Drug Enforcement Administration
Diversion Control Division
Drug & Chemical Evaluation Section

Kava(Other Names: Ava, Intoxicating Pepper, Kawa Kawa, Kew, Sakau, Tonga, Yangona)
September 2019
Introduction:
Kava, also known as Piper methysticum (intoxicating pepper),is a perennial shrub native to the South Pacific Islands, including
Hawaii. It is harvested for its rootstock, which contains thepharmacologically active compounds kavalactones.
The term kava also refers to the non-fermented, psychoactive
beverage prepared from the rootstock. For many centuries, PacificIsland societies have consumed kava beverages for social,ceremonial, and medical purposes. Traditionally, kava beverages
are prepared by chewing or pounding the rootstock to produce acloudy, milky pulp that is then soaked in water before the liquid isfiltered to drink.
There is an increasing use of kava for recreational purposes.
The reinforcing effects of kava include mild euphoria, muscle
relaxation, sedation, and analgesia.
Licit Uses:
In the U.S., kava is sold as dietary supplements promoted as
natural alternatives to anti-anxiety drugs and sleeping pills. An
analysis of six kava clinical trials found that kava (60-200 mg ofkavalactones/day) produced a significant reduction in anxiety
compared to placebo. Another meta-analysis found kava to be
more effective than placebo in 3 out of 7 trials. The FDA has notmade a determination about kava’s efficacy in that use.
A number of cases of liver damage (hepatitis and cirrhosis),and liver failure have been associated with commercial extract
preparations of kava. In 2002, the FDA issued an advisory alerting
consumers and healthcare providers to the potential risk of liverrelated injuries associated with the use of kava dietarysupplements.
Kava dietary supplements are commonly formulated as tabletsand capsules (30-90 percent kavalactones; 50-250 mg percapsule). Kava is also available as whole root, powdered root,extracts (powder, paste, and liquid), tea bags, and instantpowdered drink mix. Kava is frequently found in products
containing a variety of herbs or vitamins, or both.
Chemistry and Pharmacology:
The pharmacologically active kavalactones are found in thelipid soluble resin of the kava rootstock. Of the 18 isolated andidentified,yangonin,methysticin,dihydromethysticin,dihydrokawain, kawain, and desmethoxyyangoin are the six major
kavalactones. Different varieties of kava plants possess varying
concentrations of kavalactones.
The pharmacokinetics of the kavalactones has not been
extensively studied. Kavalactones are thought to be relatively
quickly absorbed in the gut. There may be differences in thebioavailability between each kavalactone.
The limbic structures, amygdala complex, and reticularformation of the brain appear to be the preferential sites of actionof kavalactones. However, the exact molecular mechanisms ofaction are not clear.
Kava has the potential for causing drug interactions throughthe inhibition of CYP450 enzymes that are responsible for themetabolism of many pharmaceutical agents and other herbal
remedies. Chronic use of kava in large quantities may cause a dry
scaly skin or yellow skin discoloration known as kava dermopathy.
It may also cause liver toxicity, and extrapyramidal effects (e.g.,tremor and abnormal body movement).

Individuals may experience a numbing or tingling of the mouthupon drinking kava due to its local anesthetic action. High doses ofkavalactones can also produce CNS depressant effects (e.g., sedationand muscle weakness) that appear to be transient.
Illicit Uses:
Information on the illicit use of kava in the U.S. is anecdotal. Basedon information on the Internet, kava is being used recreationally to relax
the body and achieve a mild euphoria. It is typically consumed as abeverage made from dried kava root powder, flavored and unflavored
powdered extracts, and liquid extract dissolved in pure grain alcoholand vegetable glycerin. Individuals may consume 25 grams ofkavalactones, which is about 125 times the daily dose in kava dietary
supplements.
Intoxicated individuals typically have sensible thought processes
and comprehensive conversations, but have difficulty coordinating
movement and often fall asleep. Kava users do not exhibit thegeneralized confusion and delirium that occurs with high levels ofalcohol intoxication. While kava alone does not produce the motor andcognitive impairments caused by alcohol, kava does potentiate both theperceived and measured impairment produced by alcohol.
The American Association of Poison Control Centers reported 88
case mentions and 48 single exposures associated with kava in 2016.
For 2017, the case mentions increased to 106 with 75 single exposures.
User Population:
Information on user population in the U.S. is very limited. In the1980s, kava was introduced to Australian Aboriginal communities
where it quickly became a drug of abuse. It has become a serious
social problem in regions of Northern Australia.
Illicit Distribution:
Kava is widely available on the Internet. Some websites promoting
and selling kava products also sell other uncontrolled psychoactive
products such as Salvia divinorum. Several kava bars and lounges inthe U.S. sell kava drinks.
The National Forensic Laboratory Information System (NFLIS) andthe System to Retrieve Information from Drug Evidence(STRIDE)/STARLiMS do not indicate any kava reports.
Control Status:
Kava is not a controlled substance in the U.S. Due to concerns ofliver toxicity, many countries including Australia, Canada, France,
Germany, Japan, Malaysia, Norway, Poland, Singapore, South Africa,Sweden, Switzerland, and the United Kingdom have placed regulatory
controls on kava.

Comments and additional information are welcomed by the Drug andChemical Evaluation Section; Fax 571-362-4250, Telephone 571-3623249, or Email DPE@usdoj.gov.