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Khat Training Khat Workshop Hassan Isse Aim To give participants an understanding of khat, its effects, risks and harm associated. Learning outcomes By the end of the course participants will have: 1. Have considered the difference between other substance use and Khat 2. Have gained an updated knowledge of khat, its effects and risks 3. Have considered why people use khat 4. Understand treatment options. Khat Khat Khat & its Types What is it? Khat is a green leafy plant cultivated throughout Eastern Africa and Yemen. Khat is a natural stimulant from Catha edulis and it has effect like speed and amphetamines. Street names Commonly known as qat, Jaad, chad, Khat and Miraa. There are more than 70 varities of khat in the world such as Miraa from Kenya Hawadaaye from Somalia Kaad methani sabir from Yemen Harari from Ethiopia How taken It can be chewed or drunk. A khat chewing session fulfils an important social function similar to the use of caffeine and alcohol in Europe. A khat chewing session may last 3-5 hours. Extent of use Used by specific Arabic and north, central and eastern Africans. Commonly associated with Somali men. Has a similar function to coffee with a meal, but some say its use in the UK is escalating - causing harm to certain communities. How to chew khat Khat Project resources 2004 Chewing sessions Khat Project resources 2004 Khat session Khat Project resources 2004 How It Grows Khat grows in Ethiopia, Kenya and Yemen. It grows in highlands between 3000-8000 feet as natural. Size is a 10 to 20-foot flowering evergreen. There are two type of khat “white and red” size is 510cm long and 1-4cm wide. Khat Project resources 2004 Ethiopian Hills Where Khat is cultivate Khat Project resources 2004 Khat and Law Khat is not illegal to use or trade in the UK It is controlled by law in countries such as an America, Canada, Norway and Sweden. In 1980 the WHO classified Khat as drug of abuse that can produce mild to moderate psychic dependence due to Cathinone. In the USA listed as schedule 1 drug, which is controlled substance. In UK although Cathenione and cathine controlled by the Misuse of Drug Act 1971 (class C) khat itself is not. An offence is committed only if the active constituents are isolated from the plant. However there will be some legislations soon . Khat Project resources 2004 Chemical Constituents Khat leaves contain psychoactive known as Cathinone which is structurally and chemically similar to Amphetamine and Cathine a milder form of Cathinone. Other components include: Cathidine, Celastrin, Tannin and many amino acids, minerals and vitamins mainly Vitamin C. What gives khat its stimulant effect on the Central Nervous System? Presence in fresh, young leaves of cathinone; older leaves contain cathine (norpseudoephedrine) Similar in chemistry to amphetamines CH3 CH3 CH3 CH3 O HO NH2 NH2 NHCH3 NH2 O OCH3 O Cathine (-)-Cathinone (+)-Amphetamine 'Ecstasy' Khat Project resources 2004 Effects After chewing khat people Excessive khat use can mild euphoria and 'talkativeness', users often report calming effects. Inflammation of the mouth and other parts of the oral cavity is common with users. Long time khat use can causes Psychological dependence. bring on depression, anxiety and irritation, sometimes leading to psychosis (severe mental disorder in which the individual's contact with reality becomes highly distorted (delusions). It might lead to heart disease and loss of sex drive in men. Oral cancer can develop. Pharmacological effect Mydriasis (dilation of pupil of the eye) Tachycardia (increased heart bating) Elevated blood pressure Headaches Hyperthermia (warm) Increased respiration Urinary retention Increased urine output (due to fluid intake) Khat Project resources 2004 Medical Aspects of chewing Periodontal Disease Stomatitis and oral cancer Gastritis and gastric ulcer Cirrhosis of liver (Hepatotoxic effect) Chemical hepatitis A. B and C. (chemical treatments) Constipation Anorexia (loss of Appetite and weight), leading to malnutrition Khat Project resources 2004 Heart and cardio-vascular effects Hypertension/increased blood pressure Migraine Brain haemorrhage Increased heart rate/palpitation Other heart problems Khat Project resources 2004 Mental Health problems causes by khat use Insomnia (loss of sleep) Anxiety and nightmares Aggressive behaviour and irritation Paranoia Depression and Psychosis Sex problems such as impotence Khat Project resources 2004 Risk factors associated with khat use Decreases life span due to chronic illnesses Susceptibility to infectious diseases such as TB, Increasing HIV/AIDS and STD (sex trade) Smoking increases risk of lung cancer Poor hygiene increases risk of infections Chemical poisoning due to use of pesticides Social and economic uncertainty Khat Project resources 2004 Khat Overdose Agitation, paranoia, and repetitive behaviours Rapid heart beat and breathing High body temperature Convulsions Emergency treatment includes basic support, keep person cool, and calling the emergency Khat Project resources 2004 Positive side of khat use Almost a hobby type of interest Subdued feeling, leading to lowered risks of violence and less aggression Allows longer working hours, e.g. long distance lorry drivers, students whilst ‘cramming’ for exams Sociable drug for those using Many people belief that it helps people with diabetics Many others belief that khat use helps with weight loss Used as cash crop to generate income to support themselves and their families. Khat Project resources 2004 Treatments options one Assessments Referral to appropriate treatment Support for young people their families. One to one and group work Harm minimisation and reduction (use dairy) After care support such as education, employment, training and football activities Complementary therapeutics' such as Acupuncture, Yoga and general health check Monitoring progress and life style Khat Project resources 2004 support Treatments option 2 Sessionss Cognitive-behaviour therapy (CBT) Coping skills training Relapse prevention therapy programme Motivational interventions one to one support 6 weeks Contingency management on going keyworking with regular sessions as well as appointments and progress monitoring Community reinforcement approaches such as volunteering and family approaches, cultural and customs acceptable approach Khat Project resources 2004 More information and support Hassan Isse Khat and Community Consultant Tel: 02085694822 Fax 02085694759 E-mail: [email protected] Sceptre House 75-81 Staines Road Hounslow TW3 3HW Khat Project resources 2004 Information Sources World Health Organisation research studies UN Office on Drugs and crimes studies UK & National Governments studies/report Research papers (Hassan Isse) Khat users case studies