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Pontifications on Poison

Being some ramblings on events associated with poisonous plants.

Friday 15th July 2011

The UK Home Office has published a literature review entitled ‘Khat: Social harms and legislation’ written by David M. Anderson and Neil C. M. Carrier of Oxford University. Khat is one of the many common names given to Catha edulis. I mentioned some of the others in the 10th July blog entry.

The authors examined the literature from the UK and seven other countries outside the ‘home territory’ for khat use and with a significant number of immigrants from Middle East and East African countries where khat use is traditional. They ‘found a general lack of robust evidence on the link between khat use and social harms’.

Since the increase in the number of UK immigrants from ‘khat countries’ there have been questions about its impact both on the health of users and its potential to cause societal harm. The Labour government investigated the issue but, in March 2006, announced that it did not intend to change the status of khat by classifying it under the Misuse of Drugs Act.

Catha edulis, khat

Then, early in 2010, came the mephedrone hysteria when the media decided that a number of young people had died from using this artificial (but, then, legal) substitute for cocaine and ecstasy. I say the media ‘decided’ because the cause of these deaths was widely reported before any post mortem examinations had been held and the results of those examinations, showing that mephedrone was not the cause of death, received less coverage. There is more on mephedrone on the Phantastica page on khat because mephedrone is similar to the active alkaloids in Catha edulis.

This similarity led the new coalition government’s Conservative Home Secretary, Theresa May, to write to the Advisory Council on the Misuse of Drugs (ACMD) asking that a new review be undertaken into khat and its role in society. It was generally felt that Ms May wanted to classify khat and was looking for support from the ‘independent’ ACMD.

However, the ACMD was also heavily committed to trying to find a way of dealing with the so-called ‘legal highs’, psychoactive substances being created by chemists to have the same effects as classified drugs. It was also conducting an ‘urgent’ review into cocaine after the Home Affairs Select Committee enquiry into the cocaine trade heard lots of evidence that cocaine did not cause the harms often ascribed to it.

Prof. Les Iversen, who replaced Prof David Nutt as head of the ACMD after Nutt demonstrated the independence of the committee, wrote to Ms May to say that the ACMD would put khat third on its list of priorities after legal highs and cocaine. There has been no sign that the ACMD has completed its work on either of its first two priorities so its third has been ignored. In fact, the agenda for its most recent meeting, in April 2011, made no mention of khat at all.

There is nothing in this new review to say who asked for it to be prepared but, given that is has been published by the Home Office, albeit with the caveat that ‘The views expressed in this report are those of the authors, not necessarily those of the Home Office (nor do they reflect Government policy), it seems likely that it was intended to inform the ACMD’s consideration of khat.

Catha edulis, khat

In 1988, the alkaloids of Catha edulis, cathinone and cathine, were added to the schedule of the UN Convention on Psychotropic Substances. This led to some countries making khat use illegal so Anderson and Carrier were able to select countries where it is a proscribed substance, such as the USA, Canada, and Scandinavian countries as well as those where there are ‘significant imports’ but it remains legal; Australia and the Netherlands, in addition to the UK.

Khat use amongst immigrant communities, especially Somalis, is, anecdotally associated with a number of societal harms, most often unemployment, but the authors found no evidence that khat use produces unemployment rather than that the unemployed are more likely to use khat since they are able to gather after lunch and participate in a khatting session as they would have done in their home country.

They also found that the only association between khat and criminal activity was in those countries where possessing khat is, itself, a criminal act. Khat use in countries where it is legal does not result in criminality. They did find limited evidence that khat use can cause minor anti-social behaviour, mostly spitting in public.

Khat chewing continues to be perceived as a male activity, though there is some evidence that women chew khat at home, secretly, and there have been calls from groups representing Somali women for khat to be controlled because it leads to family breakdown. This review, however, finds no evidential support for this notion but says there are indications that the cultural change of moving to a country where gender roles are very different may be the dominant factor in family breakdowns in the Somali diaspora.

Aside from the gender issue, the review found some reports that khat use by immigrants can help to maintain communities by retaining an important cultural practice. Some studies have found that even non-users believe that khat use is helpful to their community. But, it must be said, there are loud voices in the Somali community who believe khat is bad for them. As well as women groups, the ‘anti’ argument is voiced by younger Somalis who see khat use as a barrier to integration and a means of retaining the hierarchical structure they wish to leave behind. The authors, however, found insufficient evidence to support these views.

Catha edulis, khat

As with all substances, there are examples of heavy users producing the sort of problems attributed to khat in general. Heavy users may not be in a position to enter employment and may have financial problems as a result of their spending on khat but, in general, these were not found. It was found that, as in their home countries, at times when khat became expensive, users did without.

It is interesting to examine this point about financial problems caused by spending a high proportion of income on khat. The authors found little evidence that prohibition has made much difference to khat use in countries where it is illegal to possess khat. In part this is because the number of users is so small that the authorities don’t expend resources studying it or in searching out illegal imports rather than just dealing with those that, as it were, fall into their laps.

In the USA, for example, the actual number of Somalis is unknown but estimates range from 30,000 to 150,000 so, even at the highest level, the number of potential khat users is tiny. But, what the authors found was that in countries where khat is illegal its price is significantly higher. A legal bundle selling for £3 in the UK retails at £20 in Norway and £30 in the USA because of its illegality.

Wider study of the market for khat would be most useful since it seems to confirm the premise that prohibition of a substance does nothing other than create profits for criminals.

Anderson and Carrier’s review gives a clear indication that the decision against scheduling khat, taken in 2006, remains the right choice and that a government wanting to act on evidence would not alter its status. The concern, however, is that the government may not be willing to defend the evidence.

Given that the ACMD seems to be very slow in dealing with its existing workload, however, it may be that the choice doesn’t have to be made for a long time. It just may also be that the Home Office is happy to be able to say ‘the matter is under review’ rather than defend a decision to make no change.

Oddly, there is a potential read-across to the current furore over press activities and influence. If the result of that affair is that politicians are less cowed by the threat of press criticism of policies, we might see more policy being based on sense rather than public hysteria.