Khat (Catha edulis) is a flowering shrub native to East Africa and the Arabian Peninsula, where its leaves have been chewed for centuries for social, cultural, and recreational purposes [1.2.1, 1.5.5]. An estimated 20 million people worldwide use khat, which is deeply integrated into the social and economic fabric of countries like Yemen, Somalia, and Ethiopia [1.2.2, 1.5.4]. Users chew the fresh leaves to release active compounds that produce stimulant effects [1.2.1]. While the World Health Organization (WHO) classifies khat as a drug of abuse that can create psychological dependence, its legal status varies significantly across the globe [1.3.8, 1.6.4].
The Pharmacology of Khat: Cathinone and Cathine
The primary psychoactive compounds responsible for khat's effects are cathinone and, to a lesser extent, cathine [1.3.1]. Cathinone, which is structurally and pharmacologically similar to amphetamine, is most potent in fresh leaves and degrades within a few days of harvesting [1.3.1, 1.6.5]. It acts as a central nervous system stimulant by increasing the release of neurotransmitters like dopamine and norepinephrine [1.3.6, 1.3.7]. This mechanism is what produces the feelings of euphoria, alertness, and energy that users seek [1.3.2]. Cathinone is classified as a Schedule I drug in the United States, while cathine is a Schedule IV substance [1.6.8].
Perceived Advantages and Reasons for Use
The user-reported "advantages" of chewing khat are directly linked to its stimulant properties. These sought-after effects are the primary drivers of its consumption, both traditionally and today.
Sociability and Euphoria A primary reason for khat use is the feeling of mild euphoria, excitement, and well-being it produces [1.2.4, 1.2.6]. Users often become more talkative and friendly, which is why khat sessions are a central part of social gatherings, ceremonies, and daily life in many cultures [1.3.2, 1.3.8]. Some users believe it facilitates communication and strengthens social bonds [1.2.6, 1.5.4].
Increased Energy and Alertness Similar to other stimulants, khat is used to increase energy, alertness, and concentration while postponing fatigue [1.3.2, 1.3.5]. This has made it popular among workers, students, and drivers who need to stay awake and focused for long periods [1.3.3, 1.5.8]. Some farmers and laborers use it to enhance physical strength and work capacity [1.5.1, 1.3.2].
Appetite Suppression Khat acts as an anorectic, meaning it suppresses appetite [1.3.8, 1.4.9]. This effect is caused by cathinone acting on the hypothalamus [1.2.6]. While this may be perceived as an advantage by some users for weight control, it can contribute to malnutrition, especially when combined with the economic cost of the habit [1.4.5].
Cultural and Traditional Roles In regions where it has been used for centuries, khat is an integral part of cultural, religious, and social traditions [1.5.2, 1.5.5]. It is used in ceremonies like weddings and to facilitate prayer, with some users believing it helps them connect with God [1.3.2, 1.5.4]. Historically, it was also used for medicinal purposes, believed to be beneficial for ailments like headaches, depression, and fevers [1.3.2, 1.5.4].
The Other Side: Significant Health Risks
Despite the perceived benefits, the medical community highlights a vast array of short-term and long-term health risks associated with khat chewing. The initial euphoria is often followed by negative after-effects like irritability, anxiety, and depression [1.2.5, 1.2.6].
Cardiovascular Complications Chronic khat use is strongly linked to severe cardiovascular problems. It causes an immediate and sustained increase in heart rate and blood pressure [1.2.1, 1.4.7]. This elevates the risk of acute myocardial infarction (heart attack), with heavy chewers facing a significantly higher risk [1.4.2, 1.4.7]. Other documented risks include arrhythmia (irregular heartbeat), coronary vasospasm, stroke, and dilated cardiomyopathy [1.4.3, 1.4.5].
Gastrointestinal and Dental Issues The physical act of chewing and the chemical compounds in khat lead to numerous oral and digestive problems. Common issues include dental caries, gum disease, oral ulcers, and chronic gastritis [1.4.2, 1.2.9]. The tannins in the leaves are astringent and contribute to constipation, a frequent complaint among users [1.4.5]. There is also an association with an increased risk of oral, esophageal, and gastric cancers [1.4.2].
Psychological and Neurological Effects While users seek euphoria, long-term use can lead to serious mental health conditions. These include psychological dependence, anxiety, aggression, and mood disorders [1.4.4]. High doses can induce psychosis, paranoia, and hallucinations similar to amphetamine psychosis [1.2.7, 1.4.4]. Withdrawal symptoms often include depression, irritability, and nightmares [1.3.7].
Comparison: Perceived Advantages vs. Documented Risks
| Perceived "Advantage" | Documented Medical Risk | Source(s) |
|---|---|---|
| Euphoria, excitement, and sociability | Psychological dependence, anxiety, irritability, depression, psychosis at high doses | [1.2.6, 1.3.8, 1.4.4] |
| Increased energy, alertness, and concentration | Insomnia, restlessness, lack of concentration and sluggishness after effects wear off | [1.3.5, 1.2.4] |
| Suppressed appetite | Anorexia, malnutrition, weight loss, gastritis | [1.3.8, 1.4.1, 1.4.5] |
| Improved work performance | Economic hardship, loss of productivity due to time spent chewing and after-effects | [1.5.4] |
| Cultural and traditional importance | Significant negative health outcomes impacting communities where it is deeply rooted | [1.4.8, 1.5.2] |
| Reported increase in libido | Impotence and reduced sperm count and motility in men | [1.4.1, 1.4.9] |
Legal Status
The legal status of khat is inconsistent globally. It is legal and widely cultivated in nations like Ethiopia, Kenya, and Yemen where it holds cultural significance [1.6.4]. However, due to its active compounds, cathinone and cathine, it is a controlled substance in most European nations, Canada, and the United States [1.6.2, 1.6.1]. In the U.S., cathinone is a Schedule I drug, meaning it is considered to have a high potential for abuse and no accepted medical use [1.6.8].
Conclusion
While individuals chew khat for its temporary stimulant effects—such as euphoria, increased energy, and enhanced sociability—these perceived advantages are comprehensively overshadowed by a vast and severe range of documented medical risks. The scientific evidence points to significant long-term harm to the cardiovascular, nervous, and gastrointestinal systems, along with a clear potential for psychological dependence. The cultural and historical significance of khat in certain regions complicates the public health perspective, but the pharmacological reality remains that its use is associated with serious adverse health consequences.
For more information, a comprehensive review of khat's effects can be found via the National Institutes of Health (NIH).
