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Books - The health and socio-economic aspects of Khat use


H.E. Mr. Ampy Portos, Minister of the Interior of the Democratic Republic of Madagascar.
My first words will be words of welcome addressed to all those who are taking part in this Conference.
The Revolutionary Authorities Madagascar whom I am representing here are pleased to welcome you on our soil and wish you an enjoyable stay and every success in your tasks.
Since the advent of the Madagascar Socialist Revolution this is the second occasion on which Madagascar has accommodated an assembly concerning khat. The significance of this is that Madagascar is interested to the highest possible degree in the problems of khat and in its effect and wishes to preserve the health of the population. The objective of the Revolution in the matter of health can be summarized in this adage: "mens sana in corpore sano", a healthy mind in a healthy body.
What is more, we are happy to welcome you here at the present time, for we have just achieved a big victory in the strengthening of the Madagascar Socialist Revolution. The people reaffirmed their confidence in President Didier Ratsiraka in voting massively for him on the 7th November 1982 (80%).
Let us remember that these elections took place with complete respect for freedom and democracy, which reflects credit on the Madagascar Revolution and on Africa as a whole.
I hope that during your stay here you will have the opportunity of seeing Madagascar as it truly is and of gaining a better knowledge of the people of Madagascar who really are quite captivating.
I hope also that during your few leisure moments you will come to appreciate the efforts of our people in establishing the foundations of a new society where the exploitation of man by man will be banished, in spite of difficulties of all kinds and particularly those inherent in the international economic crisis.
We should also like to take advantage of this opportunity to thank those who, close by or from afar, have contributed to the success of this Conference, notably the International Council on Alcohol and Addictions (ICAA) and the representatives of each country or each institution present here.
During the year 1978, a group of experts held a meeting at Antananarivo to study the chemistry of khat and the opening of that meeting was presided over by the Secretary General of the Ministry of the Interior. Today, at the beginning of the year 1983, we are once again meeting in this capital of the Democratic Republic of Madagascar for a conference on the medical and socio-economic aspects of the use of khat.
Khat, the leaves of which certain people in some regions of our countries are in the habit of chewing throughout the day, this being made more pleasurable by the swallowing of a coca-cola or a beer from time to time. Is khat harmful to health ? Does it have a more harmful effect than cigarettes or alcohol ? Must the consumption of it be forbidden ?
In the course of this meeting you will be reporting on the research that has been undertaken in our respective countries. You will be trying to arrive at a conclusion as to whether this famous plant called khat does have harmful effects on health and serious consequences for the physical and mental equilibrium of man. And recommend whether it should be prohibited, or whether if can serve as a medicament and so help in improving the health of mankind.
Since ancient times man has been aware of the properties of plants. The knowledge that he had of these properties enabled him to combat and to resist as much as possible the harshness of nature. Thus, he had recourse to certain plants either to heal, to ease pain or to relieve hunger; in short, to survive.
Later on, the progress of science led him to isolate and to extract the active constituents of the plants that he knew to be psychoactive. On account of the benefit that they were able to bestow and the feeling of well-being that they imparted, these were quickly diverted from their original purpose. They were thus used for purposes that were no longer medical. In this way, the abusive use of such plants made its appearance.
This abuse has spread quickly, for individuals observe that the world in which they live is deteriorating rapidly; violence in all its forms seeks to oust law and order; injustice and misery become for them the daily lot. Thus, life appears to some people to be hostile, unjust or oppressive, ad psychoactive substances, in other words drugs, constitute the best refuge, the means of release and escape. Drugs, they believe, will provide them with a means of expression. But they delude themselves, for drugs end up by enslaving them to the extent of turning them into living dregs that society rejects and for whom death would become both deliverance and the haven of peace.
Notwithstanding this spectre of death which they promise in a more or less distant future, drugs continue to fascinate and the number of addicts grows unceasingly, bringing all sorts of problems in its train. What is more, fresh trends have made their appearance in some parts of the world. The international community has become upset about drugs. Nevertheless, the efforts that they are constantly deploying to eradicate or to reduce them are not succeeding in overcoming this scourge. This means that governments, in the face of this alarming situation, will have to assume heavy responsibilities for, ultimately, it is in their hands that the best means of fighting drugs are to be found. Therefore, it goes without saying that this Conference which the Madagascar government has the honour and the privilege to welcome on its soil will be an important one since it is going, I hope, to throw light on a substance which is abused in the countries of East Africa and the Persian Gulf, the substance known as khat.
Some writers have stated that "the pleasant effects produced by khat are, for a lot of people, a powerful incentive to acquire by no matter what means enough khat to allow them to consume it at least once a day or to repeat or prolong the periods of mastication, frequently to the detriment of vital needs such as food". These same writers point out, moreover, that "from the socio-economic aspect, dependence on khat results fundamentally in the depletion of the financial resources of the consumer and the progressive loss of his capacity for work; consequences which affect the individual himself and his family circle, as well as society".
The question of khat has also been a matter of concern by the United Nations Commission on Narcotic Drugs. Several of its members were in favour of the adoption of immediate restrictive measures against khat, both on a national and international level, whilst others were desirous of avoiding too hasty an action in the matter. It was then decided that the investigation of possible measures for its control should be postponed to a later date. Nevertheless, having recognized that the habitual mastication of khat created serious social problems in the countries concerned, the Commission has unanimously recommended to the Economic and Social Council the adoption of a resolution inviting the World Health Organization to study the medical aspects of the problem and to report to the Council. In addition, it decided to invite the governments of the countries concerned to maintain a close collaboration for studying the problem, for investigating the medical, social and economic effects of the consumption of khat and the possibility of limiting or abolishing the cultivation of this plant on their respective territories.
Moreover, in another resolution, the Commission recommended that the UN Narcotics Laboratory should undertake research into the chemistry of khat and that ECOSOC should ask WHO to pursue its investigations into the pharmacology and the socio-medical effects of it.
In the course of its 27th session, the Commission recommended the meeting of a group of experts entrusted with making an assessment of the research undertaken and with drawing up directives for orientating the investigations into the pharmacology of khat. It was for that reason that the group of experts met in Antananarivo in 1978, a meeting whose participants are present here. The work of that group revealed the presence, in both the fresh and the lyophilized plant, of a certain number of nitrogenous compounds hitherto unknown, compounds that have been separated into two main groups:
- phenylalkylamine derivates of the amphetamine type: cathine or d-norpseudoephedrine and cathinone, of 150 molecular mass
- polyester alkaloids or weakly basic alkaloids of 600 to 110000 molecular mass.
But it was not possible to achieve unanimity in regard to the pharmacological effects of the substance. The group had, therefore, no alternative but to recommend, in particular, that more extensive research into the pharmacological and therapeutical properties of khat should be undertaken. For this to be done it was absolutely necessary for purified amino constituents, particularly cathinone and cathine, to be made available to the investigators.
In addition, the group recommended the continuation of botanical studies into the varieties of the plant and the perfecting of tests enabling members of drug-suppression authorities to identify khat.
Khat is cultivated and consumed largely in the northern part of Madagascar. There is red khat and white khat, the properties of which differ considerably. Consumption tends to spread along the west coast of Madagascar. Apparently, it does not have particularly harmful consequences. Is this only in appearance ? It is for you to refuteated this, or else to confirm it.
Certainly, every government is responsible for the health of its population; by health must be understood, not the absence of disease of the good physiological condition, but the well-being, both physical and mental, of the individual.
Certainly, in its concern to preserve this health, it is proper that it should take all appropriate measures tending to eradicate or to reduce the source of the evil. These measures, in terms of fact, could consist in the enactment of regulations.
Now, the pharmacological data concerning khat are too contradictory for them to serve as dictating, here and now, strict measures of prohibition. The availability of precise data will enable the national authorities of the countries concerned with the problems linked to the chewing of khat to assume their national and international responsibilities when it becomes a matter of adopting measures of control on their territory. This explains the interest that the Madagascar government is taking in the work of this Conference for, as is laid down in the Charter of the Socialist Revolution: "Man is at the centre of every preoccupation o-f the Revolution". Because of this, every action to be undertaken is conducive to ensuring the development of man and of all mankind. Thus, the measures that the Madagascar government, like those of the countries concerned and represented at this Conference, are led to take will be conditioned by the results of this work. The same will apply to the united action that these same countries could take, within the possible framework of a regional agreement. This has been suggested, on the occasion of their Vienna meeting in October 1982, by the group of experts entrusted with investigating the functioning, the utility and the possible strengthening of the 1961 Single Convention on Narcotic Drugs.
Let us remember that this conference is co-ordinated, at the Madagascar level, by the Drugs Division of the National Police Authority and the opening is presided over by the Minister of the Interior and the Police. This does not straight away that your work must necessarily result in measures of prohibition and suppression. Gentlemen, what a difficult mission you have before you .
I therefore express the hope that your task may be crowned with complete success. I declare open this conference on the medical and socioeconomic aspects of the use of khat.