Khat-related Fatalities in Jazan, Saudi Arabia

Abstract

Interpreting khat-related fatalities is challenging due to a lack of data on cathinone and cathine reference concentrations in postmortem tissues. This study investigated the autopsy findings and toxicological results of Khat-related fatalities in Saudi Arabia's Jazan region from January 1, 2018 to December 31, 2021. All confirmed cathine and cathinone results in postmortem blood, urine, brain, liver, kidney, and stomach samples were recorded and analyzed. Autopsy findings and the manner and cause of death of the deceased were assessed. Saudi Arabia's Forensic Medicine Center investigated 651 fatality cases over four years. Thirty postmortem samples were positive for khat's active constituents, cathinone and cathine. The percentage of khat-related fatalities was 3% in 2018 and 2019, and increased from 4% in 2020 to 9% in 2021, when compared to all fatal cases. They were all male ranging in age from 23 to 45. Firearm injuries (10 cases), hanging (7 cases), road traffic accident (2 cases), head injury (2 cases), stab wounds (2 cases), poisoning (2 cases), unknown (2 cases), ischemic heart disease (1 case), brain tumor (1 case), and choking (1 case) were responsible for deaths. 57% of postmortem samples tested positive for khat only, while 43% tested positive for khat with other drugs. Amphetamine is the drug most frequently involved. Cathinone and cathine average concentrations were 85 and 486 ng/mL in blood, 69 and 682 ng/mL in brain, 64 and 635 ng/mL in liver, and 43 and 758 ng/mL in kidney. The 10th–90th percentiles of blood concentrations of cathinone and cathine were 18 – 218 ng/mL and 222 – 843 ng/mL, respectively. These findings show that 90% of khat-related fatalities had cathinone concentrations greater than 18 ng/mL and cathine concentrations greater than 222 ng/mL. According to the cause of death, homicidal was most common in fatalities involving khat alone (77%). More research is required, especially toxicological and autopsy findings, to determine the involvement of khat in crimes and fatalities. This study may help forensic scientists and toxicologists investigate khat-related fatalities.