Within the last decade the hitherto little known psychoactive substance of khat has emerged as a regional and international issue. In the Horn of Africa khat production has spurred an economic boom, but dramatic increases in consumption have raised public health concerns. Given the complexity of the topic spanning multiple academic disciplines and fields of professional practice, the need for a systematic overview is urgent.

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To facilitate the exchange of information, prompt interdisciplinary research and alert international organisations and governments, the authors organised an international and interdisciplinary khat conference in 2009. This special issue of the Journal of Ethnopharmacology contains articles written by different conference speakers that present the current state of knowledge and the challenges for future research and politics.

In the first article, Al-Motarreb et al. (2010) review the evidence for khat as a causal factor for cardiovascular diseases and other internal medical problems. It is not surprising that in many aspects more research is needed in order to come to clear evidence.

Khamadeep Bhui and Nasir Warfa (Bhui and Warfa, 2010) contribute to the question whether khat use is linked to psychotic disorders by re-analyzing one of their studies among Somalis living in the UK. In contrast to studies from the Horn of Africa (Odenwald et al., 2009) they cannot find such a relationship and analyze the reasons for this discrepancy.

Hoffman and Al’Absi (2010) take up a very important topic that has not been studied so far: the neurobehavioral functions that might be impaired by chronic khat use. While this is clearly the case for amphetamine and cocaine, the authors develop suggestions how cognitive impairments and neurobehavioral dysfunctions can be studied and evaluated among khat users.

Al-Hebshi et al. (2010) contribute with an article that would have been called provocative some years ago: They study a possible positive medicinal effect of khat leaves. Their well-controlled study reports first evidence for a probiotic effect in the mouth of khat chewers. Studies like this are urgently needed for a balanced and empirical oriented evaluation of khat.

Kassim et al. (2010) contribute to the field of khat research by evaluating a common psycho-diagnostic screening questionnaire for drug dependence for khat research. They developed a psychometric research tool that can be used for the study of khat addiction.

Paul Griffiths and his colleagues from the European Monitoring Centre for Drugs and Drug Abuse (Griffiths et al., 2010), write about the difficulties of monitoring khat use in the European Community. They review the available data on khat use in Europe and analyze the current situation in the EC where khat is legal in some member countries and illegal in others. They stress that no reliable data exist on khat trade and use on a European level and argue that this situation needs to be changed.

Klein and Metaal (2010) raise the question of what is the best way to regulate khat in the countries where it is a legal commodity. Their suggestions are surprisingly similar to what one would expect to be the case for any culturally sanctioned substance with a potential for harm.

In a contribution from political economy, Hansen (2010) evaluates the impact of khat use on the political situation in Somaliland, the North-Eastern part of Somalia, where khat abuse is most evident today. In his article he argues that the meaning of khat is ambiguous, contributing to the political stability and instability of this self-declared state.

Susan Beckerleg’s topic of research is the popular discourse on khat in East Africa (Beckerleg, 2010). In her contribution she reports on how khat is commonly associated with male sexual (dys)functions, female sexual lapse and prostitution as well as moral decay. She unmasks that sensationalist media reports and the general male attitudes are in many ways unsubstantiated by empirical evidence.

What will be the future of khat? Will it be another internationally traded illegal commodity? In his perspective article Gebissa (2010) reviews the evidence in favor and against such a development. He believes that khat will have a stable regional appearance but will not turn out to be an internationally traded drug. This will not make it necessary to push international scheduling.

Odenwald and colleagues try to answer the question why khat use cannot be eradicated, but why it should be regulated and why this has not yet happened (Odenwald et al., 2010). They argue that a detailed and empirically founded consensus is needed on harms and benefits that should be the base of a series of international and regional conferences.