How Can We Ensure A Better Response to Kush Addiction in Sierra Leone?

Natural Beauty of Sierra Leone in a green landscape (image generated by AI)

This blog post is co-authored by Eunice Naffie Mustapha and Jonta Kamara.

In 2012, Her Excellency Mrs. Sia Nyama Koroma, the former first lady of Sierra Leone, launched the National Mental Health Policy and Strategic Plan (NMHP), and 11 years later; Sierra Leone has a drug abuse epidemic. In 2022, BBC reported that 90% of male admissions to Sierra Leone’s Central Psychiatric ward were because of Kush. Sierra Leone’s Kush crisis is a threat to mental health. As we commemorate World Mental Health Day today, the big question is how can we address this drug abuse crisis in Sierra Leone?

‘Mental health is a universal human right’ as a theme for World Mental Health Day is a timely reminder. Embracing health equity through equal and fair access to the right to health requires the advancement of mental health. There can be no health without mental health! According to the World Health Organization, health is not merely the absence of disease or infirmity, but a state of complete physical, mental and social well-being.

The Issue of Kush

Recently in Sierra Leone, there has been an increase in the use of a synthetic cannabinoid drug which is not synonymous with marijuana. The synthetic drug is believed to be a mixture of several ingredients such as fentanyl, tramadol, and formalin which create different types of Kush which are locally known as Tramadol Kush, Jagaban Kush, and Gentle Kush. The drug is smoked and a single joint can cost 5 Leones. The source of the drug is unknown although it is believed to be imported from the neighboring countries of Guinea, and Liberia which have also seen a rise in the use of the drug.

Due to the lack of scientific studies conducted, the exact number of how many people are using the drug and the primary locations of drug use are unknown. The data available are on admissions to psychiatric wards and at the central ward in Freetown, 90% of the admissions are males. Partners in Health has helped to update this facility, and there has been over a 2,240% increase in admissions between 2020 and 2022 (2020 had 47 admissions and in 2022 there were 1,101).

Drug abuse is a problem that has been recognized at the continental level, as the African Union Plan of Action on Drug Control and Crime Prevention (2019-2023) was developed to improve the health, security and socio-economic well-being of people in Africa by addressing harmful drug use.

Applying the social determinants of health: poverty, neglect, and unemployment have been identified as the main drivers of this addiction. Sierra Leone’s National Youth Commission indicates that about 70% of youth are underemployed or unemployed, which creates financial stress. Kush is used as a coping mechanism, as users say that Kush helps them release stress and forget their frustrations. However, this mechanism of stress relief results in self-harm, criminal activities, and untimely death, among others.

However, just highlighting that Kush is a problem without educating the public about a proper response has resulted in harmful responses encompassing community members instilling corporal punishment on drug users, opening the floodgates of infringements on several human rights.

Word on the streets is that the Government of Sierra Leone has launched a Presidential Task-Force on Mental Health. However, the other big question is, to what extent will their work serve as a continuation of the initial efforts made with the NMHP?

Addressing the Issue

As we think of addressing Sierra Leone’s Kush epidemic, we agree with the Government of Sierra Leone that a great place to start is by understanding the problem. The next step is maximizing the whole-of-society approach by actively involving community members in the sensitization. Recommendations in the past have prioritized public health education including leveraging creativity, as championed in 2022 by a young Sierra Leonean woman, Mabel Ironn Sky Turay.

To create a safe space it is important to work with those who use the drug and those who sell it to understand how to address this issue. Does naming the drug illegal make individuals fearful to openly discuss how to find solutions to this issue? There are instances where individuals who use the drug have been put in jail continuing stigma and discrimination.

Should the criminalization of this drug be reconsidered as it is a deterrent for people to seek help? As the drug is illegal, it makes it hard to conduct studies to understand the population's health impact and to fully understand the prevalence and incidence of the drug, minimizing the ability to have effective solutions

There has been a reduction in stigma with those who seek treatment which has encouraged more people to seek treatment. Solely responding to those with drug addiction is a reactive response and at the core of public health is prevention. To prevent drug addiction, it is important to address the larger underlying issues pushing people to use Kush, which will be through addressing poverty and youth unemployment. ‘Kush cannot be tackled through law enforcement alone and there is a need for preventive intervention through awareness raising’ and a public health response identifying underlying social factors that contribute to addiction. This should not be done in isolation, but by turning members of society into ambassadors.

Whenever we think of the 14-year-old Kush user, we should think of an urgent response!

Guest Contributor:

Eunice Naffie Mustapha is a Sierra Leonean Health Lawyer who holds an LL.M in National and Global Health Law and a Certificate in International Human Rights Law from Georgetown University Law Center. She is currently a Senior Public Health Law Fellow at the Centers for Disease Control and Prevention, participating in the Oak Ridge Institute for Science and Education (ORISE) Research Program. The views expressed are her own and do not necessarily represent the views of the Centers for Disease Control and Prevention or the United States Government. You can reach her via LinkedIn or Twitter.