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communication) reports the use of kava and talk ther-
<br />apy, modelled on traditional Pacific kava use systems as
<br />extremely valuable in his work with heroin addicts in
<br />Thailand and Massachusetts, USA_ Leading kava
<br />expert, Dr Vincent Lebot (1991) adds weight to this
<br />discussion when stating: `hy pharreawdogical stand-
<br />ards, kava is not classified as a drug, as its consumption
<br />never leads to addiction or dependence. It has psycho-
<br />active properties but is neither an hallucinogenic nor a
<br />stupefactent' (169).
<br />The suggestion that kava damages the liver, first sur-
<br />faced in early 2000 following reports in Western Europe
<br />that 83 patients taking kava tablets died (Schmidt et al_,
<br />2005). This led to what is commonly known as the
<br />European Kava Baa At the time of the ban,
<br />European doctors were estimated to have been pre-
<br />scribing 70 million (tablet) doses of kava daily, with
<br />most of this supplied for alleviating anxiety symptoms
<br />(Schmidt et aL, 2005: 186). The withdrawal of kava
<br />from the European markets led to a 12 -year court
<br />battle which was not resolved until 2014 by the
<br />Federal Court of Germany. The final ruling by
<br />the Court was that it was unlikely kava had caused
<br />the reported deaths, and that liver damage from
<br />kava was so rare it was negligible. The Court rejected
<br />claims of liver damage caused by kava, and
<br />specified that these assertions were a gross misrepresen-
<br />tation of the possible effects (Kuchta et al., 2015;
<br />Schmidt, 2014).
<br />- - Showman
<br />et al. (2015) provide a valuable review of the kava hep-
<br />atotoxicity claim and counter claim literature (60 61)
<br />which includes potential 'Mechanisms of toxicity'
<br />(6163). They summarize that although there is evi-
<br />dence of a link between 'kava and liver toxicity demon-
<br />strated in vivo and in vitro, in the history of Western
<br />kava use, toxicity is still considered relatively ram. Only
<br />a fraction of the handful of roses reviewed for liver
<br />toxicity could be, with any certainty, linked to kava
<br />consumption and most of those involved the co -
<br />ingestion of other medications; supplements. That
<br />means that the incident rate of liver toxicity due to
<br />kava is one in 60 125 million patients' (65)
<br />Singh(2014) discusses additional potential mechan-
<br />isms of toxicity adulterants added to kava to artificially
<br />boost weight to increase sale profit. This can include
<br />'sawdust flour, and the dregs from the extraction of
<br />sugarcane (42)_ As Apoross warned in a recent radio
<br />interview, exporters who engage in this type of uneth-
<br />ical practice are playing a risky game, one that could
<br />have widespread implications should the adulterant
<br />contain bacteria, 'salmonella for instance, and if some-
<br />one gets sick ... this could threaten kava importation'
<br />as it will be `kava' that will he cited as the health threat
<br />and not the adulterant (Kumar et al., 2018, interview:
<br />45 seconds)' To assist in safeguarding kava quality,
<br />the World Health Organization (WHO) and UN
<br />have developed a Kava Codex Alimentarius Quality
<br />Standard which should be in place by 2020.
<br />Commenting on this Codex, Vanuatu kava expert Or
<br />Vincent Lebol stated Tonga, Fiji, Samoa and Vanuatu
<br />were also seeking to register the word `kava' as a trad-
<br />itional beverage associated with
<br />healthy and safe raw materials used it) prepare the bcv-
<br />cage . _kava is banned in the FU and banned in
<br />Australia and we believe this is due to a major misun-
<br />derstanding regarding what kava is... We want to pro -
<br />mom kava for what a is, a very healthy traditional
<br />beverage... If some companies elsewhere want to
<br />extract the active ingredients and prepare some cap-
<br />sules or whatever, this is not called kava any more.
<br />Like if you put caffeine in a capsule, you cannot call
<br />it coffee; if you put in dry raisin peel, you cannot call it
<br />wine, and same for tea. Kava is kava; it is the trad-
<br />dinnel beverage prepared by cold water extraction of
<br />the ground organs of the plant Piper Methysticum, and
<br />nothing else_ We want to protect the geographical on
<br />gins and the healthy quality kava plants we use here on
<br />on original basis. (Blades, 2018, also we Powyk and
<br />Lebot, 20137
<br />Linked to concerns of kava hepatotoxicity is an
<br />increase in gamma -glutamyl transpeptidase (GGT)
<br />levels in the blood following kava use, In their article,
<br />Moulds and Malani (2003) first addressed this matter in
<br />2003 when they asked rhetorically: `How relevant is the
<br />finding that some_-. heavy kava drinkers have raised
<br />serum GGT levels'?', responding: `raised GGT levels
<br />do not necessarily imply "subclinical" liver toxicity'
<br />(452). When questioned by the author in 2009 about
<br />their subclinical liver toxicity comment, former Dean of
<br />Fiji School of Medicine, Professor Robert Moulds,
<br />commented that the abnormalities can be a concern
<br />among doctors who may not be conversant with liver
<br />function tests of kava drinkers, pointing to his col-
<br />leagues article: 'while elevated GGT and white blood
<br />cells [lymphocytes] were abnormal [to those unfamiliar
<br />with kava', effects on the liver], this does not mean that
<br />this abnormality is of concern' (Malani, 2002 7).
<br />Mantesso (2016) also confirms that, kava `may throw
<br />out the liver function a little bit, altering liver enzymes_
<br />Now that's not necessarily saying it's causing liver
<br />damage.' Moreover, Evans (2009) explains that `non-
<br />steroidal anti-inflammatory drugs, lipid -lowering
<br />drugs, antibiotics, histamine blockers (used to treat
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