Many countries (such as Kenya’s recent regulatory changes regarding Muguka use) are struggling with the dilemma of how to regulate drug use by its citizens. There are many psychoactive drugs (we seem to be good at discovering them) with a variety of effects. Often there may be subjectively desirable effects in the short term, but long term addiction, the potential for withdrawal, and a host of physically and socially destructive effects.
Use of these drugs exists on a spectrum from medicinal to cultural, recreational, and addictive. There doesn’t seem to be a strong consensus about how best to regulate their use, and even if we should, but there is a clear social cost regardless of which approach is taken. It’s just a matter of which tradeoffs we are willing to accept.
But this debate is not the main focus of this article, just the background. The angle I do want to discuss, as it is central to the principles of SBM, is that whether or not psychoactive drugs with a potential for addiction and abuse are “natural” or synthetic is entirely irrelevant, at least directly. Synthetic versions tend to be more purified and potent, and therefore a much lower dose can often achieve the same effect.
We see the result of this with the Fentanyl crisis in the US. Fentanyl is a synthetic opioid that is 100 times as potent as morphine, and 50 times as potent as heroin. It was created for medical use but eventually the drug trade discovered how to make it in their own labs. The majority of fentanyl in the US is made in Mexico from chemicals sourced from China. It is then sold as is, or cut into other street drugs. Users can then unknowingly get an extremely high dose of this opioid, leading to overdoses.
Kenya is now facing their own drug crisis, in the form of Muguka. Muguka is a variety of the Khat plant, which has long been used as a stimulant. The young leaves or buds are chewed, causing a stimulant effect. The main active ingredients are cathine and cathinone, which are amphetamine analogues. Muguka is a more potent variety that is increasing the use, addiction, and withdrawal symptoms in users and is being blamed for increases in crime and mental illness.
The pharmacological effects of Khat use, and specifically cathine and cathinone, are well studied and documented. They are amphetamines with the same effects and other similar drugs. According to the NIH:
“The main toxic effects include increased blood pressure, tachycardia, insomnia, anorexia, constipation, general malaise, irritability, migraine and impaired sexual potency in men.”
In the US synthetic versions of cathinone, known on the street as “bath salts”, are a significant problem and are responsible for incidents of extreme violent and destructive behavior.
There was a push to ban Muguka in Kenya as its popularity grew. A 2019 study, looking at Khat use, found:
“The prevalence of current khat chewing in the region was at 36.8% (n = 306) with a male gender predominance (54.8%). At least one psychotic symptom was reported by 16.8% (n = 168) of the study population. Interestingly, psychotic symptoms in general were significantly prevalent in women (19.5%) compared to men (13.6%) (p = 0.023). Khat chewing was significantly associated with reported strange experiences (p = 0.024) and hallucinations (p = 0.0017), the two predominantly reported psychotic symptoms.”
In the last few years these numbers have grown with the introduction of the more potent Muguka, leading ultimately to a recent ban. However, Kenya’s president recently reversed the ban, mainly due to pressure from local farmers who rely on Muguka as a cash crop.
Another aspect of the phenomenon is that many farmers, including small scale farmers, are growing Muguka instead of food crops. This is exacerbating the food insecurity problem in the region, but the farmers cannot pass up the increased profit from selling the drug. They can make three times more selling Muguka than food crops.
And there the issue sits, without a clear resolution. But this is just one example of the many similar plants that contain significantly doses of psychoactive drugs. In the US we are also dealing with Kratom, which is again a “natural” plant that contains opioid like drugs with addiction and withdrawal potential. It is being marketed, however, as a “natural” alternative with resistance to regulation.
Whatever decisions we ultimately make about the regulation of these substances, we need to remain clear-eyed that they are drugs, taken for their pharmacological effects. The fact that they are plants or “natural” is not relevant.
