DRAFT REPORT ON
INQUIRY INTO THE ISSUE OF KAVA REGULATION
Prepared for the Sessional Committee on the Use and Abuse of Alcohol by the Community,
by Dr Peter d'Abbs and Dr Chris Burns Menzies School of Health Research, Darwin
September 1997
TABLE OF CONTENTS
EXECUTIVE SUMMARY 1
1. INTRODUCTION 13
2. KAVA - SOME BACKGROUND INFORMATION 15
2.1. Introduction 15
2.2. A conceptual framework 15
2.3. Pharmacological and toxicological properties 16
2.4. Kava in the Pacific 19
2.5. Kava in Arnhem Land 19
2.6. Summary 28
3. CURRENT SUPPLY AND USE OF KAVA IN ARNHEM LAND 33
3.1. Current supply systems 33
3.2. Current consumption patterns 36
3.3. Summary 37
4. HEALTH, SOCIAL AND ECONOMIC CONSEQUENCES OF KAVA USE IN
ARNHEM LAND 39
4.1. Overview: controversies, and the approaches underpinning them 39
4.2. Health correlates 41
4.3. Social correlates 49
4.4. Economic correlates 51
4.5. Summary 51
5. KAVA AND ALCOHOL 54
5.1. The relationship between kava and alcohol 54
5.2. Kava and alcohol in Arnhem Land 54
5.3. Interactions between kava and alcohol: a review of research evidence 55
5.4. Summary 56
6. FUTURE OPTIONS FOR REGULATION OF KAVA IN ARNHEM LAND 57 6.1. Outcome of consultations on the desirability and extent of kava availability in the
6.2. Northern Territory 57
6.2. The draft Kava Management Bill 61
6.3. Summary 62
7. RESEARCH INTO KAVA: CURRENT STATUS AND FUTURE NEEDS 64
7.1. What research? 64
7.2. How should research be conducted? 65
7.3. Funding of research 65
8. CONCLUSIONS AND RECOMMENDATIONS 67
9. REFERENCES 70
EXECUTIVE SUMMARY
Introduction
On 21 November 1996 the Northern Territory Attorney General and Minister for Health, Mr Burke, tabled in the Legislative Assembly a draft Kava Management Bill 1996, and at the same time moved that further consideration of the Bill, and of the broader issue of kava regulation, be referred to the Assembly's Sessional Committee on Use and Abuse of Alcohol by the Community (Northern Territory Legislative Assembly 1996).
The Terms of Reference of the referral, as originally proposed by the Government, set out five tasks. The Committee was asked to:
(a) investigate the association between kava drinking and alcohol;
(b) investigate the health, social and economic consequences of current patterns of kava consumption;
(c) inquire into the circumstances in which kava is brought into the Northern Territory and into Aboriginal communities and the distribution of kava to consumers;
(d) consult with all relevant stakeholders and make recommendations as to the desirability and extent of kava availability in the Northern Territory; and
(e) comment on the legislative framework proposed for kava control - The draft Kava Management Bill forms a basis for community consultation; and
In the ensuing debate, Opposition MLA Syd Stirling successfully moved an amendment, adding a sixth task to the Sessional Committee's brief.
(f) the Committee should assess the body of research into kava use and further study the educational requirements in that regard.
The report that follows is the outcome of these events.
Kava - some background information
Introduction
Kava is a beverage prepared from the plant, Piper methysticum of the pepper family. In Australia kava is prepared for consumption by infusing imported, commercially dried and powered roots of the plant in water. Kava has been used in the Pacific Islands for ceremonial and recreational purposes for at least 3,000 years, and is today used widely in Vanuatu, Fiji, Tonga, Western Samoa and Micronesia.
Although there is evidence of it having been used by Torres Strait Islanders in the early years of the 20th century, it is only since 1981 that it has become popular in several Aboriginal communities in Arnhem Land, where it was introduced in the belief that it offered a less harmful alternative to alcohol, excessive use of which was causing damage to health and family and community life.
Pharmacological and toxicological properties
Pharmacologically, kava is classified as a psychotropic agent, the effects of which have been described as giving rise to “a pleasant, warm, and cheerful, but lazy feeling”. Kava is a
complex mixture of substances, the main active compounds being a group of fat-soluble kava pyrones found in kava resin. However, the water soluble fraction may also contribute to the effects. Kava contains no alcohol. It may vary in composition and effects depending on the part of the plant used, whether it is powdered or fresh, the plant type used, the area in which the plant has been produced and the method used to prepare it for consumption.
Most of the pharmacological effects of kava described in the literature refer to acute effects of consumption, following within 20-30 minutes of drinking, as kava is absorbed from the stomach. The effects associated with chronic consumption are poorly documented.
The main effects reported are:
• local anaesthetic effects - rapid numbing of the mouth and tongue;
• muscle relaxant properties, commonly manifested as ataxia (incoordination), apparently a result of the action of kava compounds on the spinal cord rather than a direct effect on muscles;
• sedative and hypnotic (sleep-producing) effects, comparable to those of benzodiazepine drugs; however the mechanisms by which kava exerts these effects remains unknown;
• analgaesic (pain-reducing) effects;
• photophobia (a wish to avoid bright light).
Some human experimental work has been conducted on the acute effects of kava on perception, memory and learning. Experiments using a kava extract equivalent to 1.0-1.5 grams of kava suggest that the extract produced a positive effect on attention, memory processing and concentration. (However, consumption levels by kava drinkers in Arnhem Land are vastly higher than the levels here reported.). A study involving administration of 200grams of kava per person found no significant effect on cognition, although there was a trend to poorer performance.
Evidence concerning possible interaction effects between kava and alcohol is summarised separately below.
Evidence regarding the association between kava and tolerance (the need to increase the dose to achieve the same effect) is inconclusive. One study, using mice, found evidence of a development of tolerance to effects of an acqueous kava extract, but not to the lipid extract (kava resin) which contains most of the active ingredients of kava. It has been suggested that heavy kava users may become tolerant to some effects of the drug, while to other effects, tolerance may not occur.
Notwithstanding the findings reported above, the effects of chronic kava use on cognition remain unknown, particularly at the levels of consumption reported in Arnhem Land.
Kava in the Pacific
Kava is an integral part of the political, religious and economic systems in Pacific Island countries, and is widely used in Fiji, Vanuatu, Tonga, Western Samoa and Pohnpei
(Federated States of Micronesia). In many contexts, drinking practices also serve to regulate consumption.
As an export earner for these countries, particularly Fiji, Tonga and Vanuatu, kava is increasingly important, with Fiji’s kava crop estimated to be worth $100 million annually.
The demand for kava exports is largely being driven by the European pharmacological industry, although kava-based products are also being marketed in the US for a range of purposes, including stress-relief and as an aphrodisiac. In 1994 Australia was the second largest importer of Fijian kava, after Germany. However, unlike Germany which imported mainly dried kava roots for pharmacological use, Australian imports were largely in the form of dried pounded kava for consumption.
In some parts of the Pacific, kava has also become a symbol of national identity. In 1990, for example (the same year that kava became officially designated in Australia as a ‘Schedule 4’
drug) Vanuatu issued a postage stamp denoting kava as ‘the national plant’.
Kava in Arnhem Land
Kava was introduced to the Yirrkala community in 1981 following a visit to Fiji by members of the community. Over the next two years, use of kava spread to a number of other coastal and island communities in Arnhem Land. All of these communities had previously banned the supply and consumption of alcohol, and looked to kava as an alternative recreational substance which, in contrast to alcohol, did not lead to violence.
Since its introduction, views on of kava have been polarised, not only in the wider community but often within kava-using communities. and allegations of the negative social and health consequences of kava use have been common.
Initially, the Northern Territory Government, acting on advice from the Drug and Alcohol Bureau of the NT Department of Health, took the position that kava should not be defined or treated as a drug and that communities should be left to make their own decisions about the introduction of the substance. This policy was supported by the first major study of kava use in Arnhem Land, by Alexander et al in 1987, which reported that kava use had declined from the levels prevalent in the early 1980s. The report also stated that, contrary to claims that kava was being mixed more strongly in Arnhem Land than in the South Pacific, Aboriginal kava drinkers were consuming a weaker mixture. The report concluded that 'No major health problems or deaths have been shown to be kava-related'.
However, in the same year, the Menzies School of Health Research released results of a pilot study of kava users in Arnhem Land which suggested that heavy kava use was harmful to health and therefore should be discouraged. Kava drinkers were reported to be more likely than non-drinkers to suffer from general ill health, including shortness of breath and
characteristic skin rash; malnutrition, with 20 per cent loss of body weight, 50 per cent loss of body fat and other biochemical changes; liver damage, with biochemical changes similar to those caused by large doses of alcohol; and other changes in red blood cells, white blood cells and platelets.
Critics of the Menzies study argued that not all of the reported effects on health could be attributed to kava.
The first legislature to restrict the sale and supply of kava in Australia was Western Australia, which in July 1988 invoked section 22 of the W.A. Poisons Act, which allowed for prohibition of the sale, supply and promotion of designated substances by proclamation. The Act did not
outlaw possession of kava, and in fact the proclamation made provision for Pacific Islanders and others who might wish to use kava for traditional purposes to seek ministerial permission to do so. But by prohibiting the sale and supply of kava, the measure effectively banned it use in Western Australia.
In 1990, the Northern Territory Government announced that, as from June, the sale and supply of kava in the NT would be prohibited under the Consumer Protection Act, except with the written approval of the Minister, and in accordance with any conditions stipulated by the Minister. All kava-using communities were asked to indicate if they wished kava to remain available in those communities. In those that did not wish to retain kava, its sale and supply henceforth became prohibited. In the others, kava was to be sold only through the local council or some other non-profit making, accountable body; sales were to be subject to an upper limit of 50 grams of kava powder per person per day; kava was to be sold only to residents of the community aged 18 and over; the council or authorised retailer was to obtain kava only from approved wholesalers, and records were to be kept of all transactions.
Five communities elected to retain kava, while another three voted to ban it, although in two of these the decision was vigorously opposed by substantial minorities.
In October 1992, a little over two years after introduction of these measures, the NT Department of Health and Community Services engaged the Menzies School of Health Research to conduct a review of the measures and to recommend any changes that might be needed.
The review concluded that the attempt to create an orderly, regulated retail system had failed, for three main reasons: firstly, community councils were ill-prepared and ill-suited to
administering a system of controlled supply of kava; secondly, with a few exceptions, the Government had neither helped councils or other retailers to meet their requirements, nor monitored their activities to ensure compliance, and thirdly, entrepreneurs had seized opportunities created by this poorly policed system to use it to their own advantage.
Any effect that the measures might have had on consumption appeared to have been short- lived. The review found that kava sales had risen steadily throughout the latter half of the 1980s, from an estimated mean of 166 kilograms per month between January and June 1986 to 2,287 kg per month between January and June 1990 - more than a thirteen-fold increase.
Following the introduction of controls, sales fell away for about six months, after which they climbed steadily back to their previous levels.
In the meantime, several Commonwealth Government agencies had become involved in attempts to regulate kava. In September 1990 kava was officially designated as a ‘Schedule 4’ drug by the National Health and Medical Research Council. In February 1991 a new Commonwealth Therapeutic Goods Act came into effect, under which kava, as a Schedule 4 drug, automatically became registerable, and thereby subject to a range of new requirements and restrictions relating to manufacturer, importation, sale and supply. In August 1993 the National Food Authority submitted a new draft standard to the National Food Standards Council, under which kava was included in a list of ‘prohibited botanicals’, the importation and commercial supply of which was thereby prohibited.
However, in the same year the National Health and Medical Research Council rescinded its decision to place kava on Schedule 4. Within a few months, the Therapeutic Goods
Administration followed suit, declaring that kava under most circumstances would not be regulated as a therapeutic good.
The National Food Authority’s declaration of kava as a ‘prohibited botanical’, however, which took effect in March 1994, was in conflict with the NT’s regulatory system. The NT Government then took two steps: first, it suspended existing licences for the sale of kava;
secondly, in February 1995 it formally sought exemption from the provisions of the new Standard.
In response, the Commonwealth agreed to take no action under the new regulations, while the NFA convened a major inquiry into the whole issue of kava regulation.
The immediate beneficiaries of this chain of events were black marketeers. Suspension of the NT's regulatory system meant that there were no longer any legally authorised suppliers of kava in the NT. The undertaking by the Commonwealth not to enforce the new prohibition on importing kava meant that non-authorised suppliers were immune from any danger of prosecution. Herein lie the origins of the thriving black market we see today.
The NFA’s inquiry culminated in November 1995 in the release of a Draft National Kava Management Strategy, comprising four components:
• a national system for restricting and monitoring the importation of kava;
• a National Code of Kava Management by which all importers, wholesalers, retailers and distributors must abide;
• a new addition to the Food Standards Code, Standard O10, which would apply only to kava. This would prohibit kava’s use as an ingredient in other food and require labelling on packages of kava; and
• an option for States and Territories to impose their own, more restrictive legislation to address public health concerns and follow up with education and monitoring (National Food Authority (Australia) 1995).
At the time of writing this report, the proposed National Kava Management Strategy had not come into effect, although indications point to it being implemented in the near future.
Current supply and use of kava in Arnhem Land
Since 1995, when regulations governing the sale and supply of kava in the Northern Territory were suspended following kava’s classification by the National Food Authority as a
‘prohibited botanical’, there have been no legally authorised provisions for the sale and supply of kava in the NT. Despite this, an estimated 15,000 - 20,000 kilograms of kava currently enters Nhulunbuy each year, and sells at a retail level for a value conservatively estimated as $6 million to $8 million.
While it appears that the total amount of kava being sold in Arnhem Land has remained similar to the high levels reported in the early 1990s, the retail value of the market in Arnhem Land has grown in the last few years. For example in the early 1990s a 50 gram pack of kava retailed for between $5 and $10; today the lowest price appears to be $20.
The pervasiveness and sophistication of the illegal kava market in Arnhem Land have also grown in recent years. Most kava suppliers in Arnhem Land today are based in Nhulunbuy, and operate through strategic alliances with individuals in communities. Kava is now sold in at least five community that did not apply for permits under the 1990 Northern Territory legislation. In one of these communities the traditional landowners and the local community council combined to impose a ban on the sale of kava in the community in October 1996.
However, it is questionable to what extent any community can successfully maintain a ban in a situation where opinion regarding the desirability or otherwise of kava is divided within the community itself, local councils may have limited authority, and the police find themselves unable to take punitive action against those responsible for importing kava into the Northern Territory in the first place.
In one central Arnhem Land community, where kava consumption grew rapidly in the second half of 1996, weekly retail expenditure on kava appears to be between $50,000 and $75,000.
A local football competition that, prior to the growth in kava sales, supported 10 teams, has had to be abandoned as there are longer any teams.
The potency of kava being sold currently also appears to be greater than in the past.
Previously, most kava sold in Arnhem Land was the low grade ‘lowena’ variety from Fiji, but since the emergence of the Tongan-controlled black market in 1993, most kava sold is of the more powerful ‘waka’ grade. Consumption of this more potent kava may be associated with higher levels of intoxication and other health-related sequelae reportedly occurring in Arnhem Land.
Two attempts have been made in the past to obtain broad estimates of kava consumption patterns in Arnhem Land. In 1987 Alexander et al. estimated average daily consumption by drinkers at from 14 to 53 grams of kava powder. The same study also concluded that kava consumption in Arnhem Land had peaked and was in decline.
In contrast, a second study by d’Abbs in 1993, found that kava sales had increased steadily through the second half of the 1980s, from a mean 166 kilograms per month in January-June 1986 to a mean 2,287 kilograms per month in the corresponding months of 1990. Using sales data from two communities, the 1993 study estimated mean per capita consumption by drinkers to be 88.3 grams of kava powder per day in one community and 66.5 grams per day in the other. These levels were considerably higher than the 1987 study reported and fell within the ‘very heavy’ consumption range identified in an epidemiological study as being linked to adverse health effects.
A survey of kava consumption in 1992 by a doctor employed by Miwatj Health Aboriginal Corporation found that 66% of males and 33% of females reported drinking kava. A third of male drinkers (32.4%) and a quarter of females drinker (23.4%) reported drinking kava 4 to 7 times a week – 28% of male drinkers and 13% of females drinkers reported consuming 8 or more cups per drinking session.
Health, social and economic consequences of kava use in Arnhem Land Reports of adverse consequences of kava use have persisted since kava was introduced into Arnhem Land communities in the early 1980s, and have largely focused on the effects of
kava on health and, to a lesser extent, social and economic impacts. Some reports highlight positive effects of kava, especially as an alternative to alcohol.
Most attempts to assess the effects of kava are grounded in one of three approaches. The first is based on observed association between kava drinking and a number of adverse outcomes.
A second approach, generally associated with a more favourable assessment of the effects of kava, accepts the evidence of adverse outcomes, but posits three additional qualifications: (1) association does not necessarily indicate causation; kava may be a causal agent, but equally, it may be one of several contributory factors, or both heavy kava drinking and the
phenomenon in question might be effects of a deeper underlying cause; (2) even if kava is shown to be a cause of a particular effect, its removal may not lead to the disappearance of the effect, since another causal agent may take the place of kava; (3) however disturbing the effects of excessive kava misuse may be, the removal of kava would be likely to lead to more serious consequences, associated with alcohol abuse and/or petrol sniffing. The third
approach is grounded, not in the interpretation of observed correlates of kava consumption, but on analyses of the chemical and toxicological properties of kava itself. Those who adopt this approach acknowledge that the properties of the active ingredients of kava are not fully understood, but usually insist that there is at present no evidence of sufficient toxicity to warrant restricting the availability of kava, other than by the regulatory mechanisms applied to food products in general.
Very little systematic research has been carried out on possible effects on health of long term kava consumption at the levels currently prevailing in Arnhem Land.
Heavy kava consumption has long been associated with effects on the skin, although the mechanism whereby these effects occur is still not understood. Skin effects appear to be reversible.
Studies in Arnhem Land have shown kava drinkers to have markedly elevated levels of the liver enzyme γ-glutamyl transferase (GGT) - even more so than those recorded among alcohol users - an indicator of liver damage This suggests that kava may be even more toxic to the liver than alcohol. However (a) again the mechanisms involved are not understood; (b) GGT levels have been found to decrease when drinkers stop consuming kava, but (c) beyond a certain (as yet unknown) point, liver damage may not be reversible.
The Mathews et al (1988) pilot study also found evidence linking heavy kava drinking with:
• pulmonary hypertension;
• decreased numbers of blood lymphocytes and decreased platelet volumes;
• adverse effects on blood biochemistry;
• haematuria, suggesting effects on the kidneys and renal system.
Recent anecdotal reports from experienced clinicians suggest that chronic excessive kava use may be associated with an increased susceptibility to serious infectious disease and the development of neurological abnormalities.
A possible link between excessive kava consumption, ischaemic heart disease and sudden cardiac deaths in relatively young people remains open to conjecture, but there is a strong perception and some crude data to suggest that excessive kava consumption may be a
contributing factor, along with tobacco smoking, poor nutrition and excessive alcohol consumption.
Much of the evidence presented to the Inquiry either verbally or in writing contributed to the available research evidence. This evidence included reports of kava’s effects on skin;
thrombotic effects; liver damage; lower resistance to chest and other infections; fitting, and effects on eyes and vision.
In addition, several submissions associated heavy kava use with malnutrition among drinkers and drinkers’ dependents.
There is very little published literature on the social effects of kava drinking in Arnhem Land.
Alexander et al. (1987) presented findings of kava use in Arnhem Land communities between July and December 1986 as part of a study of drug use in Aboriginal communities in the Northern Territory. Findings from this study have been summarised above.
Ethnographic aspects of kava use in two Arnhem Land communities were reported by Gerrard based on fieldwork conducted in 1987 and 1988. In this paper, Gerrard reported that kava was often used as an adjunct to alcohol rather than as an alternative and she attributed
apparent high levels of consumption to a traditional hunter-gatherer mode of consumption. It was observed also that kava consumption usually took place with little or no ceremony and was not necessarily a group activity.
Anecdotal evidence presented to the Inquiry included both adverse and more beneficial reports of the social correlates of kava consumption. Several people alleged that all night kava drinking sessions were common and this impacted upon people’s ability to pursue daily activities, including employment and cultural activities, thereby weakening the social fabric of the community as a whole.
According to some, kava contributed to family conflict and breakdown and violence usually associated with disputes over the amount of money being spent on kava as opposed to food and other items. In contrast a submission from a council of a community in which kava drinking has long been widespread stated that “Kava is calm and peaceful drinking. It makes no trouble for our community”.
Submissions to the Inquiry in relation to the economic effects of kava use in Arnhem Land most commonly cited the considerable expenditure on kava and the detrimental impact this then has on the health and well-being of other family members, especially children.
Others were concerned with the profits from kava sales going to the non-Aboriginal black- marketeers and not flowing back into the local communities.
Kava and alcohol
The major reason advanced for the introduction of kava into Aboriginal communities in Arnhem Land has been that kava provides an alternative to alcohol. Kava is said to allow people to enjoy the pleasures of intoxication, but unlike alcohol does not lead to conflict, violence, injury or social disruption. This argument still persists in several Arnhem Land communities and has been advanced in many Pacific Island countries as well.
However, the extent to which kava has been used as an alternative to alcohol in Arnhem Land communities has been questioned by a number of observers. Several studies suggest that, in some communities at least, kava is often an adjunct to alcohol, rather than an alternative.
Chalmers concluded that while kava use was effective as an “anti alcohol” strategy in some communities, it has been less effective and contributed to multi drug use in other
communities. She also found no evidence to suggest that kava use reduced alcohol-related offending in Arnhem Land.
Some experimental work has been carried out in relation to the interaction between kava and alcohol. A study involving mice found that the interaction was much greater than a purely additive effect for hypnotic and toxic effects. A placebo-controlled randomised double blind study involving humans found no evidence of interactive effects between alcohol and kava with respect to safety-related psychological tests, although the dosages of kava extract and alcohol were both moderate. Another study of acute effects of kava alone, or in combination with alcohol, on subjective measures of impairment and intoxication and on cognitive performance, found that kava alone had little effect on cognitive performance, but that it potentiated both perceived and measured impairment when combined with alcohol.
Future options for regulation of kava in Arnhem Land
Among Aboriginal communities in which kava is or has been widely used, there is a wide range of views about the desirability of kava being made available, and about the benefits and costs associated with kava. In some communities, traditional owners and/or the local council have attempted to impose bans on the sale and supply of kava in their communities, on the grounds that kava has been associated with illnesses, anti-social behaviour and a breakdown in community activities such as employment programs.
However, in the absence of effective controls on the regional kava trade - controls that can only be exercised by governments - these communities have found it virtually impossible to prevent kava being brought into the community.
At the other extreme, some community authorities have called for continuing availability of kava, with sale and supply being subjected to minimal regulation. The most common justification for this view is that, while excessive kava use is recognised as a cause of problems in the community, these problems are considerably less serious than those associated with alcohol misuse, and in the absence of kava, many people would turn to alcohol.
Notwithstanding the presence of diverse views about kava, verbal consultations conducted by the Sessional Committee, as well as other sources, including a workshop attended by Yolngu
(indigenous) representatives of five kava-using communities in north-east Arnhem Land, suggest that widespread support exists for a system of controlled supply.
Yolngu advocates of a controlled supply system have indicated that they want to see a wholesale system controlled by Yolngu people themselves. A model advocated by Yolngu participants in a workshop in 1996, chaired by Miwatj Health, involved a Yolngu-
administered wholesale agency, controlled by a board on which each kava-using community would be represented, and through which profits from the sale of kava would be disbursed back to the constituent communities.
We believe that this model should receive serious consideration.
The diversity of views about kava between communities is further complicated by an absence of consensus within many kava-using communities. Those who call for communities to 'make up their own minds' need to accept that in many instances, the requisites for a consensual view simply do not exist.
The range of views about kava expressed by Aboriginal individuals and groups is matched by a similar diversity of views among non-Aboriginal people. One medical officer with
extensive experience in the region has called for an outright ban on kava, on the grounds of apparent associations between heavy kava use and malnutrition, liver damage and possible thrombotic effects, combined with an absence of knowledge about other possible effects of heavy kava use. Another has been highly critical of the NT Government for its unwillingness or inability to enforce controls on kava, and called for a system of regulated supply.
A number of submissions to the Sessional Committee Inquiry addressed the draft Kava Management Bill. One community council - the same council that had earlier banned kava - bluntly rejected it, claiming that it did not provide an appropriate solution to kava-related problems.
One submission called for a deeming clause to be set at two kilograms, rather than five, as proposed in the draft bill. The same submission called for strong financial penalties - in the order of tens of thousands of dollars - against illegal trading.
While these submissions clearly reflected considered responses to the proposed Kava Management Bill, it also became clear to the Committee that many people were not familiar with either the contents or objectives of the bill. The Committee recommends that greater efforts be made in future to describe and explain the proposed bill to members of kava-using communities.
Future research
Any program for future research into kava in Arnhem Land needs to address three issues:
• What research should be done?
• How should the research be done, and
• How should it be funded?
At present, virtually all of the recorded observations about the chronic effects of heavy kava
virtually all of the observed or imputed effects require further investigation. In particular, research is required on:
• central nervous system effects of heavy kava use;
• possible linkages between heavy kava use and susceptibility to melioidosis and other infectious diseases;
• effects of heavy kava use on vision;
• linkages between heavy kava use and malnutrition, both among drinkers and drinkers’
dependents;
• a possible association between kava use, ischaemic heart disease and sudden deaths;
• interactive effects of kava and alcohol.
Other questions that arise from observations among both professional observers and members of kava-using communities include:
• the extent to which heavy kava use is associated with the development of neurocognitive deficits and whether this effect is further exacerbated by heavy alcohol use;
• the nature of the skin reaction associated with heavy kava use, and the extent to which this reaction is associated with increased susceptibility to skin infections;
• the extent to which changes to liver function, neurocognitive deficits and skin changes that may occur with heavy kava use are completely reversible after consumption ceases;
• the nature of tolerance, withdrawal and dependence associated with heavy kava use.
Virtually no research has been carried out into social and cultural aspects of kava use in Arnhem Land. Accordingly, some questions that might be addressed include:
• the meanings and purposes that the use of kava has in kava-using communities today (not necessarily the same meanings and purposes as those associated with the introduction of kava in the early 1980s);
• attempts, particularly successful attempts, to control kava use at the level of the community;
• people’s reasons for drinking/not drinking kava, and for ceasing or reducing kava consumption;
• differences between and within communities in patterns of kava use.
To proceed further with itemising research topics in the absence of further consultation with members of kava-using communities would, in our view, be inappropriate. This brings us to the second aspect of this issue.
Research proposals must take account of indigenous perceptions about kava and problems associated with it, rather than be guided by outsiders’ curiosity, and the processes through which any research is conducted must involve negotiation with communities and groups involved, joint participation in determining the research design, ethical clearances, and adequate feedback mechanisms.
At the time the present Inquiry was set up, it was anticipated that the NT Government might impose a levy, similar to the Living With Alcohol Trust Account, on all kava sales, with a purpose of funding research and education on kava. Since that time, the High Court has, in effect, removed the constitutional legitimacy which State and Territory governments require to raise any levies or excises of this nature. Given the nature and recency of this
development, the Committee considers it to be beyond its terms of reference to suggest mechanisms for funding further research on kava in Arnhem Land.
However, we do believe that the issue needs to be addressed at a Territory level, for the reason outlined at the beginning of this chapter: namely, in a context where demands on limited health research funds are intensive, it is not realistic to expect that adequate funds will be forthcoming nationally to provide for a research program on a subject that, from the point of view of other States and Territories, is hardly of pressing concern.
1. INTRODUCTION
On 21 November 1996 the Northern Territory Attorney General and Minister for Health, Mr Burke, tabled in the Legislative Assembly a draft Kava Management Bill 1996, and at the same time moved that further consideration of the Bill, and of the broader issue of kava regulation, be referred to the Assembly's Sessional Committee on Use and Abuse of Alcohol by the Community (Northern Territory Legislative Assembly 1996). The Committee was to report back to the Assembly by May 1997.
The Terms of Reference of the referral, as originally proposed by the Government, set out five tasks. The Committee was asked to:
(a) investigate the association between kava drinking and alcohol;
(b) investigate the health, social and economic consequences of current patterns of kava consumption;
(c) inquire into the circumstances in which kava is brought into the Northern Territory and into Aboriginal communities and the distribution of kava to consumers;
(d) consult with all relevant stakeholders and make recommendations as to the desirability and extent of kava availability in the Northern Territory; and
(e) comment on the legislative framework proposed for kava control - The draft Kava Management Bill forms a basis for community consultation; and
In the ensuing debate, Opposition MLA Syd Stirling successfully moved an amendment, adding a sixth task to the Sessional Committee's brief.
(f) the Committee should assess the body of research into kava use and further study the educational requirements in that regard.
On 29 April 1997, the Minister (Mr Burke) successfully sought an extension of time for the Sessional Committee to allow it to table a completed report at the August sittings of the Assembly (Northern Territory Legislative Assembly 1996/1997, p. 11615). In the meantime, the Sessional Committee had engaged the Menzies School of Health Research to prepare a report addressing the issues covered by the terms of reference.
The report that follows is the outcome of these events. It brings together information and views contained in three sources:
• published literature on kava;
• written submissions to the Sessional Committee's Inquiry on the Issue of Kava Regulation, and
• transcripts of consultative meetings conducted by the Sessional Committee in the course of its inquiry.
In order to enhance the logical flow and coherence of the report, the terms of reference have been re-ordered in the report. Thus, for example, the first term of reference -which concerns the association between kava and alcohol - forms the subject matter of Chapter 5 of the report. The placement of each term of reference in the report is summarised in Table 1.1.
The report proper begins with a background chapter (Chapter 2), which sets out a conceptual framework for examining the effects of kava and other psycho-active substances, a summary of what is known of the pharmacological and toxicological properties of kava, and brief
accounts of the place of kava in the Pacific and its introduction into Arnhem Land. Chapter 3 reports on current trends in the supply and consumption of kava in Arnhem Land. Chapter 4 examines evidence regarding the consequences of current usage patterns, as recorded both in published literature, submissions to the Inquiry, and in consultations conducted during the Inquiry.
Chapter 5 focuses on the relationship between kava and alcohol, and addresses three issues:
the perceived relationship and differences between kava and alcohol; the relationship between kava use and alcohol use in Arnhem Land (i.e. to what extent does kava serve as an
alternative to alcohol, and to what extent as an adjunct to it?), and the limited research data on inter-active effects of kava and alcohol.
Chapter 6 surveys future options for the regulation of kava in the Northern Territory. Chapter 7 examines the current status of kava-related research, and identifies significant gaps in our understanding. The final chapter - Chapter 8 - presents recommendations arising out of the report's findings.
Table 1.1 Relationship between Terms of Reference of the Inquiry and the structure of the report
Term of reference Chapter Title of chapter (a) Investigate the association between kava
drinking and alcohol
5 Kava and alcohol (b) Investigate the health, social and
economic consequences of current patterns of kava consumption
4 Health, social and economic consequences of kava use in Arnhem Land
(c ) Inquire into the circumstances in which kava is brought into the Northern Territory and into Aboriginal communities and the distribution of kava to consumers
3 Current supply and use of kava in Arnhem Land
(d) Consult with relevant stakeholders and make recommendations as to the desirability and extent of kava availability in the
Northern Territory
6 Future options for regulation of kava in Arnhem Land
(e) Comment on the legislative framework proposed for kava control. The draft Kava Management Bill forms a basis for
community consultation.
6 Future options for regulation of kava in Arnhem Land
(f) Assess the body of research into kava use and further study the educational
requirements in that regard.
2 & 7 Research into kava: current status and future needs
2. KAVA - SOME BACKGROUND INFORMATION
2.1. Introduction
Kava is a beverage prepared from the plant Piper methysticum, a tropical plant of the pepper family (Piperacea). The species name ‘methysticum’ - a Greek word meaning ‘intoxicant’ - provides a clue to its properties. In Australia, kava is prepared for drinking by infusing commercially prepared and imported dry powdered roots of the ‘intoxicating pepper’ in water, in much the same way in which a tea bag is infused (Alexander et al. 1987, p. 2;
Duffield & Jamieson 1989).
Kava (or, as it is variously known, 'kava kava', 'awa', 'ava', 'cava' and 'yagona' (Hoyles 1982), has formed an integral part of Pacific Islands ceremonial and recreational life for at least 3,000 years (South Pacific Forum Secretariat 1995). Today, it is used on a daily basis in Vanuatu, Fiji, Tonga, Western Samoa and Pohnpei (Federated States of Micronesia) although, according to the South Pacific Commission, the use of kava in all of these places declined between 1960 and 1980 (South Pacific Commission 1994). It is drunk both in traditional village settings, and in contemporary urban kava bars or 'nakamals', and its use is generally associated with peace, sociability and camaraderie (Lebot et al. 1992, pp. 119-174). It is also used by many of the estimated 60,000 Pacific Islanders living in Australia.
Although there is evidence of it having been used by Torres Strait Islanders in the early years of the 20th century, (Brady 1991; Brunton 1989), it is only since 1981 that it has become popular in several Aboriginal communities in Arnhem Land, where it was introduced by members of those communities in the belief that it offered a less harmful alternative to
alcohol, excessive use of which was causing damage to health and family and community life.
2.2. A conceptual framework
The effects of using any mind-altering substance in a given context are a product, not simply of the chemical properties of the substance itself, but rather an outcome of three sets of factors interacting with each other:
• pharmacological and toxicological properties of the substance itself;
• attributes of the users of the substance, such as their state of physical and mental health, and their usage patterns, and
• attributes of the setting in which consumption occurs, such as the availability of food, availability of other forms of recreation, and employment levels.
(Zinberg, who proposed this conceptual framework, referred to these factors as ‘drug, set and setting’ respectively (Zinberg 1979).
It is because of the interactive effects of these three sets of factors that a pattern of kava use in one setting - say, a village in Fiji - can have very different consequences to a similar pattern of usage in a remote Arnhem Land community. Much of the controversy about whether kava is a harmful or benign substance proceeds on the erroneous premise that its effects can be deduced solely from examination of its pharmacological properties.
In the remainder of this section, we describe briefly (1) the pharmacological and toxicological properties of kava, (2) the use of kava in Pacific Island countries and (3) the introduction of kava to Arnhem Land.
2.3. Pharmacological and toxicological properties
Pharmacologically, kava is classified as a psychotropic agent (Lebot et al. 1992; Meyer 1979;
Jamieson et al. 1989; Jamieson and Duffield 1990b) - a drug that affects psychic function, behaviour or experience. According to Hocart (1929, p. 59):
“It gives a pleasant, warm, and cheerful, but lazy feeling, sociable, though not hilarious or loquacious; the reason is not obscured.”
The effects of kava have also been described as a gentle stimulation followed by depression.
Kava also possesses other pharmacological actions including sedation (a calming effect), hypnosis (sleep producing effects) and analgaesia (reducing pain sensation) as well as local anaesthetic, muscle relaxant and anticonvulsant effects (Lebot et al. 1992; Meyer 1979;
Jamieson et al. 1989; Jamieson and Duffield 1990a,b).
Like any crude vegetable drug, kava is a complex mixture of substances. The main group of active compounds of pharmacological interest has been a group of fat-soluble kava pyrones found in kava resin (Duffield and Jamieson 1988). However, the water soluble fraction may also contribute to the effects (Jamieson et al. 1989). Kava contains no alcohol (Shulgin 1973). It may vary in composition and effects depending on the part of the plant used, whether it is powdered or fresh, the plant type used, the area in which the plant has been produced and the method used to prepare it for consumption (Lebot et al. 1992).
The following pharmacological effects are described as underlying mechanisms for some of the scientifically proven, relevant effects of kava. While it is possible to standardise the dose of kava compounds in experiments, it is very difficult to do this in the field. The amount and subsequent effects of kava compounds actually absorbed by a drinker depend on the method of preparation, including the amount and strength of powder used, the amount of water used and the method of mixing. The effects also depend on the quantity consumed and whether food has also been consumed as well as the age, gender, nutritional status and general health of the drinker (Gajdusek 1979; Lebot et al. 1992; Singh 1992; Mathews et al. 1988).
Most of the pharmacological effects described below are acute effects of kava consumption and follow within 20-30 minutes of drinking, as the kava is absorbed from the stomach (Gajdusek 1979; Lebot et al. 1992).
2.3.1. Local anaesthetic effects
A commonly reported effect of kava consumption is a rapid numbing of the mouth and tongue. In guinea pigs, some kava pyrones have been shown to be equally as potent and long lasting as some local anaesthetics used in clinical practice (Meyer 1979).
2.3.2. Muscle relaxant properties
Early reports of kava consumption described its muscle relaxant properties. Titcomb (1948) quotes a report by a Hawaiian from the last century:
“If you are drunk with (kava), you will find your muscles and cords limp, the head feels weighted and the whole body too.”
Gajdusek (1979, p. 121) also reported the ataxia (incoordination) commonly observed in kava drinkers:
“(Tongarikins) we have seen walking a few hours after the drinking are usually somewhat ataxic, photophobic, and slowed in their reactions. A few who have had a higher dose are extremely ataxic and could return to their homes only with the assistance of their children or myself. There is no belligerency or irritability - only a quiet and friendly somnolence associated with weakness of the lower limbs and the accompanying ataxia”
Animal experiments have demonstrated that the relaxation of skeletal (or voluntary) muscles is a result of the action of kava compounds on the spinal cord rather than a direct effect on muscle (Meyer 1979). In laboratory animals, this effect has also been shown to assist in protecting against convulsions induced by strychnine (Meyer 1979).
2.3.3. Sedative and hypnotic effects
The German pharmacologist Lewin carried out much of the early scientific work on kava in the latter part of last century and a translation of a 1927 publication describes the sedative and hypnotic effects of kava:
“When the mixture is not too strong the subject attains a state of happy unconcern, well-being and contentment, free of physical or psychological excitement……..(When the consumption is excessive) the drinker is prey to exhaustion and feels the need to sleep more than any other sensation. He is overcome with somnolence and finally drifts off to sleep. His sleep is similar to that induced by alcoholic inebriation and the subject comes out of it grudgingly. The effect lasts for about two hours, sometimes longer and up to eight hours” (Lebot et al. 1992, p. 58).
Animal experiments using rats have suggested that kava constituents may exert their sedative and hypnotic effects in a similar fashion to the benzodiazepine group of drugs (Jussofie et al.
1994) which include diazepam (Valium) and oxazepam (Serepax.) Other research has questioned this finding (Davies et al. 1992) and the way in which kava exerts sedative and hypnotic effects remains unknown. However, the sedative and relaxant effects of kava are relatively mild when compared to diazepam and oxazepam (McKay 1995). Animal experiments have also demonstrated additive effects and interactions between kava and barbiturates for sleeping time (Keller and Klohs 1963) and between kava and alcohol for sleeping time (Jamieson and Duffield 1990b).
2.3.4. Analgaesic effects
“Women drink fresh masticated kava root as an anaesthetic when they are being tattooed”
(Lebot et al. 1992).
Kava has long been reported to have be used within traditional South Pacific culture for its potent pain reducing properties (Lewin 1931, pp. 215-225; Keller and Klohs 1963). Over eight constituents of kava have been shown to have analgaesic activity in mice and other experimental animals, but were shown to act in a different way to opiate analgaesics such as morphine (Meyer 1979; Jamieson and Duffield 1990a).
2.3.5. Effects on vision
One of the acute effects of kava consumption is photophobia (a wish to avoid bright light) (Gajdusek 1979). Frater (1952) observed that a group of students who had consumed kava had dilated pupils which reacted very slowly to light. Similarly Garner and Klinger (1985) observed that a 32 year old male who had ingested kava also had dilated pupils and a reduced near point of vision, reduced ability for the eyes to converge on an object and disturbance to the oculomotor balance (i.e. the balance between muscles controlling eye movement) (Garner and Klinger 1985). The authors concluded that these effects probably resulted from the effects of kava on the central nervous system. However, they could find no deterioration in perceptual aspects of visual “sharpness” in their subject.
2.3.6. Effects on perception, memory and learning
Some human experimental work has been carried out on the acute effects of standard kava extracts on perception, memory and learning in order to test assertions by manufacturers of kava-based products regarding the beneficial effects of these products (Munte et al. 1993;
Heinze et al. 1994). Comparisons were made between the performance of volunteers in undertaking a number of psychological tests after receiving a placebo, a 75mg dose of oxazepam (Serepax) and 200mg of a kava extract (WS 1490) (Heinze et al. 1994). It was concluded that the kava extract produced a positive effect on attention and memory processing. Similar experiments have also suggested a beneficial effect of kava extract on word recognition tests (Munte et al. 1993).
Other kava extract studies with human subjects have suggested a marked improvement in concentration tasks in individuals receiving 300 mg of kava extract (WS 1490) per day (Herberg 1993). Assuming that the extract contains 70% kava lactones (Backhauβ and Krieglstein 1992), and that dried rootstrock has a kava lactone concentration of 15-20%
(Lebot et al. 1992), these doses are equivalent to approximately 1.0-1.5 gram of kava. By comparison, heavy kava users in Arnhem Land are reported to consume between 300-400 grams per week (Mathews et al. 1988).
An Australian study carried out by Prescott et al. (1993) found that the acute administration of kava (200g/person) did not significantly affect cognition, although there was a trend to poorer performance. However, subjects reported marked feelings of intoxication with this relatively high dose.
Evidence concerning possible interactive effects of kava and alcohol is considered separately below, in chapter five.
Notwithstanding the findings reported above, the effects of chronic kava use on cognition remain unknown, particularly at the levels of consumption reported in Arnhem Land.
2.3.7. The development of tolerance to kava
Drug tolerance is defined as the need to increase the dose to achieve the same effect.
Tolerance is commonly associated with the development of dependence (Jaffe 1990).
Duffield and Jamieson (1991), using mice, found that there was a rapid development of tolerance to the effects of an intraperitoneal injection of aqueous kava extract in producing a loss of muscle control and reducing spontaneous activity (Duffield and Jamieson 1991). A lipid extract (i.e. kava resin) did not produce the same effect.
The results of these experiments were paradoxical because the active ingredients of kava are mainly found in the resin rather than the water-soluble extract and it was concluded that the tolerance was probably due to an unknown, water-soluble active ingredient (Duffield and Jamieson 1991). Furthermore, the water soluble extract was found to be pharmacologically inactive when given orally to mice (Duffield and Jamieson 1991). Nevertheless, it was suggested that while heavy kava users may become tolerant to some effects of the drug, to other effects, tolerance may not occur.
2.4. Kava in the Pacific
Lebot et al. (1992) describe kava in those Pacific Island countries where it has long been used as part of political, religious and economic systems. In the political domain, drinking
practices provide a means of expressing social relationships, defining social statuses and symbolising resolutions of conflict. At the same time, these practices also serve to regulate consumption. In the religious domain, kava is a vehicle for communicating with gods and ancient spirits, and for obtaining inspiration. It is also an important component of island economies, especially for Fiji, Tonga and Vanuatu (Lebot et al. 1992, pp. 119-174). Fiji's kava crop, for example, is said to be worth in the order of $100 million annually (South Pacific Forum Secretariat 1995). According to the South Pacific Forum Secretariat, kava exports are an increasingly important foreign exchange earner for several Forum Island Countries, with demand being driven largely by the European pharmaceutical industry. In 1995, for example, one German pharmaceutical company placed an order for 100 tonnes of dried kava with the intention of manufacturing an anti-stress pill to be marketed in Southeast Asia (South Pacific Forum Secretariat 1995).
A recent report on the activities of the Port Vila-based Kava Kompany refers to ten new products said to have been introduced onto the US market, including Mellow Out, a blend of kava and a Chinese herb selling for $US90 per litre bottle; Kavatrol, a 30-capsule packet sold for less than $US9 and directed to the 'jet-lag' market; Liquid Kalm, an after dinner syrup for stress relief, and Erotikava, a 200 ml bottle of syrup recommended for use after dinner, with candlelight and soft music! (Seneviratne 1997).
In 1994, Australia imported $606,500 worth of kava from Fiji, making it the second largest importer of Fijian kava, after Germany (with a significant difference: whereas German demand, being mainly pharmaceutical, was for dried kava roots, Australian imports were largely in the form of dried pounded kava - for consumption) (South Pacific Forum Secretariat 1995).
In some places, kava has also become a symbol of emerging national identity. For example, in 1990 (the same year, coincidentally, that the National Health and Medical Research Council in Australia officially designated kava as a Schedule 4 drug) Vanuatu issued a
postage stamp that denoted kava as 'the national plant'. Kava cups also appear on the Pohnpei state flag and the official State Seal (Lebot et al. 1992, p. 208).
2.5. Kava in Arnhem Land
The events associated with the introduction of kava into Arnhem Land have been well documented although, it should be noted, all written accounts are by non-Aboriginal
observers (Hoyles 1982; Downing 1985; Alexander et al. 1987; d'Abbs 1995). Only a brief summary will be given here.
Kava entered Arnhem Land via Yirrkala community, following a visit to Fiji late in 1981 by a group of Yolngu men in the company of a Fijian community worker employed at the time by the Uniting Church Aboriginal Advisory and Development Services (AADS) (Alexander et al.. 1987). The purpose of the visit was to study village development, but while in Fiji the visitors were offered kava, and became attracted to its potential use in their own community as a recreational beverage that had mind-altering properties but that did not lead to violence - in contrast to excessive alcohol use which, at the time, had attained what one contemporary observer described as 'epidemic proportions' (Hoyles 1982). Following the men's return to Yirrkala, they arranged for continuing supplies of kava through an importer based in Sydney.
In 1982, another AADS-employed Fijian community worker was instrumental in introducing men from the island community of Warruwi (Goulburn Is.) to kava at Yirrkala, and over the next two years its use spread to a number of other coastal and island communities (Alexander et al. 1987, p. 14).
Two points should be kept in mind regarding the introduction of kava to these communities.
Firstly, all of them had previously banned the supply and consumption of alcohol from the communities. Secondly, although a number of non-Aboriginal individuals played a key role at this time in facilitating the supply of kava, the decision in these communities to import kava was taken by Aboriginal people themselves. (This is not to say that support for kava has ever been unanimous in these communities. As is pointed out below, one of the most
intractable aspects of kava-use as a regulatory issue remains the diversity of views within many communities about the desirability or otherwise of having access to kava.)
According to Hoyles (1982), who provides an early account based on one community, early usage patterns were modelled, not on ceremonial traditions of kava-drinking, but on a style of social drinking prevalent in many Pacific Island towns. A particular attraction was the kava bowl, which became a focal point for drinking 'parties', providing the fellowship of alcohol without the attendant violence. 'Kava parties' in this community commenced around 3 pm with two or three people, growing to about twenty by midnight, and including alcohol drinkers and non-drinkers alike.
Russell (1985), in another early account, states that in most communities, homeland resource centres or other community groups ordered kava from importers in Sydney and Canberra, who in turn imported kava powder direct from Fiji and Tonga. In these cases, Russell claimed, at least some of profits from the sale of kava were retained in the community.
However, Russell also referred to European entrepreneurs who sailed boats around the coastal communities, selling petrol, cigarettes, other supplies - and kava. According to Russell, retail expenditure on kava in 1985 amounted to $773,000.
Kava at this time was classified by Australian Customs as a 'food substance' (Gregory and Cawte 1989). Powdered kava was imported into Australia under a tariff item as 'preparation for making non-alcoholic beverages' which would normally attract a duty of 5%. However, as Fiji and Western Samoa were classified as developing countries, it was admitted duty free, and was also tax exempt.
Almost from the moment of its introduction, kava generated controversy. Anecdotal reports claimed that drinkers were engaging in all night 'binges', to the detriment of their own and their families' health, and that the ensuing absenteeism was causing a virtual breakdown in the maintenance of essential community services. It was also alleged that children as young as eight years were drinking kava1.
Other allegations focused on suppliers. Some non-Aboriginal officers stationed in
communities were said to be using their official communication facilities to bring kava in from wholesalers in Sydney and Canberra in order to sell it in the communities at
considerable profit. Even more serious were suggestions that the Uniting Church (which had mission-based links with most kava-using communities) was implicated in the promotion and sale of kava. Kava, according to one observer at the time, was known as 'the church drink' (Nance 1984). In a report prepared for the church's Northern Synod in 1984, a committee of the church acknowledged that individual church employees had been involved in the
introduction and distribution of kava, but argued that they had done so as private individuals, not as representatives of the Uniting Church or its policy (Russell 1985).
Within this context of controversy and allegation, the NT Government turned to the Drug and Alcohol Bureau (DAB) of its own Department of Health for advice on an appropriate policy response. In a series of statements between 1983 and 1985 a departmental position, endorsed by the NT Government, took shape. The main elements of the position were:
• in the absence of clear evidence of its having addictive properties, kava should not be defined or treated as a drug;
• the only adverse health consequence that had been shown to be definitely caused by kava was a dermatitis-like skin condition which only occurred after regular heavy consumption, and which disappeared when consumption stopped or was reduced;
• a number of social and economic problems appeared to be associated with consumption patterns in Arnhem Land, such as absenteeism and disruption to eating routines; these, however, were problems arising out of the manner in which kava was being used, and could not be attributed to kava per se;
• kava also appeared to have beneficial consequences, especially with respect to alcohol- related problems;
• while further monitoring and research into the impact of kava on the health of Arnhem Landers was needed, there was insufficient evidence of adverse consequences to warrant banning or restricting kava. Communities should be left to make their own decisions (d'Abbs 1995).
This position was further endorsed following publication of the first major study of kava use in Arnhem Land in 1987. The study, by Alexander et al. (all of whom worked for the DAB), was based on a sample survey of drug use in non-urban Aboriginal communities conducted in 1986 (Alexander et al. 1987). The authors reported that kava use had in fact declined from the levels prevalent in the early 1980s. Of 11 communities said to have been using kava in 1983, five were reported as having subsequently imposed bans on consumption, and even in those communities where kava was still available, consumption had declined. Expenditure
1 Throughout the remainder of this section, allegations and reports such as this, unless otherwise sourced, are taken from files of the Drug and Alcohol Bureau, NT Department of Health and Community Services.
on kava was considerable - estimated at $2,000 per week in one community; $2,800 in another - but similar to expenditure on cigarettes and tobacco.
In kava-using communities, it was estimated that 71% of men aged 15 and over, and 20% of women drank kava. An average kava drinker would consume 1.6 litres of kava beverage per sitting. Most drinkers reported consuming kava at least once a week, and 21% reported drinking every day. The report stated that, contrary to claims that kava was being mixed more strongly in Arnhem Land than in the South Pacific, Aboriginal kava drinkers were consuming a weaker mixture.
The authors asserted that nobody in the kava-using communities wanted kava banned, although some acknowledged a need for controls on availability. On the positive side, kava was said to function as a 'partial' substitute for alcohol; to have helped reduce alcohol-related morbidity and violence, and to have helped with urinary-genital problems. Turning to negative aspects, the authors acknowledged the occurrence of skin dryness, scaliness and discolouration, but added that 'No major health problems or deaths have been shown to be kava-related' (Alexander et al. 1987, p32). Referring to allegations about the time and money absorbed by kava-drinking, and associated neglect of children, the authors argued that '..these problems are not associated with kava as such, but with the social impacts of its use'
(Alexander et al. 1987, p.32).
The authors also argued against imposing statutory controls on kava: kava-using communities, it was claimed, had demonstrated a capacity to regulate their own kava consumption.
Kava's favourable status received further endorsement around this time from the US Food and Drug Authority, which announced that it would not take action regarding kava in the absence of evidence of toxic effects on consumers.
Alexander et al.'s portrayal of the kava market as small and declining, however, was called into question by evidence of increases both in the size and sophistication of the kava market.
By the end of 1986, a number of commercial enterprises had been established, or were in the process of being set up, in order to exploit a still legal market.
In June 1987, Aboriginal groups in Broome demonstrated against plans by two Darwin-based entrepreneurs to market kava in the Kimberley. Aboriginal Affairs Minister Ernie Bridge, himself an Aboriginal resident of the area, responded to these moves by imposing a three- month moratorium on the sale of kava in WA.
Later in the same year, a delegation of 10 Aboriginal adults from the Kimberley and Pilbara regions of WA, together with one non-Aboriginal person, visited the NT in order to
investigate the effects of kava use. Following the visit, several members of the delegation published scathing attacks on the NT Drug and Alcohol Bureau. One member claimed that DAB officers “gave us first class sales promotion talks on kava and told us there were no side effects, but rather it is a mild sedative for a good night's sleep after a 24 hour session of kava drinking' (Assan 1987, p. 22).
The delegation also reported concerns from Aboriginal people who felt that they were being used as ‘guinea-pigs’ in experimental research on the effects of kava being conducted by the Menzies School of Health Research (Drury et al. 1987).
These concerns arose out of a pilot study being conducted by the Menzies School in a kava- using coastal community. In November 1987, the School released a preliminary statement of results from the study. The findings were very different to those reported by Alexander et al.
earlier in the same year. Kava drinkers, the Menzies researchers reported, were more likely than non-drinkers to suffer from general ill health, including shortness of breath and
characteristic skin rash; malnutrition, with 20 per cent loss of body weight, 50 per cent loss of body fat and other biochemical changes; liver damage, with biochemical changes similar to those caused by large doses of alcohol; and other changes in red blood cells, white blood cells and platelets.
The statement concluded that, while further research was needed, it appeared that heavy kava consumption was very harmful to health and should be discouraged, and that steps should be taken to prevent the introduction of kava into Aboriginal communities where it was not already available.
A more detailed account of the Menzies School findings was subsequently published in The Medical Journal of Australia in June 1988 (Mathews et al. 1988), and the following month The Lancet editorialised on the kava issue (The Lancet 1988).
Critics of the Menzies School study subsequently argued that not all of the health effects observed could confidently be attributed to kava. Douglas (1988) suggested that concomitant alcohol consumption might also have been implicated, while Lebot et al. (1992) claimed that previous alcohol use, current heavy tobacco use and generally poor levels of health might also have contributed to the findings.
In the meantime, however, release of the Menzies School’s preliminary findings strengthened official concerns about the effects of kava. The National Health and Medical Research Council (NHMRC) immediately issued a statement asserting that the effects of long term kava use had not been adequately studied, and that further use should be discouraged (McKay 1995, p. 16). The NHMRC resolution was noted at the November 1987 meeting of the Ministerial Council on Drug Strategy (MCDS), a joint Commonwealth, State and Territory body that presided over the National Campaign Against Drug Abuse, which immediately convened a working party to consider the findings and make recommendations for future research and policy. In March 1988, the working party reported back to MCDS with a series of recommendations that were formally adopted by the Ministerial Council. Under these recommendations, kava use was to be ‘actively discouraged’, advertising of kava was to be restricted, and importation monitored. The working party did not advocate a ban on kava, arguing that any decision to restrict or ban its use should be a matter for State and Territory governments.
The first legislature to restrict the sale and supply of kava in Australia was Western Australia, which in July 1988 invoked section 22 of the W.A. Poisons Act, which allowed for
prohibition of the sale, supply and promotion of designated substances by proclamation. The Act did not outlaw possession of kava, and in fact the proclamation made provision for Pacific Islanders and others who might wish to use kava for traditional purposes to seek
