Khat is a strong appetite suppressant and its use can also lead to constipation. New comment

Catha edulis (cat) is a flowering plant native to the Horn of Africa and the Arabian Peninsula. Among communities in these areas, khat chewing is a social custom with a history dating back thousands of years. Khat contains a monoamine alkaloid called cathinone, an amphetamine-like stimulant that causes agitation, loss of appetite, and euphoria. In 1980, the World Health Organization (WHO) classified this substance as a drug that can cause psychological dependence. Anti-drug organizations such as the DEA have become interested in cat. It is a controlled substance in some countries, such as Canada, Germany, the United Kingdom and the United States (de facto), while in others, including Djibouti, Kenya, Ethiopia, Somalia and Yemen, its production sale and consumption are legal. Consumption of the plant's leaves in their natural state is also permitted in Israel.

Nomenclature

In endemic areas of the Horn of Africa and the Arabian Peninsula, khat has various traditional names such as kat, qat, qaad, ghat, chat, Abyssinian tea, Somali tea, Miraa, Arabian tea and Kafta. In the African Great Lakes region, in some areas of which Catha edulis is cultivated, it is known as miraa, muhulo and muirungi. In South Africa, the plant is known as Bushman tea. Other names for khat are khat tree and flower of paradise.

Description

Khat is a slow-growing shrub or tree that typically reaches 1 to 5 m in height. However, in equatorial regions the plant can reach up to 10 meters in height. The plant usually grows in dry areas, with temperatures ranging from 5 to 35°C. The plant has evergreen leaves, 5-10 cm long and 1-4 cm wide. The flowers of the bush grow in the form of short axillary curls, 4-8 cm in length. The flowers are small, with five white petals. The lionfish is an oblong, three-valved capsule containing one to three seeds.

Cultivation and use

The qat plant is known by different names, such as qat and gat in Yemen, qaat and jaad in Somalia, and chat in Ethiopia. The plant is also known as jimaa in Oromo language and mayirungi in Luganda language. Khat has been cultivated for use as a stimulant for many centuries in the Horn of Africa and the Arabian Peninsula. There, khat chewing precedes coffee drinking and is used in a similar social context. In Uganda, khat is grown in the Central region, the kasenge Nakawuka region and parts of the western region of the country. In Kenya, the plant is grown in Meru County. Although the practice of khat chewing is still largely limited to its original cultivation area in the Red Sea region, the plant has been used for many years in South Africa, as well as in tropical areas where it grows on rocky outcrops and forested areas. The shrub today grows in the KwaZulu-Natal, Eastern Cape, Western Cape and Mpumalanga provinces of South Africa, in addition to Swaziland and Mozambique. The fresh leaves and upper parts of the plant are chewed or, less commonly, dried and consumed as tea to achieve a state of euphoria and stimulation; it also has anorectic (appetite-reducing) side effects. For easier chewing, the leaves or the soft part of the stem can be chewed with either chewing gum or roasted peanuts. In recent years, however, improved roads, the advent of off-road vehicles and air transport have increased the global distribution of this perishable commodity and, as a result, the plant has appeared in England, Wales, Rome, Amsterdam, Canada, Israel, Australia, New Zealand and the United States . Traditionally, khat is used as a socializing tool, as in Yemen, where khat chewing is a predominantly male habit. Khat is so popular in Yemen that its cultivation takes up a significant portion of the country's agricultural resources. It is estimated that 40% of the country's water resources are devoted to khat irrigation, with production increasing annually by approximately 10-15%. The production of one “daily bag” of khat requires approximately 500 liters of water. Such high water consumption is causing groundwater levels in the Sana'a basin to decline, so government officials have proposed relocating most of Sana's population to the Red Sea coast. One of the reasons why qat is widely cultivated in Yemen is the high income of farmers. Some studies conducted in 2001 estimated that the income from khat cultivation was about 2.5 million Yemeni rials per hectare, while the fruit yielded only 0.57 million rials per hectare. Between 1970 and 2000, the area under khat cultivation increased from 8,000 to 103,000 hectares. In other countries, outside the main area of ​​its cultivation and consumption, khat is sometimes consumed at parties. It can also be used by farmers and workers to reduce physical fatigue or hunger, and by drivers and students to improve attention. It takes seven to eight years for the plant to reach its full height. Apart from access to sun and water, growing khat does not require much effort. Groundwater is often pumped from deep wells by diesel engines to irrigate crops or transported by water trucks. Water the plant generously, starting about a month before harvest, to keep the leaves and stems soft and moist. Harvesting can be done four times a year, providing an annual source of income for the farmer.

Health effects

Addiction specialists in the fields of psychiatry, chemistry, pharmacology, forensic medicine, epidemiology, as well as police and legal services, conducted a Delphi analysis of 20 popular recreational drugs. Khat ranked 17th in terms of addiction development, 20th in physical harm, and 20th in social harm. Consuming khat causes mild euphoria and excitement, similar to strong coffee. Under the influence of the plant, people become very talkative. The effects of oral cathinone develop more quickly than those of amphetamine tablets; they begin approximately 15 minutes compared to 30 minutes after taking amphetamine. Khat can cause manic behavior and hyperactivity, and these effects are similar to those of amphetamines. Using khat leads to constipation. Khat causes dilation of the pupils (mydriasis), as well as an increase in heart rate and blood pressure. According to the 11th century pharmacologist Al-Biruni, other chemical and physical properties associated with khat are that it also acts as a natural coolant for the stomach and liver and relieves jaundice. Khat is an effective anorectic (causes loss of appetite). Long-term use may cause: permanent darkening of teeth (to a greenish tint), susceptibility to ulcers and decreased sexual desire. It is unclear whether khat consumption affects mental health user. Occasionally, a psychotic episode resembling a hypomanic state may occur as a result of consuming the plant.

Effects

Immediate effects:

Increased attention

Excitation

Concentration

• Friendliness

  Hyperactivity

  High blood pressure

  Increased heart rate

  Insomnia

• Suppressed appetite

  Talkativeness

  Thought disorders

  Verbosity

Long term effects:

Depression

Rare hallucinations

Impaired inhibition (similar to alcohol)

Increased risk of myocardial infarction (heart attack)

Psychosis in extreme cases in genetically predisposed individuals

Oral cancer

Unspecified effects:

• Stroke after acute coronary syndrome (artery blockage)

Chemistry and pharmacology

The plant's stimulant effects were originally attributed to "cathine", a phenethylamine-type substance isolated from the plant. However, this view has been challenged by reports showing that plant extracts from fresh leaves contained another substance that was more behaviorally active than cathine. In 1975, the related alkaloid cathinone was isolated, and its absolute configuration was determined in 1978. Cathinone is not very stable and breaks down to create cathine and norephedrine. These chemicals belong to the PPA (phenylpropanolamine) family, a subset of phenethylamines related to the amphetamines and catecholamines epinephrine and norepinephrine. In fact, cathinone and cathine have a very similar molecular structure to amphetamine. Khat is sometimes confused with methcathinone, a Schedule I drug that has a similar chemical structure to the active cationic component of the khat plant. However, both the side effects and addictive properties of methcathinone are much stronger than those of khat. If left dry, khat is more powerful. Chemical substance, cathinone, decomposes within 48 hours, leaving behind a milder chemical, cathine. Thus, farmers transport khat by packing the leaves and stems in plastic bags or wrapping them in banana leaves to retain their moisture and maintain cathinone activity. The plant is also often sprayed with water or refrigerated during transportation. When khat leaves are chewed, cathine and cathinone are released and absorbed through the mucous membranes of the mouth as well as the gastric mucosa. The effects of cathine and cathinone on the reuptake of epinephrine and norepinephrine have been demonstrated in laboratory animals. One or both of these substances have been shown to cause slower processing of these neurotransmitters, leading to wakefulness and insomnia associated with khat use. Serotonin receptors show a high affinity for cathinone, indicating that this chemical is responsible for the feelings of euphoria associated with chewing khat. In mice, cathinone produces the same types of neural stimulation or repetitive scratching movements associated with amphetamines. The peak effect of cathinone is achieved after 15-30 minutes, with almost 98% of the substance being metabolized into norephedrine by the liver. What is less clear about cathine is that it is thought to act on adrenergic receptors, causing the release of epinephrine and norepinephrine. It has a half-life of about three hours in the human body. The medication bromocriptine can reduce cravings and withdrawal symptoms within 24 hours.

Demography

It is estimated that between 5 and 10 million people worldwide use khat daily. Khat is grown primarily by communities in the Horn of Africa and the Arabian Peninsula, where khat chewing has a long history as a social custom that dates back thousands of years. Traditionally, khat chewing in Yemen is restricted to men; women use the plant less formally and less frequently. It is estimated that about 70-80% of Yemenis between the ages of 16 and 50 have used khat. Approximately 60% of Yemeni men and 35% of women chew khat daily. Yemenis spend an estimated 14.6 million man-hours a day chewing khat. The researchers also estimated that families spend about 17% of their income on khat.

Story

According to some sources, khat was first grown in Ethiopia. Researcher Sir Richard Burton suggested that the plant was later introduced into Yemen from Ethiopia in the 15th century. He mentions the eastern city of Harar as the plant's birthplace. However, among communities in the Horn of Africa (Djibouti, Ethiopia, Somalia) and the Arabian Peninsula, khat chewing has a long history as a social custom dating back thousands of years. According to ancient Egyptian imperial cults, the plant was considered a sacred substance that was capable of realizing the divinity of the user. These early Egyptians ceremoniously consumed the plant in attempts to transcend into "apotheosis" and/or collect and manifest mystical experiences, systemic trances, and other metaphysical experiences. Sufis also used the plant to enhance their mystical experiences and to experience a sense of union with God. The earliest known documented description of khat is found in Kitab al-Saidala fib al-Tibb كتاب الصيدلة في الطب, an 11th century work on pharmacy and pharmacology written by the Peruvian scientist and biologist Abu Rayhan al-Biruni. Not knowing about the origin of the plant, al-Biruni wrote that khat was imported from Turkestan and had a sour taste. Khat is reddish with a slight blackish tint. It is believed that batan alu is a red, cooling remedy that relieves jaundice and cools the stomach and liver. In 1854, the Malay author Abdullah bin Abdul Qadir noted that the custom of chewing khat was common in Al-Hudaydah in Yemen: the new fashion in the city was for everyone to chew the leaves like goats chewing the cud. There is a type of leaf, quite wide and about two fingers long, which is widely sold as people consume these leaves as they are; Unlike betel leaves, which require specific seasonings, these leaves are simply popped into the mouth and chewed. Thus, when people gather in a circle, these leaves are thrown in front of them in a mountain. When they spit, their saliva is green. I asked them, “What are the benefits of these leaves?” To which they replied: “No, it’s just another expense for us, since we’re used to it.” People who consume these leaves must eat a lot of ghee and honey, otherwise they will get sick. The leaves of the plant are known as Kad.” In 1856, English writer Charles Dickens also described the custom of chewing khat in the Horn region and surrounding areas of the Persian Gulf, comparing it to drinking strongly brewed green tea: If you do not take too much khat during the day, you can sleep well. The leaves of the medicinal plant called khat are a major source of arousal in these areas of East Africa. Botanists call the plant Catha edulis, or edible cat. Khat is widely distributed among the Arabs, where it is carried on camels in a number of small parcels, each containing about forty thin branches, with leaves attached to them, carefully wrapped to avoid exposure to air. These leaves are chewed. The effect of the plant is similar to the pleasant effect that a strong dose of green tea gives to Europeans. Europeans, accustomed to stronger stimulants, will feel little of the effects of khat, but among the more moderate Arabs, khat is so valued that every year in Aden alone about two hundred and eighty camels are used to transport it. Currently, khat consumption is limited to East Africa and Southwestern Arabia. These countries include Djibouti, Ethiopia, Kenya, Somalia (including Somaliland), Uganda and Yemen. Author Yousif Al Zarouni writes in his book: “The plant is native to the Arabian Peninsula and Horn of Africa, but despite this, it is only legal in one of several countries on the Arabian Peninsula, Yemen. The plant is, however, widely available and legal in East Africa, and is considered a protected species in some African countries such as South Africa. The plant is mainly used by East Africans and Southwestern Arabs, rarely by people from other places. Following the ban on khat in the British-controlled Aden Protectorate, the Commission concluded: “khat is not addictive like opium or hashish, and people who suddenly stop using it do not experience physical consequences withdrawal symptoms."

Regulation

In 1965, the Committee of Experts World Organization of Health (WHO) on the fourteenth report on Substances of Dependence, noted: “The Committee noted with satisfaction the Economic and Social Council resolution on khat, reaffirming the view that the abuse of this substance is a regional problem that can best be controlled there level." For this reason, khat is not included in the Single Convention on Narcotic Drugs. In 1980, the WHO classified the plant as a drug of abuse, capable of causing mild to moderate psychological dependence (less than tobacco or alcohol), although the WHO does not consider khat to be highly addictive. Khat is a controlled or illegal substance in some countries, but its sale and production is legal in other countries.

Ethiopia

Khat is legal in Ethiopia.

Somalia

Khat is legal in Somalia.

Djibouti

Khat is legal in Djibouti.

Kenya

Khat is legal in Kenya. However, its two active components, cathinone and cathine, are classified as class C substances.

South Africa

In South Africa, Catha edulis is a protected tree. Using kata is illegal.

Uganda

Mira is legal in Uganda, but efforts are being made (October 2015) to introduce a ban.

China

Khat is illegal in China.

Israel

Khat is used mainly by Yemenite Jews. In its raw form, the plant is also available for sale on several open markets. A cocktail of arak and crushed frozen khat mixed with grapefruit juice has become popular in recent years in the south of the country. However, as of June 2012, Israel's anti-narcotics authority announced that drinks containing khat would be considered illegal under the Israeli Dangerous Drugs Regulation. In 2003, a tablet based on cathinone extract, Hagigat, began to be sold in kiosks in Israel. After several cases of hospitalization as a result of cathinone poisoning, the Israeli Ministry of Health classified cathinone as a dangerous drug and Hagigat was declared illegal. The plant itself is permitted to be chewed and is sold in its natural state as it has not been found to be harmful when taken in normal quantities. Etrogat is a popular juice from Jerusalem sold by Uzi-Eli Hezi. You can also find many varieties of khat juice in Israel.

Indonesia

Khat is legal in Indonesia.

Malaysia

Khat is illegal in Malaysia.

Philippines

Khat is illegal in the Philippines.

Saudi Arabia

Khat is illegal in Saudi Arabia.

Thailand

Khat is legal in Thailand.

United Arab Emirates

Khat is illegal in the United Arab Emirates.

Yemen

Khat is legal in Yemen. However, the cultivation of khat and the sale of its leaves are subject to a number of regulations. In 2007, the Yemeni government passed a law restricting the cultivation of qat in several agricultural plains and basins with high water scarcity. The General Sales Tax Law passed in 2005 also set the tax rate on khat at 20% of its retail price. The widespread use of qat in Yemen has exacerbated the country's severe water shortage. Khat is much more water-intensive to grow than other crops.

Denmark

Khat has been illegal in Denmark since 1993.

Finland

Khat is classified as an illegal drug in Finland and possession, use and sale of the substance is prohibited and punishable. As with all illegal drugs, if khat or its metabolites are detected in the driver's blood, it will be determined that the driver is intoxicated, even if the driver does not appear to be so.

France

Khat is banned in France as a stimulant.

Germany

In Germany, cathinone is designated as a “restricted substance,” making it illegal to possess, sell, or purchase fresh khat. The derivative cathine is available by prescription only, while norephedrine is not listed.

Iceland

In August 2010, Icelandic police intercepted khat smuggling for the first time. 37 kg of the plant were seized. Most likely, the plants were going to be sold in Canada. Again, in May 2011, police intercepted approximately 60 kg of khat.

Ireland

Khat is a controlled substance under the Misuse of Drugs Act 1977 and Schedule 1 of the Misuse of Drugs Act 1988. Therefore, its unauthorized storage and supply is prohibited.

Netherlands

In areas of the Netherlands, the active components of khat, cathine and cathinone, are classified as hard drugs and are therefore prohibited. The use of khat is mainly limited to the Somali community. In 2008, Dutch Health Minister Ab Klink decided not to classify the raw plant as a drug, after consulting with experts. However, on January 9, 2012, the Dutch government announced a ban on khat.

Norway

In Norway, khat is classified as a narcotic drug, the use, sale and possession of which is illegal. Most users are Somali immigrants, and khat is smuggled from the Netherlands and the UK. In 2010, Norwegian customs seized 10 tons of khat, which is more than in 2006.

Russian Federation

The khat plant is prohibited for cultivation and circulation on the territory of the Russian Federation, falling under the List of Narcotic Drugs and Psychotropic Substances, the circulation of which in the Russian Federation is prohibited in accordance with the legislation of the Russian Federation and international treaties (List I).

Poland

In Poland, khat is classified as a narcotic drug, the use, sale and possession of which is illegal.

Romania

Khat is illegal in Romania.

Sweden

The drug was banned in Sweden in 1989, without research.

Switzerland

Khat is illegal in Switzerland. It is classified as a narcotic drug.

Great Britain

On 24 June 2014, khat was made illegal in the UK. Health professionals and citizens have raised concerns about the use of khat in the UK, particularly by immigrants from Somalia, Yemen and Ethiopia. A study of the impact of khat use among immigrants on their mental health showed that there is a need for more high-quality research on khat chewing and its possible association with mental disorders; it was also shown that public discourse on the issue showed elements of moral panic. Some Somali community organizations have also campaigned for khat to be banned. As a result of these problems, the Home Office commissioned successive studies to examine the issue, and in 2005 submitted the question of the legal status of khat to the Advisory Council on the Misuse of Drugs. The study found that the majority of participants who used khat used it moderately, in terms of both quantity and frequency and duration of chewing sessions, and that khat use tended to have a socially significant role. It was noted that only a small minority of study participants abused khat. After careful consideration of the evidence, in January 2006 the Advisory Council on the Abuse of Drugs recommended that khat continue to be legal. In 2008, Conservative politician Syeda Warsi said that a future Conservative government would ban khat. The website of the Conservative Party, which became the largest party in the UK coalition government in 2010, previously stated that the Conservative government would "address unacceptable cultural practices" by, among other things, "classifying khat". In 2009, the Home Office commissioned two new studies into the effects of khat use, and in June 2010 a Home Office spokesman said: "The Government is committed to addressing all forms of substance abuse and will keep khat use under close review." . During a parliamentary debate on the legality of khat on 11 January 2012, Mark Lancaster, a member of the Conservative Party in Milton Keynes, stated that khat imports into the UK amounted to 10 tonnes per week. On January 23, 2013, the Advisory Council on the Misuse of Drugs (ACMD) stated that there is "insufficient evidence" that khat causes health problems. The ACMD stated that there is "no evidence" that the use of khat is directly linked to serious or organized crime, and that it is used to produce a "mild stimulant effect, much less potent than the effects of stimulants such as amphetamine". On 3 July 2013, British Home Secretary Theresa May announced that khat would be banned in Britain, designating it as a Class C substance under the Misuse of Drugs Act 1971. Alex Miller, a journalist for Canada's Montreal magazine and Vice television, examined the use of the substance and the potential impact of the ban, explaining his position on the BBC nightly news program Newsnight and in a Vice documentary. Kenyan MPs have urged the UK not to "judge people" by banning the herbal stimulant khat. In March 2014, the Home Affairs Committee of the United Kingdom House of Commons announced that it would continue to lobby the UK government not to ban khat. The committee had also recently completed an investigation and issued a report in which it recommended that the British authorities refrain from banning the plant. On 12 May 2014, the House of Lords passed the Narcotic Drugs (Designation) (Amendment) (No. 2) (England, Wales and Scotland) Act 1971 2014 to move Catha edulis to Class C drugs. An amendment was proposed , which states that "the House regrets that Her Majesty's Government's plans for introducing the legislation do not include provisions for a 12-month review of the impact of the reclassification of khat, due to the highly unusual public focus on its use, to establish a detailed strategy prior to the introduction of a ban or to establish a public health strategy to prevent addiction to other substances, and not oblige the Department for International Development to work more with the Government of Kenya to mitigate the impact of reclassification on the Kenyan economy.” However, the amendment was defeated by a vote. The ban came into force on June 24, 2014. In January 2015, the Bristol Post reported that most khat houses in the city had closed, "driving users to use the plant at home." Initially, local police made no attempt to enforce the ban by giving users a grace period, however, according to the Bristol Post, they have recently begun cracking down on the use of khat, with three warnings and a caution issued. Additionally, in September 2014, police seized 24 bags of dried khat plants from a private residence in Easton, but no arrests were made. Additionally, the Somali Resource Center indicated that the ban appears to have been effective and that it has nearly destroyed the import market since the plant must be fresh to be consumed. A consultation with Somalis in Glasgow carried out by national voluntary organization Fast Forward at the request of the Glasgow Somali Association in October 2014 suggested that khat continues to be consumed in fresh and dry forms by some Somalis in the city, and that the ban has also prompted some users to search other substances. The ban has reportedly increased the price of khat in the UK. Channel 4 News reported in September 2014 that before the ban, 20 tonnes of khat were being flown into Heathrow Airport every day and selling for £3 a pack. After the ban, khat was reportedly selling for £30 a pack.

Canada

In Canada, khat is a controlled substance under Schedule IV of the Controlled Drugs and Substances Act (CDSA), which means it is illegal to purchase unless approved by a physician. Possession of khat may result in a maximum penalty of imprisonment for a period of three years. The maximum penalty for transportation or possession for the purpose of trafficking is ten years in prison. In 2008, Canadian authorities reported that the most commonly smuggled drug at airports was khat. However, in 2012, the Ontario Court of Appeal upheld a 2011 decision granting the absolute release of a young woman who transported 34 kilograms of khat to Canada in 2009. According to the defense, the ruling acknowledges that there is no empirical evidence that khat is harmful. Courts in Quebec and Ontario continued to release those accused of smuggling khat into Canada for the same reason (no evidence that khat was harmful) in 2014 and 2016.

USA

In the United States, cathinone is a Schedule I drug under the US Controlled Substances Act. In 1993, the DEA listed cathinone as a Schedule I drug and banned khat: “Cathinone is the primary psychoactive component of the Catha edulis (khat) plant. Young khat leaves are chewed to achieve a stimulant effect, and the introduction of this rule results in the placement of any substance that contains cathinone in Appendix I.” Catha edulis (khat) is a narcotic stimulant similar to amphetamine and its related compounds, according to the US Food and Drug Administration. According to FDA import Alert #66-23 (publication date 03/18/2011), “all items of khat may be detained without physical inspection” under section 801(a)(3) of the Fed. food products, medicines and cosmetics, on the grounds that “its labeling does not provide adequate guidance regarding its use.” Because federal and local khat raids have often targeted immigrants from countries where khat is legal, issues of cultural misunderstanding are sometimes raised. The plant itself is specifically prohibited in Missouri: “khat is prohibited, including all parts of the plant now classified botanically as catha edulis, its seeds, any extract of any part of such plant, and every compound, derivative, salt, mixture, or preparation of plant, its seeds or extracts." In California, both the plant itself and cathinone, its active component, are illegal.

Australia

In Australia, khat imports are controlled under the Customs (Prohibited Imports) Regulations 1956. Individual users must obtain permits from the Australian Quarantine and Inspection Service and the Therapeutic Goods Administration to import up to 5kg of khat per month for personal use. Permits must also be approved by Australian Customs, which regulates the actual import of the drug. In 2003, the total number of annual khat permits was 294, and the total number of individual khat permits was 202. Khat is listed as a Schedule 2 dangerous drug in Queensland, and is in the same category as cannabis. The legality in New South Wales is unclear.

New Zealand

In New Zealand, khat is considered a Class C drug, in the same category as cannabis and codeine.

South America

There is no legislation regarding khat in South America; The active ingredients in the plant can be found in several weight control substances sold on the continent.

Research programs

In 2009, the University of Minnesota launched the Kata Research Program (KRP), a multidisciplinary research and teaching program focusing on the neurobehavioral and health benefits of khat, under the leadership of Professor Dr. Mustafa Al Abbi. The program was funded by the National Institutes of Health and the National Institute on Drug Abuse in the United States. The inaugural event for KRP took place in Sharm el-Sheikh, Egypt in December 2009, in collaboration with the International Brain Research Organization (IBRO) and its local affiliates.

:Tags

List of used literature:

Al-Mugahed, Leen (2008). "Khat Chewing in Yemen: Turning over a New Leaf: Khat Chewing Is on the Rise in Yemen, Raising Concerns about the Health and Social Consequences.” Bulletin of the World Health Organization. 86(10):741–2. doi:10.2471/BLT.08.011008. PMC 2649518 Freely accessible. PMID 18949206. Retrieved January 9, 2014

The consumption of leaves and young shoots of the khat plant is a centuries-old tradition of the population of some regions of East Africa in the Arabian Peninsula. The main interest in khat is due to its psychostimulant effect, which has led to widespread chewing of fresh leaves in countries such as Ethiopia, Yemen, Djibouti, Somalia, limited areas of Kenya and Tanzania, as well as in parts of Saudi Arabia.

There are many geographical and linguistic variations in the designation of kata. The population of Arab countries uses the names “kat”, “khat”; these names are similar to Somali ones. In a number of East African countries, khat is referred to as “miraa”, “mera”, “murungu”. In Ethiopia, several names are used: khat, khat, chat, te, gofa and others. The Amharic word for "chat" is believed to have no direct transcription in the English alphabet. Khat is also known as African, Abyssinian, Somali, Bushman and wild tea. In English-language publications the word khat is used. In translations and original Russian-language texts there are a number of different names: kat, khat, khat, katu, kato, chat.

The history of the appearance of khat bushes on the Arabian Peninsula and in Ethiopia has many conflicting versions. The Arab historian Abdul Qadar wrote about the cultivation of khat that spread in the 14th century in the area of ​​Aden and Yemen. Other authors cite the version that khat came to Yemen from Abyssinia in the 30s of the 15th century, after the Islamic missionary Sheikh Abu Zerbin visited Harer (Ethiopia). The same route is associated with another missionary sheikh, Ibrahim Abu Zaharbui, who also visited Harar and whose name is immortalized in Al-Yaman (Yemen), allegedly precisely because of the plant he brought. According to another version, the khat bush was brought from Abyssinia to the Arabian Peninsula only in the 16th century by Sheikh Abu Said bin Abdel Kadir.

In Harare itself, there are several legends of their own about the appearance of kata. It seems appropriate to retell these stories, since they reflect the main properties of khat as a stimulant with an awakening effect, mental activation and an adaptogenic effect in relation to certain climatic difficulties.

According to the first story, a Yemeni shepherd noticed special action kata on your goats 1. Having tasted the leaves, he soon felt cheerfulness and a surge of strength, and in the evening he could not sleep and spent many hours in prayer and meditation. The name of the famous shepherd is mentioned in prayers that are recited in some places before consuming khat.

Among Harare Muslims there is also a legend about two saints who spent many nights in prayer, falling asleep from fatigue. They began to ask Allah to send them something to keep them awake, so as not to interrupt their prayers. That's when an angel appeared and pointed them to a khat bush. Therefore, in some regions, khat is still considered a sacred plant and before harvesting, ablution is performed, and the collected leaves are wrapped in a clean cloth.

One of the legends is associated with the founding of the city of Harer itself, located in the eastern mid-mountain part of Ethiopia. The location of the settlement was chosen taking into account its elevation, beautiful landscape and abundance of water sources. However, it soon turned out that people “constantly feel lethargy and deep laziness, which are associated with the characteristics of the air in this area.” To overcome the current situation, merchants were sent to Yemen to buy a sacred plant that gives strength. Thus, according to this version, khat bushes were planted in Harare.

Based on a comparison of Ethiopian, Somali and Yemeni versions, more balanced points of view are expressed about the origin and spread of khat. Their essence is that “the question goes back to early history, when there were no special obstacles to mutual exchange.”

The anthology “History of Africa” mentions the work of the Arab historian Shihab Al-Omari, which talks about khat. The historian wrote that khat grows in Ethiopia (its current southeastern part) and that it is prescribed to clarify the mind and strengthen memory. Another historian of the 15th century, Al-Marquzi, pointed to the places where this plant grows in the current central part of Ethiopia and, according to one of the retellings of his text, described the effect of khat as follows: “it has the ability to excite and revive the imagination, give clarity to thoughts, elevate mood, reduce the need for food and stimulate wakefulness.” In addition, Al-Marquzi noted that the local population loves these leaves and uses them very widely.

As you can see, the main effects of kata were described in Arabic manuscripts. The famous physician Najib Ad-Din used khat already at the beginning of the 13th century to treat melancholy, as he said in the “Book of Medicines” published in 1227. The dangers of khat abuse to health were also known to the Arabs of that time. In the 14th century, they expressed their warnings in scriptures, which were repeatedly quoted in medical literature this century.

The scientific study of khat among European scientists was started by the Swedish doctor and botanist Peter Forskal during an expedition. Forskal died in Arabia in July 1768. Of the five members of the expedition, only the Honoverian geographer Carsten Nieburg survived, who presented a botanical report in 1775. In memory of his friend, he gave the plant the name Catha edulis Forskal. Subsequently, many scientists and travelers encountered and described khat in various regions of Asia and Africa. Several reports provide detailed information about the localities of wild and cultivated khat, with botanical descriptions and lists of scientific and local names for the plant.

The khat plant belongs to the euonymus, red-vesicle (Ćelastrećees) family. Khat is found in shrub and tree forms. The shrub has a height of 1–2 m and above; cultivated forms are pruned to keep them at a certain level. In appearance it has been compared to the tea bush and lilac. The leaves of khat (Folium khat) resemble tangerines; they have an elliptical shape with a pointed or obtuse top and finely serrated sides. The length of mature leaves reaches 5–10 cm and the width is 1–4 cm. The leaves are red-brown, yellow-green and whitish in color with many shades, depending on the variety and degree of maturity. Khat bushes are located in terraces on mountain slopes and in valleys, approximately at an altitude of 1500–2500 m. For Ethiopia, the most typical altitude is 1600–2100 m, with 900–1600 m and 2100–2500 m being the marginal growth zones.

Typically, wild khat is found in Northeast Africa and the south of the Arabian Peninsula. Natural khat massifs are mainly found in Ethiopia and Yemen, but they also exist in Kenya, Tanzania and Zambia. Khat is known to grow in South Africa and Northern Madagascar. It has been grown for research purposes in a number of countries, such as Egypt.

The most famous khat cultivation centers are Harar in Ethiopia and Meru in Kenya. Khat is also grown in several provinces of Yemen and in small areas in Zambia and Somalia. The second center of khat cultivation in Ethiopia, after the Harerge region, is the Shoa province. Plantations of the plant exist in a number of other provinces - Gojam, Walega, Illubabor, Kaffa, Wollo and Arusi.

According to UN FAO estimates, cultivated and wild khat (chat) in 1971–1972. covered 99 thousand hectares of Ethiopian crop areas, and its harvest amounted to 7.2 thousand tons. The author also provides data that in the early 70s, the average annual harvest of the plant reached 10 thousand tons, and that in the province of Harerge, khat occupied up to 12% of the cultivated area. There was an increase in the latter in Ethiopia as a whole.

According to color, khat is divided into “red” and “white”. Red is considered stronger, so it is more popular and valued higher. There are 7 market types of khat in Ethiopia, which are divided into 2 large groups - kudda and karti. Kudda is considered to be of better quality as it has smaller and more delicate leaves; Particularly noteworthy is khat uretta, which is grown in the dry season on irrigated lands and which is preferred by some experts. The author draws attention to the fact that in the literature there is confusion in the names of the varieties and quality of khat, and explains, for example, that red khat can be kuda, karti and uretta. According to him, 7 species and approximately 15 subspecies of khat grow in Ethiopia.

Khat is harvested 2–3 times a week, the branches are placed in bundles and then wrapped in banana or corn leaves. To preserve the freshness of the leaves, and therefore their effect, good packaging, moisture and quick transportation are very important. Khat retains its freshness for 2–4 days. The dimensions and weight of packages vary during the stages of its transportation and sale. In the Ethiopian province of Harerge, in the area of ​​Lake Alemaya, one of the measures of khat is “akkara” - about 50 branches with a total weight of about 1 kg; Large and smaller packages are also used; a 40 cm long package contains all 3 types of khat (kudda, karti, uretta); both red and white twigs usually weigh about 30 g. In Djibouti, bundles weighing about 280 g are sold. The average weight of market packaging in Kenya is 41.8 g. In Aden, the bundle contains 40 branches 16 cm long. In Somalia, 150 gram packets of khat leaves called marduf are sold. Khat is usually sold in markets, shops and shops with special rooms.

1.2. Chemical composition of khat and experimental studies

At the end of the century before last, Fluckiger and Gerok discovered an alkaloid in dry khat leaves, which they called cathine. In 1930, cathine was identified as (+)-norpseudoephedrine and its formula was refined. A study of the local and central action of cathine showed that it is of a distinct sympathomimetic nature and qualitatively corresponds to the main effects of amphetamine. However, cathine stimulates the central nervous system 7–10 times weaker and less commonly causes stereotypy, although its toxicity to humans and animals is close to that of amphetamines. It is believed that cathine has more somatotropic adrenomimetic properties than psychostimulating ones. In the composition of khat, researchers also found a number of amino acids, a large amount of tannins, a high percentage of ascorbic acid, other vitamins and mineral salts.

The search for new khat alkaloids continued, because fresh leaves, as it was known, act on chewers somewhat differently, are stronger and are more valued by them. In 1963, a report appeared on the isolation of a new, previously unknown alkaloid from fresh leaves, which differed from cathine in the structure of the near-phenyl chain, as shown by the results of chromography and spectrometry. Since this alkaloid easily decomposed upon chemical treatment, the authors assumed that it was a labile precursor of cathine.

In 1971, the UN Commission on Narcotics recommended that the Drug Laboratory study the chemistry of fresh khat and its components, joining forces with the WHO in studying the pharmacological and socio-medical effects, which was eventually realized with financial support from the UN Drug Control Fund. In 1974, laboratory representatives collected and specially processed fresh leaves for further research in Kenya, Yemen and Madagascar.

Chemical analysis of extracts from fresh leaves allowed us to isolate several fractions. The two main groups of compounds are phenylalkylamine derivatives and weakly basic alkaloids. The already known cathine was contained in fresh leaves only in small quantities, and the main part of the psychoactive fraction was a previously unknown alkaloid (–)-alpha-aminopropiophenone, called “cathinone”. Cathinone showed instability and degraded easily; however, its absolute configuration has been established, delineated and published in the public press. The synthesis of its racemic variant and a number of optical isomers has also been reported. The identified norpseudoephedrine, norephedrine and compounds called “dimers” were considered as additional or transformed components of the psychoactive fraction of khat. The weakly basic fraction had a complex structure and included 11 alkaloids (the structure of which was established), as well as a number of other substances. Most of the components of this fraction are combined into one class of alkaloids with the general name “catheduline”.

Cathinone (1-phenyl-2-aminopropanone), a phenylalkylamine derivative, differs from amphetamine (phenamine) in that its periphenyl carbon is connected to a ketone radical. Methylcathinone (ephedrine) and pervitin (methamphetamine) have similar differences. Those substances that in the alkyl chain contain a keto group at the alpha carbon (i.e., closest to the aromatic ring) and have an amine radical at one of the carbon atoms are classified as alpha-aminoketones. Among the latter, the authors described ephedrone and norephedrone in some detail. Based on an analysis of their own and literature data, the authors came to the conclusion that it is the presence of a ketone radical that reduces the stimulating effect of ephedrone and norephedrone by approximately 2 times compared to pervitin and phenamine, respectively, and also reduces the anorexigenic and toxic effects of the first 2.

Cathinone is now considered by some authors to be an oxidized norpseudoephedrine. From another point of view, cathinone appears to be demethylated ephedrone (methylcathinone), so it is assumed that a significant part of the latter may undergo demethylation in the liver and, therefore, largely determine the psychostimulant and reinforcing effects of ephedrone. It is necessary to pay attention to the fact that in the List of Medicinal Narcotic Substances and Drugs, as well as in the English annotations of a number of articles on ephedron addiction, ephedron is presented as racemic ephedrine. This circumstance (i.e., the discrepancy between the chemical structure of substances equally called ephedrone) does not allow us to confidently compare the literature data on the action of cathinone and ephedrone.

The discovery of cathinone aroused great interest in the study of its chemical properties. pharmacological properties and generated a lot of publications. Cathinone has not been found to be medically useless. It is included in Schedule 1 of the 1961 Convention on Psychotropic Substances and therefore its use for scientific purposes is limited to certain conditions. Since the Expert Committee on Drug Dependence does not have information on the use of cathinone for any purpose in humans, it therefore relies on information about khat in assessing its effect on humans. This situation is somewhat paradoxical, because clinicians, in turn, analyzing the literature on biochemical, pharmacological and other studies of cathinone in animals, strive to better understand the nature and mechanism of action of khat on chewers.

A number of original and review publications claim that cathinone has the same neurochemical and behavioral profile as or similar to amphetamine. Like amphetamine, cathinone is a central nervous system stimulant, toxic, easily addictive, and has a number of other amphetamine-like properties. In domestic classifications, cathinone, like phenamine, is classified as a “mobilizing type stimulant.” Cathinone is considered 7 times more potent than cathine. According to others, the strength of cathinone's individual effects exceeds those of cathinone by 4–8 times. It is especially emphasized that the psychostimulating effect of cathinone is significantly higher than its weak somatotropic adrenomimetic property, which significantly distinguishes it from cathine.

Biochemical studies have shown that (–)-cathinone is comparable in strength to the release of catecholamines from their physiological storage sites with (+)-amphetamine. It was noted that (–)-cathinone at a dose of 8 mg/kg had a weak effect on changes in the circulation of norepinephrine (NA) in mice, but increased dopamine metabolism (+32%) almost as much as (+)-amphetamine (+44% ), which also had a lowering effect on the level of NA; with a twofold increase in dosage, cathinone turned out to be weaker than amphetamine in affecting the metabolism of catecholamines: the first almost did not change the level of dopamine circulation, and the second reduced it by 42%. Cathinone has been found to induce the release of dopamine in the striatum in rats and rabbits. Repeated administration of high doses of (+)-cathinone causes long-term depletion in various regions of the rat brain and reduces the amount of synaptosomal dopamine, just like repeated administration of (+)-amphetamine; It is noted that the neurotoxic effect of cathinone, like amphetamine, is selective, because with repeated administration the levels of norepinephrine and serotonin do not change. Based on their experiments, the authors conclude that cathinone, like amphetamine, causes the release of dopamine and blocks its reuptake.

An important clarification was made in Lately domestic scientists in experiments on mice. The study confirmed an increase in the concentration of extracellular dopamine in the areas of dopaminergic nerve terminals, however, it was revealed that amphetamine had a predominant effect on mesolimbic dopaminergic neurons (compared to mesocortical and nigrostriatal neurons), while cathinone had only a weak mesolimbic releasing effect. It is this fact that the author explains the quantitatively lower level of addictiveness of cathinone than amphetamine.

The literature also suggests the noradrenergic and serotonergic effects of cathinone. The serotonergic mechanism is supported by evidence that cathinone has 4 times greater affinity for serotonin receptors than racemic amphetamine. It has also been suggested that the euphorigenic effect of cathinone may be related to other neurotransmitters (glutamic acid, GABA, kainic acid) and neuropeptides (endorphin and substance P), since these substances may influence drug-induced behavioral responses. Animal experiments have shown that the analgesic effect of cathinone is associated not only with catecholamines, but also with opioid neurotransmitters.

The results of the initial period of biochemical studies of cathinone in animals made it possible at that time to identify three possible mechanisms of its action: direct stimulation of postsynaptic receptors; stimulation of the release of catecholamines accumulating in presynaptic terminals; inhibition of reuptake of free, released catecholamines from synaptic clefts. The authors considered the third route of action of cathinone to be less probable and drew attention to the fact that cathinone predominantly interacts with catecholamines due to indirect mechanisms, namely, the influence on the release of labile accumulation neurotransmitters. Comparative studies have confirmed that (–)-cathinone, like (+)-amphetamine 3, is an indirect sympathomimetic amine. The release of catecholamines from their physiological storage sites by (–)-cathinone appears to be approximately comparable in potency to (+)-amphetamine. The modulating effect of cathinone on various catecholamine systems revealed a clear dose-dependent relationship.

The results of studying individual physiological and behavioral effects of cathinone and their comparison with amphetamines are interesting. Cathinone causes such behavioral effects in mice and rats as increased locomotor activity, exophthalmos, ruffling, and sneezing, but with a lesser degree of severity than under the influence of amphetamine. Locomotor activity in mice occurs in a dose-dependent manner typical of amphetamine. There are reports of similar levels of locomotor effect caused by cathinone and amphetamine. Both drugs cause similar oral stereotypy. Noting the very high locomotor activity under the influence of cathinone and amphetamine, it is emphasized that cathinone stereotypic activity is half as much. The locomotor stimulation caused by cathinone is inhibited by a number of antipsychotics, such as haloperidol and others. There is a similarity in rotational behavior under the influence of amphetamine and cathinone. Motor stereotypy and tremor have been observed by some researchers only with the use of small doses of cathinone. In general, it was noted that cathinone disrupts animal behavior to a lesser extent than amphetamine.

The analgesic effect of cathinone in animals has been revealed. Cathinone in small doses, like phenamine, accelerates the manifestation of the conditioned defensive reflex. Administration of cathinone to a rabbit caused a hyperthymic effect, which is characteristic of chewing khat.

Cathinone and amphetamine have been shown to have similar effects on the cardiovascular system, suggesting that cardiovascular complications with high doses of khat and abuse may be similar to those of amphetamine. In anesthetized rats, blood pressure increased slightly less with (–)-cathinone than with amphetamine; The heart rate also increased, but with less pronounced differences.

On EEG, cathinone showed pharmacological activity only slightly less than amphetamine; at high doses, electrical activity appears as pseudoperiodic sharp waves, and at high doses cathinone has caused seizures. The authors observed tremors and stereotypies in rats, which are associated with the effect of cathinone on extrapyramidal subcortical structures.

Cathinone increases the metabolic rate and oxygen consumption in tissues, and also induces lipolysis. It is well absorbed when administered orally and is rapidly metabolized, with its main extracted metabolite being (–)-norephedrine.

A decrease in food consumption by animals under the influence of cathinone has been established. (–)-cathinone has been reported to have a greater inhibitory effect on food intake in rats than amphetamine.

It is important to note that tolerance to some of the central effects occurs with repeated use of cathinone. Animals with dietary tolerance to cathinone are cross-tolerant to amphetamine. Despite the presence of tolerance and cross-tolerance to food intake, physical dependence to cathinone was not detected 4.

Cathinone has been shown to have a self-administering intravenous effect in rhesus monkeys. Rhesus monkeys readily secrete cathinone as an amphetamine-like substance and quickly develop a need for self-administration. A number of researchers believe that the reinforcing effect of cathinone is equivalent to that of amphetamine and cocaine, because cathinone very easily causes an active need for self-administration in animals (for example, rhesus monkeys). During the experiment, two rhesus monkeys self-administered cathinone day and night, stopping only when exhausted; less than a day later, such fun resumed again and lasted from several hours to 2-3 days 5; the alternation of fun and relaxation lasted about a month, and then one monkey weakened, and the second developed swelling, edema.

Along with amphetamine-like psychomotor stimulation, the author notes tremor, dilated pupils, anorexia, and compares the severity of psychotoxic effects with those of amphetamine and cocaine. When using graduated methods in experiments on mice, it was revealed that the addictiveness of cathinone is lower than that of amphetamine and cocaine. The author also emphasizes that cathinone and amphetamine have demonstrated dose-dependent addictive effects. It is important to note that according to the gradual criterion, methylcathinone (ephedron) was in the group of typical drugs, which is not said about cathinone.

Particular attention should be paid to those domestic pharmacological studies that indicate a number of qualitative differences between cathinone and phenamine in the effect on the motor sphere, behavior, and differentiation of visual stimuli.

It has been established that cathinone, unlike phenamine, caffeine and cocaine, causes a two to threefold inhibition of motor activity in white rats; in small doses it causes stereotypy, different from phenamine, and long-term administration for 4 weeks had an increased inhibitory effect on all types of motor activity.

Low doses of cathinone have been shown to impair the differentiation of visual stimuli, both short-term and long-term, although it is generally accepted that activation of the dopamine system should improve the differentiation of visual stimuli. Additionally, dopamine agonists such as L-DOPA and apomorphine have been noted to attenuate the effects of cathinone. Based on a series of experiments, researchers came to the conclusion that cathinone has a hallucinogenic effect on the state of animals.

In experiments, it was noted that minimal doses of psychostimulants (cathinone, phenamine, sydnocarb, cocaine) improve the differentiation of short-term stimuli in all cases, except cathinone. When drug doses were doubled, differentiation of both short-term and long-term stimuli worsened for all drugs except cocaine. The authors conclude that psychostimulants improve the perception of visual stimuli in minimal doses, while hallucinogens, which include cathinone, worsen the perception of the physical parameters of visual signals, as well as the process of their further processing. Later it was concluded that when cathinone is administered in the brain of animals, there is a shift in sequential step-by-step problem solving to a less ordered structure of activity; During the decision, there is a constant correction of the organization of the response with the participation of wide areas of the neocortex, and therefore errors are presumably caused by a sharp increase in the motivational level. As you can see, unlike the authors who brought cathinone closer to amphetamines, this group of researchers classifies cathinone as hallucinogens, based primarily on the results of visual differentiation tests and their interpretation.

In addition to isolated studies of the properties of cathine and cathinone, in recent years a number of experimental studies have been carried out on the effect of fresh khat or its extract on small animals. Electroencephalographic control showed that in the first 5 hours, khat extract causes an increase in low-amplitude, high-frequency activity in the beta range of the frontal and occipital cortex in rats; the stimulating effect of the extract appears after 0.5–1 hour (at a dose of 50–100 mg/kg); higher doses (400 mg/kg) cause a change in EEG activation to depression after 2–3 hours. In general, the authors conclude that khat extract has an adverse effect on the central nervous system.

Changes were found in rabbits that were regularly administered khat leaf extract. energy metabolism in erythrocytes. A significant decrease in the activity of pyruvate kinase and a sharp increase in the activity of glutathione reductase and glucose-6-phosphate dehydrokinase were noted. According to researchers, almost all of the identified effects of khat are associated with the alkaloids (–)-cathinone and (+)-norpseudoephedrine.

The cytogenetic effect of khat extract was revealed in white mice when studying the state of somatic and germinal cells in males. Among the detected changes, abnormalities of the sperm head, aberrations of meiotic chromosomes and suppression of bone marrow function should be highlighted.

Guinea pigs that regularly received khat leaves during pregnancy showed a decrease in food consumption compared to the control group, a 7% lower body weight of newborns, and a predominance of mortality among small fetuses.

In conclusion of this section, we note that the role of cathinone in the composition of khat leaves is assessed ambiguously. Pharmacologists believe that it is cathinone that determines the stimulant activity of khat when chewed and its potential abuse. It is also claimed that chewing khat is pharmacologically equivalent to using an amphetamine. At the same time, one of the reviews on the abuse of psychostimulants expressed the opinion that khat leaves contain more cathine (norpseudoephedrine) than cathinone, and therefore the dominant effect of khat is not psychostimulant, but somatotropic. This point of view should be taken into account by clinicians due to the fact that, firstly, the ratio of the amount of cathinone and cathine depends on the variety and quality of khat, and secondly, cathinone is easily transformed into ephedrine-type substances.

1.3. Forms, methods and reasons for using khat

Leaves and young shoots of khat have long been used by various segments of the population for various purposes and different ways. A traditional chewer usually consumes khat either once every three days or on weekends. There are many intermediate options between traditional and regular use. Systematic chewers use khat several times a week or daily; For many, khat replaces breakfast, and then they chew it throughout the afternoon; others do this from sunrise to sunset, and some do it all night long.

Regular chewers in Djibouti consume an average of 100–200 g per day, with some using 250–400 g and others using no more than 75–100 g. Some Djiboutians chew khat in very large quantities, making it a substitute for real food. In Kenya, a chewer needs on average about 300g of khat per day. Ethiopian peasants in the Harar region consume more than 500 g of khat daily in two doses: 250–750 g of leaves in the morning and the same or less in the afternoon; some individuals use up to 2–3 kg of khat per day. The author emphasizes that the figures given vary depending on the type of khat and the quality of the khat; From one branch, usually from 25 to 40% of young leaves and shoots are used, and an experienced chewer can use up to 70% of the material. The concentration of active substances in different varieties of khat ranges from 7.3 mg to 247 mg per 100 g of fresh leaves. According to some calculations, a typical chewer absorbs from 10 to 40 mg of the active substance. Such a range of the given figures significantly weakens the value of the quantitative indicator of the khat used.

In the past, special healing properties. It was believed that 501 could be obtained from it medical product, supposedly in accordance with one of the spellings of the word: 400 + 100 + 1. Now khat is used as a medicine only in certain cases. In Somalia and Ethiopia, it is used by dervishes who “spit” chewed khat onto the sick person during a blessing. Among the Ethiopian population, the use of khat decoction in the treatment of disabled people is common. Somalis use khat to stimulate urination for gonorrhea and other genital-urological diseases. In Arabia and South Africa, khat infusion is used for chest infections and bronchial asthma. In Tanzania, the leaves are used for colds and the roots for stomach pain. Many peoples believe that khat protects against malaria, plague, and cholera, and therefore travelers take khat branches with them on the road. In addition to the prescriptions of the famous medieval physician Najib Ad-Din, khat extracts were also used by European pharmacists and were included in the pharmacopoeias of a number of countries in the first half of the last century.

The ability of kata to “delay the feeling of hunger”, “free from hunger”, “reduce” or “suppress” appetite is well known. During the experiment, anorexia lasted approximately 10–12 hours in one volunteer. Khat is often used either to suppress hunger in the absence of food, or because of misconceptions about khat as the “best food substitute.” In our opinion, it can be assumed that the anorexigenic effect of khat leaves served as the basis for their use during Muslim fasting in a number of regions.

However, khat leaves are mainly known and used as a stimulant. Since ancient times, they were used by nomadic peoples during long movements, as well as by messengers and warriors. For the same purposes, they are now used by drivers of motor vehicles, especially on long trips. In addition to commercial truck drivers, khat is chewed continuously by some city bus and taxi drivers. Khat is widely used by peasants to gain strength and endurance before work. To overcome drowsiness, khat is chewed by shepherds while guarding livestock, as well as by night watchmen and prostitutes. In part, students use khat leaves to stay awake, but their main goal is to increase concentration and improve the assimilation of material. Khat is often used to relieve fatigue after work or travel, so it can be offered to a guest as a refresher.

The traditional use of khat is deeply connected with another wide range of reasons, which include various group and social gatherings with the desire of their participants for communication, relaxation and entertainment. In these cases, khat is used not only for its stimulating effect, but also for recreation and pleasure. The author notes that many people chew khat just for pleasure and value this habit. They also believe that consuming khat together is the best way to relax, rest, maintain human relationships and achieve certain communication goals.

A generalized description of katha meetings taking place in a traditional manner is quite clearly presented in a number of publications. It is noted that, for example, in Yemen, khat is chewed at 3–4 o'clock in the afternoon or in the late afternoon, and in Somalia - later, but the characteristic days and hours, as well as the generally accepted ideas about the dose, vary even in various parts one country. All authors emphasize that khat is used only in a collective environment. They usually gather with each other or in special places, which the Djiboutians call “kate”, and the Yemenis call “mabrae”. The level of comfort of these establishments varies and depends on material capabilities and social level, but what is common to traditional meetings is the desire to create the most comfortable conditions. Preparation for the khat party can begin 2-3 days before it. The best meetings take place in a quiet room, which is decorated with beautiful carpets, lined with mattresses and pillows, furnished with ornamented hookahs and scented with incense. Some, according to the old tradition, pre-steam in a bathhouse and always eat food, preferring fatty foods. Even non-smokers smoke a lot while chewing; they consume large quantities of tea, sweet water, Coca-Cola, and spices, in particular cardamom, cinnamon.

There is always a leader in the group who sets the tone and direction of the conversations, which take place in a friendly and relaxed atmosphere. People enjoy discussing political events, current affairs and local affairs. Such communication is interspersed with jokes, quoting poetry, playing the guitar, and on special occasions, singing and dancing. Women are usually in a separate room; some of them do not chew khat at all, but come to enjoy the meetings and the opportunity to relax. The author notes that soon after the start of the meeting, the mood in the group rises and an atmosphere of well-being begins to prevail, conversations flow easily and passionately, with the emergence of various ideas; then a feeling of self-satisfaction arises, after which activity decreases, conversations become quieter and more intimate, and many people focus on their problems 6 .

The pleasurable, stimulating effects of khat have a strong influence on the social and cultural life of those populations that engage in it. Chewing khat is a form of group activity, group time, and emotional relaxation. It has become a certain type of social behavior, organized according to a special ritual. For businessmen, this is a reason for business negotiations, and for the unemployed, it is “a way to overcome difficult days.” Ethiopian men and women view and use the khat ceremony as a means of developing relationships with each other.

At the same time, chewing khat can also become a banal way of free, aimless pastime: “we have nothing to do, and we sit and chew khat.” Cat meetings can gradually turn into simple and convenient form escape from existing difficulties in life, which is known as escapism. Attachment to khat is often associated with aimlessness of existence and unemployment.

In some regions, the use of khat has deep cultural and symbolic meaning, particularly for the Meru people of Kenya. It is not permissible for the Meru - Kenya's main suppliers of khat - to use khat outside of certain regulations and traditions. It is known that during famine it was consumed before the slaughter of an animal. Boys are presented with khat before circumcision. The young man must transfer the supply of kata to the father of the girl he intends to court. Before social, legal and political discussions, it is customary to use khat, as it allows you to relax and facilitates conversations. Chewing khat accompanies such procedures as taking an oath, paying a debt, resolving a dispute or conflict, because it is believed that the one who chews khat with others expresses a desire to resolve the problem peacefully. That is, in the situations described, the kat fulfills the meaning of a symbolic peace tube. In Yemen, it was customary to present a qat twig to a guest as a sign of attention and respect. In Harare (Ethiopia) for a long time khat was not used by the tribes that grew it, i.e. there was a caste taboo. Until now, a certain part of Christian youth in Ethiopia use khat with fear, hiding it from the elderly and parents, since among some segments of Christians the idea of ​​chewing khat as a vice characteristic of Muslims still persists. In this case, khat acts as one of the symbols of religious differentiation.

Khat is indeed deeply rooted in the socio-economic and religious life of Muslims, although it has long “crossed many thresholds of faith and social levels in the areas where it is cultivated.” For example, khat is used by Ethiopian Kushites during religious ceremonies, namely during the common prayer of the Gauls during its all-night vigil. Nevertheless, khat plays a special role in the everyday and religious life of Muslims in some regions. In Harare they believe that it is sent from God and pray before consuming it. It is used during birth ceremonies, circumcisions, weddings, and funerals. As already noted, khat is also chewed during Ramadan, the Muslim month of fasting. That is, not a single private or public ceremony is complete without kata.

Accompanying fervent prayer, khat intensifies religious feelings, so it is regarded as a “gift from heaven”, called the “flower of paradise” and is not considered forbidden. This part of Muslims is convinced that, according to the interpretation of the Koran, there is only a ban on wine. And it’s as if the highest Ethiopian clergy once concluded that khat does not violate either health or the observance of religious duties, but only improves mood and imparts good nature. On this basis, the use of khat was allegedly approved by the hierarchs, although in the Islamic world there is another point of view that prevails, according to which the use of khat containing a stimulating intoxicating substance is contrary to the Koran.

The literature notes that the history of current drug use in individual countries is very complex and confusing. It is especially emphasized that, according to the definition of Muslim interpreters of the law and spiritual mentors, drugs are substances that “stupefy the head and deprive a person of the ability to think sensibly,” and, therefore, are forbidden. The author explains that, unlike khamra (wine), drugs are not directly mentioned either in the Quran, or in the Hadith (traditions about the sayings and deeds of the Prophet Mohammed), or in the comprehensive Sunnah (a collection of hadiths regulating the rules of behavior). The lack of specific references to drugs in these sources has allowed lay people in some Muslim countries to wrongfully challenge (in more recent times) the illicit use of mind-altering and addictive substances. This approach of the author raises a very important and promising question about the role of Muslim doctrine and Muslim institutions in the prevention of drug abuse and treatment of drug addiction.

1.4. Prevalence and social consequences of khat use

No systematic epidemiological studies have been conducted on khat consumption. A number of publications provide general descriptions of the extent of this phenomenon. A very clear trend has been established towards a steady expansion of the geography and scope of khat chewing. The consumption of khat is increasingly expanding beyond its growing zones due to the advent of fast means of transportation.

There is ample evidence of increasing consumption of khat in countries where such a habit did not exist. Chewing of khat leaves has been noted in Bombay, Ceylon and Mizore. The ability to quickly transport khat meant that cases of sporadic and regular use were recorded in France among people of Middle Eastern origin and in Italy among members of the Somali community. Cases of psychosis as a result of khat chewing have been identified in the UK and US. Observers note that the use of khat, even at such a distance from the places where it grows, in many cases takes on the characteristics of substance abuse. It is clear that dependence can only arise with a constant supply of khat.

The prevalence of khat chewing varies not only in neighboring countries, but even within regions of the same country. Thus, in the 5th governorate of South Yemen, there were significantly fewer khat consumers than in others. In Saudi Arabia, khat chewing is limited to the Bizet area only, with rare cases in other cities, such as Sidat, involving non-indigenous people. Not only is the level of khat consumption in the Harar region significantly higher than other places in Ethiopia, it is the highest compared to any other part of the world. The author writes that khat has become the subject of conversation here and the reason for the existence of the vast majority of the population, and that everywhere you can see people going about their business with a lump of khat on their cheek. In the old part of the city, in three of the five shops you can see people chewing khat, and next to them there are many tramps and beggars with just purchased khat. Such a widespread occurrence of this phenomenon in the Harerge region has been noted by other authors, although the use of khat is “a common habit throughout Ethiopia.” In one of the “specific areas” of Addis Ababa (in the Grand Market area), out of 600 respondents, 96% either chew khat themselves, or sell it, or have some direct connection with this matter. Despite fairly accurate and vivid verbal descriptions, statistical or even simple numerical information on the use of khat in Ethiopia is very meager and essentially non-existent.

In the territory of the present state of Djibouti, in the late 50s, khat was used by most of the population. It was then noted that 60–70% of adults are susceptible to this substance abuse. Later it was established that there are 28 thousand khat chewers in the country, of which 60% live in the capital and 20% in the suburbs. At the same time, a significant increase in the number of women addicted to khat was noted.

In Somalia in 1980, 70% of men and 7–10% of women chewed khat regularly; in places where khat is directly grown, 90% of men and a large number of women use it; The scope of the phenomenon as a whole is increasing. Habitual chewers among men in the Somali capital are 39%, and in one of the provinces - 84%; among women, various forms of khat use in the capital accounted for 25%, and in the compared provincial point - 10%, i.e. metropolitan women are affected by this phenomenon to a greater extent than provincial ones.

It can be considered that the “world championship” of the Ethiopian province of Harerge in the scope of the use of khat is “challenged” by North and South Yemen. In Aden in 1976, more than 50% of adult men chewed khat, and in cities such as Sana'a and Tide, where it is more accessible and social conditions are more conducive, rates can be as high as 80%. The author also notes that khat consumption is significantly lower among women. In the northern part of Yemen, according to his calculations, 66.23% of men and 24.19% of women are dependent on khat. According to other sources, 30% of women in North Yemen use khat. It has been suggested that in southern Yemen, women's use of khat is more strictly controlled by relatives than in the north.

As can be seen from the above data, khat chewing among women is steadily spreading. For a long time, another dangerous phenomenon has been causing concern among doctors - initiation into khat at an early age. Ethiopian health workers and teachers report with dismay that many students not only chew khat, but chew it in large quantities. Eight- and ten-year-old Harare children already know the usual procedure for consuming khat just like adults. The consumption of khat among Yemeni schoolboys and schoolgirls “has a high percentage, especially during exam periods.” It is believed that although children chew khat, this habit comes to them at a later age. In Ethiopia, first contact with khat in childhood and adolescence occurs in 20% of cases within the family, and in 68% among friends; Moreover, Muslim children begin to chew khat earlier, and Christian children - later, diligently hiding it from adults due to the ban. Among North Yemeni students aged 17–21 years surveyed, approximately 12% chewed khat, as did 90% of their fathers and 60% of their mothers.

In places where khat is traditionally consumed, some people chew khat throughout their lives. It has been noted that in Somalia, particularly in Magadisha, khat chewing in the 80s was most common among the 20–40 age group. The author connects this fact with the wave of distribution of khat in the 60s and the easier receptivity of young people to the new fashion. In Kenya, out of 500 chewers surveyed, 55% were in the age group of 10–20 years and 30% were in the age group of 41–60 years, while the duration of khat consumption among respondents was: from 1 to 5 years - 12%, from 6 to 13 years - 35%, and over 50 years - 4.5%. In Ethiopia there are virtually no upper age limits for chewing khat, but no epidemiological data are provided. A survey of a small group of regular consumers showed a significant predominance (72%) of young people aged 20–29 years.

It is known that chewing khat is most common among the Muslim population of those regions in which this shrub grows and into which it is imported. However, in places of mixed residence this phenomenon is present and expanding in other faiths, especially among young people. Thus, it is reported that the studied group of regular khat chewers in one of the districts of Addis Ababa included 60% Christians and 40% Muslims. Of the Kenyan khat chewers surveyed, approximately 50% were Muslim.

Khat is now used by people from all walks of life; chewers represent a wide variety of social groups and professions: housewives, servants, students, peasants, office workers, workers, military, police, drivers, etc.

Regular chewing of khat revealed the magnitude of its consequences at the beginning of the 20th century, and by now it has become a social and health problem in a number of countries. The totality of general social, socio-economic and medical-social consequences is such that the phenomenon itself is called not only a “vice”, but also a “scourge” and “disaster”.

One of the publications cites the words expressed by the rector of the Yemeni University in Sana'a, Dr. Abdul Azis Al-Mufalens: “qat, from my point of view, is a tragedy of the Arab world, a tragedy that has no solution.”

Abuse of khat simultaneously causes social and economic damage to the person himself, his loved ones and society as a whole. According to one point of view, the negative impact of khat at the societal level is more significant than for individuals.

What is particularly dangerous in socio-economic terms is that there is a steadily increasing tendency to use any available piece of land for cultivating khat. International organizations have for many years expressed concern about the increase in the area occupied by khat. Khat cultivation has reached such an extent in some countries that it has largely replaced well-known traditional crops such as coffee. This negative phenomenon is explained by the fact that a farmer’s income from one khat bush is approximately 10 times higher than from a coffee bush, and the khat item is 30–50% of the total annual profit of a peasant family. The peasants are confident that with little labor input, khat gives big profits, so coffee bushes are uprooted and khat is planted in their place.

In the mid-1960s, the Ethiopian government encouraged the cultivation of crops other than khat. The Somali state showed concern about the displacement of other important plants by khat in the 80s and took a number of protective measures. Reports from Kenya indicate that khat cultivation remains limited due to a system of hereditary licenses.

Unfortunately, the khat trade is becoming increasingly interested in people, which is reflected in the increase in their number; Producers, traders, and consumers are heavily dependent on the khat trade. The cat business is considered very profitable. Those who grow qat own the “green oil” in their countries; their houses are filled with modern equipment, which contrasts with the appearance of the owners; but, most importantly, they are ready to keep their money in bags and do not invest it in anything useful.

From those countries where qat does not grow or there is not enough of it, a large amount of money is spent on massive imports, which affects the social situation of the entire people. The purchase of khat costs a huge amount of money, which these countries need to purchase and produce other goods.

The main exporter of khat is Ethiopia, with Kenya and Yemen to a much lesser extent. The improvement of transport vehicles has expanded the supply areas and volumes of the latter. African experts have expressed concern about the expansion of the area of ​​khat consumption and made a special statement in this regard. Since 1947, the amount of khat exported from Ethiopia and Yemen has increased several times. Before World War II, khat arrived from Ethiopia to Djibouti by railway, and since the end of the war - delivered by air. In total, 3.5–5 tons of khat are imported into the country every day. In addition to legal routes, up to 10% of khat is obtained through smuggling. In Somalia, khat imports account for 80%. The first batch of Ethiopian khat was delivered to Aden in 1942. In 1955–1966, Ethiopian exports to Djibouti, Aden and Somalia totaled 1,490 tons.

In 1962, khat accounted for 5.3% of Ethiopia's total export earnings, but khat disappeared from the export list in the mid-1960s. The Ethiopian government announced restrictions on exports in accordance with the recommendations of international organizations; but domestically, this measure was explained by the closure of the Suez Canal. The ban was then lifted, ostensibly due to the receipt of many letters expressing outrage from residents of those countries that imported Cat 7.

For businessmen who buy khat without financial problems, chewing is a good reason for business negotiations, although it contributes to the spread of the habit. The average consumer in Somalia spends approximately 25% of their daily salary on khat. In a month, a Djiboutian working chewer spends from 30 to 50% of his salary on the potion, leaving insufficient money for food and family life. Ironically, a Kenyan who consumes khat as food spends more per day than the cost of lunch in some restaurants in Nairobi. In Saudi Arabia, where khat is prohibited, it is bought on the black market and, due to high prices, they spend a large portion of their salaries on it. For a certain category of people, the money required for regular purchases of khat exceeds their financial capabilities. Some chewers spend all their money on khat, even at the cost of giving up food for themselves and their families. A vicious circle easily develops between buying khat and poverty. Through catastrophic euphoria, the individual tries to get away from the problems of poverty, poor nutrition and climatic difficulties.

In terms of the effect of kata on work and labor productivity, cases of use and abuse are divided: in the first case, it can have a positive effect, stimulating and increasing performance, and in the second - negatively, when high mood and complacency are replaced by irritability, depression, apathy, and loss of incentive. It is emphasized that the use of khat (even in significant quantities) should not always be considered as a psychopathological disorder, since it can help a person, for example, provide a stimulating effect to a shepherd guarding herds at night. In cases where khat is not used continuously, its positive potential for improving performance is not fully understood.

It is well known that systematic use of khat reduces work productivity as a result of absenteeism, tardiness and depressed mood. The daily working period for khat chewers does not exceed 3 hours. Since work results fall, a vicious circle is then formed through a decrease in wages, which in turn leads to a loss of initiative and desire for self-improvement, which generally has a negative impact on all social life. Gradually, regular chewers become increasingly apathetic and mentally dull, physical activity decreases, they lose time and money in khat stores, and as a result, they appear to people as “lost members of society,” “useless and stupid quitters.” These individuals lose the ability to work for long periods of time and therefore become a burden, dependent on family and friends.

Systematic chewing of khat disrupts family ties and leads to family breakdown. Economic costs and the absence of the father in the family circle contribute to family instability and disintegration. While women work, men spend their time chewing khat. The head of the family spends a lot of time among the chewers, and the wife is alone busy with her family and raising children; parental authority is undermined; family life hangs by a thread and many divorces occur, including repeat ones. Somali women complained that husbands addicted to khat no longer noticed their wives. These circumstances can lead to a decrease in fertility. In the examined group of 25 regular Ethiopian khat chewers, the majority turned out to be unmarried - 15 people, despite the fact that their age was typical for married people, and 5 people. - were divorced.

In families of chewers, children and adolescents are introduced to khat very early; Some of the wives of chewers acquire the same habit. In families impoverished due to the constant purchase of khat, the female part is forced to engage in begging or prostitution. The latter also applies to cash-strapped chewers.

Abuse of khat provokes such social vice as corruption. Government officials and police officers who are addicted to khat lose their sense of responsibility and begin to wander around khat shops, as one anthropologist observed in Harar and Yemen. The influence of kata on developing personalities is especially dangerous; It is known that schoolchildren quickly lose interest in studying and stop attending classes.

In addition, due to the loss of vital activity, the chewer ceases to take care of himself, family and the rest of society; in the absence of enough money, he begins to beg or exhibit other antisocial activities, including crimes. To satisfy his need for khat (not to mention the fact that this is done at the expense of health, food and clothing), a habitual chewer can commit theft, which is a serious crime in the Muslim world.

Opinions about the antisocial and criminogenic behavior of people who use khat are very contradictory. Some authors write that quarrels and fights with serious injuries occur during or after chewing khat, and that the courts are allegedly filled with many such cases. According to local residents, the story is retold that one chewer, while intoxicated, killed his wife and “rival,” and his partner did not even attach any importance to this tragedy, continuing to chew khat. It indicates disobedience, scandalousness, antagonism towards authorities and aggressiveness of chewers.

On the other hand, a number of publications emphasize that the khat meeting takes place in an atmosphere of goodwill and complacency. Regular use of khat and the nature of its psychological effects are quite compatible with normal behavior. There is no connection between khat use and an increase in crime, especially violent crime. It is especially emphasized that not a single stage of khat intoxication is accompanied by a “release of the instinct of cruelty,” and that khat does not lead to any serious illegal torts that would be a consequence of a pronounced release of instincts, and in most cases khat dealers and debtors appear before the court. Psychiatrists believe that khat can only contribute to crime, as a relief for psychopathic individuals and the mentally ill; offenses may also be committed after additional consumption of alcohol and other drugs.

A number of authors believe that intensive khat chewing and the prevalence of this phenomenon lead to the degeneration of the race and nation. If from a socio-economic point of view society, first of all, loses income and man-hours, then from a medical and social point of view - the health of the people, which suffers due to malnutrition, exacerbation of diseases and an increase in morbidity.

It has long been argued that the social and economic aspects of khat use outweigh the medical ones, and that khat use in general does not cause much harm to human health. The immediate harm from the use of khat may outwardly seem not so significant for the health of society, but due to the occurrence of long-term consequences, the concern of representatives of medical science is growing; The global nature of this problem consists of a whole series of smaller problems caused by various national, religious and cultural characteristics.

In connection with the economic, medical and social consequences of khat use that were discovered at the beginning of the last century, various restrictive measures were taken at the regional and international levels. Back in 1921, British Somalia legislated a ban on the cultivation and sale of khat, with the exception of four license holders. However, the expected effect did not work out, and in 1939 new control measures were introduced, which were eventually replaced by the establishment of an import tax. The bans adopted by the British authorities in Aden in 1957 were unsuccessful; a year later they were replaced by price controls; In the French "overseas territories" khat was included in the official list of drugs, but due to its ineffectiveness the ban was later lifted.

In Kenya, the ban was introduced in 1945, but it also did not produce significant results. Later, in 1950, a special committee called on the leaders of the northern tribes to exert their influence and encourage the people to give up chewing khat. The King of Saudi Arabia issued a special edict in 1956 prohibiting the cultivation and use of khat. The Yemeni government passed a law in 1972 that prohibited the cultivation of khat on government lands and the chewing of khat in government offices, which caused great discontent and was repealed. In the late 1970s, an encouraging campaign began in South Yemen to combat the abuse of khat through pressure from community organizations, the use of the media, and encouraging farmers to reduce khat area by growing other crops. In Ethiopia, one of the main exporters of khat, bans were never introduced, but in the mid-1960s khat disappeared from the export list and the government announced measures to reduce the area under khat cultivation.

Health and social workers who have encountered the African khat and drug problem believe that eradication of abuse must be carried out gradually, through legislative and executive measures. Increasing the standard of living, strengthening the psychosocial development of the population, and creating new needs is a necessary basis for resolving this dramatic situation. Although legislative action is, in principle, “the central basis for controlling the khat problem,” a review of past experience suggests that governments, when choosing to approach the problem, “should consider khat as part of an overall social problem and combat it in that context.” The author rightly notes that the cultural and epidemiological aspects of khat use should not be overlooked, and cites the point of view of doctors who previously worked in Kenya, according to which an absolute prohibition is undesirable for various reasons, but restrictive legislation is necessary.

The issue of khat has been repeatedly addressed by various divisions of the League of Nations and the UN, mainly from the point of view of socio-economic consequences. But in 1957, after studying the materials presented by the UN Commission on Narcotic Drugs, the 24th session of the UN Economic and Social Council ordered the WHO to study the medical aspects of khat use. A special Secretariat has been established under the WHO Expert Committee on Drugs that Cause Dependence; The results of the Committee's work were published in a number of publications. One report concluded that khat use was a regional phenomenon and that the problems of khat and amphetamine should be viewed in the same light due to their similar medicinal effects. The 37th session of the UN Economic and Social Council agreed that khat abuse “is a local problem that can best be addressed at the local level.” The WHO Committee in its next report drew the attention of interested countries to the increase in the area under khat cultivation and recommended that they take into account first of all “the danger to public health, rather than the economic positives.” A similar approach, according to which khat is not subject to international control measures, continued after the isolation of cathinone.

At the same time, in 1982, experts from a number of African countries, who met in Rabat (Morocco), recommended that the UN Commission on Narcotic Drugs take the khat problem under international control.

A report by one of the independent international organizations (the Council on Drug Dependence) notes with alarm that khat leaves have become available and are used for recreation and pleasure in areas that are outside the geographical areas where this plant grows. The Committee expressed concerns about the possible extraction of cathinone from khat leaves, noting that it deliberately did not address the issue of international control of khat and cathinone. The Committee also emphasized that it did not consider the social side of the khat problem in terms of the possible presence of such a degree of severity that would require the appointment of international control. As can be seen from the above report, the Committee is extremely concerned about the situation and therefore has particularly highlighted issues that require urgent consideration and decision-making.

It is difficult to disagree with the opinion that the problem of khat, and in particular the issue of addiction, did not receive due attention from the WHO, although in 1972 a joint meeting of many international organizations was held, at which very specific tasks were set. The author emphasizes that in order to fully understand the problem, in addition to botanical, chemical and pharmacological information, clinical studies by specialists in various fields of medicine are necessary.

In this regard, it is appropriate to draw an analogy with the problem of hashishism, in relation to which at one time there was a call: “not to repeat previous mistakes” and “to give a biased assessment possible consequences". The above words are now more than relevant in relation to kata. It has been very accurately noted that now society is overly tolerant of “slow drugs”, and that public opinion often exaggerates the social significance of individual drug addictions, while some of its types (traditional consumption of khat, betel, peyote) are practically ignored due to lack of social demand (emphasis added by the author - R.B.), which also explains the lower intensity of scientific research on these topics. In the existence of such a situation, the author sees completely definite political guidelines.

1.5. Acute and chronic khat intoxication

Expert reviews have repeatedly emphasized the need to study the pattern of intoxication with “accidental” or episodic use of khat, which is necessary to compare its effect on “normal people” and regular chewers. From an analysis of the impressions of individuals, it was generally known that first comes intellectual excitement with euphoria, then their stupor and, finally, an eclipse of these possibilities. One of the travelers described the expectation of unfulfilled visions, as he had heard of khat as a hallucinogen.

In the 60s, two reports from pharmacologists appeared about the effect of khat on European volunteers during experimental and tasting use. In the first case, a volunteer chewed 200 g of khat leaves over half an hour and experienced subjective stimulation for 4–6 hours, which was generally assessed as equivalent to the effects of 10 mg of racemic amphetamine; the gastrointestinal sensations seemed pleasant to him and did not differ from drinking coffee or quinine water under the same tropical conditions. The behavior and experiences of the second volunteer, who chewed leaves from 100 branches over 4 hours, led the author to conclude that khat acted as an amphetamine-like stimulant, causing euphoria, brain activation and anorexia, while reducing the effects of the alcohol and barbiturates that this man was taking. The expert's sleep was difficult, and in the morning he experienced a condition reminiscent of a hangover, soreness in the mouth and disturbances in the functioning of the stomach.

After the discovery of cathinone, several special messages appeared again with the results of studying the effect of khat during the experiment. Without detracting from the significance of these interesting and important works, it should be noted that the population studied was not fully characterized from a drug addiction point of view (there is no direct indication of the absence of addiction, “hardship experience,” etc.).

Judging by indirect evidence, the subjects were not chronic consumers.

The first report defined khat chewers as student volunteers who "abstained from consuming khat for a week prior to the experiment." The author confirmed the similarity of the effects of khat and amphetamines both on the physical level (increased heart rate and breathing, increased body temperature and reaction speed in the experiment) and on the mental level (state of excitement of the mind and feelings). The highest potential of volunteers in drawing up figures was noted at approximately the 90th minute. The author is more inclined to explain the revealed amphetamine-like resistance to physical activity and a decrease in fatigue by arousal of the individual than by an increase in performance.

In the second work, the subjective experiences of people “familiar with the effects of kata” were studied using a questionnaire. The authors determined that the majority of chewers initially experienced a state of euphoria, increased intellectual capabilities and a feeling of cheerfulness, and a minority experienced a state of dysphoria and a mild sedation. Both of the latter effects appeared in all those observed after 6.5 hours. The importance of situational factors in the development of subjective reactions is emphasized. In general, the effect of khat is determined to be phenamine-like. It is regrettable that the difference in subjective reactions is correlated with the level of cat addiction or the complete denial of it.

There is no description in the literature of the “pure form” of the picture of khat intoxication in people who used khat within the framework of traditions and customs. If we do not take into account secular and religious holidays, as well as forced cases (hunger and others), which are accompanied by the use of khat, then the traditional option is now considered to be the use of khat no more than once every three days, i.e. approximately 2 times a week. The number of traditionally consumed leaves during a khat party is also very arbitrary and depends both on prevailing ideas in society and on the type of khat. In each region and even in certain areas of one country, ideas about the traditional (group) dose of khat and the frequency of its use during the week are very individual.

One of the first interdisciplinary reports on khat highlighted some likely signs of a transition from occasional to regular consumption; they can be expressed in increasing the dose to obtain the desired effects, the appearance of chronic physiological disorders - loss of appetite, loss of sleep, sleep disturbances, which increase susceptibility to various diseases; over time, volitional and intellectual strength is lost with further social consequences. Unfortunately, subsequently this dynamic line of studying chronic khat intoxication did not receive the necessary filling with specific clinical material. Almost 25 years later, a special group of WHO experts again pointed out that the effect of khat on people who chew khat occasionally and in cases of “moderate” and “heavy” use has not been studied, and therefore recommended conducting clinical studies in each of the groups separately. This situation continues to this day.

Some authors consider constant consumption of khat to be substance abuse only when there is “irresistibility of attraction.” Although a number of researchers classify all regular chewers as substance abusers, considering regularity a sign of mental attraction; however, they do not draw clear boundaries between traditional and painful forms of khat consumption and do not put forward detailed criteria for diagnosing the latter. More often, only figurative expressions are used in relation to systematic consumers, such as “habitual”, “passionate”, “inveterate” and “daily” chewers. They are also called "lovers", "adherents" and "connoisseurs" of kata. The most appropriate, from a clinical point of view, for cases of regular or systematic consumption of khat are probably the expressions “chronic consumption” and “chronic chewer”.

In all forms of consumption of khat, including chronic, its stimulating and intoxicating effects have long been distinguished. IN big picture The effects of khat on chronic chewers are marked in two phases: tonic and depressive. In the early 60s, more detailed dynamic rubrication was given. The author identified a period of excitement and a period of depression in cat drug addicts, between which he noted a short stage of sexual arousal. Soon, a similar study was repeated with “khat consumers” in order to identify the immediate consequences of its action. The authors identified a tonic phase with euphoric and illusory periods, as well as a depressive phase with a period of compensatory rest.

When describing the acute manifestations of the action of kata, chewers use many expressions that convey the subjectively positive experiences of the “tonic phase” or “period of excitation.” The emergence of a “feeling of bliss”, “a state of well-being”, “the ability to accomplish the impossible”, “a sense of completion”, “improved mood”, “pleasant insomnia” is noted. One of the descriptions says that while chewing khat, all hardships are forgotten Everyday life, the world becomes bright and a dull earthly existence turns into a “heavenly paradise”.

The expectation of spiritual uplift is conveyed in the hedonistic motives for using khat. Individuals surveyed reported that they buy and chew khat to have a good time with friends, to obtain “pleasure,” “pleasant sensations,” and “enjoyment.” It has been noted that khat relieves feelings of anxiety and “eliminates passions such as anger.”

In objective assessments, these states are terminologically referred to as central nervous system arousal with increased mood, as euphoria, or as hypomanic and manic behavior, and in some cases as “severe violent mania” and “overt manic state.”

In descriptions of elevated mood, the authors highlight such details as “fun”, “joyful excitement”, “vacuous laughter”, “intellectual excitement with laughter”, “dream-like euphoria”, “euphoria with hyperactivity”, “euphoria with ease of associations and logorrhea” . Generalized characteristics of the state of euphoria highlight complacency, a sense of well-being, easy and passionate speech, or complacent complacency, relaxedness, expansive optimism and the need for communication. However, against the background of general elation, emotional lability may appear with a rapid transition “from joy to tears,” as well as “readiness for anger and quarrel.” In addition, “a state of euphoria and hypomanic behavior” may also be accompanied by “hypersensitivity to external stimuli”, tension, wariness and suspicion.

The rise in mood among khat chewers is combined with certain changes in the intellectual, mental and mnestic spheres. Subjective descriptions include “mental alertness,” “the ability to think all night long,” “overwhelming thoughts,” “fast brain activity,” “expressing opinions freely and clearly,” “increased understanding and awareness of one’s surroundings,” “stimulating memory,” “the emergence of many thoughts and memories,” and sometimes a feeling of “scattering thoughts.” Those who chew khat feel “very smart”, it seems to them that “all problems are solvable” and they may be overcome by a feeling of “self-confident wisdom”. Gradually, “thoughts slow down” and they “become more and more foggy.”

At the beginning of intoxication, a gradual increase in the volume and pace of intellectual activity is objectively observed, but an increase in the speed of associations can lead to “reasoning,” “vagueness of thinking,” impaired judgment, verbosity, dysarthria, and loud and inappropriate statements. Along with bragging and self-overestimation, ideas of grandeur may arise, which can be associated with an existing “impaired judgment.” The possibility of increased alertness and suspicion against the background of high spirits has already been noted above. It is considered characteristic of “exacerbation of memory” (due to improved associative activity), excitement of the imagination or “flash of imagination” against the background of dream-like euphoria with impaired concentration.

After the tonic phase, a decline in psychophysical activity occurs, which is referred to as the “depressive phase,” “phenomena of mental depression,” “reactive depression,” and even “minor depressive syndrome.” These conditions may occur following a period of excitement or after a night's sleep. The period of depression may coincide with the period of sleep and therefore not manifest itself. It is believed that the “depressive phase” occurs during sleep for those who chew khat in the morning or at noon, and for those who chew khat until late, it manifests itself in the morning in the form of sadness with lethargy and fatigue. Some authors attribute the occurrence of anxiety to the depressive phase. The state that follows a period of excitement is also called apathy, and in some individuals it is called “severe stupor.”

The subjective experiences of chewers in the “depression phase” are described very sparingly. Objective characteristics indicate “exhaustion” and “mental impotence.” Within the framework of the so-called “small depressive syndrome“Instability of mood, increased self-criticism, a pessimistic view of the future, insomnia and anorexia are highlighted, which does not deprive these individuals of the opportunity to “make decisions for the future in general.” The transition from high to low mood often occurs through focusing on unresolved and difficult problems. In the “depressive phase,” there is also a slowing down of the pace of thinking and “foggy thoughts.”

The severity of the depressive phase, like the tonic phase, is associated with the amount of khat consumed, the characteristics of the person himself and the duration of his substance abuse. Depressive symptoms disappear after a more or less long rest or repeated use of khat.

Analyzing the descriptions of the period of decline in well-being among chewers, it should be noted that in most characteristics of the so-called. The core of the “depressive phase” are asthenic disorders, against the background of which depressive deviations of various forms arise, therefore this phase as a whole cannot be called depressive. It should probably distinguish between several stages or phases. The condition during morning awakening, referred to as “reactive depression,” is completely inconsistent with our traditional psychiatric terms and concepts. It is not without reason that some authors call the morning state of malaise and drowsiness a “cat hangover,” putting the general poor health of the chewers first, and talk about gloom and joylessness of mood, avoiding the term “depression.”

To assess the relationship between some of the acute physical and mental effects of khat in the immediate and long-term periods, the results of a survey of 116 daily khat chewers are interesting. While chewing khat under experimental conditions, 89 people. noted a state of rest and relaxation of the body, 59 - polyuria, 51 - dry mouth, 42 - a feeling of increased temperature, 31 - tachycardia. After chewing 76 people. indicated anorexia, 72 - sexual desire, 69 - rest and relaxation of the body, 47 - high temperature and sweating, 40 - fatigue and exhaustion, 31 - difficulty urinating. An increase in blood pressure and pulse was objectively recorded. In conclusion, the author emphasizes that khat reduces muscle activity and causes a feeling of rest and relaxation in the body.

A consensus regarding the narcotic properties of khat has not yet been developed; for a long time, representatives of various specialties and ordinary travelers unambiguously called khat a drug, describing it as a substance with narcotic and even hallucinogenic properties. In publications about khat, expressions and terms characteristic of narcotic substances are used, such as “addiction”, “daily craving”, “irresistible desire” or “habit that has become irresistible”. In these and other works, chewing khat is characterized in softer definitions: “addiction”, “simple habit”, “sluggish habit”, “ bad habit» .

It has been noted that in the past, pharmacologists were more inclined to classify khat as a narcotic substance than doctors. If pharmacologists wrote about a severe form of addiction, then doctors noted that in relation to chewing khat, “with more justification we need to talk about addiction than addiction.” Based on some of the identified properties of khat and taking into account the absence of recorded cases of organic disorders, when introducing a one-time ban on khat in one of the regions, it was assumed that this plant could be classified as a drug, but of a completely different type than morphine. A comparison of polar opinions about the “degree of trauma” of khat and its narcotic properties allowed some researchers of that time to draw the following conclusion: reality is somewhere between the opposite points of view and therefore it is permissible to make a comparison with alcohol, in which some drinkers receive inner pleasure from it , while others suffer from its excessive consumption.

In the classification of WHO experts, khat has always been classified as a non-narcotic substance, although it was believed that the problems associated with khat and amphetamine, despite the quantitative differences in their effects and some specific social and economic characteristics, should be considered in the same light due to their similar medical properties. actions . Nowadays, in pharmacological classifications, the level of dependence on khat and amphetamines is equal. There was a period when in official WHO publications on addictive substances, khat leaves and amphetamines were not in the same, but in adjacent groups. A number of international authorities in the field of drug addiction consider this approach to be more correct, because on the one hand, the problem of the khat plant should not be considered together with medicinal substances, and on the other hand, it has not yet been possible to sufficiently study the issue of khat addiction.

According to today's ideas, in order for the abuse of one or another psychostimulant to be classified as drug addiction, it is necessary to identify the process of formation and the fact of formation of a large drug addiction syndrome, which includes, as is known, the syndrome of altered reactivity, the syndrome of mental dependence and the syndrome of physical dependence.

The existence of mental dependence among khat chewers is recognized by most authors. Some differences are present in the characteristics of the severity of addiction. For example, the urge to use khat is defined as something that is “comparable to desire, but not compulsion.” It is noted that dependence on khat is usually very weak and pronounced addiction practically does not occur, although in relation to individuals an analogy is drawn with “heavy smokers”. The stable nature of the attraction is also indicated. Some researchers conclude that the majority of khat consumers may be limiting themselves. There are people who prefer to abandon the batch of khat altogether rather than consume leaves of poor quality, and the “irresistible desire” arises only in rare individuals “who are already mentally ill.” In support of the predominantly low level of mental dependence, there is an opinion about the low prevalence of khat chewing among women in those regions where its phenomenon is extremely widespread. In some way, the general position is that the level of cat mental dependence can be different - from weak to moderate. The wide range of severity of mental dependence is also emphasized by other authors.

It is known that mental dependence is expressed in the desire to get the desired substance, which is accompanied by constant thoughts about it, a rise in mood in anticipation of taking it, or in depression and dissatisfaction in its absence. A good illustration of this is the descriptions of “mass neurosis” made by various authors in a number of regions. It has been noticed how people who are tired after working in the sun suddenly begin to perk up when the time comes to head with others to the place where kata is performed. In places where khat is usually brought in, there is always a tense excitement, which turns into anxiety if its delivery is late, and then gives way to jubilation when the goods arrive. When a “cat” plane is delayed, one or two thousand Djiboutians look sadly at the sky and may not even leave for lunch. On certain days, thousands of Somalis go to the markets to buy khat and, if it has not yet been imported, the wait is characterized by alternating feelings of frustration and hope, which are replaced by an explosion of joy when the characteristic sound of the horn of a truck carrying khat sounds. The author writes that for some chewers the problem of finding and obtaining khat sometimes “takes on the character of a tragedy”; if khat cannot be obtained, then many feel bitterness over the lost pleasure, but for intensive chewers this situation is more serious and some of them are willing to pay a lot of money for it. Doctors also note that chewers undergoing treatment for various diseases experience a revival during the distribution of medications, which is comparable to the anticipation of taking khat. Note that the “drug-seeking” behavior described, regardless of khat, is considered a stage preceding the appearance of obvious signs of withdrawal syndrome.

The conclusion that there is no physical dependence in relation to khat and that withdrawal symptoms do not occur was made by a group of French doctors who worked in Djibouti and published their report in the Bulletin on Drugs in 1957. Observing hospital patients general type, they noted that patients experienced joy in getting rid of khat and improved well-being. The same or similar position was then formed among experts and specialists from international organizations. However, it is known that this issue remains poorly studied, therefore very careful formulations are always used in publications of official bodies. They usually write that cat physical dependence “if it exists, it is insignificant” or that “evidence does not exist” for it. At the same time, well-known but mildly expressed disorders that occur in some chewers after stopping taking khat are interpreted not as withdrawal symptoms, but as a “phenomenon of returning to the original state,” that is, the previous chewing of leaves.

After the discovery of cathinone in khat leaves, WHO experts slightly changed their position and recommended conducting special clinical studies, including to determine the possibility of khat withdrawal. A group of clinical pharmacologists quite rightly points out that the current clinical profile of chewers in the literature is based on random observations. They found that habitual chewers exhibit physiological and neuroendocrine changes (levels of beta-endorphin, prolactin, growth hormone, etc.), which suggest possible physical dependence. The authors refrain from making categorical statements, but note that the identification of this kind of dependence would not be perceived as a surprise.

Long before this study, one of the few psychiatrists who studied the cat problem noted that there was a small withdrawal effect, but it was difficult to attribute it to mental or physiological processes. The author draws attention to two important points: the lack of semantic clarity of the very concept of “physical dependence” and the lack of special observations of regular khat chewers during periods of deprivation, as was done in relation to morphine, marijuana and other substances. Then, in a sociological study, the opinion was expressed that the severity of the state of abstinence from khat should be considered insignificant, because it does not include any organic or any mental disorders and is expressed by the presence of sadness, bad mood, drowsiness, general weakness for several hours . Based on this, the author concludes that khat is “semi-addictive” and therefore does not belong to narcotic substances.

General practitioners have noticed that prolonged chewing of khat “turns into drug addiction,” because the chewer cannot do without khat for a single day, even while working, and in the morning he is in a state of “khat hangover,” while he no longer seeks company, as others, preferring to take khat alone. The author writes that such a person himself says that he cannot live without kata. This observation is extremely important because addicts' personal report of "craving" is an earlier, more sensitive indicator than physiological or behavioral responses.

One of the pharmacological classifications clearly states the presence of cataclysmic withdrawal syndrome. It is interesting that the Harer peasants even have expressions denoting the state before the morning intake of khat - “harara”, when they feel frustrated, gloomy and cannot think, and the state after chewing - “markana”, when they become smiling and forget about their troubles .

The question of the formation of tolerance to khat, one of the components of the syndrome of altered reactivity, is also insufficiently studied and contains conflicting points of view. In WHO publications, tolerance to khat is assessed negatively, but not categorically, and is accompanied by reservations: “apparently absent”, “practically does not occur” and “no noticeable tolerance”, or “if it exists, it is insignificant”. While leaning more towards denying khat tolerance, WHO experts at the same time recommend conducting a targeted study of this issue.

In a number of works, the development of tolerance is indicated quite definitely, based on the fact that habitual chewers throughout life significantly increase the amount of khat consumed to achieve the desired effect. The optional nature of increasing the usual dose and the possibility of limiting it if necessary were noted. In particular, the authors write that the amount used depends on financial capabilities and prudence.

It is generally accepted that the rate of development of tolerance is very slow. Cat tolerance is considered less pronounced than amphetamine tolerance. While recognizing the existence of tolerance, clinical pharmacologists caution against making hasty judgments before conducting in-depth clinical studies.

The absence or subtle nature of tolerance to khat has long been associated both with the properties of the plant itself and with the method of its consumption (chewing), which naturally limits the amount of leaves consumed. Later, the limiting role in the development of tolerance began to be assigned only to the existence of physical limits to the absorption of khat. This change in the position of WHO experts is probably due to the results of a study of the pharmacological properties of cathinone. Another psychological reason holding back chewers from significantly increasing the amount of khat consumed is the fear of the occurrence of reactive somatic disorders. Consumers of huge volumes of khat (2–3 kg) indicate that their maximum dose is related to the variety and quality of the leaves.

Objectively recording the daily amount of khat consumed is very difficult, and khat is close to the category of so-called “unmeasured” toxic and addictive substances. However, there is some direct and indirect evidence in the literature that there are several categories of regular chewers. Based on quantitative criteria, individuals are distinguished who suffer from “minor substance abuse” and consume 75–100 g of khat leaves per day, and “khat lovers,” whose daily dose is 250–400 g of khat. In addition, the author mentions “continuous chewers”, i.e. chewing khat continuously throughout the day, whose daily dose is likely to be very individual. In addition to people who “never part with khat from sunrise to sunset,” there are also individuals who chew khat “all night long.” Along with “inveterate” and “addicted” chewers, there are also people who chew khat daily in large doses until they experience a “severe stupor.” In WHO publications, cases of regular use of khat are divided into “moderate” and “severe”, but without indicating the frequency and dose in both cases.

As can be seen from the examples above, there is a very wide range of forms of systematic chewing of khat, many patterns of its use. On the other hand, it becomes clear: if a person goes from occasional, traditional consumption of khat to continuous chewing of it throughout the day, or consumes 2–3 kg of khat per day, then this process cannot occur without a profound change in tolerance.

In connection with the syndrome of altered reactivity, we note the discrepancy in the literary information about the body’s reaction to the first cases of taking khat. It is generally accepted that the occurrence of the subjectively positive effects of khat, which make it attractive, does not require an initial period, unlike opium or morphine. However, a number of authors write that the euphoric effect can be achieved only on the 3rd–4th day of chewing khat and can be fully appreciated only after 2 weeks. During the initial period of chewing khat, disorders such as headache, pain in the pancreas, secondary cardiovascular and genital effects are noted. Beginners may also experience nausea and general malaise. These examples can be considered, from the point of view of changes in reactivity, as a catalytic example of the disappearance of “defensive reactions” with repeated use of narcotic substances. It is symptomatic that a certain category of chewers is trying to get hold of more potent varieties. Some people even have a dilemma, a struggle of motives: to choose a stronger khat, but causing gastrointestinal discomfort, or a less tonic one.

In descriptions of khat intoxication in systematic chewers, one can find a number of manifestations that are given as separate or additional details of the general picture of the action of khat and which, in our opinion, are underestimated in diagnostic terms. Thus, against the background of a characteristic manic-like state, Kenyans describe the emergence of hypersensitivity to external stimuli, readiness for quarrel and anger, emotional lability in the form of a rapid transition from laughter to tears and vice versa, as well as tension, caution, anxiety and suspicion, which can gradually increase. It has been observed that among Djiboutian chewers, euphoria and a manic state can easily give way to verbal aggression. Disobedience and aggressiveness are noted among Somali and Ethiopian chewers. The occurrence of aggressiveness when using khat is also described in non-traditional regions. Aggression is usually associated with taking large doses of khat. Among the Addis Ababa chewers, there are those who are constantly in a dream-like state with a loss of sense of reality. The same author, observing 10 Kenyan volunteers from among the “long-time chewers,” identified two types of intoxication in them: with sleep-like euphoria (3 people) and with hyperexcitability (7 people), which was accompanied by either irritability or ideas of overestimating one’s own personality , achieving ideas of greatness (5 people). Among Yemeni chewers, in addition to the most characteristic conditions, either the absence of a “body response” or agitation with aggressiveness is noted. The authors associate the latter with the use of certain varieties of khat.

In the vivid descriptions of traditional khat meetings, one can also highlight individual actions and experiences that, in our opinion, are found only in a certain category of chronic chewers: absorption in unpleasant thoughts and memories, causeless bursts of irritability and anxiety, pretentiousness, unmotivated and impulsive withdrawal.

The variety of manifestations of khat intoxication is associated with the dose of khat taken, the nature of the chewer and the duration of substance abuse. The significance of these factors is undeniable, however, such a varied set of reactions to taking khat requires, first of all, a clinical and dynamic analysis in order to identify patterns of changes in the form of khat intoxication and search for the dependence of these changes on the severity of chronic intoxication.

It is considered established and generally accepted that as a result of regular use of khat, acute and chronic disorders of the functioning of many body systems occur, resistance to infectious diseases and various local lesions occur.

Stomatitis and periodontitis are widespread among regular chewers. A particularly irritating effect on the oral mucosa is attributed to the Kenyan and Somali variety "mirrow". Years of intensive chewing of khat wear away and cause teeth to fall out, so victims are forced to grind the leaves and drink them with milk. Gastrointestinal disorders are widespread among chewers, such as serous and ulcerative esophagitis, liver cirrhosis, chronic colitis, intestinal hypotension with flatulence, frequent or chronic constipation, and paralytic obstruction. Due to lack of appetite, and sometimes the inability to swallow anything other than liquid, many eat poorly, are alarmingly thin, and suffer from constipation for up to a week; after taking khat, their stomach becomes hard and slightly swollen, pain appears in the epigastric region, especially at night. Chewers know that some varieties of khat (“kudda”) are more difficult to digest and may cause pain. In recent years, a large number of cases of gastric and, especially, duodenal ulcers have been noted. The listed gastrointestinal disorders are usually explained by the action of tannin, sympathomimetic and other khat alkaloids. Note that intestinal obstruction usually resolves without surgery, and a short-term ban on khat in one region led to a 90% reduction in laxative consumption. At the same time, the role of kata in the emergence of some gastrointestinal diseases is not yet considered scientifically proven, although liver diseases the author clearly associates it with the hepatotoxic effect of amino acids.

The delay in urination that occurs in some people after several hours of chewing khat is explained by the action of the same mechanisms that cause flatulence and intestinal paresis, or the result of stagnation of spermatic fluid in the prostate.

Typical complications of regular khat use include anorexia, insomnia and exhaustion, which disappear with the cessation of intoxication. Some suffer from lack of appetite due to ingestion of very large quantities of leaves, especially at night. Among the poverty-stricken class, anorexia and the high price of khat result in the coveted leaves replacing real food. In the occurrence of anorexia, caused primarily by phenylalkylamine alkaloids and tannins, a certain role of gastrointestinal diseases of khat origin is assumed and, thus, appetite disturbance is included in a vicious circle: khat - poverty - hunger - khat - anorexia - malnutrition - indigestion - anorexia and so on .

Kata insomnia can be accompanied by a feeling of loss of sleep and sometimes requires long-term, intensive treatment; Only certain individuals can fall asleep after taking khat. However, other authors believe that insomnia occurs more often in new and inexperienced chewers, and that it does not occur in those who chew khat only in the morning before work and at lunchtime. To overcome insomnia and some cardiovascular effects, they began to use mostly light alcoholic drinks. Among Muslims, sedatives and hypnotics began to be used for the same purpose, and requests for hypnotherapy for sleep disorders were also noted. The combination of khat with alcohol is popularly considered undesirable and dangerous. The use of psychotropic drugs supposedly “does not cause serious problems,” but several people sought psychiatric help for addiction to pethidine, barbiturates, methaqualone, glutemide and other substances. It has been noted that khat reduces the actual alcoholic and barbiturate effects.

Intensive use of khat leads to the fact that by the age of 30–40 these people find themselves physically and mentally exhausted. According to the aborigines, the adverse effects of khat are more pronounced among those living in hot desert areas and without regular physical activity than among peasants in the cold zone. Exhaustion, combined with anorexia and objective malnutrition, creates a danger for the development of various intercurrent diseases on this basis. Physical exhaustion can reach such a degree that even when the need for food arises, the chewer cannot swallow anything other than milk or broth.

The high prevalence of tuberculosis among chewers and their relatives is associated with physical exhaustion due to malnutrition, while asthenia and asthenia are often detected in family members. pernicious anemia, and their blood picture may be worse than that of the khat users themselves. In the entire group of examined lactating women who were accustomed to using khat, psychoactive substances found in breast milk, as well as in the urine of one child. The harmful effects of these substances on offspring can hardly be overestimated.

The most dangerous complications of khat use are considered to be cardiovascular disorders. A special study of domestic doctors showed that blood pressure increases while chewing khat, but it increases especially sharply when applying loads, even minor ones. An increase in blood pressure and its lability are observed even with more or less regular use of khat. It is emphasized that pressure fluctuations become especially dangerous in cases of initial fragility or pathological changes. During or shortly after taking khat, the authors observed cases of meningeal hemorrhage, hemiplegia, myocardial infarction, and even acute pulmonary edema with severe cardiovascular decompensation with left ventricular failure. In older people, myocardial infarctions are often fatal. The authors suggest that persistent hypertension occurring in young people may also be a consequence of khat abuse.

Acute cat intoxication with four-day coma and death has been described; At autopsy, the stomach turned out to be filled with khat, and no other reasons were identified to explain the outcome. This and similar cases of khat overdose are mentioned in other reports. The dynamics of intoxication are as follows: first, nausea and vomiting occur, then neurological symptoms increase (impaired articulation and coordination), collapse, hyperesthesia, and tremors appear; and in terminal stage- spasms and convulsions are possible.

Chronic use of khat is associated with signs of ocular aging (senile cataracts, macular degeneration or senile-type choreoretinal degeneration), which are noted after the age of 45 years, and in a few people - up to 40 years. The role of intoxication is considered by the authors “in conjunction with the peculiarities of the harsh Djiboutian climate.”

There are very contradictory points of view on the issue of the effect of kata on sexual function. Directly during chewing, sexual desire increases, but it is combined with temporary erectile dysfunction, which is noted by 60% of chewers. According to some descriptions, around the third hour sweet love pictures appear. Only young men show real sexual activity, but they note insufficient vividness of experiences and early ejaculation. Some chewers experience testicular pain, spontaneous ejaculation, and spermatorrhea, where “semen flows like urine.” Wives of regular chewers complain that their husbands stop paying attention to them.

Long-term use of khat leads to anaphrodisiac consequences and old drug addicts are “absolutely impotent.” The level of decrease in sexual desire among regular khat users depends on age and severity of substance abuse. The author believes that sexual function can be slowly restored when khat is stopped. Some researchers associate only isolated cases of impotence with khat abuse as an indisputable cause and do not believe that there is any basis for broader generalizations. Behind medical care Patients are referred for cat frigidity in isolated cases. Pharmacological mechanisms for the development of impotence remain unclear. Anaphrodisia is usually hidden and only doctors-friends “nod affirmatively” in response to a delicate question.

There have been accidents due to inadequate “fearlessness” and road traffic accidents with serious consequences and casualties due to the risky actions of drivers in a state of intoxication. It is believed that an increase in sexual desire associated with khat use increases the risk of venereal diseases. Long hours of communication between many people in a closed room contributes to the transmission of infectious diseases, in particular respiratory diseases, among which tuberculosis is especially prominent.

The issue of psychosis arising from the use of khat leaves remains poorly understood and contains many clinical uncertainties and conflicting opinions. The first description of acute cat psychosis was made in the mid-40s in the East African Medical Journal. In two observations, the picture of psychotoxic disorders included disorientation, incoherence, and febrile agitation, which was considered a condition close to delirium. In addition, disorders of a “schizophrenic nature” were noted, which allowed the author to consider khat as a substance that may contribute to the manifestation of a latent mental illness. Subsequently, these cases in general or the noted symptoms and conclusions drawn were presented in review publications and drug addiction monographs, both with and without references to the author. In the literature of the 50s and 60s, there are individual and very laconic comments about the occurrence of cases of “madness”, “obviously expressed manic states”, “mental agitation with aggression” and “delirious episodes” in habitual chewers. Of particular note is the psychiatric statement that chewing khat does not lead to psychotic disorders. The catastrophic “psychoses of deprivation” are also completely definitely denied.

In the 1960s, French general practitioners included acute psychotic disorders as part of a comprehensive description of the medical consequences of khat chewers. The characteristics of mental disorders and the authors' conclusions are very similar. First of all, they are unanimous in that the use of khat is not accompanied by the occurrence of any specific psychiatric syndromes. Crises of psychomotor agitation with aggression or hysterical flight, which are often provoked by conflicts, as well as manic attacks, which can last several days and which occur “with an appropriate predisposition,” are identified. The latter, according to the authors, is typical for the local (Djiboutian) population. Acute psychoses occur during severe intoxication in the form of delirious attacks with short-term, unstable and polymorphic delusions against a background of confusion or in the form of rare and short oneiric phenomena. The most fundamental difference in the above reports is the drug assessment of patients who have suffered psychosis. According to the first point of view, all khat chewers suffered from substance abuse, and according to others, the patients did not have an “irresistible attraction” to khat and, therefore, could not be classified as substance abusers.

In the only psychiatric publication at that time, the author noted that in Kenyan “addicted” chewers, after taking large doses, the typical hypomanic state could be replaced by “violent mania.” With severe intoxication, disturbances occur that are more consistent with the picture of delirium (disorientation, illusions, hallucinations, a feeling of “unreality”, impaired judgment, delusions). Cases of manifestation of hidden functional mental illness that occurred under the influence of khat use. The author notes that he had the opportunity to observe cases of toxic cat psychosis in several African countries.

In the 1980s, reports of catastrophic psychoses reappeared. Patients admitted to the hospital experienced hallucinations, delirium, and aggressive behavior. The author draws attention to the fact that psychosis occurred in people who consumed large doses of khat and suffered from poor nutrition. Another group of authors finds that catastrophic psychoses are characterized by a wide range of manifestations, from typical toxic conditions with twilight stupefaction, to paranoid pictures reminiscent of schizophrenic states. Of particular note are the reported cases of psychosis in khat chewers in the US and UK; the emergence of paranoid states occurred against the background of pronounced symptoms increased activity sympathetic nervous system.

In the occurrence of catastrophic toxic psychoses, the moment of overdose is mainly highlighted. The importance of combining this factor with the “background” is also noted without specifically specifying its components.

Unfortunately, in clinical publications, as a rule, the number of observed cases of khat psychosis is not given, although it is well known that the overall assessment of the degree of danger of chewing khat for the health of both individuals and those communities depends on the answer to the question about the frequency of occurrence of toxic khat psychoses where this phenomenon is common. Quantitative characteristics become important, since in a number of review publications presented in international publications, there is a clear tendency to level the severity of the issue of catastrophic psychoses. The authors support and develop the view that khat use contributes mainly to the manifestation of “functional” psychoses in predisposed individuals and rarely causes toxic psychosis. It is assumed that psychotoxic disorders are so rare that “they may not be noticed at all.” These assumptions are accompanied by references to clinical works, which, as noted, do not contain either statistical indicators on catastrophic psychoses or the number of their own observations. In addition, experts cite impressions from a population survey indicating the rarity of toxic psychosis in regions where khat is widely used, and references to the paucity of relevant publications in the literature.

Such a predetermination seems controversial and premature, since, firstly, a number of authors, summarizing their own observations and the evidence of others, do not write about the rarity of mental disorders in constant chewers, but, on the contrary, focus on this issue; secondly, as is known, at that time, systematic epidemiological studies had not been carried out either in relation to khat psychoses, or even in relation to the use of khat in general 8.

Chronic psychotic disorders in khat chewers have not been described in the literature. Some individuals have mood disorders with irritability and resentment, or a decrease in affectivity and moral sense. Chewers themselves, who have been using khat for many years, experience a decrease in memory and performance. Some chronic khat users experience “severely impaired intellectual abilities” and “intellectual weakness, up to semi-imbecility,” and “loss of intellectual strength.” At the same time, a number of authors emphasize the absence of signs of intellectual dulling and dementia that would arise as a result of prolonged use of khat. There are also more cautious statements and reasoning. The author does not have specific clinical cases of khat dementia, but he believes that khat leaves, which cause toxic psychosis with confusion in chewers, theoretically cannot but lead to organic disorders brain, especially considering the quantities in which they are consumed over many years of life.

There are no systematic and definite indications of non-psychotic level deviations in the literature.

The personality changes of chronic khat chewers have mostly been characterized in descriptions of medical and social consequences, antisocial lifestyle and antisocial actions, so here we can limit ourselves to highlighting only the most general points. Thus, systematic consumers of khat experience an unfavorable change in character and a decrease in intellectual and volitional strength, due to which the systematic consumer of khat loses interest in work and career, ceases to take care of himself and family, i.e., a moral and ethical decline in personality occurs. Apathy that grows over the years turns intensive khat users into “useless and stupid quitters” who, through khat euphoria, try to get away from life’s problems. This path ultimately leads to the formation of escapism as an established and stable form of behavior, that is, an escape from life’s difficulties and social passivity.

Summary

As follows from all of the above, the problem of khat consumption is in many respects extremely acute for a number of African and Asian countries. A big problem consists of many components and has several aspects. The information presented in the review is divided into three groups: the first group is the results of an analysis of the literature of non-medical fields of knowledge (history, sociology, economics) and religious provisions that require generalization in this section, since they have an auxiliary orienting value in our study; the second group is represented by information from botanical, pharmacognosical and pharmacological literature, which also needs to be summarized in a certain way at this stage in order to be used in the analysis of clinical and epidemiological material; the third group - covers a very wide range of psychiatric, narcological and general somatic publications, which requires special highlighting of the most significant issues that seem to be the most important and have become the subject of direct study.

The use of khat is positively colored in historical literature and folklore. Khat is presented in legends as a plant with adaptogenic, healing and sacred properties. The real stimulating and anorexigenic effects of khat are highlighted in the literature and press as not beneficial. Chewing khat has deeply penetrated various aspects of the lives of many peoples. In the present century, this phenomenon has overcome many professional, caste and religious taboos. Over the past decades, there has been a significant feminization and juvenileization of this phenomenon. It has become a means of recreation and development of human relations, that is, it has become an ethno-cultural phenomenon. Abuse of khat has generated medical and social consequences through increased morbidity, exhaustion, and injuries. It is accompanied by axiological destruction of the individual and society, destabilization of the family and the growth of asocial tendencies. The high profitability of khat cultivation is displacing other agricultural crops. Where khat is grown, the percentage of khat chewers is highest. High incomes from its sale and the use of fast means of delivery contribute to the expansion of khat consumption beyond its growing areas. The export of khat constitutes an important source of government revenue, and widespread imports lead to an outflow of funds and negatively affect the economic situation of communities.

The information presented in a generalized form, firstly, shows the severity of the general social, socio-economic and medical-social consequences of khat abuse; secondly, they open a view of the existence of many specific obstacles of various types that stand in the way of social control of the problem of kata; thirdly, they allow us to identify various directions in which to combat the expansion of khat consumption and eliminate the consequences of this phenomenon.

Depending on the variety and quality, there are several types of khat, which differ in their effect on the body. Khat easily loses its freshness, changing its chemical composition. Cathinone and cathine (the main alkaloids of khat) are found in varying proportions in leaves of different varieties and varying degrees of freshness. Both substances are phenamine-like. Cathinone has a great psychotropic effect, and cathine has a somatotropic effect. Cathinone has a pronounced dose-dependent effect. In terms of its reinforcing effect, it is close to phenamine and cocaine. Cathinone has a modulating effect on the interaction of the adrenergic and dopaminergic systems. In some works, a number of characteristics are identified that distinguish cathinone from phenamine. The suppressive effect of cathinone on motor activity with long-term use, as well as a hallucinogenic effect and a distorting effect on the motivational sphere, has been proven.

The selected results of experimental studies, firstly, must be taken into account when analyzing drug addiction and psychiatric clinical facts; secondly, should be used when searching effective means treatment, both in terms of suppressing addiction and relieving vegetative-somatic and mental disorders.

The issues of the severity of mental dependence on khat, the presence or absence of tolerance and physical dependence are assessed contradictory in the literature, since essentially they have not been purposefully studied using psychiatric and drug addiction material itself. The picture of khat intoxication requires further study among the various categories of khat chewers. The stages of chronic cathode intoxication were not distinguished. There is virtually no description of non-psychotic level disorders. The circle is not clearly defined psychotic disorders in khat chewers, and there is uncertainty in assessing the nosological nature of some of them. The epidemiological side of catastrophic psychoses is completely unclear, the socio-demographic composition of these patients is unknown, and the conditions for the development of psychotic disorders have not been determined.

The study of these issues is necessary, first of all, to improve the diagnosis and treatment of cat psychopathology. Without an answer to the questions posed, it is impossible to determine the place of khat among other psychoactive substances, to assess the severity of the consequences it causes, and, therefore, it is impossible to carry out effective preventive measures and establish adequate measures of national and (or) international control.

Notes

1. A similar story is told about the discovery of the coffee plant.
2. Based on today's chemical and pharmacological ideas about phenylalkylamines, it is quite possible, in our opinion, to classify ephedron, norephedrone and cathinone into a separate subgroup of phenylaminoketone stimulants (FAKS), while norephedron can be considered as an isomer of natural cathinone.
3. (–)-cathinone and (+)-amphetamine are stereoisomeric analogues.
4. It should be emphasized here that a number of anorexigenic drugs (fepranon, tenuate) contain diethylpropion. It has been established that the metabolism of these drugs, which are not under WHO control, produces cathinone. The author observed 10 cases of abuse of these drugs, with the emergence of dependence in 7 people, and therefore poses the question: does the abuse occur due to the effects of the drug itself or due to the action of its metabolite cathinone?
5. The given rhythm of self-administration of cathinone reveals striking similarities with descriptions of the cyclic use of ephedrone for drug addiction.
6. The characteristics of the behavior of chewers during a traditional game also include cases of irritability, anxiety, whimsical and impulsive behavior, immersion in heavy thoughts, and more. The presence of these signs, in our opinion, is explained by the fact that a traditional khat meeting involves both irregular chewers, who form the basis of the “collective portrait,” and regular khat consumers, who are distinguished by atypical reactions.
7. During the period of our research, there was a specialized khat export association (Dire Dawa, Harerge province), which was part of the country's foreign trade system; it had 27 employees and 800 suppliers in 14 regions of the country; According to insufficiently verified data, in 1983 daily exports amounted to 6–10 tons per day, and in the coming years it was planned to increase this figure to 20 tons. It is also known from the literature that Ethiopian farmers expressed dissatisfaction with the fact that khat export is a state monopoly.
8. We presented the first epidemiological information on the incidence of catastrophic psychoses (together with L. Bespalov) in 1980 at the XVI All-Ethiopian Annual Conference of the Medical Association as part of the report “The State of Psychiatric Care in Ethiopia: Results of Statistical Analysis”, and then in a special report “Description of various forms of catastrophic psychosis and the frequency of their detection” at the XVII conference in 1981. Later, the indicators given in the reports were to a certain extent confirmed in a publication on the nosological structure of the contingent of patients who needed emergency care and received it at the Amanuel Hospital.

Khat is a herbaceous plant that grows in hot countries. It contains stimulant narcotic substances, including cathinone. Khat is popular among people who are addicted to drugs that cause euphoria and excitement. Consumption of the plant suppresses a person’s appetite and will, he becomes overly excited and behaves inappropriately.

The plant is approved for sale and consumption in some countries in Africa, Asia and Europe, including the UK. In Russia, khat is included in the list of prohibited drugs, and its distribution is punishable by law.

Khat is consumed fresh. When the leaves are dried, the psychotropic substances evaporate, leaving minimal effect on the human body. For this reason, after assembly, the plant is placed in plastic bags and transported to various countries.

The leaves are odorless and have a bitter taste. Traditionally, the leaves are chewed for several hours.

Impact on the body

The impact of khat on the human body cannot be predicted. The leaves affect each consumer differently, the person experiences a feeling of euphoria, aggression, depression, and a tendency to suicide appears.

In terms of its effect on the body, khat can be compared to adrenaline. Juice from plant leaves constricts blood vessels and increases blood pressure, increasing blood sugar.

How does addiction occur?

Dependence on khat develops slowly, so the harmful effects on the body do not frighten the consumer. Chewing the leaves becomes an analogue of chewing gum, provides good mood and pleasant employment. Cathinone enters the blood and body, affecting cannabinoid receptors, which are responsible for brain function. Without chewing the leaves, a person becomes lethargic and apathetic.

The danger of khat is that it helps to stimulate the body, a person is able to withstand heavy loads, sleeps and eats less, and subsequently causes severe addiction, destroying it from the inside.

Drug addiction?

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Signs of khat use

The signs of khat use are not as obvious as the use of hard drugs:

• disturbance of sleep and wakefulness, a person feels a constant surge of strength and does not feel tired, the body works for wear and tear;
• blurred vision, dilated pupils;
• tachycardia, rapid pulse;
• lack of hunger;
• strong sexual desire;
• unproductive monotonous activity.

Consequences of use

A person addicted to kata gradually loses what makes him human. He is able to focus exclusively on his immediate needs. The first to be hit by kata is the nervous structure, since the plant primarily stimulates the central nervous system, causing:

• tremor of the limbs after excessive excitement;
• headache, which only khat helps to get rid of;
• depression;
• sleep disorder;
• diseases of stomatitis and periodontitis are common, teeth wear out or fall out;
• the functioning of the gastrointestinal tract is disrupted, loss of appetite up to anorexia, patients suffer from constipation;;
• there is an acute lack of calcium, teeth are destroyed;
• the cardiovascular system does not work enough, drug addicts die 15 - 20 years earlier, and those who use low-quality goods die after 5 - 7 years.

Physical dependence

After using khat, the addict feels a “lift,” a surge of energy and physical strength. After 3 - 4 hours, the effect of the substance stops, the person can sleep for several hours, but upon waking up feel irritable and tired. The physical dependence of the chewer develops so strongly that he is unable to absorb food.

It is known that not a single person remained healthy for more than two years of using khat. People become disabled or die.

How does drinking khat affect the psyche?

The use of khat entails psychological dependence:

• paranoid fussiness occurs;
• manic mental disorder;
• depression;
• increasing irritability;
• inadequate inspiration alternates sharply with an apathetic state.

Is it possible to quit on your own?

There are many known cases where people experienced addiction to khat on their own. The danger is caused by the psychological state of the drug addict. He feels lost, depressed and afraid.

Treatment for khat addiction

Treatment for drug addiction in rehabilitation centers begins with a professional examination of the drug addict. The psychological and physical condition of the patient is assessed from a medical point of view. This is followed by detoxification and individual treatment. The patient then goes through a post-rehabilitation period. All treatment takes place under the supervision of medical personnel. The advantages of treatment in rehabilitation centers are as follows: confidentiality, the formation of a healthy worldview, the fight against the problem of codependency, emergency assistance in any situation.

Khat is a drug based on the catha edulis plant. When consumed, it causes excitement and relieves pain receptors. Regular chewing of grass leads to the formation of catism (mental and physical dependence). In the world, about 9.8 million people are “on” this natural psychotropic drug, 18% of them are children 10-14 years old.

Origin and distribution of matter

Catha is a shrub of the Euonymus family with large leaves that addicts chew or brew in water. Seeds, flowers or other parts of the plant are not consumed as they do not cause euphoria.

Khat leaves have a bitter taste and a pungent herbaceous odor. The narcotic effect is due to the cathinone contained in the pulp of pseudoephedrine (chemical formula - C9H11NO). When the plant dries, the substance is converted to cathine and ceases to act as dope.

How narcotic substance Khat began to be used in East Africa and from there spread to the Arabian Peninsula. The most ardent admirers of khat live in Somalia, Yemen, and Ethiopia. In these countries, the narcotic plant is chewed or drunk like tea by 90% of the population (including children).

Application in medicine

Used for treatment only in countries where it is not prohibited. For example, in Somalia and Ethiopia, local healers give the plant to relieve pain. It is also believed that chewing the leaves improves urination and the body better fights infections. Scientists confirm that Catha does have these properties, but they are much less pronounced than those of modern drugs. At the same time, the harm caused (development of addiction and violation of brain activity) exceeds the hypothetical benefit, therefore khat is not used in official medicine.

Legal status

In Africa and the Arabian Peninsula, the plant is legal and is freely sold in markets. An armful of leaves, enough for 5-7 doses, costs about $3.

In Europe there are no restrictions on the sale and consumption of khat. But the plant does not grow here, and delivery of the leaves is difficult, since they must be consumed 2 days after collection. This greatly increases the price (a bunch sells for $80 or more), so European countries Even in the absence of a ban, drugs have not become particularly widespread.

In the Russian Federation, Catha is included in the list of narcotic drugs, the circulation of which is completely prohibited by the Federal Drug Control Service. Under current legislation, criminals caught growing and selling khat face a fine (for small quantities) or a prison sentence of up to 8 years (for large quantities of the drug or participation in a criminal group).

Effect on the body

The narcotic plant is chewed or brewed into tea. The first method gives a stronger intoxicating effect. When studying the properties of the leaves, scientists found that khat is similar to amphetamines in its effect on the brain. It also has psychostimulating and somatotropic adrenomimetic effects.

The motives for taking a drug are the desire to cheer up, have fun, and relieve hunger. One dose produces hyperactivity for 1-2 hours, causes mild euphoria and suppresses appetite for 3-4 hours. A drug addict can use khat 5-8 times a day (the average daily dose is 100–200 grams of leaves).

Signs of use

Drug addicts put the leaves in their mouths and chew them for 2-3 hours, then the khat is spat out and a new portion is taken. Under the influence of the plant, a person develops symptoms:

• pupils dilate, blush appears;
• pulse and breathing increase;
• the person becomes hyperactive;
• mild hallucinations occur;
• loss of appetite and drowsiness.

An avid drug addict who has been using khat for more than 2 years is recognized by dark teeth, excessive thinness, and unhealthy skin color. Characterized by deterioration of memory and attentiveness.

The emergence of addiction

Khat does not cause rapid physical addiction. Scientists have found that a person who uses a narcotic plant 1-2 times a day for a year easily gives it up and does not feel withdrawal symptoms. But this does not mean that he does not have a drug addiction - the psychological craving for an artificial stimulant remains, and as soon as the opportunity arises to take any psychotropic, the person will gladly do it.

Physical dependence develops in the 2-4th year of regular use (the exact period depends on the dose of khat taken). In this case, a person will not be able to give up constantly chewing the plant due to signs of withdrawal: without a new dose, the drug addict feels sick, weakness, dizziness, and irritability appear.

Consequences

Khat is not a high-risk drug, rarely causes an overdose, and the effect on the functioning of internal organs is subtle. The most obvious threat to a plant addict is the loss of an objective perception of reality. The drug causes the person to lose the feeling of fear, which prompts them to perform life-threatening actions (the drug addict jumps from a height, drives a car at high speed).

In drug addicts with more than 2 years of experience, khat disrupts brain function (characteristic of schizophrenic disorders, psychoses) and increases the risk of cancer. When using khat for more than 5 years, the probability of impotence and infertility is 90%. According to statistics, the risk of heart attack and stroke in drug addicts who chew the narcotic plant is 25% higher than in other people.

Overdose and first aid

When consuming more than 500 g of the plant per day, acute intoxication occurs, followed by coma (2-4 days). Clinical picture overdose is as follows: first, the drug addict experiences nausea and vomiting, then articulation and coordination are impaired, collapse, hyperesthesia, and tremor appear. In the terminal stage, convulsions, delirium, and loss of consciousness occur.

If signs of khat poisoning appear, the patient requires gastric lavage and taking absorbent drugs. You definitely need to call an ambulance. To relieve excessive agitation, the doctor gives the patient Haloperidol. In case of severe poisoning, the drug addict is hospitalized in the narcological department for hemosorption.

Treatment

After the signs of poisoning have been removed and physical withdrawal has been relieved (withdrawal can be removed with medication within 5-8 days), the patient requires complex treatment. It is aimed at eliminating the consequences of drug use.

A person is given sleeping pills to eliminate post-drug insomnia, a special diet is prepared, and medications are given that restore blood supply to the brain, eliminate arrhythmia, and hypertension. Sessions with a psychotherapist are required to eliminate the problems that provoked drug addiction. Rehabilitation for khat drug addicts lasts 4-7 months.

Use.

Since ancient times (and long before the use of coffee in the 12th century), fresh or dried khat leaves have been used to chew or brew (as tea or paste) as a mild stimulant drug. Due to the absence of religious prohibitions on its use, the use of khat is widespread in countries of the Arabian Peninsula and the Horn of Africa, such as Yemen, Somalia and Ethiopia. In Yemen, according to some estimates, khat is used by up to 90% of the total male population and 25% of women. In a social and cultural sense, khat can be seen as a substitute for alcohol, which is prohibited in many countries.

In these countries, khat is an integral part of social life, it is taken during meetings in cafes (instead of or along with coffee) or in the morning before work, students use it while preparing for exams. In a number of countries (for example, the USA and Russia), khat is prohibited as a narcotic drug.

Worldwide, approximately 10 million people use and abuse khat.

Chewing the stimulating leaves of khat (Catha edulis) is a centuries-old tradition in several regions of East Africa and the Arabian Peninsula.

Abuse of khat creates severe medical and social consequences and is recognized as a serious problem in a number of countries. For example, in Ethiopia this phenomenon now covers all levels of society - regardless of social, professional, ethnic and religious affiliation. Chewing khat is spreading rapidly among young people and women.

The khat plant (Catha Edulis) is an Ethiopian folk pastime. In many countries, khat is considered a drug and is prohibited, but in Ethiopia it is completely legal. Young shoots of khat are chewed, getting some kind of buzz from it. In the south of the country, khat is sold on almost every corner; in self-respecting hotels there are signs “It is forbidden to chew khat in the rooms” (that’s why everyone chews it while sitting on the porch). Bus drivers chew khat so as not to fall asleep while driving, bus passengers - because it’s boring to drive, or because a neighbor has treated them, workers - to make work more fun, the unemployed - because there is nothing else to do, young people - according to the global habit of young people consumption of any narcotic rubbish.

Moreover, almost no one smokes among Ethiopians. Strong alcoholic drinks are also not in fashion here. So all that remains is to chew green khat leaves.

Spreading.

Khat is common in the Arabian Peninsula, Ethiopia, East and South Africa. It is also cultivated on a small scale in India and Sri Lanka.

Story.

The origin of kata is controversial. Some believe that it originates from Ethiopia, from where it then spread to the plateaus of East Africa and Yemen. Others believe that khat originates from Yemen, from where it was spread by the Arabs to neighboring countries.

Chemical substances.

Khat leaves are odorless, taste bitter, their astringent juice has a narcotic effect: they contain a stimulant - the alkaloid cathinone, or norephedron (b-ketoamphetamine), which is recognized as a narcotic substance in a number of countries.

The plant contains substances with a stimulating narcotic effect, and therefore has become quite widely known. When the plant is dried, the most active substance, cathinone, evaporates in two days, leaving a more mildly active component, cathine. Therefore, the harvested khat leaves and stems are transported in plastic bags, or packed in banana leaves, to preserve the high activity of the raw material.

Pharmacology.

It is believed that the stimulating effect is exerted by a substance from the plant, traditionally called catin (“katin”), from the phenylethylamine class. However, this statement is disputed - extracts from fresh leaves also contain another substance - cathinone, which is more physiologically active than cathine.

Effect on the body.

Preparations from khat cause moderate euphoria and excitement. Under its influence, people become very talkative and seem inadequate and emotionally unstable. Khat can provoke inappropriate behavior and hyperactivity.

Khat is a strong appetite suppressant and its use can also lead to constipation.

Harm and addiction.

With regular use of khat, general muscle lethargy, frequent headaches, skin itching, tachycardia, sleep and digestive disorders are observed. In some cases, stomach and duodenal ulcers may develop. Withdrawal, as with other psychostimulants, is accompanied by decreased appetite, increased fatigue, apathy and depression.

A particular danger to the body is the use of homemade cathinone solutions for intravenous injection. Most often used in the process of artisanal synthesis potassium permanganate, causing irreversible damage to the central and peripheral nervous system over several years and even months of regular use. Ultimately, these pathologies lead to impaired motor and speech functions, paranoid psychoses, paralysis of the limbs and even dementia.

Constant use of the drug in any form causes both psychological and physical dependence, but the problem of addiction is especially acute as a result of injection use. According to clinical studies, as a result of tolerance, the number of injections of the drug quickly increases from 2-3 to 8-10 times a day. In especially severe cases, the drug was taken more than twenty times during the day. In such conditions, complete personality degradation develops within one to a maximum of two years.

Legislation.

The khat plant is prohibited for cultivation and circulation on the territory of the Russian Federation, falling under the list of narcotic drugs and psychotropic substances, the circulation of which in the Russian Federation is prohibited in accordance with the legislation of the Russian Federation and international treaties of the Russian Federation.