**ORR State Letter**

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  **#07-03**                                     **Date: January 6,
                                                 2007**
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| **TO:**       | **STATE REFUGEE COORDINATORS**                       |
|               |                                                      |
|               | **STATE REFUGEE HEALTH COORDINATORS**                |
|               |                                                      |
|               | **NATIONAL VOLUNTARY AGENCIES**                      |
|               |                                                      |
|               | **OTHER INTERESTED PARTIES**                         |
+---------------+------------------------------------------------------+
| **FROM:**     | Martha Newton                                        |
|               |                                                      |
|               | Director                                             |
|               |                                                      |
|               | Office of Refugee Resettlement                       |
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| **SUBJECT:**  | Refugee Health Fact Sheet -- FAQs on Consequences of |
|               | Khat Use by Refugees                                 |
+---------------+------------------------------------------------------+

**What is khat?** Khat is an evergreen shrub (6-12 feet in height) grown
and harvested in southern Arabia and Eastern Africa, and primarily in
the countries of Somalia, Yemen, Kenya and Ethiopia. Khat is used for
its stimulant effects. The active ingredients of khat produce
psychotropic, euphoric, metabolic and cardiovascular stimulant effects
similar to amphetamine. Several million people in East Africa and the
southern Arabian Peninsula are habitual users.

**What are "street names" for khat?** Khat has over 40 street names, to
include Abyssinian Tea, African Salad, Bushman's Tea, Chat, Gat, Kat,
Miraa, Oat, Qat, Somali Tea, Tohai, and Tschat.

**Why is khat of concern in the U.S.?** Regular consumption of khat by
refugees can damage refugee community health and socio-economic
vitality, and impede refugee social integration and economic
self-sufficiency. Further, the influx to the U.S. in recent years of
immigrants and refugees from Africa and the Arabian Peninsula -- in
particular the Somali community -- has increased demand for, and
availability and use of khat here. Because only fresh khat leaves
produce greatest stimulation, consumption of khat was traditionally
confined to regions of its production. But now, faster transportation
and improved techniques for preservation have led to increased
availability and use of khat in the West.

**What are the law enforcement and immigration consequences of khat
consumption by refugees?** There are also serious law enforcement and
immigration consequences for refugee consumption of khat. The active
ingredients of khat are alkaloids; cathinone (schedule I drug) and
cathine (schedule IV drug), which are regulated under the U.S.
Controlled Substance Act (CSA). The importation, possession, or use of
khat in the U.S. is a violation of federal law and can lead to a
refugee's arrest, incarceration, detention, and/or removal from the U.S.
The same is of course true for asylees, Cuban/Haitian Entrants, and
Victims of a Severe Form of Trafficking. There is no legitimate or legal
use for khat in the United States.

**What are alkaloids?** Alkaloids are any of various physiologically
active, nitrogen-containing organic bases obtained from plants such as
nicotine, quinine, atropine, cocaine, and morphine. Cathinone is 10
times more potent than Cathine but dissipates within 48 hours of
harvest. Within 48 hours of harvest khat's chemical composition breaks
down to contain only Cathine, reducing its potency.

**How is khat consumed, and by whom?** Khat is ingested by chewing the
leaves - as is done with loose tobacco. Dried Khat leaves can be brewed
in tea or added to food. Males are by far the most common users of khat.

**What effects does Khat have on a user?** A typical chewing session is
thought to be the equivalent of ingesting 5 milligrams of amphetamine.
After ingestion the user experiences immediate increase in blood
pressure and heart rate. Its stimulant effects begin to diminish 90
minutes to 3 hours after ingestion, but can last up to 24 hours.

**What are the risks to khat use?** Individuals who consume khat
typically experience a state of mild depression following periods of
prolonged use. Taken in excess khat can cause extreme thirst,
hyperactivity, insomnia, and loss of appetite. Systematic use of khat
can reduce the user's motivation and lead to manic behavior with
grandiose delusions, paranoia, and hallucinations. Continued khat use
can cause damage to the nervous, respiratory, circulatory, and digestive
systems.

**How much khat is available in the United States?** The availability of
khat in the United States has been increasing since 1995. According to
the Federal-wide Drug Seizure System (FDSS), law enforcement seizures of
khat increased from 14 metric tons in 1995 to over 37 metric tons in
2001. During the first six months of 2002, nearly 30 metric tons of khat
were seized. El Paso Intelligence Center reported that law enforcement
seized 32, 39, 37, 54, 47, and 32 metric tons of khat in 2000, 2001,
2002, 2003, 2004, and through September 2005, respectively.

**How much does it cost to manufacture khat?** Khat is purchased from
farmers in the horn of Africa region for about \$1 per kilogram.
Warlords operating in this area use aircraft to ship khat to Europe,
where khat consumption is still legal. The khat is sold to middlemen for
\$200/kg, a profit of \$199 per kilogram. Some khat is shipped to the
United States and other regions.

**What does khat sell for in the United States?** Khat generally sells
for \$300-\$600 per kilogram or \$30 to \$60 per bundle (which is 40
leafed twigs measuring 12-15 inches in length). Evidence suggests that
funds from the sale of khat are moved to Europe and the Middle East. The
sale of khat generates illegally obtained funds, which can lead to money
laundering or other illicit financial transactions.

**How is khat shipped to the United States?** Khat is brought into the
U.S. by couriers who can place between 20 and 140 kilograms in their
suitcases, or shipped to the U.S. by express mail in boxes that contain
9-25 kilograms of khat.

**Recommendations to address khat use:** 1) Establish community
campaigns to inform refugees of the harmful health, social, legal, and
immigration consequences of khat importation, possession and use; 2)
Establish educational campaigns to inform mainstream refugee service
providers of the symptoms, health & legal consequences, and cultural
aspects of khat consumption; 3) Learn more about the variables
associated with khat use in local communities and apply the information
to policy, planning and interventions at state and local levels.

[^1]

[^1]: References: Cox G & Rampes H, (2003). Adverse effects of khat: a
    review. Advances in Psychiatric Treatment 9, 456-463; Dhaifalah I &
    Santavy J, (2004). Khat habit and its health effect. A natural
    amphetamine. Biomed. Papers 148(1), 11-15; National Drug
    Intelligence Center, (2003). Intelligence Bulletin: Khat (Catha
    edulis). (Document ID 2003-Lo424-002). Retrieved from
    <http://www.usdoj/ndic/pubs3/3920/index.htm>