Kava, the "feel-good" herb

Drug Store News, Oct 20, 1997

Kava refers to both the plant (Piper methysticum or "intoxicating pepper") and the beverage produced from its dried roots and stems. It is a well-known drink on the South Pacific islands of Western Samoa, Fiji, Tonga, Vanuatu and Hawaii, where drinking cold-water infusions of macerated kava root was an important element of religious and ceremonial occasions since the beginning of recorded history for this region.

Historically, kava has also been used for medicinal purposes such as relaxation and sleep, urinary tract congestion, asthma, rheumatism, and obesity. Today, kava drinking is a social habit of the South Pacific island people, and the kava crop an important economic commodity.

Kava and synthetic kawain formulations have been available in Europe as an anxiolytic drug since 1920. By 1995, kava-kava was the 16th most popular herbal monopreparation in Germany with sales of $8 million US dollars.

Kava has been introduced to the North American culture only relatively recently. Its popularity as a mild, relaxing beverage in its native culture as well as European studies proving its effectiveness as an antianxiety agent have fueled its popularity in the last few years. Currently, kava is classified as a dietary supplement but has potential for development as a heterogenous drug.

[NOTE: Herbs are classified as "dietary supplements" under the Dietary Supplement Health and Education Act of 1994 (DSHEA). As such, they are specifically excluded from FDA drug regulation unless they are marketed with therapeutic claims. Factual labeling claims about how dietary ingredients affect the structure and function of the body must include the following statement: "This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease."]

Since kava is known to promote a general state of well-being, there is also potential for it to become a drug of abuse here. There is anecdotal evidence of abuse in countries where there are no cultural or ritualistic limits to the use of kava. Suppliers of kava are responsible to market this potent herb properly and encourage its proper use to minimize the potential for misuse. The unique ability of kava to reduce anxiety with minimal side-effects in a non-addictive manner warrants further study and consideration by pharmacists as a new means to help their patients.

HERBAL ALTERNATIVES NOW MAINSTREAM

A 1997 telephone survey conducted by Prevention magazine found an astounding 32% (60 million) of adult Americans each spend an average of $54 per year on herbal remedies. Consumers are using herbs to self-treat such common conditions as colds, burns, headaches, allergies, rashes, insomnia, and PMS. And the majority of them feel that herbal remedies are just as safe, effective and cost-efficient as non-herbal remedies. But are pharmacists getting their share of that $3.24 billion market for botanically-based medicinals? Probably not, since people are seeking information on herbs from places other than their pharmacy.

When asked the source of information on herbal products, 72% of American consumers consult books and magazines, 41% hear about herbs from family or friends, 13% from the health food store, 9% from their physician, 5% from television, and a mere 4% from their pharmacist. Seems like a missed opportunity for America's most accessible, most respected health care professional who is the custodian of other self-care remedies.

PHARMACISTS RELUCTANCE

Nirbhay Singh, Ph.D., Professor of Psychiatry and Pediatrics at the Medical College of Virginia, feels that some pharmacists may have a natural bias against herbal products such as kava, considering them "untested, frontier" medicines. While he acknowledges that "for certain conditions, pharmacological medicines are the drugs of first choice," kava can be recommended and has been tested and proven as safe and effective for day-to-day non-clinical stress. Singh, a Fiji native, says that "natural products had been used for 1,000's of years before synthetics were developed," and in fact, "most synthetics are based on natural products." Pharmacists owe it to themselves to increase their knowledge about herbal remedies, to stock quality standardized botanical products produced by ethical manufacturers and to have the ability to offer their patients information and natural alternatives for their self-care. "Pharmacists should let their customers know that these are available and can be used effectively with few side effects," agreed Singh.

RESURGENCE OF INTEREST IN PHYTOMEDICINALS

A couple of decades ago, pharmacognosy was an important part of the pharmacy curriculum in the United States. Then the study of plant-based pharmaceuticals took a back seat to more modern educational pursuits. Now it seems that the "Western" scientific and medical community are taking a cue from the consumer and have had a resurgence of interest in the study of alternative and complementary medicines, including herbs such as kava-kava. Since most of the significant research on phytomedicines and their clinical use comes from thousands of years of herbal tradition in Europe, the German Commission E monographs now serve as the best single resource on herbal medicines and their therapeutic application. The publication of a Commission E monograph allows physicians to prescribe kava-kava for anxiety and be reimbursed by the health insurance system. These German monographs have been translated to English by the American Botanical Council and are available for purchase from the ABC. See Sidebar for the Commission E monograph for Kava-kava. Additional credibility for the use of kava in Europe and worldwide will be obtained upon the anticipated publication of another European monograph by the European Scientific Cooperative of Phytomedicine (ESCOP). ESCOP is an umbrella organization of 14 national European associations for phytotherapy. The goal of ESCOP is "advance the scientific status on safety and efficacy of phytomedicines and to assist with the harmonization of their regulatory status at the European level." A scientific review is well under way toward the development of the kava monograph with a focus on indications and safety issues.