Report: Khat: A review of its potential harms to the individual and communities in the UK

“Khat has no direct causal link to adverse medical effects,” finds a Home Office report published on 23 January 2013. The report ‘Khat: A review of its potential harms to the individual and communities in the UK’ by the Advisory Council on the Misuse of Drugs (ACMD) says: “Some of the adverse outcomes are associated with khat use i.e. a complex interaction of khat with other factors to produce the outcome, but not directly caused by khat use.”

Among a key findings of the report include:

  • Fresh khat has a short lifespan for use as a chewable stimulant, approximately 36 to 48 hours, from picking to consumption; when transported under optimal conditions. Khat can also be dried and juiced, but both forms have significantly lowered levels of active ingredients, if any at all.
  • Although chewing khat is an efficient method of extracting the active ingredient, it is not extracted rapidly, hence the long period of chewing needed to elicit an effect: and it does not have a fast onset of action. Khat‘s bitter taste and method of consumption make it unattractive to most potential consumers.
  • Khat has no direct causal link to adverse medical effects, other than a small number of reports of an association between khat use and significant liver toxicity.
  • Overall the reporting of physical harms of khat in the media is at odds with the medical evidence. A number of concerns raised may be due to other factors and contributory associations, which should be placed within the wider context of obstacles and lack of opportunities facing the user demographic, overseas nationals and those seeking asylum within our society.
  • Evidence presented to the ACMD by researchers found no link between gang crime and khat use.

There is no evidence of khat consumption being directly linked with serious or organised criminal behaviour in the UK or to support the theory that khat is funding or fuelling crime. This is unsurprising given khat is not an illegal drug, is not a high value substance and therefore attracts very little profit from the UK market.

In regard to international crime the ACMD has not been provided with any evidence of Al Shabaab or any other terrorist group‘s involvement in the export or sale of khat despite consultation with national and international official bodies.

The report stresses the need for appropriate support provision and resource to address inequalities and integration problems.

“It is essential that communities be supported and given the appropriate resource and environment within which they can manage issues e.g. to support integration and address inequalities of health. A multi-agency approach, requiring cross departmental consideration, will be essential to address the wider community issues that are well referenced in this report.”



Khat: A review of its potential harms to the individual and communities in the UK

Executive Summary

Introduction

Khat is a herbal product consisting of the leaves and shoots of the shrub Catha edulis. It is chewed to obtain a mild stimulant effect and is a less potent stimulant than other commonly used drugs, such as amphetamine or cocaine.

Khat is not controlled under the Misuse of Drugs Act 1971 and is currently imported and used legally in the UK.

Khat is imported into the UK from the main khat growing regions of Kenya, Ethiopia and Yemen.

Generally, khat chewing is a social event which takes place within family homes, community parties and at khat cafes. Traditionally khat has been used as a medicine and was widely perceived to be a food, not a drug.

Background

The ACMD reviewed the harms associated with khat use in 2005 and determined that khat should not be controlled under the Misuse of Drugs Act 1971 and made a number of education and research recommendations.

The Minister responsible for drugs requested the ACMD to review and update its assessment of 2005 and provide advice in relation to control under the Misuse of Drugs Act 1971.

Khat Use – International

There are no international comparable prevalence estimates for use of khat and no reliable published evidence as to the rates of khat use in European countries. However within Europe khat use is primarily amongst BME immigrants from the Horn of Africa countries.

Rates of khat use appear high among the general populous in Somalia, Yemen and Ethiopia. However prevalence of khat use is far less among the Somali community living in the UK than in the population living in Somalia.

Khat Use – UK

Based on VAT data from HM Revenue and Customs there has been a reduction of importation of khat to the UK since 2005.

During this period the relevant BME population in the UK has increased by 18.4%. This strongly indicates that khat use within the same UK population has decreased.

Northern Ireland and Scotland do not report any figures on prevalence or treatment data of khat users engaging with the NHS.

Only 6 referrals are recorded on the Welsh National Database for Substance Misuse since 2009.

The NHS data for England for 2010/11 shows 112 clients began treatment for the first time citing involvement with khat at any point in their past.

The ACMD is cognisant that NHS and other data may not fully represent the treatment needs of khat users due to the difficulties in engaging with all groups within communities.

The Pharmacology of Khat

Fresh khat has a short lifespan for use as a chewable stimulant, approximately 36 to 48 hours, from picking to consumption; when transported under optimal conditions. Khat can also be dried and juiced, but both forms have significantly lowered levels of active ingredients, if any at all.

Cathinone and cathine isolated in pure form from synthetic compounds are stable and controlled under the Misuse of Drugs Act 1971. This is in direct contrast to the unstable nature of cathinone in the khat plant, which quickly degrades to cathine.

It is easier and less expensive to manufacture synthetic cathinones and cathines than to extract it from fresh khat.

Although chewing khat is an efficient method of extracting the active ingredient, it is not extracted rapidly, hence the long period of chewing needed to elicit an effect: and it does not have a fast onset of action. Khat‘s bitter taste and method of consumption make it unattractive to most potential consumers.

Medical Harms

The addictive potential of khat is likely to be less than the consumption of the pure drug cathinone.

Khat has no direct causal link to adverse medical effects, other than a small number of reports of an association between khat use and significant liver toxicity.

Overall the reporting of physical harms of khat in the media is at odds with the medical evidence. A number of concerns raised may be due to other factors and contributory associations, which should be placed within the wider context of obstacles and lack of opportunities facing the user demographic, overseas nationals and those seeking asylum within our society.

Social Harms

Anecdotal evidence reported from communities in several UK cities link khat consumption with a wide range of social harms. Research into these concerns has been undertaken but no robust evidence has been found which demonstrates a causal link between khat consumption and any of the harms indicated.

Somali groups that made representations to the ACMD claimed khat use was a significant social problem within their local areas and in domestic settings. In contrast it was asserted that the Yemeni community had no problem with khat use, as it takes place within the family setting and is integrated into other social domestic events.

The majority of this group use khat in an unproblematic manner.

Existing legislative frameworks in health, police and council partnerships working with relevant BME Communities have shown they can successfully address anti-social behaviour concerns voiced.

The comparative research undertaken in London and Minneapolis draws attention to the on-going support upon arrival provided to those arriving in the USA, and how this enhanced employment opportunities, where employment was a key determination for social wellbeing.

There is no evidence of khat consumption being directly linked with serious or organised criminal behaviour in the UK or to support the theory that khat is funding or fuelling crime. This is unsurprising given khat is not an illegal drug, is not a high value substance and therefore attracts very little profit from the UK market.

In regard to international crime the ACMD has not been provided with any evidence of Al Shabaab or any other terrorist group‘s involvement in the export or sale of khat despite consultation with national and international official bodies.

Evidence presented to the ACMD by researchers found no link between gang crime and khat use.

International Issues

Legislation regarding khat in Europe and North America has been widely introduced. It appears that decisions to control khat are likely not to have been based on robust evidence of either physical or societal harms, including issues of domestic and international crime, but other factors.

The impact of legislation is difficult to measure, however there remains a demand for khat even in those countries where it is prohibited. The outcomes of enforcement are mixed and appear fragmentary in some cases.

Fears of the UK becoming a hub for importation of khat appear not borne out by the VAT figures provided by the HMRC regarding the volume of khat imported into the UK since 2005 or by any evidence suggesting the UK is a landing point for the onward transportation of significant quantities of khat.

Concerns

BME groups are not homogenous communities, but range from well settled fourth generation families to asylum seekers fleeing civil war.

The complex multi-factorial issues facing khat using asylum seekers/refugees may include: unemployment; legal uncertainties and irregular status; trauma; no social or family networks; social dislocation; discrimination; poor English literacy; gender politics; lack of inspirational realisation; devalued refugee identity; lack of validation of previous qualifications; lack of or limited access to accommodation and health care service provision.

Recommendations

Without the necessary data and robust evidence to support proportionate intervention, the ACMD does not recommend that khat be controlled under the Misuse of Drugs Act 1971. The ACMD considers that the ‘coalescence of concerns’ around the use of khat can be addressed through the recommendations made.

  1. The ACMD recommends that the status of khat is not changed and is not controlled under the Misuse of Drugs Act 1971.
  2. It is recommended that Commissioners and Directors of Public Health from Local Health Boards, NHS Boards, Health and Wellbeing Boards, and Health and Social Care Boards should:
  • Include khat in local needs assessments, particularly where there are population groups of relevant BME groups;
  • Where khat use is found to be present in local communities, this substance should be included in local generic substance misuse education and prevention initiatives;
  • Where khat use is found, the commissioning of culturally specific and tailored treatment and recovery services incorporating ‘mutual aid’ models of support should be considered;
  • Consider dialogue and partnership working with appropriate NGO, third sector, voluntary organisations and BME communities, so holistic needs of health and social issues are met.
  1. It is recommended that where concerns are expressed about social harms associated with the use of khat, Local Authorities and new Police and Crime Commissioners should address them through engagement and dialogue with the local community and good inter-agency working, supported as necessary by the use of existing measures coordinated through the relevant Community Safety Partnerships and the use of community remedy.
  2. It is recommended that Commissioners of Public Health services, as well as Criminal Justice System bodies and the new Police and Crime Commissioners should include the use of khat in regular monitoring returns required from treatment and enforcement agencies and publish annual figures. This data should form the basis of future research on khat to address the concerns raised in this report.

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p>There is a need for further research on khat to develop the evidence base of any findings. The ACMD echoes the view of the European Monitoring Centre for Drugs and Drug Addiction that ―knowledge gaps in this area remain considerable, and little is known about the social or health consequences of [khat] use.

Read the full report

English — Khat: A review of its potential harms to the individual and communities in the UK

Somali translation — Khat: A review of its potential harms to the individual and communities in the UK_Somali translation

 

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