Archives for category: Khat

The Advisory Council on the Misuse of Drugs have just published a literature review on the social harms of khat use.  Key findings:

1. The review found a general lack of robust evidence on the link between khat use and social harms.
2. Reported social harms associated with khat remain a concern among the UK’s immigrant Somali community, yet beyond often contradictory anecdotal statements, this review found no evidence to show a causal relationship between khat and the various social harms for which its consumption is supposedly responsible.
3. Inferences about khat’s social harms have largely been drawn from the experience of the Somali population, as less research has been undertaken on other communities who are also consumers of khat.
4. As well as khat, many other variables might contribute to the social problems confronting the relevant communities, i.e. the effects of civil war, displacement, gender relations, and problems of integration. These need to be more fully considered in any further research.
5. Legislating against khat in Europe and North America has had little success in curbing demand and has taken place with little consideration of evidence. In those countries where the greatest evidence on khat use has been compiled (the UK, the Netherlands and Australia), import and consumption are still permitted, albeit under the control of a permit system in the case of Australia.

Hopefully this review of the evidence is enough to prevent any moves to criminalize khat sales.  See previous discussions here and here.

 

Advertisements

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.

The UK’s home secretary recently sent an open letter to the Chair of the ACMD outlining the Council’s priorities for the year. Bizarrely, one of these priorities is to review the use of, harms arising from, and legislation of khat.  Why?

Khat is a leaf that is commonly chewed by people in or from East Africa and the Arab Peninsula. When chewed (continously, for absolutely ages) it produces a mild stimulant effect.  A taxi driver in West London let me try some once.  It’s pretty minging an acquired taste- it’s very bitter and left my mouth feeling dry and icky. I didn’t chew anywhere near enough to feel any kind of effect from it.

In the UK, khat is legal, imported from Yemen, Kenya and Ethiopia on daily flights, sold in open markets as a vegetable. It costs approximately $5 for a bundle. The two active stimulants in khat- cathine and cathinone are (I think) the main stimulants in the recently banned synthetic high, m-cat . Khat is a low-profit business, and there are no links between organized crime networks and the trade in khat, although the UK is a conduit for Khat coming from Africa and going on to the US and other countries where it is illegal.  In the US it sells for $400 per kg.

Currently, khat is used recreationally by a significant percentage of men of Somali, Yemeni and Ethiopian origins, but is not used widely outside of these populations. Men tend to chew khat in groups in mafreshes – cafes.  It is generally socially unacceptable for women to chew khat, and when they do, they tend to do it alone. There is some physical and psychological harm that can arise from abuse-  anxiety, sleep deprivation etc, and some risk of dependency.  In 2005, the ACMD likened the risk to that of caffeine.

I’m reading between the lines and paraphrasing here, but basically, when asked to review the classification of khat, the ACMD concluded that the biggest risks of societal harm facing khat users came not from their khat use, but from the poverty, poor access to jobs, and squalid housing conditions typical for these immigrant communities. Criminalizing khat would only push people towards criminal networks that they currently had no contact with. There are some (more often women than men) within these communities who’d like to see khat banned, but it’s not, as far as I’m aware, a majority.

Why is the ACMD reviewing it again?  Has anything changed? At the moment it seems to me to be a perfectly sound model of legal access to a relatively harmless substance.There could perhaps be more investment in harm reduction education and support, or maybe a look at restricting sales to young people, but what’s to be gained from banning it?

via Transform