kava and Substance-Related-Disorders

Kava is an Oceanic plant in which the root is consumed as a beverage and is becoming increasingly popular. The effects of kava consumption may include sedation, euphoria, and impairment of motor coordination. This article demonstrates kava impairment through four cases of self-reported kava use supported with Drug Recognition Expert (DRE) evaluations of each subject. Subject's urines screened negative for common drugs of abuse by immunoassay analysis. Urine from cases 3 and 4 were analyzed by liquid chromatography-tandem mass spectrometry, and gas chromatography-mass spectrometry, which yielded the presence of kavalactones. Subjects exhibited poor driving behavior and signs of intoxication. Indicators of impairment from multiple drug categories, central nervous system (CNS) depressants, CNS stimulants, and cannabis were observed, which may be consistent with the presence of multiple kavalactones and their diverse array of mechanisms of action. The consumption of kava can hinder one's ability to operate a vehicle safely.

Topics: Adult; Chromatography, Liquid; Driving Under the Influence; Gas Chromatography-Mass Spectrometry; Humans; Kava; Male; Plant Roots; Pyrans; Pyrones; Substance Abuse Detection; Substance-Related Disorders; Tandem Mass Spectrometry; Young Adult

This paper addresses the misconception that kava is an alcoholic substance. After a brief introduction as to what prompted the writing of this, I follow by discussing kava's cultural importance to Pacific peoples, and then compare kava 'intoxication' with alcohol intoxication. The paper concludes with a discussion of the historical influences that have promoted some of the misconceptions surrounding kava. Ultimately the paper demonstrates that kava and alcohol are entirely different kinds of beverages with different effects, and that lingering misconceptions can be seen as a 'colonial hangover'.

Topics: Alcoholic Beverages; Alcoholic Intoxication; Cultural Characteristics; Fiji; Humans; Kava; New Zealand; Plant Extracts; Substance-Related Disorders

Topics: Drug and Narcotic Control; Humans; Kava; Northern Territory; Plant Preparations; Substance-Related Disorders

Topics: Case-Control Studies; Cultural Characteristics; Humans; Kava; Myocardial Ischemia; Native Hawaiian or Other Pacific Islander; Northern Territory; Odds Ratio; Plant Extracts; Substance-Related Disorders

The health consequences of kava abuse in Arnhem Land Aboriginal populations in the Northern Territory (NT) and the persistence of an illegal kava trade with its associated social harms have been a cause for concern for 20 years. Despite these concerns, some Arnhem Land groups seek to continue using kava and to control its sale, distribution and the profits from the enterprise. In response, policy makers in the NT have embraced principles of harm reduction and created regulatory mechanisms to address broader public concerns and to support local management of kava supply while reinforcing control over the consequences of its use. This paper describes the kava regulatory system now being implemented in the NT which features kava management plans developed in consultation between Aboriginal communities and licensing authorities. It complements the earlier Harm Reduction Digest 9 by McDonald & Jowitt which looked at Kava in the South Pacific.

Topics: Catchment Area, Health; Commerce; Female; Humans; Kava; Licensure; Male; Northern Territory; Prevalence; Public Policy; Residence Characteristics; Substance-Related Disorders

Heavy kava use has been associated with sudden death in Aboriginal Australians in Arnhem Land (Northern Territory, Australia) where poor diets and a high incidence of premature coronary heart disease are known. Heavy kava users may suffer additional risk if further malnourished. Among 98 people (62 males, 36 females) in one community, 36 never used kava, 26 were past users, and 36 were continuing users. Across kava-using groups skinfold thickness, body mass index and body fat decreased. Total- and LDL-cholesterol were elevated in kava users compared to both former users and never users. HDL-cholesterol was higher in current users vs never users. Across kava-using groups, triglycerides, homocysteine and diet-derived antioxidant vitamins alpha-tocopherol and retinol, did not vary. Plasma carotenoid levels (indicative of vegetable and fruit intake) were very low, but when adjusted for plasma cholesterol, did not vary between kava-using groups. An obsession for kava drinking may mediate kava's direct effects on nutritional status.

Topics: Adult; Antioxidants; Biomarkers; Body Composition; Body Mass Index; Carotenoids; Cholesterol; Cholesterol, HDL; Cholesterol, LDL; Diet; Female; Humans; Hyperlipidemias; Kava; Male; Native Hawaiian or Other Pacific Islander; Northern Territory; Nutrition Assessment; Skinfold Thickness; Substance-Related Disorders

The objective of the study was to describe parameters for use in monitoring health, social and economic effects of kava use in Arnhem Land Aboriginal communities in the Northern Territory (NT). Kava has been used mainly in eight communities (population > 200), and in smaller associated homeland areas since 1982 with a total population of approximately 6800, using cross-sectional description and comparison using data from three kava-using communities. Interview data combined with health worker assessments were compiled using: (1) a sample (n=136) aged 16-34 years in one community in 2001-02; (2) a sample (n=101) aged 16 years and over in 2000 where physical assessments and biochemical and haematological data were also collected; (3) participant-observation in one community (133 people aged 18 years and over) during 1989-91. Kava, supplied illegally, was still being used in Arnhem Land in 2001-02. In 2000 dermopathy characteristic of heavy use, abnormally low body mass index (BMI), low blood lymphocytes and abnormally high gamma-glutamyl transferase (GGT) occurred more frequently with increased kava use. These acute effects emerge at average consumption levels of from 310-440 g/week of kava powder. When kava users in one community began to consume it at an average of 240-425 g/week from mid-1990, 19% of available cash resources were spent on kava with 11% of cash resources leaving the local community economy. The proportion of men drinking kava reached 70% and women 62% from mid-1990, with 20% of the population spending unprecedented amounts of time (14 + hours/week) in activities where kava was consumed. These parameters may be useful to monitor kava's adverse health, social and economic effects. Their association with increased kava use suggests that approaches to minimizing harm from its abuse may begin fruitfully with controlling supply.

Topics: Adolescent; Adult; Body Mass Index; Confidence Intervals; Cross-Sectional Studies; Female; gamma-Glutamyltransferase; Humans; Kava; Lymphocytes; Male; Northern Territory; Plant Extracts; Plant Roots; Substance-Related Disorders

Topics: Australia; Health Policy; Humans; Kava; Native Hawaiian or Other Pacific Islander; Physician's Role; Substance-Related Disorders

Kava is an extract from the Piper methysticum Forst. f. plant that has social and spiritual importance in Pacific islands societies. Herbal remedies that contain kava are used for the psychiatric treatment of anxiety and insomnia. Laboratory studies have found only subtle, if any, changes on cognitive or motor functions from the acute effects of consuming small clinical doses of kava products. Intoxication from recreational doses of kava has not been studied. The performance of individuals intoxicated from drinking kava (n=11) was compared with a control group (n=17) using saccade and cognitive tests. On average, intoxicated individuals had consumed 205 g of kava powder each (approximately 150 times clinical doses) in a group session that went for 14.4 h and ended 8 h prior to testing. Intoxicated kava drinkers showed ataxia, tremors, sedation, blepharospasm and elevated liver enzymes (GGT and ALP), together with saccadic dysmetria, saccadic slowing and reduced accuracy performing a visual search task that only became evident as the task complexity increased. Kava intoxication is characterized by specific abnormalities of movement coordination and visual attention but normal performance of complex cognitive functions. Saccade abnormalities suggest disruption of cerebellar and GABAergic functions.

Topics: Adult; Cognition; Female; Humans; Kava; Male; Middle Aged; Plant Extracts; Saccades; Substance-Related Disorders

Hepatic toxicity from manufactured herbal remedies that contain kava lactones has been reported in Europe, North America, and Australia. There is no evidence for serious liver damage in kava-using populations in Pacific Island societies or in Indigenous Australians who have used aqueous kava extracts. This article presents evidence that liver function changes in users of aqueous kava extracts appear to be reversible. Data from one Arnhem Land community [Northern Territory (NT), Australia] with 340 indigenous people older than 15 years of age in 2000 are used.. This study was a cross-sectional study with 98 participants, 36 of whom had never used kava. Among 62 kava users, 23 had discontinued kava at least 1 year before the study. Continuing users had not used kava for 1 to 2 months (n = 10) or 1 to 2 weeks previously (n = 15). Some (n = 14) had used kava within the previous 24 hr. Liver function tests were compared across these groups, taking into account differences due to age, sex, alcohol, and other substance use.. The average quantity of kava powder consumed was 118 g/week, and median duration of use was 12 years (range, 1-18 years). Kava usage levels were less than one-half of those found in previous studies. More recent kava use was independently associated with higher levels of liver enzymes gamma-glutamyl transferase (GGT) (p < 0.001) and alkaline phosphatase (ALP) (p < 0.001), but not with alanine aminotransferase or bilirubin, which were not elevated. In those who were not heavy alcohol users, only those who used kava within the previous 24 hr showed GGT levels higher than nonusers (p < 0.001), whereas higher ALP levels occurred only in those who last used kava 1 to 2 weeks (p = 0.015) and 24 hr previously (p = 0.005).. Liver function changes in users of aqueous kava extracts at these moderate levels of consumption appear to be reversible and begin to return to baseline after 1 to 2 weeks abstinence from kava. No evidence for irreversible liver damage has been found.

Topics: Adult; Alkaline Phosphatase; Australia; Beverages; Chemical and Drug Induced Liver Injury; Data Collection; Drug Interactions; Female; gamma-Glutamyltransferase; Humans; Kava; Liver Function Tests; Male; Native Hawaiian or Other Pacific Islander; Plant Extracts; Smoking; Substance-Related Disorders

Estimating illicit substance use in epidemiological studies is challenging, particularly across ethical, cultural and language barriers. While developing the methods for a case-control study of the effects of heavy kava consumption among Aboriginal people in remote Northern Territory (NT), we examined the validity and utility of alternative methods for estimating exposure.. We assessed the level of agreement between a consensus of Aboriginal health workers in two different communities using interviews conducted with community members and health workers and individuals' self-reported kava consumption. Exposure measures included history of kava use, current kava use and history of heavy use. Agreement between a health worker consensus classification and individuals' self-report was analysed and agreement among several health workers in a consensus classification without self-report was assessed.. Health workers concurred about an individual's history of kava use (k=0.83), current use (k=0.43) and also level of use (k=0.33). There was very good agreement between health workers' consensus and self-reported history of use (k=0.77). Agreement among health workers about current kava use was poor (k=0.08), while there was fair agreement between health workers and self-reported heavy kava users (k=0.36). Data from review of clinic patient notes supported agreement between consensus classification and self-reported history and level of use (k=0.39).. Self-reported kava use may be a poor estimate of current use especially when obtained from interviews away from a confidential clinic setting. Consensus classification by knowledgeable Aboriginal health workers provided comprehensive coverage, efficiently and with greater reliability and assisted to identify 'excessive' kava use.

Topics: Community Health Workers; Cross-Sectional Studies; Data Collection; Data Interpretation, Statistical; Female; Humans; Illicit Drugs; Interviews as Topic; Kava; Male; Native Hawaiian or Other Pacific Islander; Northern Territory; Reproducibility of Results; Self Disclosure; Substance-Related Disorders

Drug and alcohol abuse is one of the United States' most expensive and damaging health risk. The financial and social costs of addiction have led to a significant investment in prevention and treatment in an effort to reduce the incidence and prevalence of drug abuse. One important area of research is the chemistry of craving. It is assumed that if the neurological process of craving can be interrupted, then addiction can be successfully treated. The active ingredients found in kava, known as kavapyrones, have been found to bind to many sites in the brain that are associated with addiction and craving. In an effort to determine if kava can decrease the craving associated with substances of abuse, a craving survey and pilot study were completed where cravings of alcohol, tobacco, cocaine, and heroin were examined. The preliminary findings suggest that kava may reduce the craving associated with addiction. In one investigation, the participants reported a reduction in their desire for their drug of choice. In another investigation, a standardized amount of kavapyrones led to an apparent difference in abstinence between the experimental and placebo groups for alcohol. The studies presented are considered preliminary and exploratory, and intended only as a precursor to future, more systematic and large-scale investigations. If the findings are confirmed, kava may be a useful component to the treatment of addictions, especially for Native Hawaiian and Pacific peoples.

Topics: Adult; Alcoholism; Anti-Anxiety Agents; Behavior, Addictive; Ethnicity; Hawaii; Humans; Ill-Housed Persons; Kava; Male; Middle Aged; Motivation; Phytotherapy; Pilot Projects; Substance Withdrawal Syndrome; Substance-Related Disorders; United States

Topics: Alcohol Drinking; Commerce; Culture; Diet; Drinking Behavior; Family Health; Humans; Kava; Pilot Projects; Smoking; Social Behavior; Social Problems; Substance-Related Disorders; Surveys and Questionnaires; Urban Population; Vanuatu

Topics: Cultural Characteristics; Humans; Kava; Plant Extracts; Plants, Medicinal; Substance-Related Disorders; Vanuatu