Awa, a ceremonial Hawaiian beverage, is safe to consume as traditionally prepared, according to the state Department of Health.

DOH said it has determined awa — also known as kava — is “generally recognized as safe” after consultation with experts from the University of Hawaii College of Tropical Agriculture and Human Resources.

The drink made from the roots of awa, a canoe plant named Piper methysticum, is used during ceremonies but also consumed socially.

It has sedative properties that help induce relaxation and sleep, and is used to reduce anxiety or insomnia. It can be found at some farmers markets or purchased from individual farms and businesses.

The department’s memorandum was issued in response to the U.S. Food and Drug Administration’s determination in 2020 that kava was not safe for human consumption due to the potential for liver-related injuries.

The key difference, DOH said, is in its preparation and the resulting products.

Traditionally, the awa beverage is prepared by steeping the root of the shrub in water to extract kavalactones — the compounds that work as a sedative.

When awa is mixed with acetone, ethanol or other solvents, however, the resulting product has two to 10 times more kavalactones than with water, posing a significant health hazard to the liver.

DOH said the FDA “erroneously classified” kava as unsafe for human consumption because its review of scientific studies did not look at the traditional preparation of the beverage as practiced in Hawaii.

Instead, the FDA examined studies that focused almost exclusively on kava supplements that were manufactured using acetone or other organic compounds, according to Michael Burke, DOH’s environmental health program manager.

“This DOH memo clarifies that we agree with the FDA regarding organic extraction,” said Burke in a written response, “but because there is a strong tradition of customary awa consumption in Hawaii the traditional preparation using water is determined as safe.”

DOH said if prepared in the “specific, traditional, and customary manner” with the noble variety of the awa root mixed with water or coconut water, the state would not consider the awa to be a violation of the law.

Any other preparation of awa, however, or use of another variety of awa, would be a violation of the law. No penalties or citations have been issued, Burke said.

A victory for awa

The announcement by DOH was hailed as a victory by awa practitioners who say it has long been miscategorized and misunderstood.

“It’s about time,” said Ka‘iana Runnels, a farm educator on Hawaii island. “For a long time it’s kind of been in this gray zone.”

Runnels said officials in Europe misunderstood awa and had no regulations on how people there produced it. This created “bad industry,” he said, contributing to the misconception that it is bad for the liver.

“Our ancestors have known for hundreds of years this is a perfectly safe beverage,” he said. “When people start mixing it up and making extracts or making pills, and adding things to it — that’s what created this bad industry around awa.”

The ancestral beverage is “powerful medicine for our people,” he said, with anti-­inflammatory and healing properties.

A study out of New Zealand is exploring awa for its potential healing effects for those suffering from post-­traumatic stress disorder.

It is just as important to Hawaiians culturally and spiritually to be rooted in these ancestral practices, he said, giving them an identity in the face of adversity, for “without roots a plant will blow over.”

Runnels on Tuesday was with a gathering of practitioners on Hawaii island, along with Ed Johnston, a founder of the Association for Hawaiian Awa, discussing these spiritual aspects of awa.

The group was founded with the mission of preserving the cultural and medicinal values associated with the awa plant with education and research.

“We are just extremely happy,” said Johnston. “It’s wonderful news that they’re recognizing this, and also very significant, in my opinion, the statement from DOH explaining the traditional ways awa was used in Hawaii.”

Awa is perfectly safe to drink, he said, but when made into pills, extracts or tinctures, it’s “like hitting pure caffeine out of coffee.”

“It’s the pills and the extracts that are the links to the liver issues,” he said, “not the traditional beverage.”

Practitioners also take issue with the FDA’s classification of kava as a dietary supplement rather than a food item, saying it is the latter.

DOH noted that the World Health Organization in 2016 published a technical report finding awa had been consumed for more than 2,000 years in the South Pacific, with little documented evidence of adverse health effects.

Since WHO’s report was focused on the South Pacific, DOH collected additional literature from CTAHR for its memo on the use and traditional preparation of awa specific to Hawaii prior to 1958.

Still, DOH said consumers should be advised not to use awa with alcoholic beverages, and to consult a doctor prior to consumption if taking medication. Awa should not be used by persons under 18 or pregnant or breastfeeding women.

Excessive use of awa or use with products that cause drowsiness could impair one’s ability to operate a vehicle or heavy equipment, DOH warned, and a potential risk of rare, but severe, liver injury may be associated with dietary supplements containing awa.