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Khat and its effects on the Heart and the Central Nervous System

Khat is a flowering plant originating in Northeastern Africa (Horn of Africa) and the Arabian Peninsula. It has been chewed for many years as a cultural tradition in Northeastern Africa and the Arabian Peninsula.(1) Khat contains two active ingredients, Cathine and the alkaloid called Cathinone, an amphetamine like stimulant, which is similar to cocaine. Although Khat is legal in certain parts of Europe, east Africa, and the Arabian Peninsula, it is illegal in the United States. The WHO classified the plant as a drug of abuse that can produce mild to moderate psychological dependence, although they consider it to be weakly addictive. (2) Khat,is considered to be a recreational and religious drug; and is most commonly used by the natives of the source countries. Khat can be found in many social environments. During Ramadan, Khat use is very popular to relieve fatigue and reduce appetite. Furthermore, Khat is sometimes used in place of alcohol. The two main ingredients of Khat, are chemically similar to amphetamines and ephedrine. Cathinone is a schedule 1 drug under the convent of psychotropic substances. (3)

The effects of Khat

The consumption of khat stimulates the sympathetic system in which causes high blood pressure, increased heart rate and dilated pupils. The chronic use of Khat results in constipation. (4) Khat may also have some physical effects on other organ systems such as bronchitis, tuberculosis, tachypnea, and dyspnea in the respiratory system.(5) In addition, khat has many central nervous system effects, negative impact on liver function, permanent tooth darkening (of a greenish tinge), susceptibility to ulcers; spermatorrhea and diminished sex drive may follow prolonged use of Khat. Immediate effects after the use of Khat may cause myocardial infarction due to vasoconstriction of the coronary arteries. (5) Pregnant women also sometimes use khat, where it may result in low birth weight of the fetus, still births, and impaired lactation.(5)

The effects of Khat on the Heart

According to a study that was conducted about the relationship of Khat herbal amphetamine use and acute coronary syndrome, Khat chewers (who were 19% of the sample population) were less likely to have a history of coronary artery disease. However, Khat chewers were more likely to present with ST-segmentelevation myocardial infarction. A higher risk of death, recurrent myocardial ischemia, cardiogenic shock, ventricular arrhythmia, and stroke was found amongst khat users compared with non-khat users (who were 81%). (7) In a similar study about the use of herbal amphetamine and the risk of death and stroke in those with heart disease amongs men and women in 65 hospitals in Saudi Arabia, Yemen, Bahrain, Qatar, United Arab Emirates, Oman. Khat users had lower cardiovascular risk factors such as diabetes mellitus, dyslipidemia, and hypertension. The researchers undergoing the study found a double risk of death amongst patients

with heart diseases who chewed Khat relatively to the non Khat chewers. Following the patients with heart diseases for one year, the death rate of those who used Khat was 18.8% compared to only 10.8 percent deaths amongst non Khat-users. (8) Furthermore, researchers found that users were more likely to experience adverse health effects, including heart failure, recurrent ischemia, a second heart attack, cardiogenic shock and stroke compared to non-users.(8)

The effects of Khat on the Central Nervous System

The central nervous system is highly affected by the intake of many various narcotic drugs. Therefore, Khat has been described as a natural amphetamine because of its similar effects to those produced by other Psychostimulants. Khat has both peripheral and central nervous system affects. Khat chewers describe a feeling of well being, euphoria, alertness, and an increase in libido. Insomnia and anorexia are encountered at high doses along with hyper activity and excessive talking.(9) Furthermore, Khat intoxication may cause psychiatric manifestations such as manic-like behaviors or Schizophreniform Psychosis or paranoia which are similar effects found with amphetamine intoxication. However, the latter has a higher risk of toxic psychosis. (9) Schizophreniform Pyschosis occurs with heavy consumption of Khat. Patients typically present with paranoid delusions, fear, and auditory hallucinations, displaying aggressive behavior towards others. Resolution of symptoms occurs if Khat consumption is ceased.(5)(6) Many researchers have found that Khat may also cause reckless driving and criminal behavior after long-term use.(5) The withdrawal signs of Khat are minor lethargy, mild depression, nightmares and slight tremor. However, Khat does not have physical dependence after prolonged use.(5)

References: 1. ^ a b c d e f g h i j k l m 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 2. ^ a b Nutt D, King LA, Blakemore C (March 2007). "Development of a rational scale to assess the harm of drugs of potential misuse". Lancet 369 (9566): 104753. doi:10.1016/S0140-6736(07)60464-4. PMID 17382831. 3. 4. Giannini AJ, Castellani S (July 1982). "A manic-like psychosis due to khat (Catha edulis Forsk.)". Journal of Toxicology. Clinical Toxicology 19 (5): 4559. doi:10.3109/15563658208992500. PMID 7175990. 5. Adverse effects of khat: a review Glenice Cox and Hagen Rampes 6. Gough, S. P. & Cookson, I. B. (1984) Khat induced schizophreniform psychosis in UK (letter). Lancet, i, 455. 7. Acute coronary syndrome and khat herbal amphetamine use: an observational report. Ali WM, Al Habib KF, Al-Motarreb A, Singh R, Hersi A, Al Faleh H, Asaad N, Al Saif S, Almahmeed W, Sulaiman K, Amin H, Al-Lawati J, Al Bustani N, Al-Sagheer NQ, Al-Qahtani A, Al Suwaidi J. 8. 9. East African Medical Journal Vol. 77 No. 6 June 2000 MECHANISM OF ACTION OF CATHINONE: THE ACTIVE INGREDIENT OF KHAT (CATHA EDULIS) N. B. Patel, PhD, Senior Lecturer, Department of Medical Physiology, University of Nairobi, P O. Box 30197, Nairobi, Kenya. 10. P. Kalix. The Pharmacology of Khat and of the Khat Alkaloid Cathinone. In M.Randrianame,K. Szendrei, A. Tongue (Eds) The Health and Socioeconomic Aspects of Khat Use.1983, Lausanne, Switz.,Intl Council on Drug and Addictions ,pp140-143 1. ^ Al-Motarreb AL, Broadley KJ (Oct-Dec 2003). "Coronary and aortic vasoconstriction by cathinone, the active constituent of khat". Autonomic & Autacoid Pharmacology 23 (5-6): 31926.

Done by: Faisal Al-Tamimi Abdallah Khogeer Nawaf Al-Salamah Majed Al-Rumayyan Abdallah Al-Shaalan