Correcting Misinformation Google Link #2 - Australian Alcohol and Drug Foundation Article

[The Kap'n]

Australian Alcohol & Drug Foundation Article

Today I went into google, swapped over to an incognito window and again typed in “kava”. Our results come to us from the Australian Alcohol and Drug Foundation. This is result #2 after the WebMD article. This one is quite a bit shorter, and a good bit more accurate than the last.

Article Source:
“Kava.” https://adf.org.au/drug-facts/kava/.

Here we go. I’ll reference each section and then my comments on them.

• What is kava?
  1. This section goes on to describe the different forms of kava, and its scientific name. Refers to kava here as a depressant, and overall I can agree with that.
• Other Names
  1. They list the local names for kava, and do a decent job. No issues here.
• Other types of depressants
  1. Not really sure why this is here. I assume it’s some page algorithm that populates other “similar” drugs. None of these are similar to kava in the respect that alcohol, benzos, and GHB cause tolerance, addiction, and withdrawal upon long term use.
• How is it used?
  1. Pacific Islands
     1. Good section. They go into detail about the traditional usage of kava and even speak about how kava was used to strengthen ties among groups.
  2. Aboriginal and Torres Strait Islander peoples
     1. Good short explanation of kava use in the Northern Territory. It goes on to say kava was used as a substitute for alcohol and also says it was used “in much the same way that alcohol is used”. That’s debatable.
  3. Herbal preparations
     1. No issues here. At least this article acknowledges the use of kava in the treatment of insomnia, stress and anxiety.
• Effects of kava
  1. These listed effects are pretty accurate. The only one I have an issue with is where they say “mild fever”. This fundamentally doesn’t make sense. Kava has pretty strong anti-inflammatory properties, and as such should do the opposite in terms of fevers, considering fever is an immunologic inflammatory condition. I also don’t see in their sources where this is mentioned. They list source 7 which is Ramzan in 2015, but that source says nothing about kava and fevers.
• Long-term effects
  1. Here the problems begin to arise. In this section the author cites “getting infections more easily” and “shortness of breath”. They pulled the “shortness of breath” effect from Matthews 1988 study in Arnhem Land. It’s a very strange effect that we don’t see in normal kava drinkers, and doesn’t show up in other research. The Mathews study goes on to conclude that lung function was not correlated to kava usage. The likely culprit here was that the population studied were the aboriginal communities, and they carried high instances of decreased lung volumes and other morbidities not related to kava. I have a number of issues with this study, because it’s the one that many other researchers cite to say kava causes liver damage, however the study itself names GGT increases in metabolic tests as “liver damage”. This is patently false. Increase in GGT/ALP indicates adaptation. Without increases in AST/ALT we cannot say liver damage, and there were none here. It’s an old study with tired information that needs to be retired in regard to trying to make the whole liver claim again. (Mathews, J. D., M. D. Riley, L. Fejo, E. Munoz, N. R. Milns, I. D. Gardner, J. R. Powers, E. Ganygulpa, and B. J. Gununuwawuy. 1988. “Effects of the Heavy Usage of Kava on Physical Health: Summary of a Pilot Survey in an Aboriginal Community.” The Medical Journal of Australia 148 (11): 548–55. https://doi.org/10.5694/j.1326-5377.1988.tb93809.x.)
  2. In source 8 it says "increased susceptibility to infection" under "General Body" Long term effects, but conveniently omits any source of this information. The phrase "increased susceptibility to infection" only appears once, and is not sourced. Remember: "That which can be asserted without evidence, can be dismissed without evidence." - Christopher Hitchens
  3. The article says “Kava has been shown to cause liver damage when taken in an alcoholic or acetonic extract. For this reason water based extracts of Kava ( as a drink or tablet) should not be consumed with alcohol”. While I agree not to combine with alcohol, this reason does not make logical sense.
• Using kava with other drugs
  1. While the suggestions are correct, the source that this statement is drawing from is based on incorrect conclusions. The source here says that quite a number of CYP enzymes are affected by kava and kavalactones, however what we're seeing is inhibition at CYP1A2, CYP2C19, and induction of CYP2E1 in vivo.
     (Russmann, Stefan, Bernhard H. Lauterburg, Yann Barguil, Erwan Choblet, Pierre Cabalion, Katharina Rentsch, and Markus Wenk. 2005. “Traditional Aqueous Kava Extracts Inhibit Cytochrome P450 1A2 in Humans: Protective Effect against Environmental Carcinogens?” Clinical Pharmacology and Therapeutics. https://doi.org/10.1016/j.clpt.2005.01.021)
• Kava in Australia
  1. This section looks good. Slightly behind what’s happening, but I don’t expect them to have live updates here.
• Withdrawal
  1. Finally, a web article that clearly spells out that kava usage incurs no withdrawal. Good section.
• References
  1. Thomson N. & Urquhart B. Review of the misuse of kava among Indigenous people. Mt Lawley, Western Australia, Australia: Australian Indigenous HealthInfoNet, Kurongkurl Katitjin: Centre for Indigenous Australian Education and Research, Edith Cowan University; 2009. [Accessed 27 November 2020].
  2. University of Maryland Medical Centre. Kava Kava UMMC; 2011. [Accessed 27 November 2020].
  3. Michigan Medicine. Kava University of Michigan; 2020. [Accessed 27 November 2020].
  4. National Centre for Complementary and Integrative Health. Kava: NCCIH; 2016. [Accessed 27 November 2020].
  5. Lee K, Freeburn B, Ella S, Miller W, Perry J & Conigrave K. Handbook for Aboriginal Alcohol and Drug Work. 2012. [Accessed 27 November 2020].
  6. Currie B & Clough A. Kava hepatotoxicity with Western herbal products: does it occur with traditional kava use? Medical Journal of Australia. 2003;178(9).
  7. Ramzan I. Phytotherapies: Efficacy, Safety, and Regulation. New Jersey: John Wiley & Son; 2015. [Accessed 27 November 2020].
  8. Territory Health Services Public Health Strategy Unit. The Public Health Bush Book: Public Health Strategy Unit, Dept. of Health and Community Services; 2005.
  9. The Office of Drug Control. Import restrictions: Kava and Khat: Australian Government Department of Health; 2020.

 

[the_wilderness]

useful breakdown, Kapt.

 

[The Kap'n]

useful breakdown, Kapt.

Thank you!