Khat – a UK legal high

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Khat is a plant grown in parts of Africa and is chewed for mild stimulant effects. Last week the UK Advisory Council on the Misuse of Drugs issued a review of khat and made recommendations to the Home Secretary with regard regulation.

 

 

Khat, the more common name for Catha edulis, is grown at high altitude in many African countries.  The majority of the product is used locally, differentiating it from cocaine or heroin which are mainly grown for export.  The shoots and leaves may be chewed, often for hours on end, to produce a mild stimulant effect.  The effects, including increased euphoria, alertness and heart rate are similar to those experienced when taking amphetamine but less pronounced.  Use can lead to rebound effects such as grumpiness and lethargy.

 

As it is not controlled by law, khat may be legally imported and sold in the UK.  The Advisory Council on the Misuse of Drugs (ACMD) reported that over 2500 tonnes of the plant are imported into the UK each year with an approximate value of £13.8 million (raising £2.8 M in VAT income).  Whilst this seems a large amount of money the Serious Organised Crime Agency estimate that the UK cannabis market alone is worth around £1 billion pounds per year.  Khat is controlled by law in a number of other countries, including many European nations and the United States.

 

The compounds released from the plant include the main active ingredients cathine and cathinone (shown below).  These compounds are at their highest concentration in the plant material when very fresh with the dried leaves containing significantly less of the active ingredients.  Whilst khat is not controlled in the UK both cathine and cathinone were classified as Class B in 2010.  Possession of a Class B drug can lead to a maximum five year gaol sentence and unlimited fine.   Cathine is an isomer of phenylpropanolamine, which is found in many cold remedies.  Substituted cathinones (slight alterations to the chemical structure of cathinone) are frequently sold as drugs of abuse.  One example of this is mephedrone which was in the news frequently and was also classified as a Class B drug in 2010.

 

Cathinone

Cathine

The use of khat has not been very common in European countries.  Most of the drug’s use  is found amongst immigrant populations, particularly Somali and Yemini in the UK.

 

When used on a short term basis there is little evidence that khat is harmful.  There are a few reports that serious liver damage may occur after prolonged use, which appears to be the most serious charge.  There may be links with mental illness and khat use, with reports that post traumatic stress disorder in the war ravaged Somali community may be exacerbated, but more research is required in this area.

 

 

If we were to design a system of drug regulation based on potential harm and dependence, such as suggested by David Nutt et al (The Lancet, 24 March 2007), then the classification would be based on a robust analysis of evidence.  The ACMD report was over 90 pages long and was certainly extensive in its scope. As well as harm to the individual the report looked at the impact on society, stating that there was a lack of evidence of a link between khat use and social harm. They also found no link from khat import and distribution to organised crime.

 

In the covering letter to the Home Secretary, the committee chair Professor Less Iverson wrote:

‘Our recommendations are based on a rigorous and systematic process of evidence gathering’

 

And in the report the first recommendation was:

‘The ACMD recommend that the status of Khat is not changed and is not controlled under the Misuse of Drugs Act 1971.’

 

Here we have a very nice example of evidence based policy advise.  There are some other recommendations, mainly around monitoring the societal and health impacts which are currently less well researched.

 

Many in the scientific community have applauded this report, including Prof. Nutt calling it “robust, rational, rigorous’.  Will the government heed this advice?  A few years ago a senior politician (Baroness Warsi) promised that a Conservative government would control khat when in power.  The Home Secretary has the next say on the matter.  Watch this space!

 

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Dr Tom Bassindale

About Dr Tom Bassindale

Dr Tom Bassindale is a forensic scientist, and the founder of We Are Forensic. He's managed hundreds of forensic toxicology cases, and is an experienced court witness. He has specialist expertise in forensic toxicology and drug testing in sport. Dr B is currently a senior lecturer at Sheffield Hallam University. And yes... he watches CSI.