the body, it produces chemicals including cathine and norephedrine, which have a similar structure to amphetamine and adrenaline (epinephrine). Regular khat use is associated with a rise in arterial blood pressure and pulse rate, corresponding with levels of cathinone in the plasma. Moreover, regular khat chewers have gingivitis and loose teeth, but there appears to be no convincing unusual incidence of oral cancer. Among khat users in Yemen there is, however, a higher incidence of esophageal cancer compared with gastric cancer. Long term use or abuse can cause insomnia, anorexia, gastric disorders, depression, liver damage and cardiac complications, including myocardial infarction. Manic and delusional behavior, violence, suicidal depression, hallucinations, paranoia and khat-induced psychosis have also been reported. On the basis of the scientific data it seems clear that khat use has negative consequences on the economic development of a country and on the health of the society.

Camptothecin and khat (Catha edulis Forsk.) induced distinct cell death phenotypes involving modulation of c-FLIPL, Mcl-1, procaspase-8 and mitochondrial function in acute myeloid leukemia cell lines

Background

An organic extract of the recreational herb khat (Catha edulis Forsk.) triggers cell death in various leukemia cell lines in vitro. The chemotherapeutics camptothecin, a plant alkaloid topoisomerase I inhibitor, was tested side-by-side with khat in a panel of acute myeloid leukemia cell lines to elucidate mechanisms of toxicity.

Results

Khat had a profound effect on MOLM-13 cells inducing mitochondrial damage, chromatin margination and morphological features of autophagy. The effects of khat on mitochondrial ultrastructure in MOLM-13 correlated with strongly impaired routine respiration, an effect neither found in the khat-resistant MV-4-11 cells nor in camptothecin treated cells. Enforced expression of anti-apoptotic Bcl-2 protein provided protection against camptothecin-induced cell death and partly against khat toxicity. Khat-induced cell death in MOLM-13 cells included reduced levels of anti-apoptotic Mcl-1 protein, while both khat and camptothecin induced c-FLIP_L cleavage and procaspase-8 activation.

Conclusion

Khat activated a distinct cell death pathway in sensitive leukemic cells as compared to camptothecin, involving mitochondrial damage and morphological features of autophagy. This suggests that khat should be further explored in the search for novel experimental therapeutics.

Extraction and microencapsulation of khat: effects on sexual motivation and estradiol level in female rats

INTRODUCTION

Khat (Catha edulis) is an evergreen tree/shrub that is thought to affect sexual motivation or libido. Its positive effect on sexual desire is more frequently observed in females than in males and occurs when khat is chewed. Thus, khat's effects on sexual behavior may depend on the release mode of its active constituent.

AIM

This study aimed to investigate the effect of dried khat alkaloids on the sexual motivation and estradiol levels of female rats, with special emphasis on the importance of the sustained release effect.

METHODS

Dried khat leaves were extracted and isolated. The alkaloids in khat extract were identified and calculated using thin layer chromatography and high-performance liquid chromatography. The isolated khat extract was microencapsulated using a phase separation coacervation method. The morphology, particle size, yield, drug loading, and entrapment efficiency were evaluated. The in vitro release and stability of alkaloids in khat extract and in khat extract microcapsules were determined. The effect of khat extract microcapsules and varying doses of khat extract on sexual motivation in female rats were investigated. Additionally, estradiol levels, vaginal secretions and vaginal pH were determined.

MAIN OUTCOME MEASURES

The differences in the effect of khat extract and khat extract microcapsules on sexual motivation, vaginal secretion and estradiol levels in female rats were compared. Results. Cathine and norephedrine were identified in the isolated khat extract at composition of 81.3% and 17.2%, respectively. Among the formulations studied, khat extract microcapsules of formulation 2:3:5 (containing a ratio of khat extract to ovalbumin to gelatin of 2:3:5) were found to exhibit higher yield, loading, and entrapment efficiency. Khat extract microcapsules showed sustained in vitro release and were more stable than khat extract. In addition, khat extract microcapsules enhanced sexual motivation, increased vaginal secretions, and upregulated estradiol level in female rats.

CONCLUSION

The sustained release of alkaloids from dried khat has significantly enhanced the sexual motivation and increased the estradiol level of female rats. Thus the release of dried khat alkaloids from microcapsules might be an effective means of enhancing the libido in females.

A review of the neuropharmacological properties of khat

BACKGROUND

The psychostimulant khat (Catha edulis Forsk), is a herbal drug cultivated and chewed as a recreational and socializing drug in East Africa and the Arabian Peninsula for centuries. Due to increasing air transportation and the loosening of customs restrictions, it is now readily available in the Western Countries mainly used by immigrants from khat growing areas causing a concern to policy-makers.

OBJECTIVE

We conducted this review to further gain an insight to the neuropharmacological effects of khat.

METHODOLOGY

PubMed search engine with key terms 'khat' or 'qat' or 'mirra' or'qaad/jaad' or 'cathinone' was used to obtain articles relevant to khat chewing. In total 284 English written articles published from 1959 to 2007 were screened.

RESULTS

Most of the studies focused on cathinone, the postulated active psychostimulant alkaloid in khat. There were few studies which investigated the entire plant extract in either in vitro or animal studies. In the majority of the studies it was reported that both cathinone and cathine, another psychoactive constituent, have actions that are similar to those of amphetamine.

CONCLUSIONS

It seems that the well investigated khat alkaloids have many features similar to amphetamines; however there is a need for a more thorough examination of khat itself in well designed in vitro, animal and human studies with a range of comparator drugs before confirming the claim that khat is a "natural amphetamine".

Chemotaxonomic Relationships in Celastraceae Inferred from Principal Component Analysis (PCA) and Partial Least Squares (PLS)

This paper describes a chemotaxonomic analysis of a database of triterpenoid compounds from the Celastraceae family using principal component analysis (PCA). The numbers of occurrences of thirty types of triterpene skeleton in different tribes of the family were used as variables. The study shows that PCA applied to chemical data can contribute to an intrafamilial classification of Celastraceae, once some questionable taxa affinity was observed, from chemotaxonomic inferences about genera and they are in agreement with the phylogeny previously proposed. The inclusion of Hippocrateaceae within Celastraceae is supported by the triterpene chemistry.

Khat chewing from the pharmacological point of view: an update

Khat chewing is deeply rooted in the every day life of people living in the Horn of Africa and in South Arabia, where Catha edulis is endemic. Considered little more than an exotic habit producing just mild pharmacological effects, systematic investigations on its active principles have instead lead to the isolation and chemical characterization of cathinone, a compound structurally related to amphetamine. Three decades of intense experimental and clinical research on khat have depicted a consistently clear picture of its pharmacological and toxicological effects.

The consumption of khat and other drugs in Somali combatants: a cross-sectional study

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.

Khat (Catha edulis) Chewing during Pregnancy in Yemen: Findings from a National Population Survey

AIMS

This study examines the prevalence of khat chewing among women during pregnancy and some of the risk factors for this habit in Yemen.

METHODS

Survey data on 7,343 ever-married women from the Yemen Demographic and Maternal and Health Survey (YDMHS), conducted in 1997 are used. Women who had a live birth during the 5 years preceding the survey were asked if they chewed khat during each of their pregnancies (=1) or not (=0). Associations between chewing khat and socio-demographic risk factors were assessed using odds ratios from binary logistic regression models.

RESULTS

About 40.7% of women surveyed reported chewing khat while pregnant during the 5 years before the survey. Old age, no education, rural residence, living in mountainous regions, and low wealth were significant risk factors for chewing khat.

CONCLUSIONS

Khat chewing during pregnancy is highly prevalent in Yemen. Socio-economically disadvantaged women were more likely to chew khat than other women.

High relative frequency of oral squamous cell carcinoma in Yemen: qat and tobacco chewing as its aetiological background

To study the association of qat chewing with the occurrence of oral cancer, the frequency of oral cancer among whole body cancers and the patients' histories of tobacco consumption and qat chewing were examined in Yemen where qat chewing has been most popular. All primary malignant tumors listed in the surgical pathology files at Al-Thawra Hospital, University of Sana'a, in the year 2004 were analyzed, and the patients' histories of tobacco consumption and qat chewing were examined. A total of 649 cases of primary malignant tumors (348, 53.6% males and 301, 46.4% females) were extracted. Oral cancer was the most frequent body cancer in both males (17.2%) and females (19.6%). Squamous cell carcinoma (SCC) was the most frequent oral cancer (84%), and the tongue (42%), gingiva (23%) and buccal mucosa (20%) were the most common sites. Among the 119 patients with oral cancer, information on chewing habits and smoking was obtained in 92 patients (77.3%). There were 70 tobacco chewers (76.1%), 55 qat chewers (59.8%), and 22 smokers (23.9%). Simultaneous chewing of tobacco and qat was found in 48 cases (52.2%). The present survey has disclosed for the first time that oral SCC is the most frequent cancer in this study area in Yemen, and that the high relative frequency of oral SCC may be related to the habits of chewing tobacco and qat.