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excess stomach acid production), antifungal agents,
<br />seizure medication, antidepressants, and hormones
<br />such as testosterone', ran elevate CGT levels, although
<br />these continue to be routinely prescribed (24).
<br />In making the case for kava, it is worth extrapolating
<br />the rarity of kava hepatotoxicity (liver damage as men-
<br />tioned above) against the risk level posed by other com-
<br />monly prescribed drugs. A comparison with Diazepam,
<br />a widely prescribed benzodiazepine that has similar
<br />effects to kava, is useful at this point. Schmidt et al.
<br />(2005), who investigated 83 kava toxicity reports that
<br />had been influential to initiating the Kava Ban in
<br />Europe, pointed out that: `only three cases could be
<br />attributed to kava with high probability'. Of these
<br />cases it was suspected that other factors were respon-
<br />sible for the negative reaction (Schmidt et al., 2005:
<br />182). The study reported 12 `probable' cases of liver
<br />failure would account for a kava toxicity rate 'of 0.23
<br />cases per 1 million daily doses' (187). Schmidt and col-
<br />leagues note that at the time of the European Kava Ban,
<br />diazepam toxicity rates accounted for 2.12 cases of per
<br />million daily doses (187). In another study, kava hep-
<br />atotoxicity rates were compared with that of
<br />Paracetamol/Panadol. In that study, Rasmussen
<br />(2005) reported that these commonly prescribed over-
<br />the-counter pain medications amounted for 'an esti-
<br />mated 458 deaths due to acute liver failure in the
<br />U.S. each year', and summarized that kava was
<br />'dramatically' safer than the popular readily available
<br />analgesic's (7).
<br />In an article which considers rates of kava hepatotox-
<br />icity, Baker (2011) argues that attempting to calculate
<br />risk between kava and commonly prescribed pharma-
<br />ceutical drugs is ambiguous. For instance, he explains
<br />that simply trying to estimate 'the number of people
<br />taking a specific medication' is a challenge in and of
<br />itself, whereas 'counting cases of adverse reactionis
<br />even more difficult (374). Regardless that the risk detcr-
<br />mination of well-controlled pharmaceuticals is ambigu-
<br />ous and problematic, these continue to be widely
<br />prescribed. Conversely, while `the frequency of toxicity
<br />from any kava -containing substance is exceedingly low;
<br />low enough that it can be difficult to ever observe it in
<br />the relatively small populations in which kava is trad-
<br />itionally consumed', kava tends to draw a higher level of
<br />criticism than a number of well controlled and regularly
<br />prescribed pharmaceuticals known to be associated with
<br />hepatotoxicity (Baker, 2011 379 380) such as Diazepam
<br />and Paracetamol/Panadol as explained allrrve.
<br />.! Of even greater relevance
<br />in the re -branding of kava, is the risk comparison
<br />and Law
<br />between kava, alcohol and tobacco. The WHO reports
<br />that annually there are approximately 3 million deaths
<br />worldwide from alcohol (Poznyak and Relive, 2018),
<br />with this socially accepted substance reported as the
<br />leading cause of harm worldwide for 15 to 49 year
<br />olds (Griswold et al., 2018), and alcohol addiction the
<br />most prevalent form of addiction globally (Degenhardt
<br />et al., 2013). Australia, one of the few countries world-
<br />wide with heavy kava use restrictions; reported more
<br />than 5500 deaths as a direct result of alcohol use in
<br />2014, and over 15,500 from smoking tobacco (Cancer
<br />Council Australia, 2016; Gan et al., 2014: vii). Over the
<br />last 10 years there has not been a single death world-
<br />wide attributed directly to kavas The 2016 WHO kava
<br />risk assessment reported that on balance, the weight -
<br />of -evidence from both a long history of use of kava
<br />beverage and from the more recent research findings
<br />indicate that it is possible for kava beverage to he con-
<br />sumed with an acceptably low level of health risk'
<br />(Abbott, 2016: 26). The use of the terms 'on balance'
<br />and 'weightaf-evidence by the WHO is in contrast to
<br />the risks posed by tobacco and alcohol. In a recent drug -
<br />harm ranking exercise undertaken in Australia, experts
<br />assessed the harts levels of 22 drug substances to both
<br />the user and others using the Multicnteria Decision
<br />Analysis (MCRA) methodology. When the scores for
<br />both the harts to the user (36) and harm to others (41)
<br />were combined (77), 'alcohol was the drug ranked as
<br />causing the greatest overall ham', scoring higher than
<br />crystal methamphetamine (42/24: harm to user/others
<br />respectively), heroine (45/13), tobacco (18/14), cocaine
<br />(22/3) and ecstasy (5/2) (Bonomo et al., 2019: 763).
<br />Conversely, kava was ranked as the least -most harmful
<br />of the 22 assessed substances, with the harm to the user
<br />scored at 2, and harm to others 1 (Bonomo et al., 2019:
<br />764)- Concerning alcohol and harm to others, an esti-
<br />mated 53 million people in the USA — or I in 5 — are
<br />reported to annually experience `secondhand harm' from
<br />alcohol use (Nayak et al., 2019) whereas the 'wealth of
<br />new evidence on the health effects of exposure to second-
<br />hand tobacco smoke' led the WHO (2007) to implement
<br />policy recommendations aimed at protecting others
<br />from second-hand tobacco smoke (3). Due to the dispro-
<br />portional
<br />ispmportional risk levels of (legal) alcohol and tobacco when
<br />compared with kava, weight and balance comparisons as
<br />reported by the WHO present kava in a very favourable
<br />light.
<br />So far we have seen how rosins around kava evolved
<br />over time This was the result of the first explorers
<br />Eurocentric views of the South Pacific, and misinfor-
<br />mation and prejudice that has survived into the 21st
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