Kava

{{See also|Domesticated plants and animals of Austronesia}}

Kava is conspecific with Piper wichmannii, indicating kava was domesticated from Piper wichmannii (syn. Piper subbullatum).{{cite journal |last1=Applequist |first1=Wendy L. |last2=Lebot |first2=Vincent |title=Validation of Piper methysticum var. wichmannii (Piperaceae) |journal=Novon: A Journal for Botanical Nomenclature |date=25 April 2006 |volume=16 |issue=1 |pages=3–4 |doi=10.3417/1055-3177(2006)16[3:VOPMVW]2.0.CO;2|s2cid=86552278 |url=https://www.biodiversitylibrary.org/part/121786 }}{{cite book|first1=Malcolm|last1=Ross|editor1-first=Malcolm|editor1-last=Ross|editor2-first=Andrew|editor2-last=Pawley|editor3-first=Meredith|editor3-last=Osmond|title =The lexicon of Proto Oceanic: The culture and environment of ancestral Oceanic society|chapter =Other cultivated plants|publisher =Pacific Linguistics|volume=3 |year =2008|pages=389–426|isbn =978-0-85883-589-4|chapter-url =https://openresearch-repository.anu.edu.au/handle/1885/106908}}

Kava was spread by the Austronesian Lapita culture after contact eastward into the rest of Polynesia. It is endemic to Oceania and is not found in other Austronesian groups. Kava reached Hawaii, but it is absent in New Zealand, where it cannot grow.{{cite journal |last1=Lebot |first1=V. |last2=Lèvesque |first2=J. |title=The Origin and Distribution of Kava (Piper methysticum Forst. F., Piperaceae): A Phytochemical Approach |journal=Allertonia |date=1989 |volume=5 |issue=2 |pages=223–281}}{{cite web|url=http://www.temarareo.org/PPN-Kava.html|title=*Kava ~ *Kavakava |work=Te Mära Reo: The Language Garden|publisher=Benton Family Trust|access-date=15 January 2019}} Consumption of kava is also believed to be the reason why betel nut chewing, ubiquitous elsewhere, was lost for Austronesians in Oceania.{{cite journal |last1=Blust |first1=Robert |last2=Trussel |first2=Stephen |title=The Austronesian Comparative Dictionary: A Work in Progress |journal=Oceanic Linguistics |date=2013 |volume=52 |issue=2 |pages=493–523 |doi=10.1353/ol.2013.0016 |s2cid=146739541 |url=https://www.researchgate.net/publication/265931196}}

According to Lynch (2002), the reconstructed Proto-Polynesian term for the plant, *kava, was derived from the Proto-Oceanic term *kawaR in the sense of a "bitter root" or "potent root [used as fish poison]". It may have been related to reconstructed *wakaR (in Proto-Oceanic and Proto-Malayo-Polynesian) via metathesis. It originally referred to Zingiber zerumbet, used to make a similar mildly psychoactive bitter drink in Austronesian rituals. Cognates for *kava include Pohnpeian sa-kau; Tongan, Niue, Rapa Nui, Tuamotuan, and Rarotongan kava; Samoan, Tahitian, and Marquesan {{okina}}ava; and Hawaiian {{okina}}awa. In some languages, most notably Māori kawa, the cognates have come to mean "bitter", "sour", or "acrid" to the taste.{{cite journal |last1=Lynch |first1=John |title=Potent Roots and the Origin of kava |journal=Oceanic Linguistics |date=2002 |volume=41 |issue=2 |pages=493–513 |doi=10.1353/ol.2002.0010|s2cid=145424062 }}{{cite journal |last1=Heathcote |first1=Gary M. |last2=Diego |first2=Vincent P. |last3=Ishida |first3=Hajime |last4=Sava |first4=Vincent J. |title=An osteobiography of a remarkable protohistoric Chamorro man from Taga, Tinian |journal=Micronesica |date=2012 |volume=43 |issue=2 |pages=131–213}}{{cite book|first1=Mervyn|last1=McLean|title =Music, Lapita, and the Problem of Polynesian Origins|publisher = Polynesian Origins|year =2014|isbn =978-0-473-28873-0|url =http://polynesianorigins.org/chapter-11-food-plants/|archive-url =https://web.archive.org/web/20160125155846/http://polynesianorigins.org/chapter-11-food-plants/|url-status =usurped|archive-date =25 January 2016}}

In the Cook Islands, the reduplicated forms of kawakawa or kavakava are also applied to the unrelated members of the genus Pittosporum. In other languages, such as Futunan, compound terms like kavakava atua refer to other species belonging to the genus Piper. The reduplication of the base form is indicative of falsehood or likeness, in the sense of "false kava".{{cite web|url=http://www.temarareo.org/TMR-Kawa.html|title=Kawa ~ Kawakawa |work=Te Mära Reo: The Language Garden|publisher=Benton Family Trust|access-date=15 January 2019}} In New Zealand, it was applied to the kawakawa (Piper excelsum), which is endemic to New Zealand and nearby Norfolk Island and Lord Howe Island. It was exploited by the Māori based on previous knowledge of the kava, as the latter could not survive in the colder climates of New Zealand. The Māori name for the plant, kawakawa, is derived from the same etymon as kava, but reduplicated. It is a sacred tree among the Māori people. It is seen as a symbol of death, corresponding to the rangiora (Brachyglottis repanda), which is the symbol of life. However, kawakawa has no psychoactive properties. Its connection to kava is linked to its similarity in appearance and bitter taste.

Other names for kava include ʻawa (Hawaii),{{cite web|url=http://wehewehe.org/gsdl2.85/cgi-bin/hdict?a=d&d=D1669|title=Nā Puke Wehewehe ʻŌlelo Hawaiʻi|website=wehewehe.org|access-date=22 December 2017}} ʻava (Samoa), yaqona or yagona (Fiji),{{cite web|url=http://www.fijiembassy.be/index.php?page_in=yaqona|title=Embassy of the Republic of Fiji|website=www.fijiembassy.be|access-date=22 December 2017|archive-url=https://web.archive.org/web/20180610162905/http://www.fijiembassy.be/index.php?page_in=yaqona|archive-date=10 June 2018|url-status=dead}} sakau (Pohnpei),Balick, Michael J. and Leem, Roberta (2002) [http://sciweb.nybg.org/science2/pdfs/mb/Kava.pdf Traditional use of sakau (kava) in Pohnpei: lessons for integrative medicine] Alternative Therapies, Vol. 8, No.4. p. 96 seka (Kosrae),{{Cite book|title=Kava |last1=Lebot|first1=Vincent|last2=Merlin |first2=Mark|last3=Lindstrom|first3=Lamont|date=1992-12-23|publisher=Yale University Press|isbn=978-0-300-23898-3|doi = 10.2307/j.ctt211qwxb}} and malok or malogu (parts of Vanuatu).{{cite book|url=https://books.google.com/books?id=wxTrQOP36NsC&pg=PA37|title=Kava: The Pacific Elixir: The Definitive Guide to Its Ethnobotany, History, and Chemistry|last2=Merlin|first2=Mark|last3=Lindstrom|first3=Lamont|publisher=Inner Traditions / Bear & Co|year=1997|isbn=978-0-89281-726-9|page=58|last1=Lebot|first1=Vincent}}

Kava was historically grown only in the Pacific islands of Hawaii, Federated States of Micronesia, Vanuatu, Fiji, the Samoas, and Tonga. It appears to have originated in Vanuatu; an inventory of P. methysticum distribution showed it was cultivated on numerous islands of Micronesia, Melanesia, Polynesia, and Hawaii, whereas specimens of P. wichmannii were all from Papua New Guinea, the Solomon Islands, and Vanuatu.{{cite journal|author1=Vincent Lebot|author2=Patricia Siméoni|title=Is the Quality of Kava (Piper methysticum Forst. f.) Responsible for Different Geographical Patterns?|journal=Ethnobotany Research & Applications|date=2004|volume=2|pages=19–28| url=https://scholarspace.manoa.hawaii.edu/bitstream/10125/135/4/I1547-3465-02-019.pdf |doi=10.17348/era.2.0.19-28|doi-access=free}}

Traditionally, plants are harvested around four years of age, as older plants have higher concentrations of kavalactones. After reaching about {{convert|2|m|ft}} in height, plants grow a wider stalk and additional stalks, but not much taller. The roots can reach a depth of {{convert|60|cm|ft}}.

File:John LaFarge - Young Girls Preparing Kava Outside of the Hut Whose Posts Are Decorated wih Flowers.jpg ({{Circa|1891}}).]]

Kava consists of sterile cultivars cloned from its wild ancestor, Piper wichmanii. Today it comprises hundreds of different cultivars grown across the Pacific. Each cultivar has not only different requirements for successful cultivation, but also displays unique characteristics both in terms of its appearance and its psychoactive properties.

Scholars make a distinction between the so-called noble and non-noble kava. The latter category comprises the so-called tudei (or "two-day") kavas, medicinal kavas, and wild kava (Piper wichmanii, the ancestor of domesticated Piper methysticum).{{Cite journal|last1=Teschke|first1=Rolf|last2=Lebot|first2=Vincent|date=2011-10-01|title=Proposal for a Kava Quality Standardization Code|journal=Food and Chemical Toxicology|volume=49|issue=10|pages=2503–2516|doi=10.1016/j.fct.2011.06.075|pmid=21756963}} Traditionally, only noble kavas have been used for regular consumption, due to their more favourable composition of kavalactones and other compounds that produce more pleasant effects and have lower potential for causing negative side effects, such as nausea, or "kava hangover".

The perceived benefits of noble cultivars explain why only these cultivars were spread around the Pacific by Polynesian and Melanesian migrants, with presence of non-noble cultivars limited to the islands of Vanuatu, from which they originated. More recently, it has been suggested that the widespread use of tudei cultivars in the manufacturing of several kava products might have been the key factor contributing to the rare reports of adverse reactions to kava observed among the consumers of kava-based products in Europe.

Tudei varieties have traditionally not been grown in Hawaii and Fiji, but in recent years there have been reports of farmers attempting to grow "isa" or "palisi" non-noble cultivars in Hawaii, and of imports of dried tudei kava into Fiji for further re-exporting.{{Cite web|url=http://www.fijitimes.com/story.aspx?id=262207|title=Drink the right mix - Fiji Times Online|website=www.fijitimes.com|access-date=2016-05-29|archive-url=https://web.archive.org/web/20160630143526/http://www.fijitimes.com/story.aspx?id=262207|archive-date=30 June 2016|url-status=dead}} The tudei cultivars may be easier and cheaper to grow: while it takes up to 5 years for noble kava to mature, non-noble varieties can often be harvested just one year after being planted.

The concerns about the adverse effects of non-noble varieties, produced by their undesirable composition of kavalactones and high concentrations of potentially harmful compounds (flavokavains, which are not present in any significant concentration in the noble varieties), have led to legislation prohibiting exports from countries such as Vanuatu. Likewise, efforts have been made to educate non-traditional customers about the difference between noble and non-noble varieties and that non-noble varieties do not offer the same results as noble cultivars.{{Cite web|url=http://www.radionz.co.nz/international/pacific-news/289424/vanuatu-hopes-for-kava-export-growth|title=Vanuatu hopes for kava export growth|date=2015-11-11|website=Radio New Zealand |access-date=2016-05-29}}{{Cite web|url=http://www.radionz.co.nz/international/programmes/datelinepacific/audio/201778477/vanuatu-kava-cleared-for-european-market|title=Vanuatu kava cleared for European market|date=2015-11-12|website=Radio New Zealand |access-date=2016-05-29}} In recent years, government regulatory bodies and non-profit NGOs have been set up with the declared aim of monitoring kava quality; producing regular reports; certifying vendors selling proper, noble kava; and warning customers against products that may contain tudei varieties.{{Cite journal|last1=Teschke|first1=Rolf|last2=Sarris|first2=Jerome|last3=Lebot|first3=Vincent|date=2011-01-15|title=Kava hepatotoxicity solution: A six-point plan for new kava standardization|journal=Phytomedicine|volume=18|issue=2–3|pages=96–103|doi=10.1016/j.phymed.2010.10.002|pmid=21112196|url=http://agritrop.cirad.fr/568311/|url-access=subscription}}

In Vanuatu, exportation of kava is strictly regulated. Only cultivars classified as noble are allowed to be exported. Only the most desirable cultivars for everyday drinking are classified as noble to maintain quality control. In addition, their laws mandate that exported kava must be at least five years old and farmed organically. Their most common noble cultivars are "Borogu" or "Borongoru" from Pentecost Island, "Melomelo" from Aoba Island (called Sese in the north Pentecost Island), and "Palarasul" kava from Espiritu Santo. In Vanuatu, Tudei ("two-day") kava is reserved for special ceremonial occasions and exporting it is not allowed. "Palisi" is a common Tudei variety.

In Hawaii, there are many other cultivars of kava ({{langx|haw|ʻawa}}). Some of the most common cultivars are Mahakea, Moʻi, Hiwa, and Nene. The Aliʻi (kings) of precolonial Hawaii coveted the Moʻi variety, which had a strong cerebral effect due to a predominant amount of the kavalactone kavain. This sacred variety was so important to them that no one but royalty could ever experience it, "lest they suffer an untimely death". The reverence for Hiwa in old Hawaiʻi is evident in this portion of a chant recorded by Nathaniel Bright Emerson and quoted by E. S. Craighill and Elizabeth Green Handy: "This refers to the cup of sacramental ʻawa brewed from the strong, black ʻawa root (ʻawa hiwa), which was drunk sacramentally by the kumu hula":

{{Blockquote|

The day of revealing shall see what it sees:

A seeing of facts, a sifting of rumors,

An insight won by the black sacred 'awa,

A vision like that of a god!}}

Winter describes a hula prayer for inspiration that contains the line, He ʻike pū ʻawa hiwa. Pukui and Elbert translated this as "a knowledge from kava offerings". Winter explains that ʻawa, especially of the Hiwa variety, was offered to hula deities in return for knowledge and inspiration.{{Cite book |url=http://www.awadevelopment.org/wp-content/uploads/2014/01/awabook-web-part-1-of-2.pdf |title=Hawaiian ʻawa: views of an ethnobotanical treasure |last1=Johnston |first1=Ed |last2=Rogers |first2=Helen |last3=Association for Hawaiian ʻAwa|date=2006-01-01 |publisher=Association for Hawaiian ʻAwa |location=Hilo, Hawaii|page=34|language=en|oclc = 77501873}}

More recently, specialized kava varieties have been introduced to South Florida which have been acclimated and adapted to grow well in South Florida's unique soil and climate and have significant resistance to pest and disease pressures. As of 2024, cultivation of these varieties is limited to a small number of commercial farms and backyard growers.

File:Piper excelsum excelsum G.Forst. (AM AK347570-2).jpg to New Zealand due to its similarities to kava.]]

The Kawakawa (Piper excelsum) plant, known also as "Māori kava", may be confused with kava. While the two plants look similar and have similar names, they are different, but related, species. Kawakawa is a small tree endemic to New Zealand, having importance to traditional medicine and Māori culture. As noted by the Kava Society of New Zealand, "in all likelihood, the kava plant was known to the first settlers of Aotearoa [New Zealand]. It is also possible that (just like the Polynesian migrants that settled in Hawaii) the Maori explorers brought some kava with them. Unfortunately, most of New Zealand is simply too cold for growing kava and hence the Maori settlers lost their connection to the sacred plant."{{Cite web|url=https://kavasociety.nz/blog/2018/2/5/kava-vs-kawakawa-and-the-maori-memories-of-kava|title=Kava vs Kawakawa {{!}} Kava use in New Zealand {{!}} Maori Memories of Kava|website=kavasociety.nz|access-date=2016-07-02}} Further, "in New Zealand, where the climate is too cold for kava, the Maori gave the name kawa-kawa to another Piperaceae M. excelsum, in memory of the kava plants they undoubtedly brought with them and unsuccessfully attempted to cultivate. The Maori word kawa also means "ceremonial protocol", recalling the stylized consumption of the drug typical of Polynesian societies". Kawakawa is commonly used in Maori traditional medicine for the treatment of skin infections, wounds, and cuts, and (when prepared as a tea) for stomach upsets and other minor illnesses.{{Cite web|url=http://maoriplantuse.landcareresearch.co.nz/WebForms/PeoplePlantsDetails.aspx?firstcome=firstcome&PKey=DF6C4669-4A57-4473-8B3F-CE49593273A2|title=Māori Plant Use Database Plant Use Details of Macropiper excelsum|website=maoriplantuse.landcareresearch.co.nz|access-date=2016-07-02|url-status=dead|archive-url=https://web.archive.org/web/20160811031207/http://maoriplantuse.landcareresearch.co.nz/WebForms/PeoplePlantsDetails.aspx?firstcome=firstcome&PKey=DF6C4669-4A57-4473-8B3F-CE49593273A2|archive-date=11 August 2016}}

Fresh kava root contains on average 80% water. Dried root contains approximately 43% starch, 20% dietary fiber, 15% kavalactones,{{cite journal|pmc=4325077|year=2013|last1=Wang|first1=J|title=Kavalactone content and chemotype of kava beverages prepared from roots and rhizomes of Isa and Mahakea varieties and extraction efficiency of kavalactones using different solvents|journal=Journal of Food Science and Technology|volume=52|issue=2|pages=1164–1169|last2=Qu|first2=W|last3=Bittenbender|first3=H. C|last4=Li|first4=Q. X|doi=10.1007/s13197-013-1047-2|pmid=25694734}} 12% water, 3.2% sugars, 3.6% protein, and 3.2% minerals.

In general, kavalactone content is greatest in the roots and decreases higher up the plant into the stems and leaves. Relative concentrations of 15%, 10%, and 5% have been observed in the root, stump, and basal stems, respectively. The relative content of kavalactones depends not only on plant segment but also on the kava plant variety, plant maturity, geographic location, and time of harvest. The kavalactones present are kavain, desmethoxyyangonin, and yangonin, which are higher in the roots than in the stems and leaves, with dihydrokavain, methysticin, and dihydromethysticin also present.

The mature roots of the kava plant are harvested after a minimum of four years (at least five years, ideally) for peak kavalactone content. Most kava plants produce around {{convert|50|kg|lb|abbr=on}} of root when they are harvested. Kava root is classified into two categories: crown root (or chips) and lateral root. Crown roots are the large-diameter pieces that look like {{convert|1.5|to|5|in|mm}}-diameter wooden poker chips. Most kava plants consist of approximately 80% crown root upon harvesting. Lateral roots are smaller-diameter roots that look more like a typical root. A mature kava plant is about 20% lateral roots. Kava lateral roots have the highest content of kavalactones in the kava plant. "Waka" grade kava is made of lateral roots only.

File:Kavalactone General Structure.PNG

A total of 18 different kavalactones (or kavapyrones) have been identified to date, at least 15 of which are active.{{cite journal | vauthors = Sarris J, LaPorte E, Schweitzer I | title = Kava: a comprehensive review of efficacy, safety, and psychopharmacology | journal = Aust N Z J Psychiatry | volume = 45 | issue = 1 | pages = 27–35 | year = 2011 | pmid = 21073405 | doi = 10.3109/00048674.2010.522554 | s2cid = 42935399 }} However, six of them, including kavain, dihydrokavain, methysticin, dihydromethysticin, yangonin, and desmethoxyyangonin, have been determined to be responsible for about 96% of the plant's pharmacological activity. Some minor constituents, including three chalcones{{Mdash}}flavokavain A, flavokavain B, and flavokavain C{{Mdash}}have also been identified, as well as a toxic alkaloid (not present in the consumable parts of the plant{{Cite journal|last1=Bunchorntavakul|first1=C.|last2=Reddy|first2=K. R.|date=2013-01-01|title=Review article: herbal and dietary supplement hepatotoxicity|journal=Alimentary Pharmacology & Therapeutics|language=en|volume=37|issue=1|pages=3–17|doi=10.1111/apt.12109|pmid=23121117|s2cid=6949220|issn=1365-2036|doi-access=free}}), pipermethystine.{{cite journal | vauthors = Olsen LR, Grillo MP, Skonberg C | title = Constituents in kava extracts potentially involved in hepatotoxicity: a review | journal = Chem. Res. Toxicol. | volume = 24 | issue = 7 | pages = 992–1002 | year = 2011 | pmid = 21506562 | doi = 10.1021/tx100412m }} Alkaloids are present in the roots and leaves.{{cite web|url=https://www.drugs.com/npp/kava.html|title=Kava|date=3 January 2018|publisher=Drugs.com|access-date=12 January 2018}}

The following pharmacological actions have been reported for kava and/or its major active constituents:{{cite journal | vauthors = Singh YN, Singh NN | title = Therapeutic potential of kava in the treatment of anxiety disorders | journal = CNS Drugs | volume = 16 | issue = 11 | pages = 731–43 | year = 2002 | pmid = 12383029 | doi = 10.2165/00023210-200216110-00002| s2cid = 34322458 }}

• Potentiation of GABA_A receptor activity (by kavain, dihydrokavain, methysticin, dihydromethysticin, and yangonin).
• Inhibition of the reuptake of norepinephrine (by kavain and methysticin) and possibly also of dopamine (by kavain and desmethoxyyangonin).
• Binding to the CB₁ receptor (by yangonin).{{cite journal | vauthors = Ligresti A, Villano R, Allarà M, Ujváry I, Di Marzo V | title = Kavalactones and the endocannabinoid system: the plant-derived yangonin is a novel CB₁ receptor ligand | journal = Pharmacol. Res. | volume = 66 | issue = 2 | pages = 163–9 | year = 2012 | pmid = 22525682 | doi = 10.1016/j.phrs.2012.04.003 }}
• Inhibition of voltage-gated sodium channels and voltage-gated calcium channels (by kavain and methysticin).
• Monoamine oxidase B reversible inhibition (by all six of the major kavalactones).

Methanolic leaf extracts of Hawaiian kava cultivars showed stronger binding inhibition to several CNS receptors—including GABA_A, dopamine D2, opioid (μ, δ), and histamine (H1, H2)—than root extracts, suggesting that compounds beyond the main kavalactones may contribute to the pharmacological effects of kava leaves.{{cite journal | vauthors = Dinh LD, Simmen U, Bueter KB, Bueter B, Lundstrom K, Schaffner W | title = Interaction of various Piper methysticum cultivars with CNS receptors in vitro | journal = Planta Med. | volume = 67 | issue = 4 | pages = 306–11 | year = 2001 | pmid = 11458444 | doi = 10.1055/s-2001-14334 | bibcode = 2001PlMed..67..306D | s2cid = 260281694 }}

Recent usage of kava has been documented in forensic investigations by quantitation of kavain in blood specimens. The principal urinary metabolite, conjugated 4'-OH-kavain, is generally detectable for up to 48 hours.R. Baselt, Disposition of Toxic Drugs and Chemicals in Man, 8th edition, Biomedical Publications, Foster City, CA, 2008, pp. 803–804.

Kavalactones are quickly absorbed in the gut and vary in bioavailability.{{cite web |title=Kava (Other Names: Ava, Intoxicating Pepper, Kawa Kawa, Kew, Sakau, Tonga, Yangona) |url=https://www.deadiversion.usdoj.gov/drug_chem_info/kava.pdf |publisher=Drug Enforcement Administration, U.S. Department of Justice |date=April 2025 |access-date=2025-05-17 |format=PDF}} They primarily act on brain areas like the limbic system, amygdala, and reticular formation, but their exact molecular mechanisms are not yet fully understood.{{cite web |title=Kava (Other Names: Ava, Intoxicating Pepper, Kawa Kawa, Kew, Sakau, Tonga, Yangona) |url=https://www.deadiversion.usdoj.gov/drug_chem_info/kava.pdf |publisher=Drug Enforcement Administration, U.S. Department of Justice |date=April 2025 |access-date=2025-05-17 |format=PDF}}

Data on the pharmacokinetics of kavalactones remain limited. In animal studies, particularly in rats, kavain—the primary kavalactone found in traditional kava preparations—was shown to be well absorbed, with an estimated bioavailability of approximately 50%. In humans, kavain undergoes extensive hepatic metabolism, primarily via cytochrome P450 (CYP) enzyme-mediated pathways, followed by further phase II biotransformation processes such as sulfonation, glucuronidation, and glutathione (GSH) conjugation.

In rats administered a 100 mg/kg bodyweight dose of kavain, over 90% was eliminated within 72 hours through urine and feces, either as unchanged compound or as metabolites. No evidence of bioaccumulation has been observed in rats, mice, or humans.

File:Kava fiji.jpg village, Ovalau, Fiji (2005)]]

The traditional kava beverage is prepared through aqueous extraction of the fresh or dried roots of the Piper methysticum plant. When using fresh roots, the outer layer is typically peeled before the root is either chewed or mechanically ground into a fine, fibrous pulp, which is then mixed with water. For dried roots, the material is finely ground, placed in a porous cloth, and infused in water. The resulting brew is usually consumed immediately after preparation, often from a communal bowl.

Traditional and recreational preparation of kava beverage involves macerating, grinding, or pounding fresh or dried rhizome/root (1.0–1.5 g) and mixing it with water or coconut milk (100–150 mL) to form an emulsion, which is then agitated and strained through cloth or bark filters into a communal bowl. The resulting drink is grey and slightly pungent, with fresh rhizome/root producing a stronger and more complex beverage than dried forms due to the retention of volatile compounds. In Vanuatu, fresh root is commonly used, while in non-Pacific countries, kava is typically prepared from dried root powder soaked in water (about one tablespoon per cup) for 30 minutes before straining. On Pohnpei in Micronesia, preparation also includes mixing the kava root with the fibrous bark of Hibiscus tiliaceus before pressing.

Chewing produces the strongest effect because it produces the finest particles.{{citation needed|date=May 2025}} The strength also depends on the species and techniques of cultivation.{{citation needed|date=May 2025}}

In Vanuatu, a strong kava drink is normally followed by a hot meal or tea. The meal traditionally follows some time after the drink so that the psychoactives are absorbed into the bloodstream more quickly. Traditionally, no flavoring is added.{{citation needed|date=May 2025}}

In Papua New Guinea, the locals in Madang province refer to their kava as waild koniak ("wild cognac" in English).{{citation needed|date=May 2025}}

File:Fijian kava ceremony.jpg

{{anchor|Grog}}Fijians commonly share a drink called grog, made by pounding sun-dried kava root into a fine powder, straining and mixing it with cold water. Traditionally, grog is drunk from the shorn half-shell of a coconut, called a bilo. Grog is commonly used in Fiji, especially among young men, and often brings people together for storytelling and socializing. Drinking grog for a few hours brings a numbing and relaxing effect to the drinker; grog also numbs the tongue, and grog drinking typically is followed by a "chaser" or sweet or spicy snack to follow a bilo.{{citation needed|date=May 2025}}

File:Kava vanuatu.jpg Island, Vanuatu (2006).]]

Water extraction is the traditional method for preparation of the plant. Pharmaceutical and herbal supplement companies extract kavalactones from the kava plant using solvents such as supercritical carbon dioxide,{{cite journal|last=Viorica|first=Lopez-Aila|title=Supercritical fluid extraction of kava lactones from Piper methysticum (kava) herb|doi=10.1002/jhrc.1240201007|volume=20|issue=10|year=1997|journal=Journal of High Resolution Chromatography|pages=555–559}} acetone, and ethanol to produce pills standardized with between 30% and 90% kavalactones.

Numerous scholars and regulatory bodies{{Cite journal|date=2016-05-25|title=Kava: A Human Health Risk Assessment|url=http://www.foodstandards.govt.nz/publications/documents/30_Kava1.pdf|journal=Technical Report Series No 30|access-date=25 May 2016|archive-date=11 February 2016|archive-url=https://web.archive.org/web/20160211001359/http://www.foodstandards.govt.nz/publications/documents/30_Kava1.pdf|url-status=dead}} have raised concerns over the safety profile of such products.

One group of scholars say that organic solvents introduce compounds that may affect the liver into the standardized product; these compounds are not extracted by water and are consequently largely absent from kava prepared with water.{{Cite journal|last1=Kraft|first1=M|last2=Spahn|first2=T W|last3=Menzel|first3=J|last4=Senninger|first4=N|last5=Dietl|first5=K.-H|last6=Herbst|first6=H|last7=Domschke|first7=W|last8=Lerch|first8=M M|date=2001|title=Fulminantes Leberversagen nach Einnahme des pflanzlichen Antidepressivums Kava-Kava|journal=Deutsche Medizinische Wochenschrift|language=en|volume=126|issue=36|pages=970–972|doi=10.1055/s-2001-16966|pmid=11544547|s2cid=260067545|issn=0012-0472}} For instance, when compared with water extraction, organic solvents extract vastly larger amounts of flavokavains, compounds associated with adverse reactions to kava that are present in very low concentrations in noble kava, but significant in non-noble.{{Cite journal|last1=Zhou|first1=Ping|last2=Gross|first2=Shimon|last3=Liu|first3=Ji-Hua|last4=Yu|first4=Bo-Yang|last5=Feng|first5=Ling-Ling|last6=Nolta|first6=Jan|last7=Sharma|first7=Vijay|last8=Piwnica-Worms|first8=David|last9=Qiu|first9=Samuel X.|date=December 2010|title=Flavokawain B, the hepatotoxic constituent from kava root, induces GSH-sensitive oxidative stress through modulation of IKK/NF-κB and MAPK signaling pathways|journal=The FASEB Journal|volume=24|issue=12|pages=4722–4732|doi=10.1096/fj.10-163311|doi-access=free |issn=0892-6638|pmc=2992378|pmid=20696856}}

Also, "chemical solvents used do not extract the same compounds as the natural water extracts in traditional use. The extraction process may exclude important modifying constituents soluble only in water". In particular, it has been noted that, unlike traditional water-based preparations, products obtained with the use of organic solvents do not contain glutathione, an important liver-protecting compound.{{Cite journal|date=2003-10-01|title=Kava lactones and the kava-kava controversy|journal=Phytochemistry|language=en|volume=64|issue=3|pages=673–679|doi=10.1016/S0031-9422(03)00381-9|issn=0031-9422|last1=Whitton|first1=Peter A|last2=Lau|first2=Andrew|last3=Salisbury|first3=Alicia|last4=Whitehouse|first4=Julie|last5=Evans|first5=Christine S|pmid=13679089|bibcode=2003PChem..64..673W }} Another group of researchers noted: "The extraction process (aqueous vs. acetone in the two types of preparations) is responsible for the difference in toxicity as extraction of glutathione in addition to the kava lactones is important to provide protection against hepatotoxicity".

It has also been argued that kavalactone extracts have often been made from low-quality plant material, including the toxic aerial parts of the plant that contain the hepatotoxic alkaloid pipermethystine, non-noble kava varieties, or plants affected by mold {{Ndash}}which, in light of the chemical solvents' ability to extract far greater amounts of the potentially toxic compounds than water, makes them particularly problematic.

In the context of these concerns, the World Health Organization advises against the consumption of ethanolic and acetonic kavalactone extracts, and says that "products should be developed from water-based suspensions of kava".{{Cite book|url=https://books.google.com/books?id=2KXWY6kPESUC&q=%22products+should+be+developed+from+water-based+suspensions+of+kava%22+WHO&pg=PA25|title=Assessment of the Risk of Hepatotoxicity with Kava Products|last=Organization|first=World Health|date=2007|publisher=WHO Regional Office Europe|isbn=978-92-4-159526-1|language=en}} The government of Australia prohibits the sales of such kavalactone extracts, and only permits the sale of kava products in their natural form or produced with cold water.{{Cite web|url=https://www.legislation.gov.au/Details/F2011C00587|title=Australia New Zealand Food Standards Code - Standard 2.6.3 - Kava|last=Health|website=www.legislation.gov.au|date=11 July 2011 |language=en|access-date=2018-09-02}}

File:Kava.JPG, in the Northern Territory of Australia.]]

{{Main|Kava culture}}{{See also|Nakamal}}

Kava is used for medicinal, religious, political, cultural, and social purposes throughout the Pacific. These cultures have a great respect for the plant and place a high importance on it. In Fiji, for example, a formal yaqona (kava) ceremony will often accompany important social, political, or religious functions, usually involving a ritual presentation of the bundled roots as a sevusevu (gift) and drinking of the yaqona itself.{{cite book |last1=Biturogoiwasa |first1=Solomoni |first2=Anthony R. |last2=Walker |year=2001 |title=My Village, My World: Everyday Life in Nadoria, Fiji |location=Suva, Fiji |publisher=Institute of Pacific Studies, University of the South Pacific |pages=17–20 |isbn=978-982-02-0160-6}}{{cite journal |last1=Tomlinson |first1=Matt |year=2007 |title=Everything and Its Opposite: Kava Drinking in Fiji |journal=Anthropological Quarterly |volume=80 |issue=4 |pages=1065–81 |doi=10.1353/anq.2007.0054|s2cid=144600224 }}{{synthesis inline|date=June 2013}} Due to the importance of kava in religious rituals and the seemingly (from the Western point of view) unhygienic preparation method, its consumption was discouraged or even banned by Christian missionaries. The nakamal, traditionally the central meeting place in Vanuatu, serves as a cultural and social hub where kava is consumed to facilitate communal gathering, dialogue, and the exchange of knowledge across different groups and generations.{{cite web |last1=Huffer |first1=Elise |last2=Molisa |first2=Grace |title=Governance in Vanuatu: In Search of the Nakamal Way |url=https://www.academia.edu/92133478/Governance_in_Vanuatu_in_search_of_the_Nakamal_way |website=Academia.edu |access-date=May 17, 2025}}

Bars serving kava beverage exist outside of the South Pacific.

Kava bars exist in several American cities as social, alcohol-free spaces, with the number increasing to around 180 establishments between 2012 and 2017.{{cite web |last=Wolinski |first=Cat |title=What Is Kava (Kava Kava)? |website=VinePair |date=March 18, 2018 |url=https://vinepair.com/articles/what-kava-kava-drink/ |access-date=2025-05-17}}{{cite journal |last1=Pont-Fernandez |first1=Salma |last2=Kheyfets |first2=Marina |last3=Rogers |first3=Jeffrey M. |last4=Smith |first4=Kirsten E. |last5=Epstein |first5=David H. |title=Kava (Piper methysticum) in the United States: the quiet rise of a substance with often subtle effects |journal=The American Journal of Drug and Alcohol Abuse |volume=49 |issue=1 |pages=85–96 |year=2023 |doi=10.1080/00952990.2022.2140292 |url=http://doi.org/10.1080/00952990.2022.2140292|url-access=subscription }}{{cite news |last=Solomon |first=Serena |title=Counting on the Trendy to Revive Kava, a Traditional Drink |url=https://www.nytimes.com/2017/02/23/business/fiji-kava-prices-drink.html |work=The New York Times |date=February 23, 2017 |access-date=May 17, 2025}}

The nature of effects will largely depend on the cultivar of the kava plant and the form of its consumption. Traditionally, only noble kava cultivars have been consumed, as they are accepted as safe and produce desired effects.{{Cite journal|last1=Lebot|first1=V.|last2=Do|first2=T. K. T.|last3=Legendre|first3=L.|date=2014-05-15|title=Detection of flavokavins (A, B, C) in cultivars of kava (Piper methysticum) using high performance thin layer chromatography (HPTLC)|journal=Food Chemistry|volume=151|pages=554–560|doi=10.1016/j.foodchem.2013.11.120|issn=0308-8146|pmid=24423570}} The specific effects of various noble kavas depend on various factors, such as the cultivar used (and the related specific composition of kavalactones), age of the plant, and method of consumption.{{Cite book|url=https://books.google.com/books?id=783SJSFvoucC|title=Kava: Medicine Hunting in Paradise: The Pursuit of a Natural Alternative to Anti-Anxiety Drugs and Sleeping Pills|last=Kilham|first=Christopher|date=1996-06-01|publisher=Inner Traditions / Bear & Co|isbn=978-0-89281-640-8|language=en}} However, it can be stated that in general, noble kava produces a state of calmness, relaxation, and well-being without diminishing cognitive performance.{{Cite journal|last1=Cairney|first1=Sheree|last2=Clough|first2=Alan R|last3=Maruff|first3=Paul|last4=Collie|first4=Alex|last5=Currie|first5=Bart J|last6=Currie|first6=Jon|date=2003-02-14|title=Saccade and Cognitive Function in Chronic Kava Users|journal=Neuropsychopharmacology|language=en|volume=28|issue=2|pages=389–396|doi=10.1038/sj.npp.1300052|issn=0893-133X|pmid=12589393|doi-access=free}}{{Cite journal|last1=LaPorte|first1=E.|last2=Sarris|first2=J.|last3=Stough|first3=C.|last4=Scholey|first4=A.|date=2011-03-01|title=Neurocognitive effects of kava (Piper methysticum): a systematic review|journal=Human Psychopharmacology|volume=26|issue=2|pages=102–111|doi=10.1002/hup.1180|issn=1099-1077|pmid=21437989|s2cid=44657320}} Kava may produce an initial talkative period, followed by muscle relaxation and eventual sleepiness.{{Cite journal|last=Baker|first=Jonathan D.|date=2011-06-01|title=Tradition and toxicity: evidential cultures in the kava safety debate|journal=Social Studies of Science|volume=41|issue=3|pages=361–384|issn=0306-3127|pmid=21879526|doi=10.1177/0306312710395341|s2cid=33364504}} The beverage has initial numbing and astringent effect in the mouth caused by the local anesthetic action of kavalactones and chewing it has local anesthetic effects similar to that of cocaine and longer lasting than benzocaine.

As noted in one of the earliest Western publications on kava (1886): "A well prepared Kava potion drunk in small quantities produces only pleasant changes in behavior. It is therefore a slightly stimulating drink which helps relieve great fatigue. It relaxes the body after strenuous efforts, clarifies the mind and sharpens the mental faculties".{{Cite book|url=https://books.google.com/books?id=S2FnAwAAQBAJ&q=%22listening+to+kava%22&pg=PA63|title=Kava: Medicine Hunting in Paradise: The Pursuit of a Natural Alternative to Anti-Anxiety Drugs and Sleeping Pills|last=Kilham|first=Christopher S.|date=1996-06-01|publisher=Inner Traditions / Bear & Co|isbn=978-1-62055-034-2|language=en}}

Despite its psychoactive effects, kava is not considered to be physically addictive and its use does not lead to dependency.{{Cite journal|last1=Lebot|first1=V.|last2=Lèvesque|first2=J.|date=1989-01-01|title=The origin and distribution of kava (Piper methysticum Forst. F., Piperaceae): A phytochemical approach|journal=Allertonia|volume=5|issue=2|pages=223–281|jstor=23187398}}{{Cite journal|last1=Sarris|first1=J.|last2=Stough|first2=C.|last3=Teschke|first3=R.|last4=Wahid|first4=Z. T.|last5=Bousman|first5=C. A.|last6=Murray|first6=G.|last7=Savage|first7=K. M.|last8=Mouatt|first8=P.|last9=Ng|first9=C.|date=2013-11-01|title=Kava for the Treatment of Generalized Anxiety Disorder RCT: Analysis of Adverse Reactions, Liver Function, Addiction, and Sexual Effects|journal=Phytotherapy Research|language=en|volume=27|issue=11|pages=1723–1728|doi=10.1002/ptr.4916|pmid=23348842|s2cid=19526418|issn=1099-1573}}

Regular use of large amounts of kava may cause mood swings, apathy, dry, scaly skin, malnutrition, weight loss, increased susceptibility to infections, and shortness of breath. Long-term use has also been associated with liver damage; however, the available evidence remains inconclusive.{{cite web | last1 = Asare-Doku

| first1 = W.

| last2 = Settumba Stolk

| first2 = S.

| last3 = Peacock

| first3 = A.

| last4 = Shakeshaft

| first4 = A.

| last5 = Waller

| first5 = E.

| title = Monitoring and evaluation of the kava pilot program

| date = 2023

| publisher = National Drug and Alcohol Research Centre, UNSW

| url = https://espace.library.uq.edu.au/data/UQ_05108d5/Kava_eval_report_final.pdf

| access-date = 2025-05-16

}} The risk is higher with alcoholic or acetonic extracts, or concentrated forms like pills. Water-based kava extracts in moderate doses are considered safer, but should not be consumed with alcohol, particularly in those with a history of liver issues.

There is limited safety information available on the effects of kava consumption, but in general, moderate consumption appears unlikely to be harmful, while there is evidence of harm from heavy use.

Adverse health and social effects associated with kava consumption—such as skin rashes, increased body mass index (BMI), elevated gamma-glutamyl transferase (GGT) enzyme levels, and higher lymphocyte counts—may begin to appear at intake levels of approximately 240 to 440 grams of kava powder per week, corresponding to 3,500 to 6,440 mg of kavalactones per day. One shell of kava contains an average of 250 mg kavalactones. Published and anecdotal evidence further indicates that recreational consumption of kava beverages can often exceed these levels, surpassing the kavalactone doses used in clinical settings for the treatment of anxiety, where aqueous extracts containing 140–250 mg per day over six weeks have demonstrated no significant toxicity.

Long-term use has also been associated with liver damage with the available evidence remains inconclusive.{{cite web | last1 = Asare-Doku

| first1 = W.

| last2 = Settumba Stolk

| first2 = S.

| last3 = Peacock

| first3 = A.

| last4 = Shakeshaft

| first4 = A.

| last5 = Waller

| first5 = E.

| title = Monitoring and evaluation of the kava pilot program

| date = 2023

| publisher = National Drug and Alcohol Research Centre, UNSW

| url = https://espace.library.uq.edu.au/data/UQ_05108d5/Kava_eval_report_final.pdf

| access-date = 2025-05-16

}} There is however, published evidence of the hepatotoxicity of kava extracts, and concerns about this led to kava being omitted from the US Pharmacopeia.{{cite journal |vauthors=Brown AC |title=Liver toxicity related to herbs and dietary supplements: Online table of case reports. Part 2 of 5 series |journal=Food Chem Toxicol |volume=107 |issue=Pt A |pages=472–501 |date=September 2017 |pmid=27402097 |doi=10.1016/j.fct.2016.07.001 |type=Review}} Kava has been linked to rare but serious liver disease cases, prompting warnings from health authorities in the United States, Australia, and Canada.

The potential causes include contamination with toxic alkaloids from kava leaves and stems, differences in traditional versus commercial preparations, drug interactions affecting liver enzymes, and genetic variations in metabolism among populations. While kava appears safe in traditional South Pacific use, caution is advised, especially during pregnancy, in people having preexisting liver conditions, or when combined with alcohol consumption, prescription drugs or dietary supplements. The risk is higher with alcoholic or acetonic extracts, or concentrated forms like pills. Water-based kava extracts in moderate doses are considered safer, but should not be consumed with alcohol, particularly in those with a history of liver issues.

Adverse reactions may result from the poor quality of kava raw material used in the manufacturing of various kava products.{{Cite journal|last1=Teschke|first1=Rolf|last2=Schulze|first2=Johannes|title=Risk of Kava Hepatotoxicity and the FDA Consumer Advisory|journal=JAMA|year=2010|volume=304|issue=19|pages=2174–5|doi=10.1001/jama.2010.1689|pmid=21081732|issn=0098-7484}}{{Cite journal|last1=Teschke|first1=Rolf|last2=Sarris|first2=Jerome|last3=Glass|first3=Xaver|last4=Schulze|first4=Johannes|year=2016|title=Kava, the anxiolytic herb: back to basics to prevent liver injury?|journal=British Journal of Clinical Pharmacology|volume=71|issue=3|pages=445–448|doi=10.1111/j.1365-2125.2010.03775.x|issn=0306-5251|pmc=3045554|pmid=21284704}} In addition to the potential for hepatotoxicity, adverse reactions from chronic use may include visual impairment, rashes or dermatitis, seizures, weight loss, and malnutrition, but there is only limited high-quality research on these possible effects.

Several adverse interactions with drugs have been documented, both prescription and nonprescription — including, but not limited to, anticonvulsants, alcohol, anxiolytics (central nervous system depressants such as benzodiazepines), antipsychotics, levodopa, diuretics, and drugs metabolized by CYP450 in the liver.

A few notable potential drug interactions are, but are not limited to:

• Alcohol: It has been reported that combined use of alcohol and kava extract can have additive sedative effects.{{cite journal |author1=Cairney S. |author2=Maruff P. |author3=Clough A. R. |author4=Collie A. |author5=Currie J. |author6=Currie B. J. | year = 2003 | title = Saccade and cognitive impairment associated with kava intoxication | journal = Hum. Psychopharmacol. | volume = 18 | issue = 7| pages = 525–533 | doi=10.1002/hup.532|pmid=14533134 |s2cid=21555220 }} Regarding cognitive function, kava has been shown to have additive cognitive impairments while taken with alcohol when compared to taking placebo and alcohol alone.{{cite journal | author = Spinella M | year = 2002 | title = The importance of pharmacological synergy in psychoactive herbal medicines | journal = Altern Med Rev | volume = 7 | issue = 2| pages = 130–137 | pmid = 11991792 }}
• Anxiolytics (CNS depressants such as benzodiazepines and barbiturates): Kava may have potential additive CNS depressant effects (such as sedation and anxiolytic effects) with benzodiazepines and barbiturates. Kava taken in combination with alprazolam can cause a semicomatose state in humans.{{cite journal |last1=Hu |first1=Z |last2=Yang |first2=X |last3=Ho |first3=PC |last4=Chan |first4=SY |last5=Heng |first5=PW |last6=Chan |first6=E |last7=Duan |first7=W |last8=Koh |first8=HL |last9=Zhou |first9=S |date=2005 |title=Herb-drug interactions: a literature review. |journal=Drugs |volume=65 |issue=9 |pages=1239–82 |doi=10.2165/00003495-200565090-00005 |pmid=15916450 |s2cid=46963549}}
• Dopamine agonist — levodopa: One of levodopa's chronic side effects that Parkinson's patients experience is the "on-off phenomenon" of motor fluctuations, where there will be periods of oscillations between "on", where the patient experiences symptomatic relief, and "off", where the therapeutic effect wears off early.{{cite journal|author=Lees AJ|title=The on-off phenomenon|journal=J Neurol Neurosurg Psychiatry|year=1989|volume=Suppl|issue=9|pages=29–37|pmid=1033307|pmc=1033307 | doi=10.1136/jnnp.52.suppl.29|doi-access=free}} When taking levodopa and kava together, it has been shown that there is an increased frequency of this "on-off phenomenon".Izzo AA, Ernst E. Interactions between herbal medicines and prescribed drugs: a systematic review" Drugs 2001;61(15):2163-75.

Long-term and heavy kava consumption is associated with a reversible skin condition known as "kava dermopathy", or kanikani (in the Fijian language), characterised by dry and scaly skin covering the palms of the hands, soles of the feet, and back.{{Cite journal|last=Ruze|first=P.|date=1990-06-16|title=Originally published as Volume 1, Issue 8703Kava-induced dermopathy: a niacin deficiency?|journal=The Lancet|volume=335|issue=8703|pages=1442–1445|doi=10.1016/0140-6736(90)91458-M|pmid=1972218|s2cid=9737032|doi-access=free}}{{Cite journal|last1=Norton|first1=Scott A.|last2=Ruze|first2=Patricia|date=1994-07-01|title=Kava dermopathy|journal=Journal of the American Academy of Dermatology|volume=31|issue=1|pages=89–97|doi=10.1016/S0190-9622(94)70142-3|pmid=8021378}} The first symptom to appear is usually dry, peeling skin; some Pacific Islanders deliberately consume large quantities of kava for several weeks in order to get the peeling effect, resulting in a layer of new skin.{{cite web|title=Kava Side Effects|url=http://www.kavalibrary.com/side-effects.html|website=The Kava Library|access-date=8 September 2017}} These effects appeared at consumption levels between {{convert|31|g|oz}} to {{convert|440|g|lb}} a week of kava powder. Despite numerous studies, the mechanism that causes kava dermopathy is poorly understood "but may relate to interference with cholesterol metabolism". The condition is easily treatable with abstinence or lowering of kava intake as the skin appears to be returning to its normal state within a couple of weeks of reduced or no kava use. Kava dermopathy should not be confused with rare instances of allergic reactions to kava that are usually characterised by itchy rash or puffy face.{{cite journal|title=Sebotropic drug reaction resulting from kava-kava extract therapy: A new entity?|journal=Journal of the American Academy of Dermatology|volume=38|issue=1|pages=104–6|doi=10.1016/S0190-9622(98)70547-X|pmid=9448214|year=1998|last1=Jappe|first1=Uta|last2=Franke|first2=Ingolf|last3=Reinhold|first3=Dirk|last4=Gollnick|first4=Harald P.M.}}

A 2003 systematic review found that kava extract reduced anxiety symptoms compared to placebo, with a small effect size and mostly mild, transient side effects.{{Cite journal|author=Pittler MH, Ernst E |title=Kava extract for treating anxiety |journal=Cochrane Database of Systematic Reviews |issue=1 |pages=CD003383 |year=2003 |volume=2003 |pmid=12535473 |doi=10.1002/14651858.CD003383|editor1-last=Pittler|editor1-first=Max H|pmc=6999799 }} Kava may help with anxiety after several weeks of use, but current evidence does not support its effectiveness for generalized anxiety disorder or other conditions. Meta-analyses suggest kava can reduce anxiety symptoms — sometimes comparably to medications like oxazepam and buspirone — with strongest evidence seen in multiweek studies using aqueous extracts for generalized anxiety disorder, although results were mixed and standardized trials are limited.

A study of heavy and long-term kava users in northern Australia found no evidence of cognitive or brain dysfunction despite some physical health effects, including liver enzyme elevation and skin changes.{{cite journal |vauthors=Cairney S, Clough AR, Maruff P, Collie A, Currie BJ, Currie J |year=2003 |title=Saccade and cognitive function in chronic kava users |journal=Neuropsychopharmacology |volume=28 |issue=2 |pages=389–96 |doi=10.1038/sj.npp.1300052 |pmid=12589393 |doi-access=free}}

Kava extracts have no proven effects on cancer, cognitive function, or microbial infections.

File:Yaqona-bundle-Fiji-2010.jpg

Over centuries, kava has been used in the traditional medicine of the South Pacific Islands.{{Cite journal|last1=Showman|first1=Angelique F.|last2=Baker|first2=Jonathan D.|last3=Linares|first3=Christina|last4=Naeole|first4=Chrystie K.|last5=Borris|first5=Robert|last6=Johnston|first6=Edward|last7=Konanui|first7=Jerry|last8=Turner|first8=Helen|date=2015-01-01|title=Contemporary Pacific and Western perspectives on 'awa (Piper methysticum) toxicology|journal=Fitoterapia|volume=100|pages=56–67|doi=10.1016/j.fitote.2014.11.012|issn=1873-6971|pmid=25464054}}

In Australia, the supply of kava is regulated through the National Code of Kava Management.{{cite web |url=https://www.legislation.gov.au/Details/F2009C01242|title=Australia New Zealand Food Standards Code - Standard 2.6.3 - Kava|date=5 October 2006 |publisher=Federal Register of Legislation|access-date=22 October 2016}} Travellers to Australia are allowed to bring up to 4 kg of kava in their baggage, provided they are at least 18 years old and the kava is in root or dried form. Commercial import of larger quantities is allowed, under licence for medical or scientific purposes. These restrictions were introduced in 2007 after concern about abuse of kava in indigenous communities. Initially, the import limit was 2 kg per person; it was raised to 4 kg in December 2019, and a pilot program allowing for commercial importation was implemented on 1 December 2021.{{cite news |url=http://www.xinhuanet.com/english/2019-12/17/c_138637423.htm |archive-url=https://web.archive.org/web/20191217110924/http://www.xinhuanet.com/english/2019-12/17/c_138637423.htm |url-status=dead |archive-date=17 December 2019 |title=Travelers from Fiji to Australia can now take more kava for social functions |date=17 December 2019 |access-date=21 January 2020 |publisher=Xinhua}}{{cite web |url=https://www.odc.gov.au/import-requirements-kava|title=Import requirements: Kava|date=1 December 2021|website=The Office of Drug Control, Department of Health, Government of Australia|access-date=7 February 2022}}.

The Australian Therapeutic Goods Administration has recommended no more than 250 mg of kavalactones be taken in a 24‑hour period.{{cite web | url=http://www.tga.gov.au/cm/kavafs0504.htm | access-date=10 July 2006 | title=Kava fact sheet | publisher=Therapeutic Goods Administration, Government of Australia | date=April 2005 | url-status=dead | archive-url=https://web.archive.org/web/20060720200953/http://www.tga.gov.au/cm/kavafs0504.htm | archive-date=20 July 2006}} ([http://www.tga.gov.au/cm/kavafs0504.pdf Download PDF 44KB] {{webarchive|url=https://web.archive.org/web/20060820014802/http://www.tga.gov.au/cm/kavafs0504.pdf |date=20 August 2006 }}).

Kava possession is limited to 2 kg per adult in the Northern Territory.{{cite web|url=https://nt.gov.au/law/crime/kava|title=Kava|publisher=Northern Territory Government|date=12 December 2016|access-date=14 February 2017}}{{cite web|publisher=Special Broadcasting Service (SBS), Sydney|url=http://www.sbs.com.au/news/article/2015/02/18/islanders-shocked-australia-moves-ban-kava|title=Islanders shocked as Australia moves to ban kava|date=10 July 2015|author=Armbruster, Stefan|access-date=14 February 2017}} While it was previously banned in Western Australia in the 2000s, the Western Australian Health Department announced the lifting of the ban in February 2017, bringing Western Australia "into line with other States" where it has always remained legal, albeit closely regulated.{{Cite news|url=https://thewest.com.au/news/health/kava-legal-in-relaxation-of-was-drug-laws-ng-b88384684z|title=Kava legal in WA, marketed at troubled sleepers|date=2017-02-13|work=The West Australian|access-date=2017-02-13|language=en-AU}}

Following discussions on the safety of certain pharmaceutical products derived from kava and sold in Germany, the EU imposed a temporary ban on imports of kava-based pharmaceutical products in 2002. The sale of kava plant became regulated in Switzerland, France, and in prepared form in the Netherlands.{{cite web | author=C.I.J.M. Ross-van Dorp | title=Besluit van 23 april 2003, houdende wijziging van het Warenwetbesluit Kruidenpreparaten (verbod op Kava kava in kruidenpreparaten) | publisher=Staatsblad van het Koninkrijk der Nederlanden | year=2003 | website=Sdu Uitgevers | url=http://www.ipfsaph.org/cds_upload/kopool_data/FAOLEX_0/unknown_net60412.pdf | access-date=7 February 2007 | archive-url=https://web.archive.org/web/20080227114537/http://www.ipfsaph.org/cds_upload/kopool_data/FAOLEX_0/unknown_net60412.pdf | archive-date=27 February 2008 | url-status=dead }} Some Pacific island states which had been benefiting from the export of kava to the pharmaceutical companies have attempted to overturn the EU ban on kava-based pharmaceutical products by invoking international trade agreements at the WTO: Fiji, Samoa, Tonga, and Vanuatu argued that the ban was imposed with insufficient evidence.{{cite web|url=http://www.worldtradereview.com/news.asp?pType=N&iType=A&iID=113&siD=23&nID=22522|title=Fiji takes kava ban fight to WTO|date=August 2005|publisher=The World Trade Review|access-date=26 October 2013|url-status=dead|archive-url=https://web.archive.org/web/20131029190558/http://www.worldtradereview.com/news.asp?pType=N&iType=A&iID=113&siD=23&nID=22522|archive-date=29 October 2013}} The pressure prompted Germany to reconsider the evidence base for banning kava-based pharmaceutical products.{{cite web|url=http://www.wto.org/english/res_e/booksp_e/casestudies_e/case33_e.htm|title=The Pacific Island Nations: Towards Shared Representation|last=Bowman|first=Chakriya |publisher=WTO|access-date=26 October 2013}} On 10 June 2014, the German Administrative Court overturned the 2002 ban, making selling kava as a medicine legal (personal possession of kava has never been illegal), albeit strictly regulated. In Germany, kava-based pharmaceutical preparations are currently prescription drugs. Furthermore, patient and professional information brochures have been redesigned to warn about potential side effects.{{cite web |url=https://www.pharmazeutische-zeitung.de/ausgabe-162015/comeback-unter-strengen-auflagen/ |title=Comeback unter strengen Auflagen |publisher=Pharmazeutische Zeitung |date=16 August 2015 |language=de |access-date=25 July 2021}} These strict measures have been opposed by some of the leading kava scientists. In early 2016, a court case was filed against the Bundesinstitut für Arzneimittel und Medizinprodukte (BfArM/German Federal Institute for Drugs and Medical Devices), arguing that the new regulatory regime is too strict and not justified.{{Cite web|url=https://www.dailypost.vu/news/new-kava-challenge/article_8e921a99-f924-54a9-b17c-891d55811f52.html |title=New Kava Challenge|website=Vanuatu Daily Post |access-date=12 June 2023 |date=17 February 2016 |last=Joshua |first=Jane }}

In the United Kingdom, it is a criminal offence to sell, supply, or import any medicinal product containing kava for human consumption.{{cite web| url=http://www.legislation.gov.uk/uksi/2002/3170/contents/made|title=The Medicines for Human Use (Kava-kava) (Prohibition) Order 2002|access-date=26 October 2013 |website=Legislation.gov.uk}} It is legal to possess kava for personal use or to import it for purposes other than human consumption (e.g., for animals).

Until August 2018, Poland was the only EU country with an "outright ban on kava" and where the mere possession of kava was prohibited and may have resulted in a prison sentence.{{Cite news|url=http://dailypost.vu/news/kava-banned-in-poland/article_845575d3-6dd0-5c03-a1c4-e0720c868a7a.html|title=Kava banned in Poland |date=Dec 27, 2017 |last=Garae|first=Len|work=Vanuatu Daily Post|access-date=2018-09-02|language=en}} Under the new legislation, kava is no longer listed among prohibited substances and it is therefore legal to possess, import, and consume the plant,{{Cite web|url=https://isap.sejm.gov.pl/isap.nsf/DocDetails.xsp?id=WDU20180001591 |title=Rozporządzenie Ministra Zdrowia z dnia 17 sierpnia 2018 r. w sprawie wykazu substancji psychotropowych, środków odurzających oraz nowych substancji psychoaktywnych|website=prawo.sejm.gov.pl|language=pl|access-date=12 June 2023 }} but it remains illegal to sell it within Poland for the purpose of human consumption.{{Cite web|url=https://www.rp.pl/Zdrowie/309039965-Kava-zalegalizowana-Marihuana-bedzie-nastepna.html|title=Kava zalegalizowana. Marihuana będzie następna?|website=www.rp.pl|language=pl|access-date=2018-12-12}}

In the Netherlands, for unknown reasons, the ban was never lifted, and it is still prohibited to prepare, manufacture, or trade kava or goods containing kava.{{Cite web|url=https://wetten.overheid.nl/BWBR0012174/2022-07-01/0#Artikel4|title=Warenwetbesluit Kruidenpreparaten|first=Ministerie van Binnenlandse Zaken en|last=Koninkrijksrelaties|website=wetten.overheid.nl}}

Due to safety concerns, including reports of hepatotoxicity and limitations in clinical evidence, the Committee on Herbal Medicinal Products (HMPC) concluded in 2017 that the benefit-risk balance for the oral use of kava in the treatment of anxiety disorders is unfavorable, and therefore a European Union herbal monograph could not be established.{{cite web |title=Final Assessment Report on Piper methysticum G. Forst., rhizoma |url=https://www.ema.europa.eu/en/documents/herbal-report/final-assessment-report-piper-methysticum-g-forst-rhizoma_en.pdf |website=European Medicines Agency |publisher=Committee on Herbal Medicinal Products (HMPC) |date=21 November 2017 |access-date=14 May 2025}}

When used traditionally, kava is regulated as a food under the Food Standards Code. Kava may also be used as an herbal remedy, where it is currently regulated by the Dietary Supplements Regulations. Only traditionally consumed forms and parts of the kava plant (i.e., pure roots of the kava plant, water extractions prepared from these roots) can legally be sold as food or dietary supplements in New Zealand. The aerial parts of the plant (growing up and out of the ground), unlike the roots, contain relatively small amounts of kavalactones; instead, they contain a mildly toxic alkaloid, pipermethysticine. While not normally consumed, the sale of aerial plant sections and non-water based extract (such as {{CO2}}, acetonic, or ethanol extractions) is prohibited for the purpose of human consumption (but can be sold as an ingredient in cosmetics or other products not intended for human consumption).{{Cite web|url=https://www.beehive.govt.nz/release/dunne-kava-unaffected-psychoactive-substances-bill|title=Dunne: Kava unaffected by Psychoactive Substances Bill|website=The Beehive|access-date=2016-10-24}}{{Cite web|url=https://gazette.govt.nz/notice/id/2015-gs1906|title=Standard 2.6.3 – Kava – Food Standards (Proposal P1025 – Code Revision) Variation—Australia New Zealand Food Standards Code – Amendment No. 154 - 2015-gs1906 - New Zealand Gazette|website=gazette.govt.nz|access-date=2016-07-02}}

In 2002, Health Canada issued an order prohibiting the sale of any product containing kava.{{cite journal|title=Marketed Health Products Directorate Heath Products and Foods Branch|journal=Canadian Adverse Reaction Newsletter|volume=12|issue=4|url=http://www.hc-sc.gc.ca/dhp-mps/medeff/bulletin/carn-bcei_v12n4-eng.php|year=2002}} While the restrictions on kava were lifted in 2012,{{cite web |url=http://www.hc-sc.gc.ca/dhp-mps/prodpharma/applic-demande/guide-ld/newdrug-drognouv/ndrugs_ndrogue-eng.php |title=Listing of Drugs Currently Regulated as New Drugs (The New Drugs List) |date=26 May 2016 |website=www.hc-sc.gc.ca |publisher=Health Canada |access-date=3 July 2017}} Health Canada lists five kava ingredients, as of 2017,{{cite web|url=http://webprod.hc-sc.gc.ca/nhpid-bdipsn/ingredsReq.do?srchRchTxt=kava&srchRchRole=-1&mthd=Search&lang=eng|title=Ingredients - Kava|publisher=Health Canada|date=2017|access-date=1 July 2017|archive-date=11 August 2022|archive-url=https://web.archive.org/web/20220811202841/http://webprod.hc-sc.gc.ca/nhpid-bdipsn/ingredsReq.do?srchRchTxt=kava&srchRchRole=-1&mthd=Search&lang=eng|url-status=dead}} although manufactured products containing kava or its extracts must be approved by the federal government before marketing.{{cite web|url=https://www.healthlinkbc.ca/healthwise/kava|title=Kava|publisher=HealthLink BC, Government of British Columbia|date=14 June 2023|access-date=15 May 2025}}

In the United States, kava is sold mainly as a dietary supplement and is not approved by the FDA as a drug.{{cite web |title=Kava: Usefulness and Safety |url=https://www.nccih.nih.gov/health/kava |website=National Center for Complementary and Integrative Health |publisher=U.S. Department of Health and Human Services |access-date=2025-05-16}} Manufacturers are responsible for ensuring product safety and proper labeling, while consumers are advised to consult healthcare professionals before using kava supplements.{{cite web |title=Kava: Usefulness and Safety |url=https://www.nccih.nih.gov/health/kava |website=National Center for Complementary and Integrative Health |publisher=U.S. Department of Health and Human Services |access-date=2025-05-16}}

In 2002, the U.S. Food and Drug Administration warned that kava-containing dietary supplements, promoted for relaxation and other uses, may cause rare but severe liver injury—including hepatitis, cirrhosis, and liver failure—and advised consumers, especially those with liver issues or on liver-impacting drugs, to consult a doctor before use and to report any related adverse effects.{{cite web| url=https://www.fda.gov/Food/ResourcesForYou/Consumers/ucm085482.htm|title=Consumer Advisory: Kava-Containing Dietary Supplements May be Associated with Severe Liver Injury|publisher=US Food and Drug Administration|archive-url=https://web.archive.org/web/20090603082809/https://www.fda.gov/Food/ResourcesForYou/Consumers/ucm085482.htm|archive-date=2009-06-03|access-date=2020-06-28|url-status=dead|date=25 March 2002}}

The FDA concluded in 2020 that kava is not generally recognized as safe (GRAS) for use in conventional foods due to evidence of toxicity, potential liver damage, possible carcinogenicity, drug interactions, and a lack of sufficient safety data.{{cite web

|title=Scientific Memorandum: Kava

|url=https://www.fda.gov/media/169556/download

|publisher=U.S. Food and Drug Administration

|date=2020-08-11

|access-date=2025-05-14

}}

In response to the FDA’s determination, the Hawaii Department of Health concluded in 2024 that traditionally prepared beverages made from noble kava root using water or coconut water are considered under specific conditions, based on historical use prior to 1958.{{cite web

|title=GRAS Determination for 'Awa

|url=https://health.hawaii.gov/food-drug/files/2024/01/DOH-GRAS-Determination-for-Awa.pdf

|publisher=Hawaii Department of Health

|access-date=2025-05-14

}}

The Pacific island-state of Vanuatu has passed legislation to regulate the quality of its kava exports. Vanuatu prohibits the export or consumption of non-noble kava varieties or the parts of the plant that are unsuitable for consumption (such as leaves and stems).{{Cite web|url=http://faolex.fao.org/docs/html/van38473.htm|title=Vanuatu - Legislation - Kava Act 2002|website=faolex.fao.org|access-date=2016-07-02|archive-date=10 January 2017|archive-url=https://web.archive.org/web/20170110211302/http://faolex.fao.org/docs/html/van38473.htm|url-status=dead}}

• List of herbs with known adverse effects
• Alcohol and Drugs History Society
• Betel
• Domesticated plants and animals of Austronesia
• Kava culture
• Nakamal
• Paan
• Samoa 'ava ceremony
• Samoan plant names

{{Reflist}}

{{Wikispecies|Piper methysticum}}

{{EB1911 poster|Kava}}

• {{cite web|url=http://www.unodc.org/unodc/en/data-and-analysis/bulletin/bulletin_1973-01-01_2_page008.html|title=UNODC - Bulletin on Narcotics: The narcotic pepper - The chemistry and pharmacology of Piper methysticum and related species|year=1973|publisher=United Nations Office on Drugs and Crime|pages=Issue 2|access-date=19 February 2014}}
• [https://web.archive.org/web/20030901220234/http://www.spc.int/cis/kava.htm Kava ban documents]
• [http://www.hear.org/species/piper_methysticum/ Piper methysticum information] from the Hawaiian Ecosystems at Risk project ([http://www.hear.org/ HEAR])
• {{Cite EB9|wstitle=Kava|volume=14 |short=x}}

{{Kava}}

{{Herbal Sedatives}}

{{Culture of Oceania}}

{{Cannabinoidergics}}

{{Channelergics}}

{{GABAAR PAMs}}

{{Opioidergics}}

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{{Authority control}}

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