Some Dangers

The acetylcholine-type drugs, especially musca-rine, can be deadly when taken in high doses. In fact, muscarine is the active ingredient causing some forms of lethal mushroom poisoning, but it is unlikely that the mixture of any of the plant products in betel-nut preparations are potent enough to cause lethal overdose. Regular "recreational" use of betel nut is, however, responsible for a number of adverse health consequences that can contribute to the risk for early death.

The most prominent dangers associated with betel-nut chewing are probably the result of a combined effect of the active ingredients and the lime on the gums. The first and most frequently observed physical changes are white plaques appearing on the mucosal lining of the mouth or on the tongue. These are precancerous lesions (leukoplakia) that often lead to the development of very aggressive and serious tumors (squamous cell carcinoma), which can subsequently invade muscles and bone tissue. The prevalence of this cancer among regular betel-nut users is estimated to be as high as 7 percent. Potentially lethal cancers may also develop in the esophagus. Chronic use may also cause oral submucous fibrosis—a form of fiber formation (fibrosis) that usually starts just beneath the gums and may involve the back of the throat and the pharynx. The problem is estimated to be seen in at least mild form in up to 50 percent of chronic betel-nut chewers. This condition usually has a very slow onset, and if use continues it is irreversible, untreatable, and likely to become progressively more severe. The major finding involves a loss of elasticity of the tissue lining the mouth, which causes stiffness that can become so severe as to interfere with eating. Associated problems are a burning sensation in the mouth, ulcers or blisters on the lining of the mouth, decreased sense of taste, and dryness of the mouth lining.

There is little doubt that betel-nut substance can produce fairly intense psychological dependence. Individuals can develop a pattern of constant use, feeling unhappy and incomplete if they cannot get their betel nut. They are also likely to feel they cannot work properly without it, and may spend a great deal of money and time obtaining and using betel-nut mixtures. It is not clear, however, that there is a prominent and identifiable form of physical withdrawal associated with cessation of use.

Betel-nut consumption can be viewed as a public-health hazard in parts of the world where its use is prevalent, because, at least theoretically, the habit of spitting the juice on the street can increase the spread of diseases such as tuberculosis.

(See ALSO: Plants, Drugs from)

BIBLIOGRAPHY

Beecher, D., et al. (1985). Betel nut chewing in the United States, Journal of the Indiana Dental Association, 64, 42-44. Ford, C. S. (1967). Ethnographical aspects of kava. In D. H. Efron, B. Holmstedt, & N. S. Kline, (Eds.), Ethnopharmacologic search for psychoactive drugs. PHS Publ. No. 1645. Washington, DC: U.S. Department of Health, Education, and Welfare. Lewin, L. (1964). Phantastica: Narcotic and stimulating drugs. New York: Dutton. Schuckit, M. A. (1992). Betel Nut: A widespread drug of abuse. Drug Abuse & Alcoholism Newsletter, 21 (1). San Diego: Vista Hill Foundation. Schullian, D. M. (1984). Toothpastes containing betel nut from England of the 19th century. Journal of History of Medicine, 39, 65-68. Talonu, N. T. (1989). Observations of betel nut use, habituation, addiction and carcinogenesis. Papua New Guinea Medical Journal, 32, 195-197.

Taufa, T. (1988). Betel nut chewing and pregnancy. Papua New Guinea Medical Journal, 31, 229-233.

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