Cultural clash over medicinal kava

Around 20 years ago, potent kava pills and extracts began to be prescribed for stress and anxiety - and soon took over the Western world.

But the boom collapsed in the early 2000s after a few reports of adverse reactions to products containing kava.

Now, it's back on the radar - with potent extractions now available in New Zealand from medical herbalists.

At Oomph, a clinic in Auckland, naturopath and medical herbalist Lisa Fitzgibbon uses kava to treat her patients.

The calming effects of kava come from active ingredients called kavalactones. They act as a mild sedative - the closest comparison is benzodiazepines like Xanax.

A consultation with Ms Fitzgibbon is very similar to a GP visit. The patient outlines their ailment and Ms Fitzgibbon tries to find a solution.

But unlike traditional methods of drinking kava, her liquid is extracted using cold percolation. It's then placed in a base of 60 percent-proof ethanol which allows the creation of a highly concentrated liquid.

A small amount is poured into a shot glass and downed in one go.

The liquid's effects are sudden - and evident almost straight away.

Perhaps surprisingly, the majority of people Ms Fitzgibbon treats are women.

"[They're] definitely female. It's kinda shifted recently, before I would have said mid-20s to late-50s, but now we are seeing younger women," she says.

And despite its role in the Pasifika community, Ms Fitzgibbon says that few of her clients are Pacific Islanders.

"Possibly that's because, you know, most of my clientele are female and the fact that it's still sort of taboo for Pacific Island women to imbibe kava," she says.

But for many Pacific Islanders who practice the traditional ceremonial consumption of kava, its use in Western medicine neglects the central element of the healing process.

"I believe it's the talanoa, or discussion which accompanies the kava, which is probably more therapeutic than the kava itself," says Dr Apo Aporosa, research fellow at the University of Waikato.

"I often wonder whether kava pill-poppers are missing out on the full experience as they are not part of traditionally influenced kava settings where they can genuinely connect with others and talk through issues and problems.”

There may also be health differences between traditional kava and modern extractions.

"The available data indicates that traditional kava beverage prepared from the root has a long tradition of safe use in the South Pacific Islands," a 2004 Food Standards Australia New Zealand report reads.

"It is compositionally different from kava products prepared by extraction using organic solvents.

"The cases of liver toxicity associated with kava extracts observed in Western countries in recent years appear to be associated with consumption of kava-containing dietary supplements only."

However, Ms Fitzgibbon says there's nothing inappropriate about her use of kava extracts.

"Part of the healing is them being heard by their naturopath or medical herbalist, you know, knowing that they've got someone that's going to support them so I guess it is quite similar in a way - even though ours is medicinal," she says.

"I meant technically speaking, it's totally different. It's a totally different product, it serves a different purpose and it would just be a shame to have such a fabulous plant available to us and not be able to utilise it for its medicinal properties."

Could this be the inevitable final step, as kava becomes separated from traditional Polynesian rituals and usages and becomes another medicinal tool to help treat people?

"Would that be a problem if they dissociated with it? You know, I think that like me cause I've dissociated with it. This is medicine," Ms Fitzgibbon says.