Khat consumption: a pharmacological review

The present review deals with the considerable body of evidence gathered in the last ten years on the clinical and experimental pharmacology of Khat. Khat effects are generally agreed to be of amphetamine-like type. In particular, Khat ingestion, like amphetamine ingestion, produces sympathetic activation, anorexia, euphoria, increased intellectual efficiency and alertness. These effects are mainly mediated by phenylalkylamines, such as cathinone and cathine, because the pharmacological actions of these agents and those produced by amphetamine almost overlap. In infra-human species cathinone is an effective positive reinforcer (i.e., it maintains self-administration). However, it would be inappropriate to infer from cathinone and cathine effects assessed in animals a high potential of abuse for Khat in humans; apart from other reasons the bulk volume of Khat leaves, limits the ingestion of high quantities of the active principles. Accordingly, in habitual consumers Khat dependence is probably mild, because craving and tolerance to the sympathomimetic and neuroendocrine effects of Khat are present, but there is no definite abstinence syndrome. Therefore, in our opinion, policies restricting the use of Khat should be adopted with caution, lest they simply change the pattern of drug abuse and increase the spread of more dangerous drugs.