AN AMPHETAMINE-LIKE compound commonly used in East African societies for hundreds if not thousands of years is stoking the flames of Somalia's civil conflict, draining that nation's economy and, until recently, thwarting international relief efforts in the region.
Somalis commonly chew the leaves of the khat shrub for its stimulating effects. Khat's active component, cathinone, closely resembles ephedrine and amphetamine in chemical structure (see figure). Its users report euphoria and increased alertness, although their concentration and judgment are objectively impaired (Psychol Med. 1989;19:657-668).
Chewing khat is as socially acceptable in Somali culture as is drinking espresso in Western culture. Both men and women chew khat in congenial social gatherings in which family and guests discuss topics of interest or listen to poetry or music. Somali homes often include rooms called muffraj, designed specifically for these gatherings. Khat chewers normally chew 100 to 200 g of leaves and stems over 3