Khat Abuse and Side Effects

Khat, also known by the name Catha edulis, is a plant that grows in parts of Africa and on the Arabian Peninsula. Certain parts of the plant are used for their psychoactive effects.

How Is Khat Used?

People living in areas where khat is indigenous use the various parts of the plant, such as the leaves, twigs, and shoots of the young plant. These parts of the plant are chewed in a way similar to how tobacco is chewed in the United States and other areas. Khat use has a long history in these areas, dating back many centuries.

The parts of the plant can also be made into a tea that is consumed, ground up and smoked, and made into a paste or a powder that can be chewed or put on food.

What Are the Effects and Active Substances of the Khat Plant?

The important active components found in the khat plant are cathinone (β-keto-amphetamine) and cathine (d-norpseudoephedrine). Both of these substances have amphetamine -like qualities, and their use results in stimulant effects.

The United States Drug Enforcement Administration (DEA) classifies them in different categories. Cathinone is classified as a Schedule I controlled substance, indicating that the DEA considers it to have no use for medicinal purposes and to be a drug that is strongly associated with abuse and the development of physical dependence. Schedule I controlled substances cannot be obtained legally in the United States except by special permission from the government. Cathine is classified as a Schedule IV controlled substance, indicating that it has a moderate potential for abuse and the development of psychological or physical dependence, but it can be obtained with a prescription from a physician. Thus, due to cathinone being an active substance in the khat plant, its use and possession is illegal in the United States. Other countries have also made possession of khat illegal.

The amphetamine-like effects of khat have been reported as consisting of:

• Euphoria
• Increased energy that can range from mild stimulation to hyperactivity
• Extreme talkativeness
• Sensitivity to environmental stimulation
• Becoming very excitable
• Potential trancelike states or stupor
• Hypertension
• Accelerated heartbeat
• Increased thirst and even dehydration
• Decreased appetite
• Issues with nausea
• Sores in the mouth
• Insomnia

Many individuals in the countries where the plant is indigenous use khat frequently. There are reports of a number of detrimental effects associated with chronic use of khat that have included:

• Continued hyperactivity
• Mania
• Increased aggression
• Depression and suicidal ideation (most likely when individuals are recovering from its use)
• Psychosis (hallucinations and delusional behavior)
• Physical exhaustion due to lack of sleep

In addition, there are numerous studies that have reported increased probabilities of the following conditions being associated with chronic use (chewing) of khat:

• Decreased motivation
• Poorer work productivity
• Lower birth weights for children born to women who use khat
• Ulcers
• Increased potential for cancer (particularly gastric cancer and cancers of the mouth, tongue, and throat)
• Problems with urination
• Testicular degeneration
• Cardiovascular issues
• Stroke
• Physical dependence

The development of physical dependence as a result of chronic use of khat appears to be debated among sources such as the National Institute on Drug Abuse (NIDA). NIDA reports that it is uncertain if chronic use of this drug can result in abuse and the development of physical dependence despite many countries banning its usage.

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Who Is Prone to Use Khat?

Khat is used extensively in many Middle Eastern and African countries and by individuals from that heritage during to the holy period of Ramadan. Individuals who use excessive amounts of this drug during these periods are prone to developing seizures. There have been many confiscations of illegal imports of the drug in the United States; therefore, the drug does have a demand. There also sources online that advertise use of the drug for recreational purposes.

Because the main active ingredients in the leaves and other parts of the plant contain known amphetamine-like substances, the drug most likely does have a potential for abuse in the same way that other amphetamines do. The most likely individuals to use or abuse khat in the United States are immigrants from the Middle East or Africa and relatives of these individuals. Large urban areas with significant immigrant populations from these areas, such as New York, Los Angeles, Detroit, Dallas, and other cities, most likely see the most use of this drug. It is unclear what the extent of khat use is outside of this demographic group.

There are a number of street names associated with khat. Some of the street names for the drug include chat, oat, Bushman’s tea, African salad, Qat, Abyssinian tea, Tohai, and kat.

Khat and Violence

There are a number of empirical studies that have drawn an association between khat use and an increased probability to develop mental illness and engage in violent behavior. In addition, there are reports that sales of khat have been used as potential fundraisers for terrorist activities in countries overseas. This has led to an association between khat use and violent behavior. There are a couple of things to consider in this context.

Because khat does have amphetamine effects, it is no surprise that chronic use of the drug would be associated with increased potential for violence. Some of the side effects of amphetamine use are aggression and violence. Individuals under the influence of the drug are less capable of monitoring their impulses and emotions. Chronic use of any form of psychoactive substances is associated with an increased probability for the co-occurrence of some other form of mental illness. Thus, the first two findings should not be surprising.

The potential marketing of the drug for activities related to terrorist organizations and other groups should also not be surprising as this is a common occurrence with many different illicit drugs, including heroin and cocaine. Thus, khat is not unique in its association with an increased probability to develop mental illness, increased aggression, and other illicit activities.

Treatment for Khat Abuse and Addiction

There are currently no medications that are designed to treat addiction to khat. The use of medications in the treatment of a substance use disorder (addiction or substance abuse) associated with khat abuse would most likely focus on symptom management. Individuals who are experiencing anxiety or depression could be given medications to deal with those symptoms; individuals experiencing hallucinations would be given antipsychotic medications; benzodiazepines could be used for seizures; etc.

The treatment of an individual with suspected khat abuse would need to be carefully planned. The reason for this is that a number of cultural factors and beliefs regarding medical treatment, addiction and substance abuse, and mental illness could complicate standard treatment protocols that mental health professionals used to treat substance use disorders in the United States. Certainly, involving the individual’s family and peers in the treatment process is extremely important and remaining sensitive to cultural differences in certain beliefs regarding health and wellness is also extremely important.

Because the use of khat is socially accepted, a number of cultures adopting an approach to complete abstinence may not be realistic in some cases. The individual would need to be convinced of the connection between their use of khat and the negative ramifications that are occurring in their life. This would require a great deal of sensitivity and empathy on the part of the therapist and corroboration with the individual’s family and friends. The traditional approach to the treatment of a substance use disorder would most likely need to be adjusted due to cultural issues. Certainly, using a therapist or physician with a similar background to the client would help facilitate the treatment process. In addition, the use of spiritual leaders could be helpful in certain instances.

Treatment for individuals who have adopted or grown up with Western beliefs regarding health, well being, mental illness, and substance use could follow the traditional approach to treating a substance use disorder that would include a withdrawal management program, if needed; psychotherapy for substance use disorders; social support; and other interventions, including medical management of other mental health conditions as appropriate.