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ʻAwa drinking rituals marking births, deaths, battles, long voyages, and new beginnings abound in Pacific legends. For instance, the storied shark watchman Kalāhiki shared ʻAwa with his human family to cement spiritual ties. When canoes returned from epic wayfinding journeys across our Moana, ʻAwa ceremonies welcomed them to shore. These narratives reveal ʻAwa’s role in forging meaningful relationships – between deities and people, voyagers and land, the living and the departed.

Beyond myths, Kava drinking has long facilitated real-world community building. As Nina Etkin notes, “Kava drinking was integral to the social, political and religious lives”. ʻAwa breaks down barriers and bonds people through peaceful communion. In Tahiti, another variety of ʻAva called ʻAvini ʻUte provides peace, respect, love and brotherhood for successful endeavors guided by Mana Atua (Divine Power).

This rich cultural heritage endures today. After over a century of Kava prohibition by missionary and colonial suppression, ʻAwa bars and traditional ceremonies are resurging among Pacific Islanders seeking to reconnect with their identity and some of the old beliefs. Events like the annual Pacific Kava Festival gather hundreds to celebrate Kava’s enduring cultural treasure through workshops, music, and of course, communal ʻAwa drinking.

However, along with deep cultural importance, Kava consumption – especially frequent heavy usage – carries health considerations that spark debate over how to balance risks and benefits.

On January 23, 2024, Ka ʻOihana Olakino (Hawaiʻi Department of Health) declared ʻAwa as “generally recognized as safe” for drinking if prepared in the traditional way. On the positive side, moderate Kava intake mainly acts as a mild analgesic muscle relaxant that reduces anxiety and stress without impairing cognition. Kava does not cause aggression or inhibit social functioning the way alcohol often does. Pacific Islanders report using Kava to treat insomnia, menstrual discomfort, urinary difficulty, headaches, and other ailments. Emerging research shows Kava’s potential as an alternative anxiety treatment and possible anti-cancer agent.

However, heavy Kava usage correlates with several adverse effects. Persistently high doses can cause scaly skin eruptions, weight loss, nausea, appetite loss, and elevated liver enzymes. While not liver toxicity per se, this signals possible stress. A few case reports also link Kava beverages to rare incidents of actual hepatotoxicity – inflammation and damage to liver tissue. Estimates suggest regular heavy binging on Kava may lead to severe reaction. The mechanisms behind Kava-related liver injury are still not fully understood.

Proposed explanations include accumulation of kavalactones or pipermethystine alkaloids which become toxic at high levels, inhibition of cytochrome P450 detoxifying enzymes, formation of reactive metabolites that attack liver cell proteins, depletion of glutathione antioxidant defenses, and vulnerability to contaminants like mold or aflatoxins from poor Kava storage. Individual genetic variability in metabolizing enzymes may also contribute. While the root cause remains unclear, heavy dosage and duration emerges as the clearest risk factor.

With cultural revival and Kava bars popping up globally, policies balancing public health protection and cultural rights present challenges. Germany banned Kava sales in 2002 after liver toxicity reports, despite low incidence and confounding factors like co-administration with pharmaceuticals. This regulatory backlash threatened livelihoods in Kava-exporting Pacific Islands like Fiji where the plant is called Yaqona in Fijian.

Recent years have brought more nuanced approaches focused on harm reduction through quality controls and consumer education rather than placing a Tapu (blanket prohibition). The European Union moved to lift restrictions in 2008. Consensus holds that using traditionally-prepared noble Kava varieties in moderation carries minimal risk and substantial social and cultural benefits. Caution is still warranted with concentrated commercial extracts and Tudei Kava (“Two-day” in Bislama) found in Vanuatu.

In Hawaiʻi, ʻAwa still is unregulated but recommendations advise limiting intake to 300-400g of root powder per week, avoiding preparations using stems or peelings, not combining with drugs, and allowing one alcohol-free rest day per week. Kava bars like Keoni Verity’s Hale Noa screen customers on medications and pregnancy while offering clear guidance on risks.

While keeping Liver toxicity around 1-in-10,000 remains the goal, Chrysanthe Guss, researcher at Hawaiʻi Pacific University cautions, “Zero risk is an unrealistic expectation for any substance... We don’t ban peanuts even though for a very small portion of people, they can be deadly.” Eating too many bananas at once will cause a spike in potassium in your body and can lead to cardiac arrest. So, finding the sweet spot between safety and preserving culturally-vital Kava traditions calls for open, evidence-based dialogue and adequate policymaking.

Through thoughtfully crafted measures, rich heritages need not be sacrificed due merely to small dangers or inconsiderate behaviors. Just as Pacific wayfinders once navigated the greatest ocean guided by sophisticated ancestral knowledge, Kava consumed in moderation can mitigate health risks while fulfilling deep cultural meaning and forge a sense of community belonging.

The ceremonial drinking of Piper Methysticum is deeply interwoven into the cultural fabric of our Pacific Islander communities. Popularized as “Kava” in several Pacific Islands languages (such as Tongan, ʻUvean, Niuean, Rarotongan, Tuamotuan, Rapa Nui), the plant has played a central role in cultural stories, myths, rituals, social bonding and identity for centuries of oceanic travel. Translated as “Bitter”, Kava is a pungent, earthy beverage that has been considered a treasured gift from the gods.

"Zero risk is an unrealistic expectation for any substance"

In their 2010 masterpiece ʻAwa Drinking as Identity Marker and Cultural Practice, Christine Nahua Patrinos and Kekailoa Perry studied the reemergence of drinking ʻAwa (Hawaiian spelling). They explain that the Hawaiian creation chant Kumulipo places ʻAwa near the beginning of the long recitation, which means it carries a more sacred dimension.
Chants praising ʻAwa are ubiquitous in oral traditions. The offering and consumption of ʻAwa is believed to please Akua (gods) and ʻAumakua (ancestral spirits). According to June Gutmanis, “Of all the offerings man has to give the gods, that of ʻAwa is the most pleasing”.

Kava: Finding Balance Between Rich Cultural Heritage and Health Hazards