Michelle Muscat MD MRCS(Ed) MSc, PG Dip, FRCPath, PhD
Khat or Catha edulis, also known as ‘miraa’ or ‘qat’, (1) is a plant which provides mild stimulant effects. It is consumed by chewing twigs and leaves. Cathinone and cathine are the main addictive components (2). It is native to Africa as well as the Arabian Peninsula from where exports need to be transported quickly to ensure the psychoactive effect is retained by the time of consumption. In countries where the plant is indigenous, khat is used socially and traditionally amongst communities. It is sometimes used by students when studying for exams (3). Varied beliefs and perceptions (4) surround use of this drug. Some see it as a substance use disorder (5) given abstinence may be difficult after chronic use (6), dependence has been reported and (7) withdrawal symptoms have been documented (8). Others see it as an innocuous cultural tradition rather than drug abuse (9), although there exists no universal agreement to that effect (10).
Some documented side-effects include insomnia, adverse cardiovascular effects (11), impotence (12), liver disease (13-16), anxiety (17), reduced appetite, increased risky sexual behavior in consumers (18), hypnagogic hallucinations (19), and decreased pulmonary function after longer term consumption (20). There have been associations with oral conditions such as periodontal disease, xerostomia and possibly oral cancer (21, 22). A case report described khat combined with tranylcypromine resulting in subarachnoid hemorrhage (23) There is potential for drug interactions (24).
At one point there were concerns that some of the profits of khat sales may have been used by terrorist groups (28) although khat farmers have denied this.
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