Betel chewing and public health

The use of betel as a recreational drug is a common practice in Asia and among immigrant communities around the world. Betel quid is a mixture of areca nut, betel leaf, slaked lime (aqueous calcium hydroxide paste), and, in some countries, also includes tobacco. There are several different varieties of betel quid, including kheni (tobacco with lime), mawa (mixture of areca nut, tobacco and slaked lime), pan masala plain (areca nut, catechu, lime, cardamom, and unspecified flavoring agents), and pan masala with tobacco (gutkha).1 Betel quid is chewed for the main psychoactive ingredient arecoline extracted from the areca nut.2 Arecoline a, parasympathomimetic tertiary amine, is known to stimulate the central nervous system causing euphoric effects and feelings of heightened alertness. There is a well-established association between betel quid use and severe oral disorders, including oral submucous fibrosis, oral leukoplakia, oral squamous cell carcinoma, and periodontal disease.1,3-5 It has also been suggested that the deleterious effects of betel quid could extend beyond the oral cavity.6,7. Despite the known harmful effects of betel quid chewing, it remains a socially accepted practice in many societies and its use is popular among women, including pregnant women, and adolescents