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Background Khat (Catha edulis), a psychoactive plant commonly chewed in Ethiopia, is known to influence drug metabolism through its active compound, cathinone. Among patients with T2DM, concurrent khat chewing and OAD use may result in pharmacokinetic and pharmacodynamic interactions, particularly in polypharmacy contexts. Despite these concerns, the clinical relevance of khat–OAD interactions remains poorly understood in high-prevalence, low-resource settings. Methods This study assessed the prevalence, predictors, and perceptions of potential khat–OAD interactions among T2DM patients. A convergent parallel mixed-methods design was employed from July 1 to December 30, 2024, at Gondar University Hospital, Ethiopia. A total of 422 adult T2DM patients on OAD therapy who reported khat use were systematically sampled. Quantitative data on demographics, clinical profiles, medication use, and khat chewing behaviors were collected through structured interviews and verified via medical records. Potential interactions were identified using drug interaction databases, and logistic regression was used to determine independent predictors. Additionally, in-depth interviews with 20 patients and healthcare providers explored awareness, perceptions, and clinical experiences related to khat use and diabetes care. Results Among the 422 participants, 63.3% ( n  = 267) had at least one potential khat–OAD interaction, and 23.2% ( n  = 98) experienced a major interaction. The most frequently implicated drugs were glibenclamide and sitagliptin. Significant predictors of interaction included female sex (AOR = 1.38; 95% CI: 1.00–1.89), polypharmacy with ≥ 7 medications (AOR = 2.43; 95% CI: 1.61–3.67), daily khat use (AOR = 2.20; 95% CI: 1.52–3.18), and khat use for ≥ 13 years (AOR = 1.09; 95% CI: 1.04–1.15). Qualitative findings highlighted the widespread cultural normalization of khat chewing, low patient awareness of potential interactions, and gaps in provider counseling. Conclusions Harmful khat–OAD interactions are common among T2DM patients in Northwest Ethiopia, primarily driven by behavioral and treatment-related factors, highlighting the need for culturally sensitive pharmacovigilance and patient education. Clinical trial number Not applicable.

The use of khat (Catha edulis) is a major public health and social problem that is believed to be growing globally. The khat chewing habit is prevalent in all areas of the Jazan region, Kingdom of Saudi Arabia (KSA). However, few studies have been conducted at the community level to investigate the khat chewing habits in this area. This study was conducted with the aim of assessing the prevalence and predictors of khat chewing among the Jazan community population. A cross-sectional study was conducted with a sample (n = 4,500) of the Jizani population who attended primary heath care centers in Jazan region. The participants were selected using a two-stage cluster random sampling. A structured questionnaire was used for data collection. The overall lifetime prevalence of khat chewing was 33.2% (95% CI 31.8-34.7) and was significantly higher for males 42.2% (95% CI 40.4-43.9) than for females 11.3% (95% CI 9.6-13.1) (P < 0.001). Current khat chewers accounted for 28.7% (95% CI 27.4-30.1) of the population sampled; 36.9% (95% CI 35.2-38.6) of whom were males, which is a significantly higher percentage than the 8.7% (95% CI 7.3-10.4) of current khat chewers who were females (P < 0.001). The multivariate logistic regression analysis suggests that the most important independent predictors of khat chewing were having a friend who chewed khat (OR = 20.1, P < 0.001), participant's smoking status (OR) = 3.9, P < 0.001), friend's smoking status (OR = 2.2, P < 0.001), gender (OR = 2.2, P < 0.001) and educational level (OR = 1.5, P < 0.05). A large proportion of the Jizani populations chew khat. Government and non-governmental organizations NGOs should design and strengthen community prevention programs to curb the high prevalence of khat use.

Khat chewing has become a common practice among university students in developing countries like Ethiopia. It has a potential effect on physical, mental, social and cognitive aspects of student functioning. In Ethiopia, study findings regarding the prevalence of khat chewing were highly dispersed and inconsistent. Therefore, this systematic review and meta-analysis estimates the pooled prevalence of khat chewing and its predictors among Ethiopian university students. A systematic review and meta-analysis was conducted to assess the prevalence and predictors of khat chewing among university students in Ethiopia. We searched literature from the databases of PubMed, Google Scholar, Science Direct, and the Cochrane Library. A total of 24 Ethiopian studies reporting the prevalence of khat chewing among university students were included. Data were extracted using a standardized data extraction format prepared in Microsoft Excel and the analysis was done using STATA 14 statistical software. To assess heterogeneity, the Cochrane Q test statistics and I2 test were used. Since the included studies exhibit high heterogeneity, a random effect meta-analysis model was computed to estimate the pooled prevalence of khat chewing. Moreover, the association between predictor variables, and khat chewing practice were examined. The meta-analysis of 24 studies revealed that the pooled prevalence of khat chewing among university students in Ethiopia was 23.22% (95% CI: 19.5, 27.0). In the subgroup analysis, the highest prevalence was observed in Oromia region (31.6%; 95CI: 21.2, 41.9) whereas the lowest prevalence was observed in Amhara region (18.1%; 95%CI: 12.4, 23.8). Being male OR: 2.76 (95% CI 1.64, 4.63), family khat chewing practice OR: 2.91 (95% CI 1.06, 7.98), friend khat chewing habit OR: 4.74 (95% CI 3.48, 13.06), alcohol drinking OR: 7.06 (95% CI 5.65, 8.82) and cigarette smoking habit OR: 15.11 (95% CI 8.96, 25.51) were found to be predictors of khat chewing. The study found that the prevalence of khat chewing among university students was quite common, with slightly more than 1 in 5 students engaging in the use of this substance. Being male, family khat chewing practice, friend's khat chewing habit, alcohol drinking, and cigarette smoking were found to be predictors of khat chewing practice among university students.

Catha edulis (Vahl) Forssk. ex Endl. (Khat) is a stimulant plant that contains cathine and cathinone, which its abuses induce euphoria, alertness, and motor activity. Since the toxicokinetics of these substances remain unclear, this study was carried out to investigate the disposition kinetics of cathine and cathinone, the neurotransmitter profile, following a single dose of C. edulis extract in rats.Twenty-four adult male Wistar albino rats (250–300 g) were randomly selected and divided into six groups of four rats each. All groups received a single oral dose of 2,000 mg/kg body weight, and blood and tissue samples from the brain, lung, heart, liver, and kidney were obtained at intervals of 0.5, 1, 2.5, 5, 12, and 24 h. The cathine and cathinone concentrations were identified and quantified using ion trap ultra-high performance liquid chromatography (HPLC-IT/MS). The neurotransmitter profile was detected using the quadrupole time of flight UPLC-QTOF/MS method.The lung, liver, and heart tissues attained the highest levels of cathine, while the highest level of cathinone was determined in the heart. Cathine and cathinone concentrations in the blood and heart peaked at 0.5 h. The concentrations peaked in the brain 2.5 h later, indicating that the heart had an immediate effect, whereas the brain had a longer-lasting one. They have longer half-lives (2.68 and 5.07 h, respectively) and may remain in the brain for longer durations (3.31 and 2.31 h, respectively). The neurotransmitters epinephrine, dopamine, norepinephrine, and serotonin were detected in a delayed, prolonged and organ-specific manner.Cathine and cathinone were deposited in considerable concentrations in all tissues analyzed, with the highest Cmax in the lung and Tmax in the heart tissues but not in the brain. In addition, neurotransmitters such as adrenaline, dopamine, norepinephrine, and serotonin were differentially detected in all tested samples in a organ-specific fashion. More study is needed to identify cathine and cathinone’s effects on neurotransmitter profiles. Nevertheless, these findings provided a further basis for experimental, clinical, and forensic investigations.

Chewing fresh leaves of Catha edulis (khat) is a popular pastime activity among Ethiopians where 12% women chew it. Reports show that khat use has been associated with poor nutritional status. This study aimed to determine whether khat chewing is linked to underweight and anemia. We analyzed data from the 2016 Ethiopian Demographic and Health Survey (EDHS). The EDHS used two stage stratified cluster sampling to collected data from 16,650 households. We used data from a total of 15,683 respondents and 1904 respondents who chewed ever chewed khat in their lives. We used Pearson's chi-square, and logistic regression while stratifying by residence (urban vs rural) to control for confounders. Our results indicated 10.7% (95%CI: 10.92,11.26) of women chewed khat for an average of 16.5 days in the previous month. A woman's current khat chewing status was significantly associated with age, educational level, region, religion, wealth group, and marital status. Women aged 40-44 were significantly more likely to chew (AOR = 2.89,) compared to those aged 15-19. Compared with Protestant women, Muslim women were 210 times more likely (AOR = 210, 95% CI 102,435.7) to chew and women in the poorest wealth quintile had 73% higher odds (AOR = 1.73, 95% CI 1.22,2.44) of chewing khat when compared with the richest. Anemia was not associated with a woman's chewing status, whereas rural women who chewed khat for more than 26 days in a month had a 78% increased risk (OR = 1.78) of being underweight when compared to non-chewers. Khat chewing is associated with sociodemographic factors and current khat use is associated with a higher risk of underweight among women living in rural areas. Implementing targeted awareness campaigns for women about the risks of khat chewing is recommended.

•DUID cases related to drugs abuse have been reported in Asia, USA, and Europe.•Amphetamine, cocaine, cannabis, BZDs, and opiates were frequently reported in DUID.•Regular testing of drivers was needed to collect data for DUID in traffic accident. Driving Under the Influence of Drugs (DUID) is considered a serious issue related to the abuse of illegal drugs. DUID cases, including deaths, are being continuously reported in Asia, USA, and Europe. This literature review focuses on illegal drug abuse in recent DUID cases reported in Asia, USA, and Europe. To determine illegal drug abuse in DUID suspects, previous studies collected and analyzed biological samples, such as blood, urine, oral fluids, and hair. In addition, there were forensic autopsies and surveys for investigation of illegal drugs in DUID cases and drivers. In previous studies, ketamine, morphine, methamphetamine (MA), and khat were mainly reported in Asia, whereas amphetamine, benzodiazepines (BZDs), and cannabinoids were mainly reported in USA, and synthetic cannabinoids (SCs), opiates, and cocaine were mainly reported in Europe. Since DUID suspects related to illegal drugs have been frequently reported in Asia, USA, and Europe, there is a need to plan for national monitoring for drivers or motor vehicles to regulate and prevent drug abuse and relevant DUID cases.

Khat chewing has become a highly prevalent practice and a growing public health concern in Ethiopia. Although there have been many small scale studies, very limited national information has been available in the general population. This study aimed to identify factors associated with khat chewing practice among Ethiopian adults. The study used the 2011 Ethiopian demographic and health survey data. The survey was cross-sectional by design and used a multistage cluster sampling procedure. Bivariate and multivariable logistic regression models with adjusted odds ratio (AOR) and their 95% confidence intervals (CI) were used to quantify the predictors. The overall khat chewing prevalence was 15.3% (95% CI: 14.90-15.71). Regional variation was observed with the highest in Harari [(53.2% (95% CI: 43.04-63.28)] and lowest in Tigray regional state [(1.1% (95% CI: 0.72-1.66)]. Multivariable analysis showed that Islam followers were 23.8 times more likely to chew khat as compared to Orthodox followers. Being a resident in Oromiya, South Nation, Nationalities and People (SNNP), Gambella, Harari and Dire Dawa regions had 1.9, 1.6, 3.1, 5.2 and 3.5 times higher odds of chewing khat as compared to Addis Ababa residents, respectively. Adults in the age group 45-49 years were 3.6 times more likely to chew khat as compared to 15-19 years. The middle and richest wealth quintiles were 1.3 and 1.5 times more likely to chew khat, respectively, as compared to the poorest category. Rural residents had 1.3 odds of chewing khat than urban residents. Those individuals who had occupation in sales, agriculture, service sector, skilled and unskilled manual workers were 1.6, 1.3, 2.4, 1.7 and 2.3 times more likely to chew khat, respectively, as compared to those who have no occupation. Females were 77% less likely to chew khat as compared to males. Formerly married and those experienced in child death had 1.4 and 1.2 times higher odds to chew khat as compared with those never married and never had child death, respectively. Those who attended mass media were 1.4 times more likely to chew khat compared with not attended. Khat chewing is a public health concern in Ethiopia. The highest wealth quintiles, older age group, rural residence, child death, formerly married, males, regions of Oromiya, SNNP, Gambella, Harari and Dire Dawa and Islamic followers had statistically significant association with khat chewing. Due attention needs to be given for these factors in any intervention procedures.

This study aimed to evaluate the effects of oral contraceptive (OC) use, khat chewing, and their combined effect on telomerase level and tumor suppressor genes, p53 and p21 in breast cancer (BC) patients and normal volunteers. 140 Yemeni women aged 25–40 years old enrolled, 60 newly diagnosed pretreated BC patients, and 80 control subjects. Venous blood (5 ml) was collected and the results showed BC patients to have significantly raised levels of telomerase, p53, and p21 compared to the control group. The use of OCs significantly raised telomerase in control group with no effect in BC patients; whereas p53 and p21 were significantly increased in BC patients. On the other hand, khat chewing significantly increased p53 in controls and BC patients, whereas p21 was significantly raised in BC patients. The combined use of OCs and khat chewing significantly increased telomerase and p53 in control group, and significantly increased p53 and p21 in BC patients. Telomerase was shown to be a risk factor (OR 4.4) for BC, and the use of OCs was a high-risk factor for increasing telomerase (OR 27.8) in normal subjects. In contrast, khat chewing was shown to be protective (OR 0.142), and the combined use of OCs and khat chewing decreased the risk factor of telomerase from OR 27.8 to 2.1.

•Derivatization of S and R cathinone with menthyl chloroformate.•Full separation of S and R cathinone diastereomers by GC–MS.•Determination of S and R cathinone in leaves and stems of fresh Khat.•Both S and R cathinone detected in all samples.•S-cathinone concentration higher in stems but lower in leaves. The main psychoactive compound in Khat is cathinone which consists of two enantiomers, S-(-)-cathinone being more stimulant than its R antipode. This study aimed to the enantioseparation and determination of these two stereoisomers in different parts of fresh Catha edulis. The samples were solvent extracted and cathinone was derivatized with menthyl chloroformate. The separation of the two diastereomeric derivatives was carried out by gas chromatography and showed an excellent resolution, while their structure was confirmed by mass spectrometry. The quantitative determination of both enantiomers showed a different distribution in various investigated parts of the plant, as shown in their enantiomeric excess. Unlike the results published in some previous articles, the current study confirmed the presence of both S and R cathinone in all parts of the fresh plant. The concentration of S-cathinone was higher in stems while its values were lower in leaves. The obtained concentrations were in the ranges 0.081-0.290 and 0.087-0.211 mg/g for S and R antipodes, respectively. Also, S-cathinone which is the most psychoactive stereoisomer showed an increasing concentration from lower to upper stems of the plant. The present study is the first quantitative investigation of the two cathinone enantiomers in different parts of fresh Catha edulis.

The burden of hypertension is more devastating in low-and middle-income countries, including sub-Saharan Africa than in high-income countries. Among the modifiable risk factors, dyslipidemia and khat chewing were expanding at an alarming rate in Ethiopia but were still underestimated. Thus, this study aimed to assess heavy khat (Catha edulis) chewing and dyslipidemia as modifiable hypertensive risk factors among patients in the southwest, Ethiopia. A facility-based case-control study was conducted among 136 cases and 270 controls from May 15 to July 30, 2017. A consecutive sampling technique was used in this study. Epi data version 3.1.1 and SPSS version 21 were used for data entry and analysis. Descriptive statistics and bivariate and multivariate logistic regression analyses were performed. Both crude and adjusted odds ratios and 95% confidence intervals were reported. The majority of the cases had a total cholesterol to high-density lipoprotein ratio of >5 (72.1%). The odds of hypertension increased among participants who had attended no formal education [AOR = 2.25, 95% CI: (1.05-4.82)], history of alcohol consumption [AOR = 5.93,95% CI:(3.11-11.30)], moderate khat chewing [AOR = 3.68, 95% CI:(1.69,8.01)], heavy khat chewing [AOR = 18.18, 95% CI: (3.56-92.89)], mild intensity physical activity [AOR = 3.01, 95% CI: (1.66-5.47)], type of oil used for food preparation [AOR = 2.81, 95% CI: (1.49-5.28)], and dyslipidemia [AOR = 6.68, 95% CI: (2.93-15.23)]. The study showed that modifiable risk factors were the major factors associated with the development of hypertension. The findings of this study highlighted that health education is needed to focus on physical exercise, quitting excess alcohol consumption, quitting khat chewing by giving special emphasis to those who had no formal education. In addition, consideration should be given to a healthy diet free of cholesterol and unhealthy behavior.