Beyond the politics, here is what science says about miraa, muguka

Some of the Muguka traders at Kongowea market in Mombasa County on May 29, 2024, a day after a court lifted the Muguka Ban in three coast counties. [Kelvin Karani, Standard] Mombasa, Kilifi and Taita Taveta counties have kicked up a storm over the trade and consumption of muguka. At the centre of this is the banning of entry, transportation, distribution, sale, and use of muguka in the counties due to its perceived negative health and socio-economic effects in the coastal region. The ban was occasioned by the rising number of children, adolescents and youth who are abusing miraa and muguka and other substances. Understandably, the producing counties of Embu protested the ban due to the economic loss resulting from the ban. However, the moral question of upholding good health and well-being of society against profits emerges as the crux of the discourse. It is common knowledge that scientific facts are stubborn because they involve extensive research - including laboratory analysis - and peer review before adoption as scientific certitude. Khat which is popularly known as Miraa, is scientifically classified as Catha edulis. Muguka is a variant of miraa. In the scientific community, research conducted in the United Nations Narcotics laboratory in Geneva, Switzerland, in the 1970s, revealed that Khat contains cathine and cathinone as its active ingredients. As a result, Cathinone and cathine were listed in the 1971 United Nations Convention on Psychotropic Substances under schedules I and III respectively. A psychotropic substance is a drug or other substance that affects how the brain works and causes changes in mood, awareness, thoughts, feelings, or behaviour. The World Health Organization (WHO) lists khat as a drug that creates "dependence" in people, meaning it produces a continuing desire to keep using it. In the 2013 World Drug Report, khat was placed under plant-based substances containing cathinone and cathine which are psycho-active compounds on global markets or the national arena. Structurally and pharmacologically, cathine and cathinone are amphetamine-like stimulants and are therefore known as natural amphetamines. It has been scientifically proven that the most efficient way of extracting the two chemical compounds is chewing fresh khat leaves as they are readily isolated from the leaves by the active action of enzymes in saliva and are responsible for the stimulant effect on its users. Khat is not food, all its consumers chew it for the stimulant effect and recreation. Once consumed, cathinone is broken down in the body to produce cathine and norephedrine, which have a similar structure to amphetamine and adrenaline. On average, fresh muguka and miraa have been reported to contain 36 milligrammes of cathinone, 120 miligrammes cathine, and 8 milligrammes norephedrine per 100 gramme leaves. And the typical user consumes approximately 250 milligrams of muguka and Miraa in a chewing session whose effects last for several hours. Addiction is the most common effect of muguka and miraa due to the stimulant effects on the users. Once hooked, one can no longer function without a dose of the stimulant. Research globally and regionally in Kenya, Ethiopia and Yemen, have associated muguka and miraa with increased risk of adverse health and negative socio-economic effects. Among the immediate health effects are Increased energy levels and a general sense of well-being, a sense of euphoria and excitement. Increased alertness, improvement in self-esteem, increased ability to concentrate, an increase in libido, enhanced imaginative ability, improvement in the ability to communicate and capacity to associate ideas, and subjective improvement in work performance are some of the other noted effects. The immediate effects result in over-talkativeness, overactivity, insomnia, irritability, anxiety, agitation, and aggression. Cathinone is known to increase heart rate and blood pressure. Persistent chewing leads to moderate consumption and has been shown to result in erectile dysfunction, increased and uncontrolled production of sperms in males, excessive fear and paranoia, hostile perception of the environment, and psychotic reactions such as auditory hallucinations. The user also tends to isolate him/herself or display aggressive behaviour towards others; and has Poor decision-making. Chronic consumption affects male fertility by decreasing sperm count, motility, quality, and testosterone level together with changes in the sperm structure. It also results in sexual dysfunction and other sexual problems associated with aggressive and altered sexual behaviour with a significant negative impact on the family unit. It further leads to memory impairment, psychosis, exacerbating or triggering primary psychotic illnesses such as Schizophrenia spectrum disorders, and diminishes the therapeutic efficacy of antipsychotic drugs during treatment. It has also been associated with major depressive and other anxiety disorders. Research has shown an association between miraa use and heart disease such as coronary syndrome, myocardial infarction, stroke, and arrhythmias. Long-term regular miraa/muguka chewers more frequently report oral symptoms including pain in the jaw joint while chewing, mouth ulcers, dental problems such as toothache, dental carries and tooth decay, dryness of the mouth, and burning sensation in the tongue or other parts of the mouth. There is research evidence linking khat with an increased risk cancer - especially the ones related to the gastrointestinal system such as malignant oral disorders. Addicted individuals who suddenly stop consumption of miraa and muguka experience withdrawal symptoms such as nightmares, tremors, depression, Sedation, and low blood pressure. Kenya is a member state of the United Nations and among the 186 countries that ratified the Single Narcotic Convention of 1961 as amended by the 1972 Protocol; the Convention of Psychotropic Substances of 1971; the United Nations Convention against Illicit Trafficking in Narcotic Drugs and Psychotropic Substances (I) and (II) of 1988. Furthermore, article (2) of the constitution obligates the state to enforce all international treaties and conventions. As a country we further proceeded to domesticate the three UN conventions through the enactment of the Narcotic Drugs and Psychotropic Substances (Control) Act No. 4 of 1994, wherein the chemicals Cathine and Cathinone are classified as psychotropic substances, listed under the Second Schedule of the Act. The Solution to the current impasse that seem to be taking an ethnic and political face lie in educating and creating awareness on the negative effects of khat and miraa, the establishment of rehabilitation centres by the government in the regions affected by increasing substance abuse and funding for research and production of alternative crops in the counties that produce these controversial crops to mitigate a further fallout as a result of economic loss. Dr Chibanzi Mwachonda is a Senior Psychiatry Registrar at the University of Nairobi and Mathari National Teaching and Referral Hospital

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