Khat, driver impairment and road traffic injuries: a view from Ethiopia

This article comments on the problem of driver impairment due to khat and the resulting road traffic injuries in Ethiopia. The authors maintain that research into traffic accidents has been dominated by issues of concern to high-income countries while issues of primary concern to developing countries have been neglected. One of these is the stimulant effect of the leaf khat (Catha edulis, also spelled qat or kat), commonly chewed by drivers in Ethiopia and other countries in eastern Africa and the Arabian peninsula. The authors first review the traffic and safety statistics from Ethiopia, which has some of the most dangerous roads in the world. Although there is no equipment available to law enforcement officers to measure drug use, both police and government officials as well as the general public believe khat use is a major cause of driver error and crashes. Khat is a stimulant and its regular use as been integral to social life in Ethiopia. The use of khat initially leads to euphoria, feelings of alertness and excitability, typically followed by irritability and insomnia and, later, lethargy. The authors review the legalities of growing and using khat in Ethiopia; the inclusion of khat use under a little-enforced law regarding driving under the influence of "mind-affecting" drugs; how Ethiopia can learn from the international experience of dealing with driving under the influence (DUI) problems; and the need for more road safety research, particularly regarding khat-related impairment. The authors suggest that khat-related impairment could be an overlooked contributor to the extraordinarily high traffic crash and fatality rates in Ethiopia and other countries in eastern Africa. They call for research in three areas that could be used to support effective policy responses: which drivers chew khat; when, and under what circumstances, they chew it; and the beliefs that drivers have about the effects of khat on their driving ability.