Betel quid (Paan)

How is betel quid used?

Betel quid is either chewed, or held between the cheek/lip and gums.¹

Cultural practice

Betel-quid and areca-nut chewing is an important cultural practice in some regions in south and south-east Asia, and the Asia Pacific. It has traditionally played an important role in social customs, religious practices and cultural rituals.^{1, 5, 6}

Some people from these regions who have settled in other countries have continued their cultural practice of chewing betel quid.^{1, 5, 6}

Effects of betel quid

The use of any drug can have risks. It’s important to be careful when taking any type of drug.

Betel quid can affect everyone differently, based on:

• size, weight and health
• whether the person is used to taking it
• whether other drugs are taken around the same time
• the amount taken
• the strength of the drug (varies from batch to batch)
• the environment (where the drug is taken).

Onset and duration of effects

How fast a drug takes effect and how long it lasts can vary depending on how it's taken - for example, whether it's chewed or placed between the lip and gum.^{10, 11}

Effects

Effects can include:

• euphoria (feeling happy)
• relaxation
• feeling alert
• reduced appetite
• fast heart rate
• heart palpitations
• increased blood pressure
• increased saliva production
• red face and feeling warm
• sweating.
• tremors
• dizziness
• upset stomach
• diarrhoea
• vomiting
• anxiety
• psychosis (in rare cases).^{1, 5, 12-14}

Impact of mood and environment

Drugs that affect a person’s mental state (psychoactive drugs) can also have varied effects depending on a person’s mood (often called the ‘set’) or the environment they are in (the ‘setting’):

• Set: a person’s state of mind, previous encounters with the drug, and expectations of what’s going to happen. For example, feelings of stress or anxiety before using betel quid may result in an unpleasant experience and make those feelings worse.
• Setting: the physical and social environment where you use betel quid – whether it’s known and familiar, who you're with, if you're indoors or outdoors, the type of music or sounds, and lighting. The ideal setting to have betel quid will vary based on the individual and drug they’re using. For example, one person might use betel quid in a loud or busy social setting, while another may prefer being at home resting.¹⁵

Being in a good state of mind, with trusted friends and a safe environment before using betel quid reduces the risk of having a bad experience.¹⁵

Overdose

If you use a large amount of betel quid or have a strong batch, you could overdose.¹⁶

Your risk of overdose can also increase if you mix betel quid with alcohol or other drugs, including medications.¹⁶

There is limited evidence on betel quid and overdose effects.

However, many betel quid mixtures contain nicotine and tobacco which can cause overdose.¹

In rare cases, nicotine overdose can cause death.

Call triple zero (000) and request an ambulance if you or someone else has any of the following symptoms (emergency services are there to help and can provide more instructions).

• unconscious or non-responsive
• spasms or seizures
• feeling tired or fatigued
• heart attack symptoms such as:
• difficulty breathing
• sharp pain/discomfort in chest, arm, shoulder, back, neck, or jaw
• severe agitation, confusion, or panic
• racing heartbeat
• hot, flushed (red), or sweaty skin
• very large pupils.^{17, 18}

Mixing betel quid with other drugs

Mixing betel quid with other drugs can have unpredictable effects and increase the risk of harm.

Mixing includes using more than one drug (including alcohol or medications) at the same time, or one after another. You should also consider what drugs you’ve taken in the last 24 hours.

• Betel quid and tobacco: greatly increases the risk of developing oral cancers.
• Betel quid and antidepressants/antihistamines/scopolamine: betel quid may decrease the effects of these types of medications.^{5, 19}

Reducing harm

There are ways you can reduce the risk of harm when using betel quid:

• Start low, go slow – try a little bit first to see how you feel and wait 30 minutes before deciding whether to take more.
• Take care of your teeth and mouth – using betel quid can affect your mouth health. Avoid dry mouth by drinking plenty of water or chewing gum. Brush, floss and visit the dentist regularly.
• Think about your intake – try setting limits around the times and places that you use betel quid. Keep it out of easy reach when you’re not using it.
• Avoid using betel quid if you have a pre-existing mental health condition (such as depression or anxiety) – as betel quid may worsen symptoms of your condition.
• Avoid betel quid products containing nicotine or tobacco – if you have a pre-existing heart condition or disease, as nicotine can put added strain on the heart.
• Keep out of reach of children – nicotine/betel quid poisoning can cause death. If swallowed by children, call the Poisons Information Centre immediately on 13 11 26.
• Don’t use if you are pregnant or breastfeeding.^{1, 19-25}

Coming down

Betel quid is not known to cause comedowns - but the tobacco/nicotine within some betel quid mixtures can mask the effects of alcohol or other drugs. This can lead to using more alcohol or other drugs and experiencing a worse comedown or hangover.²⁶

Long-term effects

Long-term effects can vary depending on how much, how often and how betel quid is consumed. Regular use may eventually contribute to:

• discolouration of teeth and gums, sometimes turning them reddish-brown
• mouth ulcers and gum disease
• oral (mouth) cancers
• sub mucous fibrosis (a pre-cancer condition)
• stomach ulcer
• heart disease
• increased tolerance (needing to use more to get the same effect)
• dependence on betel quid.²⁷

Betel quid and mental health

The relationship between the use of betel quid and depression is complex.²⁸

Some evidence suggests that using betel quid is associated with depression, anxiety, and sleep disturbances.^{28, 29}

On the other hand, there is also some evidence that areca nut, one of the main ingredients in betel quid, has antidepressant effects.^{28, 29}

Tolerance

Regularly using betel quid can lead to developing a tolerance, which means you need to take larger amounts to get the same effects.^{1, 30}

Dependence

People who regularly use betel quid may become dependent. They may feel they need to use betel quid to go about usual activities like working, studying and socialising, or just to get through the day.^{1, 30}

Some evidence suggests that people who use betel quid mixtures that contain tobacco are more likely to become dependent.⁷

Withdrawal

Withdrawal refers to the symptoms that can occur when someone who is dependent on a drug, or who has been using it regularly over time, stops or reduces their use.³¹

Withdrawal can include physical symptoms (such as headaches, or nausea) and psychological symptoms (such as anxiety, or depressed mood).³¹

Symptoms - including how strong they are and how long they last - will vary depending on the type of drug and a person’s history of use.³¹

Withdrawal symptoms

People who use betel quid have reported experiencing withdrawal symptoms that are similar to nicotine withdrawal.³²

These include:

• cravings
• feelings of distress/discomfort
• dry mouth
• irritability
• anxiety
• fatigue
• inability to concentrate
• altered taste
• appetite changes
• trouble sleeping.^{30, 33}

Pregnancy, breastfeeding and betel quid

There is limited evidence on how the use of betel quid affects pregnancy and breastfeeding.

Some evidence suggests that:

• The use of betel quid during pregnancy is associated with low birthweight of the baby.
• The use of betel quid during pregnancy may affect the growth of the child within the first five years of life.^{34, 35}

However, tobacco and nicotine which are ingredients in some betel quid mixtures, do affect pregnancy and breastfeeding. Check out our pages on Tobacco and Nicotine to learn more.

Getting help

If your use of betel quid is affecting your health, family, relationships, work, school, financial or other life situations, or you’re concerned about someone, there is help and support.

If you’re thinking about quitting, trying to quit or need help staying on track, the below services can help:

• Call Quitline on 13 78 48, visit the Quit website, or speak to your doctor about the best quitting strategies for you. These can include gradually tapering off (reducing) use, nicotine replacement therapy, prescribed e-cigarettes, and a range of other approaches.36
• Call the National Alcohol and Other Drug Hotline on 1800 250 015 for free and confidential advice, information and counselling about alcohol and other drugs
• Use the confidential Path2Help portal to get matched with information and services specific to your needs <find out more>
• Search our Help and Support directory to find your preferred support, by adding your location or postcode and filtering by service type.