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Books - The health and socio-economic aspects of Khat use
Written by A. Getahun   


1.1 Economics
The economic importance of khat, where it is grown, is high as an export and cash crop. In Ethiopia, in some years, khat has reached the fifth ranking export commodity in the national economy. The Kenyan national daily paper "The Standard" commented on March 28, 1982, that trade in khat was comparable to the opium trade of the legendary "Golden Triangle" of South East Asia. Domestic trade within producer countries though not shown in official statistics is also significant.
The economics of khat is equally significant for the farmer, the national government and for those involved in both, internal and external trade. Income from khat (Chat) in Eastern Ethiopia (Harar, Dire-Dawa, Jijiga), particularly in the recently organised khat marketing co-operatives, is reportedly very high. The Ethiopian farmers' income from khat is now more than ten times that from coffee.
Historically, khat's export and trade in Ethiopia has been as important as coffee, civet cat and honey, thus enabling the country to import spices and weapons. The interaction and interdependence of the Ethiopian agrarian highlands with the pastural lowlands was made possible through the trade and exchange of salt, gums and resins from the lowlands with khat and coffee from the highlands.
Both of these trades (regional and international) have increased manyfold over the years. Many a country would be much happier to produce more khat if it were possible to do so "FOR EXPORT ONLY" much like the case of pesticides and pills for "export" only.
1.2 Socio-Economic 
Khat chewing is reportedly good for the poor, according to the chewer, as it provides one with a dream-world or fantasy. After chewing, the poor imagines that he has everything and possesses the world. Khat chewing for the rich, on the other hand, appears to provide worry wherein one may think he has suddenly lost his wealth or business. Such repeated emotional or stressful experiences with each chewing could lead to gradual mental deterioration. The chewer, nowadays, uses alcohol to break this state of animation (mirkana), a practice referred to as the "breaker" or "chebss" after which he/she can go to sleep.
Health-wise, the consequence of khat chewing is not as severe on the rich as it is on the poor as the diet of the rich is often superior to that of the poor. The loss of appetite, and sleep, due to khat chewing by the poorer habitual user are expressed in loss of body weight and generally poor health. Thus, such conditions are severe in both the urban and rural poor where, unfortunately, khat chewing is even more prevalent in this latter group. The urban poor is the group that is most affected socio-economically as the habit depletes income and health as well as reducing economic productivity. It is not unusual to see the man, in an urban family, use as much as 85% of his monthly income on khat, thus leaving his family to starve. Such a state often culminates in broken homes and every member of the family suffers socio-economically with little or no chance to recover. The general trend is, however, for individuals to reduce their dependence on khat as they move up in the economic and social ladder. The reverse is true, however, among the poor.The poorer one gets, which is fuelled by one being a khat habitué, the more khat-dependent one becomes.
Guarding khat farms at night and chewing khat for long hours greatly reduces the farmer's physical and economic productivity, often reducing the daily effective working hours to three to five. Food crop production greatly declines as a result.
The socio-economic problem is more severe in economically weak, importing countries which are often Muslim societies with deeper tradition and disposition for khat chewing as a substitute to alcohol, cigarettes, and related drugs which are prohibited on religious grounds. In these same khat-importing countries, sitting in groups to pray or to socialise is common where khat is ceremonially provided, including wedding feasts and funeral ceremonies and vigils for the dead.
1.3 Agro-Ecological Importance 
Khat does not demand a high level of soil fertility and can withstand drought. In Ethiopia, khat cultivation typically occurs in uplands between the main agricultural highlands and the pastoral lowlands with the geographic intensity of cultivation being in the Muslim-dominated sub-regions such as Harar, Jima, Southern Shoa, Bale, and parts of Wollo and Eritrea. In areas of severe weather or limited rainfall such as those regions with under 800 mm per year, yields are low and periodic irrigation is required to attain a high level of crop yield and hence income. Thus, the main khat growing areas closely correspond to the major sorghum areas where displacement of the sorghum crops by permanent khat plantations is more common. This greatly reduces the cultivation of sorghum, the traditional staple crop of the area. This process of sorghum/maize crop displacement is very severe in Eastern Ethiopia and has resulted in malnutrition or even starvation.
In contrast to other cultivated woody perennial cash crops, such as tea, coffee, etc., khat can enable farmers to better grow food crops under an inter-cropping system, particularly during the khat "establishment stage". Food or other crops typically inter-cropped with khat include beans, sweet potato, vegetables, sorghum and maize. Food production in khat fields is not optimal as khat chewing greatly reduces the farmer's effective working hours. He often tries to purchase food with the extra cash he may have.
1.4 Issues and Trends 
The economic incentives of khat growing and trade are, at the present time high and no other common agricultural crop can replace it effectively. The current levels of cultivation and use are already very extensive, making its prohibition difficult. Attempts to ban its cultivation and use have been met by stiff resistance in Kenya and Ethiopia and as a result governments are becoming less reluctant to continue on this course especially in view of high revenues derived from khat. (1) As a crop, khat is very attractive to farmers for it generates very high income with minimum production input.
Furthermore, demand for khat continues to increase and farm-gate prices have accordingly continued to rise. Under these conditions, it is unrealistic not to expect expanded cultivation of khat
particularly in the absence of government control, or guidelines which are not enforced.
Khat chewing on social and religious grounds, is well rooted and deeply imbedded in the socio-cultural fabric of the countries in question. On the other hand, health and social welfare programmes are non-existent or at best poorly developed in these same countries so as to minimise the negative consequences of khat use and abuse.
If there is any progress to be made to reduce the adverse effects of khat, it will be necessary for both the primary khat-producing and the major khat-importing (consuming) countries to enter into a dialogue. Public education on khat is, however, essential to attain positive and voluntary changes gradually by the society since any change imposed by governments, in areas where there is a large consumer population, will be resisted equally by both the producers and the consumers of khat.
Despite the increasing agricultural and socio-economic importance of khat in a greater number of countries in Africa and the Middle East, official government positions and efforts to date have only been symbolic. It is also becoming increasingly more difficult for khat producing and importing countries to have a similar stand on khat.
The efforts of UN, WHO and ICAA in supporting investigations and conferences such as this one, though modest, are beneficial for a better understanding of the chemistry, pharmacology and socioeconomic impacts of khat. Outside these efforts, the long history of khat is marked by sporadic and individual investigations resulting, to some extent, in conflicting views on its pharmacological and socio-economic effects.
We note the spread and intensity of khat cultivation and use has been slow compared to its ease of being grown and its alleged of the benefits. There are, however, indications that this rate is now increasing and cuts across religious, cultural and age classes, hitting more largely the lower socio-economic strata which make up the majority. This may be partly due to improvements in transport and communication greatly facilitating movement of people and khat and partly to changing social and economic conditions, particularly in the urban societies.
Considering the current socio-economic impacts of khat in both the khat producing and importing countries the following lines of policy oriented actions and programmes are suggested: -
Legislation on khat, cathinone and its relatives 
I. Cathinone is an amphetamine-type drug and should be scheduled as such. In countries where there is a strong desire to curb and/or eliminate khat cultivation and use, appropriate legislation should be enacted on a country by country basis without recourse to the World Health Organization. It is particularlTirtant to recognize that this kind of decision should be made by the governments themselves;
a) on ethical grounds, not medical grounds, and
b) only if it is prepared and able financially not only to enact  the law but also to enforce it.
Perhaps, the Kingdom of Saudi Arabia where khat production and use is reportedly very limited and restricted to an isolated part of the country, and where a strong moral tradition of a well-respected and large Royal Family prevails and where no financial constraints exist could serve as a model for a bold and much needed ethical stand?
II. On the other hand, producer/consumer countries like Ethiopia where the tradition is ancient and thoroughly ingrained in certain regions, and where there is virtually no possibility of effecting and enforcing legal restraints, present a very different type of problem.
Here there is a need for a comprehensive and long-term approach to the problem.
A. We recommend, as a first step, an intensive screening and evaluation of khat towards an ultimate long-range solution from a:
a) botanical point of view;
b) chemical point of view;
c) pharmacological point of view and;
d) clinical and pharmacological point of view.
Such screening should take into account: harvesting, marketing and grading procedures.
It should emphasize germ plasm from various geographical regions and ecotypes, mode and setting of use.
B (a) If there is shown to be, as we suspect, a wide range of chemical and pharmacological "ecotypes", it would then be possible to carry out a subtle "ecotype or pharmacotype" substitution programme. In this progress one generally "weans" a population from the stronger, harsher, psychoactive substances and ultimately replaces them with successively weaker or mere "placebo" pharmaco-ecotypes.
It would be possible to effect such a programme only if there is cooperation, particularly among the exporting countries and if there is an extensive and simultaneous education programme.
(b) an ultimate crop substitution programme coupled with a system of price supports for the new crops would need to be simultaneously planned.
(c) everything possible should be done to upgrade the socio-economic status of the society.
While these suggestions do not pretend of offer immediate solutions, they are in our view realistic, and at least have a potential for success. This is, in our view, more than the chaos that is sure to occur if one tries to call upon medical arguments to ban khat. Since khat abuse is self-limiting, the issue becomes ethical. In the event the above lines of action are not effectively carried outout to increase technical and scientific data on khat, we suggest the following areas of research and services:
Khat Research, Development and Services (an Outline) 
1.1 Agricultural-botany
1.2 Post-harvest research, technology development
1.3 Pharmacology
1.4 Socio-economics of khat
1.5 Khat dependence and the law
2.1 Genetic conservation
2.2 Information and related services 2.3 Khat newsletter
3.1 UN bodies and international organizations
3.2 Regional/national teaching/research institutions
1. Khat genetics, screening and evaluation of khat germ plasm
2. Morpho-chemical selection/breeding
3. Breeding/selecting for agricultural types
1. Propagation technology and management
2. Khat and food crop (inter-cropping / agro-forestry)
3. Khat production/management
" sources of quality influence
vt It yield influence
4. Khat entomology/diseas vs yield and quality
1. Handling and storage vs quality and health
2. Marketing including grading and standards
1. Clinical
A Khat-importing (consuming) countries
B Khat-exporting and consuming countries
1. Khat dependency and health
2. Socio-cultural impacts of khat
3. Economic (rural/urban) productivity
1. Germ plasm collection/storage
a) seeds
b) tissue culture
2. khat seed orchard
1. Data/storage/retrieval
2. Diagnostic research or service laboratories
3. Grades/standards
4. Khat dependency monitoring/ services
1- socio-medical advice/guide
2- medical/nutrition guide to users
2.3 KHAT "newsletter"

Our valuable member A. Getahun has been with us since Tuesday, 21 May 2013.