cultivated. The herb is chewed, smoked or drunk as an infusion. The active
principles are the two alkaloids, norpseudoephedrine (cathinine) and cathi-
none. Khatproduces a feeling of well-being and lessens fatigue. Although
users say that the herb is not addictive, withdrawal has been known to cause
lethargy and nightmares. In 1980 the World Health Organization classified
khatas a drug of abuse that can produce mild-to-moderate psychological
dependence, and the plant has been targeted by anti-drug organisations. It
is a controlled/illegal substance in many countries. On the basis of the
evidence presented to the UK Advisory Council on the Misuse of Drugs in
2005, it was recommended that khatshould not be controlled under the
Misuse of Drugs Act 1971. The Council report (http://tinyurl.com/mj4t85)
stated that use of the substance was limited to specific communities within
the UK, and had not, nor did it appear likely to, spread to the wider commu-
nity. However, use ofkhatwas not without detrimental effects and should be
discouraged. Fresh leaves ofkhatcontain the alkaloid stimulants cathinone (S-
()-a-aminopropiophenone) and cathine (S,S-()-norpseudoephedrine) in
addition to more than 40 alkaloids, glycosides, tannins and terpenoids.
Although khatis not currently controlled under the UK Misuse of Drugs Act
1971, cathinone and cathine are classified as class C drugs under the Act.
An offence is committed if they are extracted from the plant. Although this
offence has been identified there have been no successful prosecutions to
date.
The UK is a major destination for imports and exports of khaton to other
countries in the world. In the first 6 months of 2005 there were imports each
day of approximately 5–7 tonnes from Kenya, 500 kg from Ethiopia and
175 kg from Yemen (equates to roughly 25 000 bundles or doses), the bulk
of which was held in transit for export to the USA where its use is illegal. Khat
has a varied legal status across Europe. Most countries include cathinone
and cathine under drug misuse legislation and they are listed in the UN
Convention on Psychotropic Substances 1971.
Betel (Piper betle)
Use of betel is discouraged in western countries because of its alleged
carcinogenic and perceived dysaesthetic properties; nevertheless, betel is
widely available in the west.^15 The British Dental Health Foundation
(www.dentalhealth.org.uk) has long advised betel users of the risks of
mouth cancer. Warning signs include ulcers that do not heal within 3 weeks,
red and white patches in the mouth, and unusual swellings or changes in the
mouth and neck.
A betel quid comprises tobacco, Areca catechu, saffron and lime wrapped
in a leaf from the plant Piper betle. The quid is placed in the buccal cavity,
where it stimulates salivation. It is considered to have beneficial digestive
properties. A number of the ingredients are reported to be carcinogenic. An
210 | Traditional medicine