Source: Guardian
Date: 05 February 2004

Chew on this

As the government considers banning qat,
Alok Jha exclusively reveals new research on the drug

There are no signs outside the house, nothing to make it stand out on the rundown north London high street. Soft voices drift out from behind the faded black door. Inside, a man wearing a dishevelled beige suit stops whatever it is he has been doing and asks if he can help. We are hoping to buy some of his product. He pauses for a heartbeat and turns to pull out a box from beneath some plastic covers at the back of the room. "How much?" he asks, handing me a sample bundle of leafy twigs wrapped in a moist banana leaf. This is qat. And it's perfectly legal - for now. Qat has been used for centuries in countries such as Yemen, Ethiopia and Somalia to enhance relaxation or even to lubricate social gatherings. It is increasingly popular in Britain and is seen as a relatively safe high; an alternative to the west's favourite drug, alcohol.

But new research on the plant, seen by Life, could taint this cosy image. It shows that qat's main psychoactive ingredients, cathinone (which is almost identical in chemical terms to amphetamine) and cathine (much less potent) might not be alone in causing the plant's buzz. There could be dozens more chemicals involved and no one knows what long-term effects they could have on the brain. The government's Advisory Council on the Monitoring of Drugs is considering possible classification later this year amid concerns from doctors and counsellors that qat is at the heart of increasing psychological problems and a breakdown in social relations in communities that use it.

In the United States, Canada and most of Europe, qat (also known as chat, jaad, or khat) is illegal; penalties for trafficking or dealing it are equivalent to those given out for cocaine or heroin. In the UK, I managed to buy it for £3 a bundle without much difficulty.

Qat is an evergreen shrub that grows naturally on the mountain sides of many parts of Africa. In Ethiopia, Yemen and Kenya the plant is cultivated and several tons a week are bundled up for export; the majority ends up in Britain for use by the Somali community. Around 90% of Somali men in Britain are thought to chew the plant. The biggest population of chewers is in Yemen, where the plant is used as a social stimulant.

Peter Houghton, a professor of pharmacognosy at King's College, has been studying the chemical constitution of qat for over four years. "We're still not very sure what is actually happening when people chew qat," he says. In the first meeting of its kind in the UK, he decided to corral the latest scientific thinking. A group of chemists, pharmacologists, doctors and counsellors came together to share what they knew and what concerned them about the possible effects of qat. A report of the meeting will be published tomorrow in the Pharmaceutical Journal.

Houghton had new research to share with the group: one of his students, Muna Ismail, had found a new class of psychoactive chemicals in qat. Known as cathedulins, Ismail had shown that these chemicals, like cathinone, make the brain release dopamine, the feel-good neurotransmitter chemical. Ismail presented her work to fellow scientists at a conference in Seattle last week; Houghton hopes to get a paper on her work published in a scientific journal as soon as possible, hopefully leading to further work on the cathedulins.

"We do need to find out more about biological activity of these cathedulins because it adds another dimension to the analysis," says Houghton. "There need to be more medical surveys to see what adverse effects there might be and try to tease them out from other factors."

Those abusing qat tend to be young Somali males who feel stranded in the UK."They've come from a war-torn area away from their families [and] with less support and constraints than a family environment would impose," says Elina Palazidou, a psychiatrist at St Clement's hospital in east London, and a seminar participant.

According to the scientists, there are several potential results of excessive qat use. It raises tolerance to the chemicals in the plant and this, in turn, raises the user's blood pressure and risk of heart disease. Studies in Yemen showed that the incidence of heart at tacks among chewers was 49% higher than in non-chewers. Regular users had bad gum disease and a tendency to lose teeth and there is a high incidence of oesophageal and gastric cancers among users. The plant has also been linked to a reduction in sperm quality and impotency.

There are also issues of hygiene. "Qat rooms are traditionally kept dark and hot - in Yemen and Ethiopia observers report that the windows are closed to keep the heat in as this is believed to raise the potency of the qat," says Axel Klein of Drugscope. "Tobacco smoke hangs in the air, qat leaves are placed on dirty carpets and chewed without washing; tea and water is drunk from cups that are not cleaned properly and, as some chat chewers have internal lesions in their mouths, infectious diseases can be passed on."

Perhaps the biggest issue is what the plant is doing to users' heads."The main reason [qat's] causing concern is that quite a lot of people who chew qat regularly get psychotic episodes," says Houghton.

"They can become agitated, aggressive and their psychotic state will worsen. Or they can become manic and reckless," says Palazidou. "While they're chewing qat they're aroused, they don't feel like sleeping, they're hyperactive and they may become psychotic. When the effects have worn off, they feel worn out, they are sleepy, they can be depressed and can even feel suicidal."

The extreme psychological effects of qat abuse do not seem to mirror problems of cannabis use, where psychosis appears to develop only in those with a history of it. "The evidence available so far suggests that the majority of people who develop psychosis while taking qat had no previous history of mental illness and had no family history of mental illness," says Palazidou.

It's not all bad. There has never been a record of an overdose due to qat use and there is no evidence of addiction to qat in the sense of physical withdrawal symptoms.

"There is some evidence that there is psychological dependence in that it's been claimed that people do have cravings - they go out seeking qat," says Palazidou. "In smaller amounts, there may be very mild withdrawal symptoms like a bit of trembling sweating and feeling a bit euphoric. But people who consume larger amounts, they can have a more serious withdrawal state which can happen a few days after they stop chewing."

The government has decided that the potential dangers of the narcotic plant need further examination. The Home Office's drugs and alcohol research unit began its own investigation late in 2003 and will report in the autumn. If they conclude that qat is dangerous, they may well recommend that it should be classified along with other illegal drugs such as cocaine, cannabis and amphetamines, bringing UK law into line with the majority of western countries.

But without a definitive smoking gun that links qat to any confirmed psychological or physical harm, making it illegal may be a step too far. "My view is that banning it would be counter-productive," says Houghton. "At the moment, it's restricted mainly among the Somali community and, although it does cause these problems, it's more a matter of educating people and getting them to tell the health professionals they're working with. Banning it _ would just make it a sort of attractive black market commodity," says Houghton.

Whatever the public may think of qat, the plant is an integral part of everyday life in some communities. In a survey of Somali communities' attitudes to qat in 1997, 66% of respondents felt that it helped them maintain their cultural identity. A staggering 90% said they would rather their children chew qat than drink alcohol.

The Home Office says that its decision will rest on one thing: whether research shows qat is harmful to human health. As scientists have just begun to demonstrate, however, finding a definitive answer will be far from easy.

* * *

Getting high on the road to Addis

It was going to be a long journey, perhaps 11 hours on stressful northern Ethiopian roads and tracks. My companion Mark and I had seen the shrub called qat - pronounced "chat" - growing widely in the fields but didn't think about it much for the first 100 miles.

But curiosity got the better and when we saw an old man selling a huge bunch of fresh leaves, we could not resist. We handed over $2 and - to the hilarity of our driver - began chewing one leaf at a time, followed, it must be said, by three or four, and then handfuls.

After 10 minutes there was a slight numbing of the gums. After 15, Mark started jabbering loudly. At 25 minutes we were laughing uproariously. After 45 minutes, Ethiopia's troubles had slipped away and a sense of wellbeing, alertness, euphoria and lucidity took over.

Over the next three hours we could report heightened senses, ideas flowing, periods of great calmness, interspersed with spells of reflection and analysis - like, why can't British charities develop a line of fair trade chat chewing gum, and turn round Ethiopia's economy?

In fact, Ethiopia does pretty well out of qat. The seedless plant which best grows at 3-6,000 feet above sea level is grown across vast areas as a cash crop and in economic terms is the country's fourth largest export. In upland regions such as Harange, it is the backbone of the economy, employing thousands of farmers, packers, harvesters and traders. Ethiopia is thought to have earned about $60 million from qat cultivation in 2000.

It is a popular plant to grow, too. It resists drought, can be harvested throughout the year and suppresses appetite. It is also far more profitable than most traditional crops. Moreover, the trade, transport and price is - theoretically - regulated by the government with responsible producer associations, licensed exporters and traders making large, legal profits. The price is set through inter-governmental agreements, regional government is allowed to tax exports, and huge quantities are trucked to neighbouring Djibouti or flown to Yemen where more than 85% of the adults use it.

But although overuse of the drug is condemned in Ethiopia and throughout the Middle East, it is widely recognised to be as important, socially, as coffee in the west. Users say that it has no criminality associated with it, and many people insist that it helps to create a friendly environment, even to help resolve disputes. Many Muslims use it during Ramadan because it reduces fatigue and hunger. Qat is also believed to have medicinal value, being used locally to treat influenza, gonorrhea and asthma.

The west, however, is increasingly suspicious of the plant. This largely follows the botched US-led 1992 invasion of Somalia during which many troops used top-grade qat. The drug was blamed by the military for some of the well-documented mistakes made, and the US drug enforcement agency now classes its main active ingredient, cathinone, as a schedule 1 drug, on the same level as heroin and cocaine. Recently, it has been pressurising other countries to crack down on it. Since it was banned in Canada, a black market has opened, and the price has risen tenfold.

But in Britain, qat is still legal and can be bought in many markets. However, the leaves available here are seldom fresh. This is important because the cathinone reverts to very mild cathine within 48 hours of the leaves being picked. Rather than a massive Ethiopian buzz, the British user is likely to get only a very mild hit.

Although the World Health Organisation says that medical problems associated with qat are "infrequent", governments claim it is addictive and has a negative impact on communities. "People forget about their work commitments and spend hours chewing," regretted one Ethiopian official in London this week.

As we discovered on that long road to Addis, the man is absolutely right. John Vidal

* * *

Further reading

Pharmacognosy department, King's College:

All you need to know about qat:

Go To Good Drug Guide
The Good Drug Guide
mental health in the third millennium


Methcathinone: structure
Khat/qat : the natural amphetamine