Khat Abuse and its Effects

Khat is a flowering evergreen shrub (Catha edulis) that grows in the Arabian Peninsula and parts of Africa.

The people who live in these areas use the leaves, twigs, and shoots much in the way that tobacco is chewed to release substances that have stimulant-like effects. Among the natives of these areas, chewing khat is a social custom that appears to date back many centuries.

How Is Khat Used?

Khat is typically chewed and retained in the cheek to be re-chewed on an intermittent basis, much in the same way that tobacco is chewed.

Khat leaves can also be made into a tea, a paste that can be chewed, or a powder that can be used or sprinkled on food. It can also be smoked.

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What Active Substances Are Found in Khat?

The active substances found in khat are cathine (d-norpseudoephedrine) and cathinone (?-keto-amphetamin). Both of these drugs have amphetamine or stimulant qualities. Cathinone is classified by the United States Drug Enforcement Administration as a Schedule I stimulant, indicating that it has an extremely high potential for abuse, physical dependence, and addiction, and it has no known medical use in the United States. Cathine is considered a Schedule IV drug, indicating it has a moderate potential for abuse and physical dependence.

Khat is known by a number of street names that include:

Who Uses Khat?

In the United States, the use of khat occurs most often in large cities with immigrant populations that come from Africa (particularly Somalia and Ethiopia) and the Middle East. Cities where use is high include Boston, MA; Columbus, OH; Detroit, MI; Dallas, TX; Los Angeles, CA; New York, NY; and Washington, DC, among others.

Because the substances found in khat are considered to be a controlled substances in the United States, and its possession and use is illegal (because cathinone is a Schedule I controlled substance, it cannot be used legally). The practice of chewing khat is illegal in Great Britain, as the substance was recently made illegal in the United Kingdom and several European countries as well.

What Are the Effects of Khat?

The stimulating effects of chewing khat have been reported to be:

In countries where there is widespread chewing of khat, it has been suggested that the practice leads to lower productivity levels in individuals because it decreases worker motivation. There is also evidence that chewing large quantities of khat may lead to an increased probability of:

In addition to the aforementioned effects, there are research studies that have drawn an association between the use of khat and an increased probability to engage in violent behavior as well as an increased probability to develop mental illness. There have been published reports that have linked sales of khat as potential funding mechanisms of terrorist activities in countries like Somalia. Thus, for many, khat use is associated with violence and terrorism.

However, the drug is used socially in certain cultures and akin to the social use of alcohol or coffee in America. Thus, it appears that its use occurs in a wide range of contexts. Because many of these studies investigating the use of khat and its association with violence and mental illness are correlational studies (studies that measure associations and not cause and effect), it is impossible to determine if use of the drug actually causes many of these conditions. There is, however, evidence to suggest that chronic use of the drug can cause oral cancer and result in other health problems, such as producing hallucinations and hyperactivity.

Moreover, despite many claims that khat usage increases the probability for abuse and addictive behavior, the National Institute of Drug Abuse states that it is not known if khat is addictive, even though the drug is illegal in many countries and considered to be a potential drug of abuse. Many individuals of African and Middle Eastern heritage chew a great deal of khat during Ramadan, and some develop seizures associated with use during this period.  Moreover, confiscation of illegal imports of the substance are becoming more common, indicating that the substance does have a demand, is used illegally, and most likely has abuse potential as most stimulant drugs do.

Who Is at Risk for Abusing Khat?

It appears that immigrants from Africa and the Middle East, where khat usage is a socially accepted practice, are at the highest level of risk for abusing the substance.

How Can One Be Treated for Khat Abuse?

According to the National Institute of Drug Abuse, there are no medications designed to treat potential khat abuse or addiction. Because of the cultural factors associated with use of khat, it would most likely be advantageous to approach someone who is suspected of abusing the drug with a group of that person’s respected peers and to discuss the advantages of stopping use of the drug with the person in that context.

Treatment for abuse of khat follows the same general guidelines and treatment principles for alcohol abuse or any other form of drug abuse or addiction. This requires the person to acknowledge a problem with abusing khat, decide on a formal plan of action to change the behavior, and enlist the support of family and friends as well as a professional counselor or addiction specialist to help the individual participate in a program of abstinence and recovery. Such a program would help the individual avoid people who use khat, engage in coping strategies to address potential cravings, and develop a long-term plan to avoid potential issues with relapse.

Any intervention or treatment program for an individual who abuses khat would need to be performed with consideration to the individual’s cultural background. Interventions should be designed within that context in order to be effective.

Khat leaves can also be made into a tea, a paste that can be chewed, or a powder that can be used or sprinkled on food. It can also be smoked.