Khat (Catha edulis Forsk.) Dependence Potential and Pattern of Use in Saudi Arabia

Understanding Khat: Its Sociocultural and Health Implications in Saudi Arabia

This review offers an insight into the historical background, utilization, chemical composition, health impacts, processes, and cultural aspects associated with the usage of khat, a psychoactive, mind-altering plant indigenous to the Arabian Peninsula and the Horn of Africa. It further explores the cultural importance of khat in nations such as Saudi Arabia, Yemen, Ethiopia, and Somalia, detailing its chemical makeup containing alkaloids and other compounds, its physiological impact on the body, and its potential health risks like cardiovascular complications, mental health disorders, and dental problems. The cultural, economic, and religious aspects that affect perceptions and consumption of khat were also considered while emphasizing its usage despite legal bans in many nations.

Perceived harms and protective behavioural strategies among khat chewers: a qualitative study in Jimma, Ethiopia

BACKGROUND

While there have been many previous studies focusing on the adverse effects of khat chewing, attempts to investigate the protective behavioural strategies (PBS) employed by the khat using population are rare. PBS are strategies that substance users employ to minimize or alleviate the possible negative consequences related to the behaviour. This study focuses on the harms that chewers associate with khat use, and the behavioural strategies they practise to prevent or minimize these harms.

METHODS

A community-based qualitative study was conducted using a snowball sampling technique to recruit a diverse sample of khat chewing participants (N = 102) in Jimma city, Ethiopia. Face-to-face in-depth interviews were carried out with the participants.

RESULTS

Participants identified a variety of harms likely to result from chewing khat. These include impacts on their finances, work, social life and health. The PBS that participants employed to avoid or minimize the risks were classified into four themes based on their temporal sequence with khat chewing sessions: prior to chewing, during chewing, after chewing and general PBS covering the whole of their khat chewing career. The PBS enable khat chewers to prevent or minimize the adverse health consequences of chewing, socialize and work without or with fewer difficulties and manage their economy successfully.

CONCLUSION

The study participants believe that khat-related harms are avoidable if khat users implement appropriate strategies prior to, during and after chewing, and if they apply PBS to khat-related factors (e.g. type, amount and frequency), set factors (e.g. reason for using and health behaviour) and setting factors (e.g. place of use, when used, with whom used and social norms) covering the whole of their khat chewing career.

Is chewing khat associated with mental health disorders? A scoping review of the content and quality of the current evidence base

BACKGROUND

Khat (Catha edulis) is a plant commonly found in the horn of Africa whose leaves are chewed for their psycho-stimulant effects. Several studies have demonstrated the association between khat use and mental health problems. Nevertheless, evidence is mixed and inconsistent, warranting further review of available studies. This scoping review is aimed at investigating the content and quality of evidence base on the associations between khat use and mental health disorders and suggesting avenues for further research.

METHODS

We used a scoping review methodology to map the existing evidence using PubMed, SCOPUS, Embase, and CINAHL databases. Primary studies focusing on the association between any pattern of khat use and any form of mental health disorders are included. The review focused on all age groups, any study design, all geographical locations, and any publication year. The terms used for searching eligible studies include khat, mental disorders, and various alternative terminologies. Narrative review is employed to present findings.

RESULTS

7,121 articles were found, of which 108 were eligible, conducted across 12 different countries. The majority of the studies was done during the last ten years and the studies mostly employed cross-sectional design. About 10 different categories of mental health disorders have been identified as showing associations with khat use. Despite many contradictory findings between the studies, most of the evidence base suggests that khat use is associated with mental health disorders. Non-specific psychological distress is the most frequently mentioned mental health problem (reported in 26.9% of the studies). Khat use as a predictor variable is mostly assessed using a 'yes/no' category, and as a result, dose-dependent effects of khat use on mental health are not given much consideration.

CONCLUSION

Although most of the studies associate khat use with mental health disorders, the causal relationships are inconclusive given the cross-sectional design of the studies, and the presence of potential confounders and several forms of biases. Available studies also report contradictory findings. Further studies are recommended using prospective designs, standardized and valid measures of khat use, and focusing on specific types of mental health disorders.

Development and Validation of an Arabic Version of the Drug Abuse Screening Test-10 (DAST-10) among Saudi Drug Abusers

The Drug Abuse Screening Test-10 (DAST-10) is a valid and reliable screening tool for drug use-related problems, however there is no Arabic version. To our knowledge, this is the first study to develop and validate an Arabic DAST-10 version. Saudi young adults participated in the study as two groups; drug users (n=360) recruited from Alamal Complex for Mental Health, Jeddah, and drug non-users (n=100). Three measures were used: (1) Demographic and drug use description questionnaire, (2) Arabic DAST-10 version, and (3) Urine analysis for drug use. The developed Arabic DAST-10 version demonstrated adequate internal consistency. High correlations were shown between its scores and the two standard measures (urine analysis and self-reporting question) indicating good criterion validity. Sensitivity and specificity values were between 91.5 - 99.7% and 57 - 92.5% with different DAST-10 cutoff values. An optimal performance at a cutoff score of 3 or more was most likely to significantly identify drug users. Discriminant analysis showed that more than 90% of cases were correctly classified. Distribution of participants in categories of DAST-10 scores according to degree of problems was reasonable. It is concluded that the developed Arabic DAST-10 version is a reliable and valid screening tool for drug use-related problems in Arabic speakers.

Tea in the Morning and Khat Afternoon: Health Threats Due to Khat Chewing

Khat or qat (Catha edulis) is a flowering plant with an Arabic name قات, regularly named as qāt, also is known by various descriptive names, such as Abyssinian tea, Somali tea, Arabian tea, Miraa, Jima, and Kafta in its endemic regions of the Horn of Africa and the Arabian Peninsula. Fresh leaves and tops of khat are chewed or dried and consumed as a tea to attain a state of euphoria and excitement; it also has appetite-reducing effects. Traditionally, khat is used as a socializing habit in Yemen and is also widely cultivated because of its high income. However, in recent years the plant has been reported in England, Wales, Rome, Amsterdam, Canada, Israel, Australia, New Zealand, and the United States. Although it is believed that khat is a relatively low-risk drug, it's associated with an increased risk for various medical complications, including dental and oropharyngeal disease, gastrointestinal, cardiovascular, neuropsychiatric, obstetric, and even can be the cause of cancer. Our goal in this review article is to revise and determine the relationship between chewing khat and its health issues. Additionally, we tried to determine the mechanism involved in health hazards due to consuming the khat.

Seven in every ten khat chewers in Gondar City had an intention to stop khat chewing: cross-sectional study using Transtheoretical Model

BACKGROUND

Khat chewing practice is rapidly expanding worldwide and currently, an estimated over 10 million people chew khat daily. The transtheoretical model explains how behavior change occurs across the stages of change. So, this study aimed at assessing the intention to stop khat chewing and associated factors among khat chewers in Gondar City, northwest Ethiopia.

METHODS

Community-based cross-sectional study was conducted from March to April 2019 in Gondar City, northwest Ethiopia. Six hundred five khat chewers participated in the study from six randomly selected kebeles. The data were collected using structured and interviewer-administered questionnaire. Bivariate and multiple logistic regression models were fitted. Adjusted Odds ratio (AOR) with 95% confidence interval (CI) and p-values less than 0.05 were used to declare a significant association.

RESULTS

Of the study participants, 69.3% (95% CI: 65.8-72.9) had the intention to stop khat chewing within 6 months or before. The majority of the participants (55.4%) were at the contemplation stage. Higher self-reevaluation [AOR = 2.8, (95%CI: 1.6-5.0)], environmental reevaluation [AOR = 1.9, (95%CI: 1.1-3.3)] and social liberation [AOR = 1.8, (95% CI: 1.0-3.1)] were associated with intention to quit khat chewing. In addition, using additional substances daily, khat dependency, and early age initiation of khat chewing were associated with lower intention to quit khat chewing.

CONCLUSION

The majority of the khat chewers had the intention to quit khat chewing. Increased self-reevaluation, environmental reevaluation, and social liberation process of changes were associated with enhanced intention of quitting khat chewing. Thus, stage-based interventions should be done to inspire khat chewers to realize their motivation of stopping khat chewing.

Exploring the Molecular Mechanisms of 17β-HSD5-induced Carcinogenicity of Catha edulis via Molecular Modeling Approach

BACKGROUND

The tradition of khat chewing has been deep-rooted in the African and Arabian Peninsula for centuries. Due to its amphetamine-like psycho-stimulant or euphoric effect, khat has been used by millions in Somalia, Ethiopia, Saudi Arabia and Yemen. The long-term use of khat can induce many major health outcomes, which may be serious and irreversible.

OBJECTIVE

Prolonged use of khat constituents has been associated with different types of cancers such as prostatic, breast and ovarian cancer. However, it has been very difficult to identify the molecular targets involved in khat carcinogenesis that interact with the Khat constituents by in vitro/in vivo experimental tools.

METHODS

In silico tools were used to predict potential targets involved in the carcinogenesis of khat. Pass on-line prediction server was used for the prediction of a potential molecular target for khat constituents. Molecular Dynamics simulation and MM-GBSA calculation of the predicted target were carried out.

RESULTS

Molecular Dynamics simulation and MM-GBSA calculation revealed that among khat constituents, β-sitosterol showed a high binding affinity towards 17β-HSD5. On the other hand, this study highlights for the first time some new interactions, which were observed in the case of cathine, cathinone and nerol during the simulation.

CONCLUSION

In silico molecular dynamic simulation tools were used for the first time to investigate the molecular mechanism of widely used leaves of psychoactive khat (Catha edulis) constituent. The present study provides deep insight to understand the effect of khat constituents involved in the impairment of the reproductive system and its binding to 17β-HSD5. ADMET profiling also suggested that few khat constituents do not fulfill the requirements of the Lipinski rule of five i.e. poor absorption and blood-brain barrier impermeability.

Magnitude and predictors of khat use among patients with tuberculosis in Southwest Ethiopia: A longitudinal study

INTRODUCTION

Tuberculosis (TB) is a leading cause of morbidity and mortality in low and middle-income countries. Substance use negatively affects TB treatment outcomes. Our recent study has found that khat use predicted poorer adherence to anti-TB medications. However, there is scarce longitudinal study on predictors of khat use among outpatients with TB, and this study aimed at addressing this research gap.

METHODS

From October 2017 to October 2018, 268 outpatients with tuberculosis on DOTs were enrolled in a longitudinal study from 26 health institutions in Southwest Ethiopia. Structured questionnaires translated into local languages (Afaan Oromoo and Amharic) were used to assess khat use. Patients were followed for six months, and data were collected on three occasions during the follow-up. A generalized linear mixed model was used to identify the relation between khat use and predictors. Model fitness was checked using the Bayesian Information Criterion (BIC). Odds ratio (OR) and 95% CI were used to describe the strength of association between the outcome variable and predictors.

RESULTS

The overall prevalence of khat use at baseline and first follow up was 39.2% while it was 37.3% at second follow up. Of this, 77.1% and 96.2% of them believed that khat use reduces the side effects of anti-TB medications and symptoms of tuberculosis respectively. In the final model, being male (aOR = 7.0, p-value = 0.001), being government employee (aOR = 0.03, p-value≤0.001) and presence of alcohol use disorders (AUD) (aOR = 2.0, p-value≤0.001) predicted khat use among outpatients with tuberculosis.

CONCLUSION

A considerable proportion of patients with TB used khat throughout DOTs and wrongly perceived that it had health benefits. The finding implies that all patients diagnosed with TB should be screened for khat use, and a particular emphasis should be given to males and individuals with a history of alcohol use. Moreover, further studies are needed to assess patients' beliefs regarding the benefits of khat use so that interventions can be developed.

Pattern and outcome of perforated peptic ulcer disease patient in four teaching hospitals in Addis Ababa, Ethiopia: a prospective cohort multicenter study

BACKGROUND

Perforated peptic ulcer disease is a surgical emergency with a high morbidity and mortality. The socio-demographic characteristic and the factors associated with morbidity and mortality seems to differ between the developed and developing world. This is the first a prospective cohort study in Ethiopia designed to analyze pattern and outcome of patients with perforated peptic ulcer disease in four teaching hospitals affiliated with SOM, CHS of Addis Ababa University.

METHOD

This is a prospective cohort study of patients operated for perforated peptic ulcer disease from June 1, 2018 to May 31, 2019 in four teaching hospital affiliated to department of surgery of SOM, CHS of Addis Ababa university.

RESULT

A total of 97 patients were operated in a year. 86.6% were males with a male to female ratio of 6.5:1. The age group 21-30 were most affected constituting 42.3% of all patients. Mean age is 31.9, Median of 27, age ranges from 16 to 76. Alcohol use (45.4%) and previous history of ulcer disease (75.3%) were the most prevalent risk factors.33% were smokers. Abdominal was present in all and most presented within 48 h (79.4%). 85.6% had pneumo = peritoneum in an x-ray at presentation. Size of the perforation is 10 mm or less in 81.3%. 91(93.8%) had anterior first part duodenum perforation. Repair with pedicled omental patch was done in 65 (67.1%) patients. Age, duration of presentation, hypotension at presentation, size of perforation, degree of peritoneal contamination were found to be the significant factors for morbidity and mortality. Major morbidities were observed in 16 (16.5%) and mortality occurred in 3 (3.1%) patients.

CONCLUSION

Perforation of peptic ulcer disease here occurs in the young. Age, duration of presentation, hypotension at presentation, size of perforation, degree of peritoneal contamination were found to be the significant factors for morbidity and mortality. Morbidity and mortality rate of 16.5 and 3.1% observed here are quite acceptable.

Phytochemical Screening and Cytotoxic Properties of Ethanolic Extract of Young and Mature Khat Leaves

The khat plant has been culturally used in many parts of Africa and the Arabian Peninsula for many years to induce psycho-stimulating effect. Because of the global wide-spreading nature, khat chewing is being considered as a universally growing problem. Catha abbottii, Catha edulis, and Catha transvaalensis are the three species of khat commonly chewed in Saudi Arabia and nearby regions. Khat users usually prefer to chew young leaves over mature ones due to the diverse effects produced by both. Though many of the constituents of khat leaves have been identified, the complete phytochemical profile of young and mature leaves was not performed or compared; also, no evidence is available to affirm the cytotoxicity of young or mature leaves. Therefore, this study aimed to investigate the phytochemical basis of the differential response of the young and mature leaves and to assess the cytotoxicity of young and mature khat leaves. Ethanolic extracts of young and mature leaves of three khat cultivars were subjected to GC-MS. Hierarchical cluster analysis revealed the existence of two major clusters. The extracts of young leaves were found to contain the maximum content of cathinone; however, methoxyamphetamine was found in only one extract of young leaves. Cytotoxicity investigations were also conducted on both types of leaves using three cancer cell lines, human breast adenocarcinoma, human ovary adenocarcinoma, and human colon adenocarcinoma and also normal human fetal lung fibroblast cell line was used. All extracts showed comparable cytotoxicity, IC50 ranging from 22–59 μg/mL on the cancer cells; however, we observed more cytotoxicity against normal cells (IC50: 6–41 μg/mL). The predominant cytotoxicity on normal cells may pose many health hazards to khat consumers.

Impact of khat price increases on consumption behavior - price elasticity analysis

Background

The long border of Saudi Arabia with Yemen is the primary route for khat entry to the Kingdom. As of April 2015, the government of SA tightened the border, making it more difficult to import khat into the country. As a result, local user prices of khat probably increased due in part to higher supply costs and perhaps lower quantities. One anti-drug strategy is to increase consumption cost by increasing the price of supply. We aim in this study to measure the responsiveness of khat demand to price changes.

Methods

This study used a cross-sectional survey design. Two stage sampling was used to recruit 350 khat chewers from four selected primary healthcare centers in Jazan province (South western province of Saudi Arabia). The data were collected during the first quarter of 2017. This study used both contingent valuation and revealed preference methods to assess the impact of price increases on the purchasing of khat. Graphical analysis, paired-samples t-test, and one-way repeated measures analysis of variance (ANOVA) were used to assess the impact of price increases on khat consumption.

Results

The study results showed a significant decrease in khat consumption amount (t = 8.63, p ≤ 0.05), frequency (t = 30.42, p ≤ 0.05), and expenditure (t = 34.67, p ≤ 0.05) after the tightening of the Saudi–Yemeni border. Hence khat demand is price elastic. The price elasticity of khat demand in Jazan is estimated to be between − 2.38 and − 1.07. Therefore, each 1% increase in price is associated with 1–2% reduction in quantity demanded. This means khat chewers are relatively responsive to price changes (i.e., khat demand is price elastic). Repeated measures analysis of variance showed price increases significantly affect the quantity {F(4, 2.58) = 257, p ≤ 0.05, ηp² = 0.423} and frequency {F(4, 1.83) = 415, p ≤ 0.05, ηp² = 0.543} of khat chewing.

Conclusions

Increased prices for khat would significantly decrease demand. Accordingly, we recommend implementing law enforcement strategies focused on disrupting the khat supply chain to realize high prices and so discourage use, hence reducing the incidence of khat-related illnesses.

The characteristics and patterns of utilization of healthcare services among Omanis with substance use disorders attending therapy for cessation

BACKGROUND

It is indicated that Oman is witnessing an increase in issues pertinent to alcohol and psychoactive substance use.

AIM

The aim of this study was to identify the characteristics of Omanis with substance use disorder attending a specialized hospital in Oman and the pattern of their utilization of healthcare services. A related aim was to ascertain the age group most vulnerable to alcohol and substance use in Oman.

METHOD

A cross-sectional study was conducted in a tertiary care center specialized for treatment of those engaging in substance use in Oman. The participants in the study were selected from a convenience sample among patients seeking consultation at the center for alcohol and substance use. A six-part questionnaire was designed to obtain information regarding socio-demographic background, clinical history, healthcare utilization and perceived hurdles to access. Chi-square analyses were used to evaluate the significance of differences among categorical data. Logistic regression modelling was used to obtain measures of association after adjusting for confounding factors.

RESULTS

Among the patients (n = 293) seeking cessation therapy, 99% were male and less than 30 years of age. Peer influences on the initiation of substance use were significant. Most patients had a history of polysubstance use, including intravenous substance use. Cannabis and alcohol were the first substances consumed by most patients and Hepatitis C and psychiatric disorders were found to be the most common co-morbidities. The participants that reported use of cannabis and benzodiazepines were more likely to perceive "improvement" upon receiving treatment.

CONCLUSION

This study indicated that males below 30 years of age with a history of polysubstance use were likely to attend a hospital specialized in treating substance use disorder in Oman. This study identified information regarding socio-demographic background, risk factors and perceived hurdles to healthcare that could serve as groundwork for further studies conducted on newly emerging issues of substance use in Oman.