In response to my previous post on khat, Pete commented:

I would be with you on this if it wasn’t for my experience when I attended the last ACMD meeting of 2010. There were a number of Somalian community members there with varying experience of khat use.

On the basis of what I heard, I’m not sure that khat is as relatievly harmless as you suggest. Even though I am decidedly an anti-prohibitionist, my assessment is that khat is rather like speed – destructive and physically damaging with very little to recommend it. If I was thinking about regulating it, I’d be controlling it very strictly.

I’d be interested to see the write-up of the 2010 meeting- there don’t seem to be any minutes available on the ACMD website.

With regards to the personal and individual concerns, I think the 2005 report, and the previous reports by Turning Point and Nacro address those. The ACMD report states that, “There is some evidence that khat using can be seen as a strain in family relationships. However it is impossible to say that a person’s khat use is the cause of family disruption, or just a convenient scapegoat for it

With regards to whether khat has anything to recommend it, the report also acknowledges “a viewpoint that Khat is an important part of the culture, particularly in relation to social occasions such as weddings, funerals, parties and religious ceremonies.” My own personal view here is each to his own. I can’t see the point in herbal tea, but some people believe it’s beneficial. I’m a big fan of alcohol, and there’s very little in the way of positive or beneficial effects, unless I’m going to limit myself to a glass of ‘medicinal’ red wine each evening.

In terms of the links between khat use and psychosis, the ACMD recognize the lack of conclusive research, “…it is evident that khat use is widespread amongst communities in East Africa and the Middle East and here it causes little morbidity. However khat may contribute to psychiatric morbidity in those vulnerable through traumatic life experiences. Unfortunately many of those settled in the UK from khat using communities may have suffered such trauma and are subject to considerable stress during the process of immigration to a new country and culture. Khat use outside its usual social context may further contribute to this problem. There is little published literature on the link between psychosis and khat use in the UK, however anecdotal evidence suggests a link is possible.”

There is clearly a need for more robust, primary research, but I don’t think that means that in the meantime the sale should be prohibited- the risks of criminalizing sale and use are considered quite carefully in the 2005 report, and I think they come to the right conclusion with regards to the risks and benefits that criminalization poses.

With regards to controlling it very strictly, what would be the best way to do this, without making the plant prohibitively expensive within a regulated environment, thereby incentivising a black market?  The 2005 report recommended ‘that the Government/local relevant authorities explore the possibility of a voluntary agreement amongst retailers of khat on excluding sale of khat to those under 18 years old’.  I don’t know if this was implemented. And, as far as I’m aware, very little investment has gone into the specific harm reduction interventions that they recommended either- culturally specific educational materials for a population for whom English is a second language, and literacy levels are low, or harm reduction training for community workers.

There were compelling personal stories about the harm that alcohol wrought on families which persuaded many that prohibition would be a good thing, but it didn’t work. I would say that the best way to prevent the problematic use of a substance is to inform people of the risks, and the best way to treat problematic use is to address the health and social care needs that make a person’s use problematic. But I can’t believe that making khat illegal is the answer, regardless of how harrowing some people’s experiences are.