Khat

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For the headcloth worn by Ancient Egyptian Pharaohs, see Khat (apparel). For the village in Azerbaijan, see Hat, Azerbaijan.
Khat
Catha edulis
Conservation status
Scientific classification
Kingdom: Plantae
(unranked): Angiosperms
(unranked): Eudicots
(unranked): Rosids
Order: Celastrales
Family: Celastraceae
Genus: Catha
Species: C. edulis
Binomial name
Catha edulis
(Vahl) Forssk. ex Endl.

Catha edulis (Khat, qat, or "edible kat"[2]) is a flowering plant that is native to the Horn of Africa and the Arabian Peninsula. Among communities from these areas, khat chewing has a history as a social custom dating back thousands of years.[3]

Khat contains a monoamine alkaloid called cathinone, an amphetamine-like stimulant, which is said to cause excitement, loss of appetite, and euphoria. In 1980, the World Health Organization (WHO) classified it as a drug of abuse that can produce mild-to-moderate psychological dependence (less than tobacco or alcohol),[4] although WHO does not consider khat to be seriously addictive.[3] The plant has been targeted by anti-drug organisations such as the DEA.[5] It is a controlled substance in some countries, such as the United States, Canada and Germany, while its production, sale and consumption are legal in other nations, including Djibouti, Somalia, Ethiopia and Yemen.[6]

Nomenclature

Khat goes by various traditional names, such as kat, qat, ghat and chat, in its endemic regions of the Horn of Africa and the Arabian Peninsula.[7][8] Accordingly, it is also known as Arabian tea in the west. In the African Great Lakes region, where Catha edulis is in some areas cultivated, it is known as miraa.[9] In South Africa, the plant is known as bushman's tea.[10]

Description

Khat is a slow-growing shrub or tree that typically attains a height between 1 and 5 m (3.3 and 16.4 ft). However, it can reach heights of up to 10 metres (33 ft) in equatorial areas. The plant usually grows in arid environments, at a temperature range of 5 to 35 °C (41 to 95 °F).[8] It has evergreen leaves 5–10 cm long and 1–4 cm broad. The flowers are produced on short axillary cymes 4–8 cm long. Each flower is small, with five white petals. The samara fruit is an oblong three-valved capsule containing one to three seeds.

History

According to some sources, khat was first grown in Ethiopia,[11] with the explorer Sir Richard Burton suggesting the plant was later introduced to Yemen from Ethiopia in the 15th century.[12] He specifically mentions the eastern city of Harar as the birthplace of the plant.[13]

Man chewing khat in Sana'a, Yemen (January 2009)

However, amongst communities in the Horn of Africa (Djibouti, Eritrea, Ethiopia, Somalia) and the Arabian Peninsula, khat-chewing has a long history as a social custom dating back thousands of years.[3]

The Ancient Egyptians considered the khat plant a divine food, which was capable of releasing humanity's divinity. The Egyptians used the plant for more than its stimulating effects; they used it for transcending into "apotheosis", with the intent of making the user god-like.[14]

The earliest known documented description of khat is found in the Kitab al-Saidala fi al-Tibb كتاب الصيدلة في الطب, an 11th-century work on pharmacy and materia medica written by Abū Rayhān al-Bīrūnī, a Persian scientist and biologist. Unaware of its origins, al-Bīrūnī wrote that khat is:[15]

[A] commodity from Turkestan. It is sour to taste and slenderly made in the manner of batan-alu. But khat is reddish with a slight blackish tinge. It is believed that batan-alu is red, coolant, relieves biliousness, and is a refrigerant for the stomach and the liver.

In 1854, Malay author Abdullah bin Abdul Kadir noted that the custom of chewing khat was prevalent in Al Hudaydah in Yemen:[16]

You observed a new peculiarity in this city – everyone chewed leaves as goats chew the cud. There is a type of leaf, rather wide and about two fingers in length, which is widely sold, as people would consume these leaves just as they are; unlike betel leaves, which need certain condiments to go with them, these leaves were just stuffed fully into the mouth and munched. Thus when people gathered around, the remnants from these leaves would pile up in front of them. When they spat, their saliva was green. I then queried them on this matter: ‘What benefits are there to be gained from eating these leaves?’ To which they replied, ‘None whatsoever, it’s just another expense for us as we’ve grown accustomed to it’. Those who consume these leaves have to eat lots of ghee and honey, for they would fall ill otherwise. The leaves are known as Kad."

In 1856, English writer Charles Dickens also described the custom of khat chewing in the Horn region and the adjacent Gulf territories, likening it to drinking strong green tea:[2]

And one may sleep well if, during the day, too much kat has not been chewed. The leaves of the drug called kat are the chief source of pleasurable excitement in these districts of East Africa. Botanists, taking the native name for the plant, turn it into Catha edulis, eatable kat. It is much used by the Arabs, to whom it is sent in camel loads, consisting of a number of small parcels, each containing about forty slender twigs, with the leaves attached, carefully, wrapped so as to avoid exposure to the air. These leaves are chewed, and act upon the spirits of those using them, much as a strong dose of green tea acts upon us in Europe, when it acts agreeably. Europeans used to stronger stimulants, are little affected by the use of kat, but among the more temperate Arabs it is so welcome a provocative to good humour, that about two hundred and eighty camel-loads of it are used ever year in Aden only.

Cultivation and uses

Khat cultivation in western Yemen near At Tawilah

The khat plant is known by a variety of names, such as qat and gat in Yemen, qaat and jaad in Somalia, and chat in Ethiopia.[3] It is also known as jimma in the Oromo language. Khat has been grown for use as a stimulant for centuries in the Horn of Africa and the Arabian Peninsula. There, chewing khat predates the use of coffee and is used in a similar social context.[3]

Although the practice of khat-chewing is still primarily restricted to its original area of cultivation in the Red Sea area,[3] the khat plant has over the years found its way to Southern Africa as well as tropical areas, where it grows on rocky outcrops and in woodlands. The shrub is today scattered in the KwaZulu-Natal, Eastern Cape, Western Cape and Mpumalanga provinces of South Africa, in addition to Swaziland and Mozambique.[17]

Its fresh leaves and tops are chewed or, less frequently, dried and consumed as tea, to achieve a state of euphoria and stimulation; it also has anorectic side effects. The leaves or the soft part of the stem can be chewed with either chewing gum or fried peanuts to make it easier to chew.

Khat use has traditionally been confined to the regions where it is grown, because only the fresh leaves have the desired stimulating effects. In recent years, however, improved roads, off-road motor vehicles, and air transportation have increased the global distribution of this perishable commodity, and as a result, the plant has been reported in England, Wales, Rome, Amsterdam, Canada, Israel, Australia, New Zealand,[18] and the United States. Traditionally, khat is used as a socialising drug, and this is still very much the case in Yemen, where khat-chewing is predominantly a male habit.[19] Yemenis use traditional costumes and chew the stimulating plant in the afternoons. Chewing khat is also part of the Yemeni business culture to promote decision-making, but foreigners are not expected to participate. Some Yemeni women have their own saloons for the occasion, and participate in chewing khat with their husbands on weekends.

Bundles of khat, seized by the DEA in July 2006

Khat is so popular in Yemen, its cultivation consumes much of the country's agricultural resources. An estimated 40% of the country's water supply goes towards irrigating it,[20] with production increasing by about 10% to 15% every year. One "daily bag" of khat requires an estimated 500 litres (130 US gal) of water to produce.[21] Water consumption is so high, groundwater levels in the Sanaa basin are diminishing, so government officials have proposed relocating large portions of the population of Sana'a to the coast of the Red Sea.[19]

One reason for cultivating khat in Yemen so widely is the high income it provides for farmers. Some studies done in 2001 estimated that the income from cultivating khat was about 2.5 million Yemeni rials per hectare, while fruits brought only 0.57 million rials per hectare. Between 1970 and 2000, the area on which khat was cultivated was estimated to have grown from 8,000 to 103,000 hectares.[22]

In other countries, outside of its core area of growth and consumption, khat is sometimes chewed at parties or social functions. It may also be used by farmers and labourers for reducing physical fatigue or hunger, and by drivers and students for improving attention. Within the counter-culture segments of the elite population in Kenya, khat (referred to locally as veve or miraa) is used to counter the effects of a hangover or binge drinking, similar to the use of the coca leaf in South America.

Chemistry and pharmacology

Cathinone structure

The stimulant effect of the plant was originally attributed to "katin", cathine, a phenethylamine-type substance isolated from the plant. However, the attribution was disputed by reports showing the plant extracts from fresh leaves contained another substance more behaviourally active than cathine. In 1975, the related alkaloid cathinone was isolated, and its absolute configuration was established in 1978. Cathinone is not very stable and breaks down to produce cathine and norephedrine. These chemicals belong to the PPA (phenylpropanolamine) family, a subset of the phenethylamines related to amphetamines and the catecholamines epinephrine and norepinephrine.[23] In fact, cathinone and cathine have a very similar molecular structure to amphetamine.[24] Khat is sometimes confused with methcathinone (also known as cat), a Schedule I substance that possess a similar chemical structure to the khat plant's cathinone active component. However, both the side effects and the addictive properties of methcathinone are much stronger than those associated with khat use.[25]

When khat leaves dry, the more potent chemical, cathinone, decomposes within 48 hours, leaving behind the milder chemical, cathine. Thus, harvesters transport khat by packaging the leaves and stems in plastic bags or wrapping them in banana leaves to preserve their moisture and keep the cathinone potent. It is also common for them to sprinkle the plant with water frequently or use refrigeration during transportation.

When the khat leaves are chewed, cathine and cathinone are released and absorbed through the mucous membranes of the mouth and the lining of the stomach. The action of cathine and cathinone on the reuptake of epinephrine and norepinephrine has been demonstrated in lab animals, showing that one or both of these chemicals cause(s) the body to recycle these neurotransmitters more slowly, resulting in the wakefulness and insomnia associated with khat use.[26]

Receptors for serotonin show a high affinity for cathinone, suggesting this chemical is responsible for feelings of euphoria associated with chewing khat. In mice, cathinone produces the same types of nervous pacing or repetitive scratching behaviours associated with amphetamines.[27] The effects of cathinone peak after 15 to 30 minutes, with nearly 98% of the substance metabolised into norephedrine by the liver.[24]

Cathine is somewhat less understood, being believed to act upon the adrenergic receptors causing the release of epinephrine and norepinephrine.[28] It has a half-life of about three hours in humans. The medication bromocriptine can reduce cravings and withdrawal symptoms within 24 hours.[29]

Growing

It takes nearly seven to eight years for the khat plant to reach its full height. Other than access to sun and water, khat requires little maintenance. Ground water is often pumped from deep wells by diesel engines to irrigate the crops, or brought in by water trucks. The plants are watered heavily starting around a month before they are harvested to make the leaves and stems soft and moist. A good khat plant can be harvested four times a year, providing a year-long source of income for the farmer.

Effects

Comparison of physical harm and dependence regarding various drugs (the British medical journal The Lancet[1])

Khat consumption induces mild euphoria and excitement, similar to that conferred by strong coffee.[3] Individuals become very talkative under the influence of the plant. The effects of oral administration of cathinone occur more rapidly than the effects of amphetamine pills, roughly 15 minutes as compared to 30 minutes in amphetamine. Khat can induce manic behaviours and hyperactivity similar in effects to those produced by amphetamine.[30]

The use of khat results in constipation. Dilated pupils (mydriasis) are prominent during khat consumption, reflecting the sympathomimetic effects of the drug, which are also reflected in increased heart rate and blood pressure.

Withdrawal symptoms that may follow occasional use include mild depression and irritability. Withdrawal symptoms that may follow prolonged khat use include lethargy, mild depression, nightmares, and slight tremor. Khat is an effective anorectic (causes loss of appetite). Long-term use can precipitate: negative impact on liver function, permanent tooth darkening (of a greenish tinge), susceptibility to ulcers, and diminished sex drive.

It is unclear if the consumption of khat directly affects the mental health of the user or not.[23] Occasionally, a psychotic episode can result, resembling a hypomanic state in presentation.[31]

Demographics

Man in Mogadishu dividing khat into bunches for guests in preparation for a long evening of tea, conversation and chewing

An estimated 10 million people globally use khat on a daily basis.[6] It is grown principally by communities in the Horn of Africa and the Arabian peninsula, where khat-chewing has a long history as a social custom dating back thousands of years.[3]

The traditional form of khat chewing in Yemen involves only male users; khat chewing by females is less formal and less frequent. Researchers estimate about 70–80% of Yemenis between 16 and 50 years old chew khat, at least on occasion. Yemenis spend an estimated 14.6 million person-hours per day chewing khat. Researchers have also estimated that families spend about 17% of their income on khat.[22]

Research programs

In 2009, the University of Minnesota launched the Khat Research Program (KRP), a multidisciplinary research and training program[32] focusing on the neurobehavioral and health effects of khat, led by Prof. Dr. Mustafa al'Absi. The program was funded by the National Institutes of Health and the National Institute for Drug Abuse of the United States.[33] The inaugural event for the KRP was held in Sharm El-Sheik, Egypt, in December, 2009[34] in collaboration with the International Brain Research Organization (IBRO) and its local affiliates.

Health

Immediate effects:

  • increased heart rate, blood pressure[3]
  • euphoria[3]
  • hyperactivity[30]
  • decreased appetite[citation needed]

Long-term effects:

Indeterminate effects:

Regulation

In 1965, the World Health Organization (WHO) Expert Committee on Dependence-producing Drugs' Fourteenth Report noted, "The Committee was pleased to note the resolution of the Economic and Social Council with respect to khat, confirming the view that the abuse of this substance is a regional problem and may best be controlled at that level."[40] For this reason, khat was not scheduled under the Single Convention on Narcotic Drugs. In 1980, the WHO classified the plant as a drug of abuse that can produce mild to moderate psychological dependence (less than tobacco or alcohol),[4] although the WHO does not consider khat to be seriously addictive.[3] It is a controlled or illegal substance in some countries, but is legal for sale and production in others.

Africa

Ethiopia

Khat is legal in Ethiopia.[6]

Somalia

Khat is legal in Somalia.[6]

Djibouti

Khat is legal in Djibouti.[41]

Kenya

Khat is legal in Kenya. However, two of its active components, cathinone and cathine, are classed as Class C substances.[42]

South Africa

In South Africa, Catha edulis is a protected tree.[10]

Asia

Malaysia

Khat is illegal in Malaysia.

Israel

Khat is consumed mainly by Yemenite Jews, and the raw plant is available for sale in several open markets. A cocktail of Arak and minced frozen khat, mixed with grapefruit juice, has become popular in the south of the country in recent years.[citation needed] In 2003, Hagigat, a pill based on extracted cathinone, began to be sold in kiosks in Israel.[43] Following several cases of hospitalisation the Israeli Ministry of Health classified cathinone as a dangerous drug and Hagigat has been outlawed.[44][45] The plant itself is allowed to be chewed and sold, as no harm was found in normal quantities.

Saudi Arabia

Khat is illegal in Saudi Arabia.[46]

Yemen

See also: Culture of Yemen

Khat is legal in Yemen.[6] However, cultivation of the crop and the selling of its leaves are governed by a series of regulations. In 2007, the Yemeni government passed a law that restricted the cultivation of khat in a number of agricultural flatlands and basins with high water stress. The Law Concerning the General Sales Tax in 2005 also set the tax rate on khat at 20% of its retail price.[47]

The widespread cultivation of khat in Yemen has exacerbated a severe water shortage in the country. Khat is much more water-intensive to grow than other crops.[48]

Europe

Finland

Khat is classified as an illegal drug in Finland,[49] and possession, use and sale of the substance is prohibited and punishable. As with all illegal drugs, operating a motor vehicle with detectable levels of Khat or its metabolites in one's system can also lead to a conviction for driving under the influence, even if the driver does not appear intoxicated.

France

Khat is prohibited in France as a stimulant.[23]

Germany

In Germany, cathinone is listed as a "non-trafficable substance", which makes the possession, sale and purchase of fresh khat illegal. The derivative cathine is only available on subscription, while norephedrine is not listed.

Iceland

In August 2010 the Icelandic police intercepted khat smuggling for the first time. 37 kg were confiscated. The drugs were most likely intended for sale in Canada.[50] Again in May 2011 the police intercepted around 60 kg.[51]

Ireland

Khat is a controlled drug for the purpose of the Misuse of Drugs Act 1977 and Schedule 1 of the Misuse of Drugs Regulations 1988. As such its unauthorised possession and supply is prohibited.

Netherlands

In the Netherlands the active ingredients of khat, cathine and cathinone, are qualified as hard drugs and forbidden. Use is mostly limited to the Somali community.[52] In 2008 health minister Ab Klink decided against qualifying the unprocessed plant as drugs after consultation with experts.[53] However, on 9 January 2012 the Dutch government announced a ban on khat.[54]

Norway

In Norway khat is classified as a narcotic drug and is illegal to use, sell and possess. Most users are Somali immigrants and khat is smuggled from the Netherlands and the UK.[55]

Norwegian Customs seized 10 metric tons of khat in 2010, an increase from less than 4 in 2006.[56]

Poland

In Poland khat is classified as a narcotic drug and is illegal to use, sell and possess.[57]

United Kingdom

Although concerns have been expressed by commentators, health professionals and community members about the use of khat in the UK, particularly by immigrants from Somalia, Yemen and Ethiopia, it was not a controlled substance prior to July 2013.[58][59] As a result of these concerns, the Home Office commissioned successive research studies to look into the matter, and in 2005, presented the question of khat's legal status before the Advisory Council on the Misuse of Drugs. After a review of the evidence, the expert committee recommended in January 2006 that the status of khat as a legal substance should remain for the time being.[58]

In 2008, Conservative politician Sayeeda Warsi stated that a future Conservative government would ban khat.[60] The website of the Conservative Party, which is now the larger party in a UK coalition government in the UK, previously stated that a Conservative government would "Tackle unacceptable cultural practices by", amongst other measures, "classifying Khat".[61] In 2009, the Home Office commissioned two new studies in the effects of khat use and in June 2010, a Home Office spokesperson stated: "The Government is committed to addressing any form of substance misuse and will keep the issue of khat use under close scrutiny".[62]

Because it was legal in the UK up to 2013, and because of khat's short shelf life, Britain serves as a main gateway for khat being sent by air to North America.[63]

During a parliamentary debate on the legality issue on 11 January 2012, Mark Lancaster, the Conservative Member of Parliament for Milton Keynes, stated that the importation of Khat into the UK stands at 10 tonnes every week.[64]

On 23 January 2013, the Advisory Council on the Misuse of Drugs (ACMD) said there was "insufficient evidence" that khat caused health problems. The ACMD said there was "no evidence" khat was directly linked with serious or organised crime, and was chewed to obtain a "mild stimulant effect much less potent than stimulant drugs, such as amphetamine".[65]

On 3 July 2013, the British Home Secretary Theresa May announced that khat was to be banned, designating it a Class C substance under the Misuse of Drugs Act 1971.[66][67]

Alex Miller, a journalist from the Montreal, Canada-based magazine and television channel Vice, looked into the use of the substance and the potential impact of the ban for BBC nightly current affairs programme Newsnight[68] and for a Vice documentary.[69][citation needed]

North America

Canada

In Canada, khat is a controlled substance under Schedule IV of the Controlled Drugs and Substances Act (CDSA), meaning it is illegal to seek or obtain unless approved by a medical practitioner. Punishment for the possession of khat could lead to a maximum sentence of three years in prison. The maximum punishment for trafficking or possession with the intent of trafficking is ten years in prison.[70]

In 2008, Canadian authorities reported that khat is the most common illegal drug being smuggled at airports.[71]

However, in 2012 the Ontario Court of Appeal upheld a 2011 absolute discharge of a young woman who brought 34 kilograms of khat into Canada in 2009. According to the defence, the ruling recognises that there is no empirical evidence that khat is harmful.[72]

United States

In the United States, cathinone is a Schedule I drug, according to the US Controlled Substance Act. The 1993 DEA rule placing cathinone in Schedule I noted that it was effectively also banning khat:[73]

Cathinone is the major psychoactive component of the plant Catha edulis (khat). The young leaves of khat are chewed for a stimulant effect. Enactment of this rule results in the placement of any material that contains cathinone into Schedule I.

Catha edulis (khat) is a stimulant narcotic that is similar to that of amphetamine and its congeners, not a drug as categorised by US FDA (United States Food & Drug Administration) and FDA import Alert #66-23 (published date 03/18/2011) states that "Districts may detain, without physical examination, all entries of khat",[74] based on section 801(a) (3) of the Federal Food, Drug, and Cosmetic Act on the grounds that "its labeling fails to bear adequate directions for use"

Khat has been seized by local police and federal authorities on several occasions.[75]

The plant itself is specifically banned in Missouri:[76]

Khat, to include all parts of the plant presently classified botanically as catha edulis, whether growing or not; the seeds thereof; any extract from any part of such plant; and every compound, manufacture, salt, derivative, mixture, or preparation of the plant, its seed or extracts.

South America

In South America, there is no legislation regarding khat; the active ingredients in the plant can be found in several weight control compounds sold on the continent.

Oceania

Australia

In Australia, the importation of khat is controlled under the Customs (Prohibited Imports) Regulations 1956. Individual users must obtain permits from the Australian Quarantine and Inspection Service and the Therapeutic Goods Administration to import up to 5 kg per month for personal use.[77] Permits must also be endorsed by the Australian Customs Service which regulates the actual import of the drug.[78] In 2003, the total number of khat annual permits was 294 and the total number of individual khat permits was 202.

Khat is listed as a Schedule 2 dangerous drug in Queensland, in the same category as cannabis.[79] Legality in New South Wales is not clear.[80]

Notes

  1. ↑ either from impaired insight into symptoms by the khat chewer, delay to care, or poorly understood pathophysiological mechanisms

See also

  • Betel leaves, a related narcotic herb in Southeast Asia
  • Phenylpropanolamine
  • List of Southern African indigenous trees

References

  1. ↑ Nutt, D.; King, L. A.; Saulsbury, W.; Blakemore, C. (March 2007). "Development of a rational scale to assess the harm of drugs of potential misuse". Lancet 369 (9566): 1047–53. doi:10.1016/S0140-6736(07)60464-4. PMID 17382831. 
  2. ↑ 2.0 2.1 Dickens, Charles (1856) [Digitized February 19, 2010]. "The Orsons of East Africa". Household Words: A Weekly Journal, Volume 14. Bradbury & Evans. p. 176. Retrieved 9 January 2014.  (Free eBook)
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 3.10 3.11 3.12 3.13 Al-Mugahed, Leen (2008). "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". Bulletin of the World Health Organization 86 (10): 741–2. doi:10.2471/BLT.08.011008. PMC 2649518. PMID 18949206. Retrieved 9 January 2014. 
  4. ↑ 4.0 4.1 Nutt, D.; King, L.A.; Saulsbury, C.; Blakemore, Colin (March 2007). "Development of a rational scale to assess the harm of drugs of potential misuse". Lancet 369 (9566): 1047–53. doi:10.1016/S0140-6736(07)60464-4. PMID 17382831. 
  5. ↑ DEA. "2006 in Pictures". Archived from the original on 1 December 2009. 
  6. ↑ 6.0 6.1 6.2 6.3 6.4 "Haight-Ashbury Free Medical Clinic". Journal of psychoactive drugs (Haight-Ashbury Publications) 41: 3. 2009. 
  7. ↑ "Khat facts". ADF. Retrieved 14 May 2013. 
  8. ↑ 8.0 8.1 "Growing Catha edulis". Plot55. Retrieved 26 January 2014. 
  9. ↑ "USDA GRIN Taxonomy". Agricultural Research Service (US Department of Agriculture). Germplasm Resources Information Network. 
  10. ↑ 10.0 10.1 "Protected Trees". Department of Water Affairs and Forestry, Republic of South Africa. 3 May 2013. 
  11. ↑ Chevalier, A. (1949). "Les Cat's d'Arabie, d'Abyssinie et d'Afrique orientale". Revue de Botanique appliquée 29: 413. 
  12. ↑ Burton, Richard (1856). First Footsteps in East Africa. ISBN 1-4191-1982-6. 
  13. ↑ Libermn, Mark (2003). "LANGUAGE RELATIONSHIPS: FAMILIES, GRAFTS, PRISONS". Basic Reference (Pittsburgh, PA: University Pennsylvania Academics) 28: 217–229. Retrieved 2012-04-27. 
  14. ↑ Giannini, A.J.; Burge, H.; Shaheen, J.M.; Price, W.A. (1986). "Khat: another drug of abuse?". Journal of Psychoactive Drugs 18 (2): 155–8. PMID 3734955. 
  15. ↑ Kiple, Kenneth F.; Ornelas, Kriemhild Coneè (2001). The Cambridge World History of Food. Cambridge University Press. pp. 672–3. ISBN 0-521-40216-6. OCLC 174647831. 
  16. ↑ Ché-Ross, Raimy (2000). "Munshi Abdullah's voyage to Mecca: A preliminary introduction and annotated translation". Indonesia and the Malay World 28 (81): 173–213. doi:10.1080/713672763. 
  17. ↑ "Catha edulis". Plantzafrica. Retrieved 15 January 2014. 
  18. ↑ Simon, O'Rourke (13 December 2006). "Concerns over African methamphetamine-like drug in Hamilton". The New Zealand Herald. Retrieved 12 October 2011. 
  19. ↑ 19.0 19.1 Kirby, Alex (7 April 2007). "Yemen's khat habit soaks up water". BBC News. Retrieved 26 January 2014. 
  20. ↑ Marshall, Tim (15 January 2010). "Sky News report on Yemen's Qat". Sky News. Retrieved 4 April 2010. 
  21. ↑ Filkins, Dexter (11 April 2011). "After the Uprising". The New Yorker. Retrieved 5 April 2011. 
  22. ↑ 22.0 22.1 The Encyclopedia of Yemen (in Arabic) (2nd ed.). Alafif Cultural Foundation. 2003. pp. 2309–2314. 
  23. ↑ 23.0 23.1 23.2 Drugs.com (1 January 2007). "Complete Khat Info". 
  24. ↑ 24.0 24.1 Cox, G. (2003). "Adverse effects of khat: a review". Advances in Psychiatric Treatment 9 (6): 456–63. doi:10.1192/apt.9.6.456. 
  25. ↑ "DF - Khat". Drugfree.org. Retrieved 2014-01-26. 
  26. ↑ Ahmed, M.B.; El-Qirbi, A.B. (August 1993). "Biochemical effects of Catha edulis, cathine and cathinone on adrenocortical functions". J Ethnopharmacol 39 (3): 213–6. doi:10.1016/0378-8741(93)90039-8. PMID 7903110. 
  27. ↑ "Behavioral Effects of Cathinone". 
  28. ↑ Adeoya-Osiguwa, S.A.; Fraser, L.R. (March 2007). "Cathine, an amphetamine-related compound, acts on mammalian spermatozoa via beta1- and alpha2A-adrenergic receptors in a capacitation state-dependent manner". Hum. Reprod. 22 (3): 756–65. doi:10.1093/humrep/del454. PMID 17158213. 
  29. ↑ Giannini, A. J.; Miller, N. S.; Turner, C. E. (1992). "Treatment of khat addiction". J Subst Abuse Treat 9 (4): 379–82. doi:10.1016/0740-5472(92)90034-L. PMID 1362228. 
  30. ↑ 30.0 30.1 Peter, Kalix. (1983), "The Pharmacology of Khat and of the Khat Alkaloid Cathinone", in Randrianame, M.; Szendrei, K.; Tongue, A., The Health and Socioeconomic Aspects of Khat Use, Lausanne, Switzerland: Intl. Council on Drug and Addictions, pp. 140–143 
  31. ↑ Giannini, A.J.; Castellani, S. (July 1982). "A manic-like psychosis due to khat (Catha edulis Forsk.)". Journal of Toxicology. Clinical Toxicology 19 (5): 455–9. doi:10.3109/15563658208992500. PMID 7175990. 
  32. ↑ "al'Absi Launches the Khat Research Program" (Press release). Med.umn.edu. Archived from the original on 2009-12-08. Retrieved 4 April 2010. 
  33. ↑ "KRP". Khatresearch.org. Retrieved 4 April 2010. 
  34. ↑ "KRP Symposium". 
  35. ↑ "Long-term effects of chronic khat use: impaired inhibitory control". Frontiers in cognition. 12 January 2011. Retrieved 17 January 2011. 
  36. ↑ Al-Motarreb, A. L.; Broadley, K. J. (October–December 2003). "Coronary and aortic vasoconstriction by cathinone, the active constituent of khat". Autonomic & Autacoid Pharmacology 23 (5–6): 319–26. doi:10.1111/j.1474-8673.2004.00303.x. 
  37. ↑ "Khat - DrugInfo Clearinghouse". Druginfo.adf.org.au. 20 September 2006. Retrieved 28 July 2010. 
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