Authors:
Abu Conteh
Corporate Author:
Social Science in Humanitarian Action Platform
Published:
2024

Sierra Leone has seen a sharp rise in the use of ‘kush’ – a relatively new drug formed through mixing several constituent drugs, including opioids, which is proving highly addictive and is having serious negative health and social consequences. In April 2024, the government declared a public health emergency resulting from high levels of kush use, with security services launching crackdowns.1

Limited data on kush use presents challenges to understanding the scale of the problem. The lack of evidence has hampered the government’s response to the kush crisis. This has contributed to a misunderstanding of the problem and a response that has negatively impacted those people using the drug. The composition of kush is similarly unclear; it is described as a combination of cannabis, fentanyl, tramadol,2 formaldehyde,3 disinfectants4 and – according to some media reports – ground human bones.3,5 Tests by the Global Initiative against Transnational Organized Crime6 found that the drug contains synthetic cannabinoids and nitazenes.6 Youth are thought to be major consumers of the drug.4 The response to this emergency has been primarily punitive with dealers and addicts being arrested by security forces and placed in detention centres or rudimentary mental health facilities.7–9

This brief contextualises and provides insight into the ongoing kush epidemic. While kush use in Sierra Leone has reached crisis levels – requiring urgent action – it is symptomatic of deeper, long-standing issues of poverty, unemployment and limited opportunities for youth. These issues require sustained and comprehensive solutions beyond immediate emergency measures. This brief draws on academic and grey literature as well as consultations with practitioners working with regulatory authorities in Sierra Leone. There is currently little research on kush use in Sierra Leone, especially on the perspectives of users and the circumstances of their use. Due to the lack of social science evidence that articulates the drivers of substance use in Sierra Leone, what is presented in this brief is an attempt to identify factors likely to be shaping the epidemic and is thus speculative in nature. Ultimately, this brief aims to catalyse a dialogue that supports more effective responses to the crisis, including a multidisciplinary response to the epidemic and harm reduction approaches that focus on mitigating the dangers associated with drug use.

Key considerations

  • Undertake collaborative research to build an evidence base on kush use in Sierra Leone. There is limited evidence on the patterns and drivers of kush use. Evidence generation drawing on the perspectives of people with lived experiences of using the drug is urgently needed. This should be shared with policy makers to understand who is more affected and why, and to support an informed and measured response to the crisis.
  • Prioritise investigations into the political economy of drug supply to identify effective control measures. Knowing where drugs come from, who is benefitting from their sale, and how organised (or not) the distribution system is essential in order to develop strategic control interventions.
  • Apply a humanistic and people-centred approach to support the rehabilitation of drug users. Public response to drug use must consider humane approaches by supporting users to recover and rehabilitate, rather than being overly punitive. This may include harm reduction approaches.
  • Provide funding for institutions providing mental health support and rehabilitation. Mental health facilities and rehabilitation centres in Sierra Leone are overburdened and there is only one psychiatric hospital in the country. With a dramatic spike in drug addiction in Sierra Leone since 2020, there is an urgent need to invest in institutions providing mental health and rehabilitation support for people impacted by drug use.
  • Champion a multidisciplinary response to address the underlying causes of drug addiction. An integrated approach is needed to bring together diverse expertise and perspectives from social workers, mental health professionals, community stakeholders, and representatives from local community structures. This will support a comprehensive understanding of the complex social, economic, and health factors driving the epidemic, allowing for a more holistic, culturally sensitive and effective response to the immediate crisis and its underlying causes.
  • Utilise long-term planning to address the drivers of drug use in Sierra Leone. Policymakers should focus on long-term strategies that tackle the underlying socioeconomic factors driving youth drug use, such as high unemployment rates and limited opportunities for social mobility. This approach should prioritise sustainable economic development, education reform, and youth empowerment programmes, while also strengthening healthcare and social support systems.
  • Treat addiction as a health issue rather than a criminal issue. Policy makers and public health practitioners must consider drug use as a health issue that negatively impacts the wellbeing of people affected, and refrain from criminalising users. This approach must prioritise intersectoral collaboration, bringing on board different stakeholders to support drug users to recover.

Background to the kush epidemic

Kush is a recently introduced synthetic drug that has become a significant issue in West Africa, especially in Sierra Leone. It is a dangerous mixture of several substances, whose composition changes regularly, making it hard for authorities to understand and find ways to address its use. However, most reports have found that the base substances found in kush are cannabis, fentanyl, tramadol, and formaldehyde. There have been reports of acetone, paints, and disinfectants as constituent ingredients. Kush is produced locally in makeshift laboratories run by criminal gangs in Sierra Leone. The process involves mixing locally sourced cannabis with imported opioids, like fentanyl (a powerful synthetic opioid) and tramadol (a prescription painkiller). These opioids are thought to be sourced from illegal laboratories in China and other Asian countries and smuggled into Sierra Leone.10

Kush is also relatively cheap and more accessible compared to other illicit drugs. The combination of substances make it highly addictive. Kush has severe effects on both physical and mental health.3 According to consultations undertaken with practitioners working with drug users in Sierra Leone, users often experience extreme drowsiness, hallucinations and impaired motor skills. Long-term use can cause significant malnutrition, organ damage, respiratory issues, and even death. Users also experience paranoia, anxiety, and severe mood swings. Chronic use can lead to depression, cognitive impairments, and dependency on the drug that is difficult to break.

Political economy and the supply of kush

The origin of kush as a concoction of drugs has not been well documented. However, some of its components, such as fentanyl, are known to be trafficked from China to Sierra Leone and other West African countries.3 The West African region has been used as a trafficking route for other drugs, such as cocaine, from Latin American countries – notably from Venezuela and Colombia – destined for the European market.11 Two of the reasons cited for the spread of the drug is that it is cheap and easily available. Experts working with regulatory authorities consulted with as part of developing this brief stated that the kush trade has grown significantly since 2017. They clarified that although the profit margin for kush is not large relative to other drugs, its production is low-tech, which has facilitated the proliferation of producers and a ‘democratisation’ of the trade.

Distribution networks involve Nigerian and Sierra Leonean criminal groups, with street-level sales making the drug widely accessible due to its low cost.12 While specific profiteers are not clearly identified, it is believed that criminal gangs, corrupt officials, and international networks benefit from the trade.10 The epidemic has regional implications, spreading to neighbouring countries like Guinea and Liberia.13

Socio-political context of kush use and regulation in Sierra Leone

Addressing underlying socio-political factors contributing to drug use is essential for a comprehensive approach. This requires a diagnosis of the political economy of drug use and supply, and targeted regulatory action. It also requires a better understanding of the socio-economic drivers of drug use in order to develop supportive services.

The kush epidemic in Sierra Leone, particularly amongst young people, has reached critical levels since its use was first reported in 2016, prompting President Julius Maada Bio to declare a national emergency in April 2024.1 Mental health facilities and rehabilitation centres in the country have exceeded their capacity by three-fold and the only psychiatric hospital has seen a surge of almost 4,000% in people presenting with drug addiction since 2020.14,15 Societal fears of kush include rising crime, family breakdown and socio-economic harms, as young people drop out of school and the workforce due to the effects of the drug. In response, a National Task Force on Drugs and Substance Abuse was established, led by Brigadier General Prof. Foday Sahr of the National Public Health Agency.16 However, the activity of this taskforce remains unclear to the public.

Sierra Leone’s vulnerability to drug trafficking

When a plane containing several kilograms of cocaine from Latin America landed at the Freetown International Airport in July 2008, there were calls to deter traffickers, dealers and users of narcotic drugs.17 The incident prompted the enactment of The National Drug Controls Act (2008), followed by the establishment of the National Drug Law Enforcement Agency.18 The arrival of the narcotics aircraft in Freetown was an illustration of the vulnerability of Sierra Leone, and other West African countries to drug trafficking. However, the hasty signing of The National Drug Controls Act under a certificate of emergency meant that there was limited time to engage with the public and the civil society on the wider implications. In particular, support for the welfare of drug users and a guarantee of institutional support for rehabilitation and community engagement was missing, despite advocacy by the West Africa Drug Policy Network.

National response to the kush epidemic

The government’s approach has largely focused on criminalisation and detainment, with arrests of users initially leading to imprisonment and later to overcrowded mental health facilities.19 Raids on drug manufacturers and sellers have been conducted, but resources for rehabilitation and treatment are limited. Private rehabilitation centres provide services, but their high costs make them inaccessible to many.20 The response to the crisis has been complicated by the circulation of unsubstantiated rumours, such as the inclusion of human bones in kush, which echo previous moral panics about youth behaviour and drug use.3 These sensationalised narratives risk trivialising the complex socioeconomic factors driving drug use and may hinder the development of more nuanced, evidence-based interventions.2,21 The kush epidemic unfolds against a backdrop of high youth unemployment and limited economic opportunities, highlighting the need for a more comprehensive approach that addresses the root causes of substance use in Sierra Leone.

Policy, legal and institutional frameworks

Sierra Leone’s drug enforcement landscape is weak, with limited development of legal, policy and institutional frameworks since the end of the war in 2002. The Pharmacy and Drugs Act was enacted in 2001, to regulate the supply and use of illegal pharmaceutical drugs and some narcotic drugs.22 Little consideration is given to the rehabilitation of people using drugs in policy or legal instruments in Sierra Leone. Meanwhile, people convicted of possessing and using drugs under this law face up to 20 years imprisonment.

The West Africa Drug Policy Network has been advocating for a reform of The National Drug Controls Act (2008), by integrating humanistic approaches into rehabilitating drug addicts.23 In November 2021, the National Drug Law Enforcement Agency launched a validation workshop to review a strategic ‘master plan’ as part of efforts to review The National Drug Controls Act (2008). Among other things, the master plan called for the use of an evidence-based approach to drug use, and the respect of fundamental human rights through the provision of treatment, rehabilitation, and reintegration for drug users.24

Drivers of the kush epidemic in Sierra Leone

There is currently very little research on kush use in Sierra Leone. The following contextual factors are offered as potential drivers, the impacts and implications of which require more research and deeper consideration in the response to the epidemic.

Post-war reconstruction, poverty and chronic stress

By the end of the war in 2002, Sierra Leone had gained much international attention to support infrastructure projects and macroeconomic stabilisation to help it attain sustainable development through institutional strengthening. A programme was initiated to demobilise ex-combatants and resettle displaced persons in their homes. However, post-conflict development has been challenged by corruption and institutional weaknesses.25 Freetown has grown rapidly since the end of the war, with many settlements located in hazardous risk-prone environments, leading to a situation where people’s homes and work is insecure.

Poverty is widespread in Sierra Leone, with a significant number of families facing food insecurity. Support systems for the poor are constrained due to financial limitations faced by the government. Although its effect is temporary, kush offers a momentary escape from poverty and stress.20 For those who manage to secure casual manual labour – such as working at construction sites, offloading boats and transporting goods – kush is believed to serve as an important energy booster. As remarked by a young man in one study: ‘It gives you the energy to keep going, even when your body wants to quit…’2

Youth exclusion and coercion

The use of drugs by young people in Sierra Leone has a troubled history. Drugs were essentially a weapon of war, and child combatants and young people were forced to use heroin and cocaine in order to commit violence. Different fighting factions introduced drugs. This was critical in the way violence was perpetuated, particularly by conscripted child soldiers.26 Mitton’s research on Sierra Leone examines how factors like child soldier recruitment and drug use intersected with broader socioeconomic and political dynamics to shape patterns of violence during and after the civil war.27 The decades since have seen continued youth marginalisation, unemployment and stigma. This is despite huge donor attention and investment in programmes following the recommendations of the Truth and Reconciliation Commission, which called for youth empowerment as an essential component of peace building.

It is estimated that the youth (15-35 years) constitute 42% of the country’s population, many of whom have limited prospects for social and financial mobility, partly due to social exclusion, and minimal financial and educational opportunities.28 There is also a long history of youth manipulation and coercive drug use. This may have a bearing on how the kush emergency is playing out, helping to explain why youth are reportedly the main users of the drug.

Young people in Sierra Leone are often blamed and stigmatised for violent or immoral behaviour. However there is evidence to show that young people are often exploited and coerced into violence,29 including in the recent waves of political demonstrations in Freetown and other parts of the country. A government investigation of the violent demonstrations of 10 August 2022 reported that the event was executed and financed by ‘rogue politicians’ who exploited economic hardship and unemployment to their political advantage.30

The examples of youth coercion into contemporary political violence and drug use during the war illustrates that the behaviours of young people that are deemed problematic often have deeper roots. Any response to kush should consider how social, economic and political factors may be playing into youth susceptibility to kush.

Psycho-social trauma

Traumatic experiences related to the loss of loved ones, particularly in violent circumstances, have been cited as closely related to the use of kush in Sierra Leone.2 Recent post war shocks such as the Ebola epidemic and the mudslide in Freetown compounded the collective memories of the civil war, where many families tragically lost loved ones. Sierra Leone has extremely limited social safety nets, so children can become homeless when they lose parents or caregivers. These traumatic experiences and challenging circumstances can lead to feelings of hopelessness and distress, which may increase the risk of individuals turning to substance use as a coping mechanism. It is notable that Sierra Leone has extremely limited mental health service provision, and that the country has been through major traumas that have likely led to significant unmet mental health needs.

Addressing the kush epidemic through a humanistic approach

An effective response to the kush epidemic requires rapid and systematic evidence generation to understand the users of the drug, and their inherent vulnerabilities, as well as the drivers shaping the supply chain and availability of the drug within the political economy.

Alternatives to punishment

Institutional support for the rehabilitation of people impacted by drug use remains very limited, and is undermined by the limited funding for and prioritisation of mental health services.31 Communities across Freetown, wanting to act but with limited resources and knowledge about managing addiction, have resorted to forcefully arresting kush users. The country’s only mental health facility is overwhelmed, with daily admissions of young people using drugs or with other mental health problems.15 The limited number of psychiatric experts in Sierra Leone makes it difficult to provide adequate care and support. There is a need for increased investment in psychosocial support and mental health conditions related to drug use.

Harm reduction approaches

Given the complex nature of kush use, a harm reduction approach could be more effective than focusing solely on abstinence or cessation (ending use entirely). This approach acknowledges the reality of drug use while aiming to minimise its negative health and social impacts. Key strategies could include education and awareness initiatives that provide accurate, non-judgmental information about kush and its potential risks to users and the wider community. Establishing safe consumption spaces is often a core part of harm reduction approaches elsewhere, but this may not be feasible in Sierra Leone and there is not currently an evidence base about whether such an approach would work for kush.

Access to health services

Improving access to primary care and mental health services for kush users, treating addiction as a health issue rather than a criminal one, is vital. Engaging former and current kush users in outreach and support roles can leverage their experiences to connect with and assist others more effectively. This peer support approach can be particularly valuable in building trust and providing relatable guidance. Finally, advocating for drug policies that prioritise public health over criminalisation is crucial. Such policy reform could reduce stigma and barriers to seeking help, creating a more supportive environment for those struggling with kush use. By adopting these harm reduction strategies, Sierra Leone could work towards mitigating the negative impacts of kush use on individuals, families, and communities, while also addressing the broader social and economic factors contributing to the crisis.

Towards a people-centred response

So far in Sierra Leone, response to drug use has tended to blame the users. Rather than viewing drug use primarily as a criminal or moral issue, a people-centred approach based on social science would examine underlying social, economic, and psychological factors driving drug use. Research is required to identify what these may be in Sierra Leone and this brief suggests some likely factors including poverty, unemployment, lack of opportunities, legacies from the civil war and social marginalisation.

Acknowledging and understanding the role such factors play in driving drug use would shift the focus from punishment to creating meaningful employment and educational opportunities for young people. Resources currently used for law enforcement and incarceration could be redirected toward job creation programmes, vocational training, mental health services and community development initiatives.

In order to stem the drivers of drug addiction, the discourse around youth and addiction must  move toward a more empathetic, public health-oriented framing, with youth seen as victims of circumstances out of their control, rather than criminals. Community-based interventions, harm reduction strategies, and addressing collective trauma must be emphasised. Policy reforms to decriminalise use and possession, comprehensive data collection, and a holistic approach integrating solutions for poverty, governance, education, and healthcare must be prioritised. This nuanced, compassionate perspective could lead to more effective and sustainable solutions to the kush epidemic in Sierra Leone and help to prevent future drug-related problems.

References

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  3. Cole, M. (2024, January 15). Kush: What is this dangerous new west African drug that supposedly contains human bones? The Conversation. https://theconversation.com/kush-what-is-this-dangerous-new-west-african-drug-that-supposedly-contains-human-bones-220608
  4. Bah, S. (2024, January 2). Inside the ‘zombie’ drug epidemic sweeping West Africa. The Telegraph. https://www.telegraph.co.uk/global-health/terror-and-security/kush-synthetic-drug-addiction-epidemic-west-africa/
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  11. Rousseau, R. (2017). West Africa – the Region’s Pivotal Role in International Drug Trafficking. Khazar Journal of Humanities and Social Sciences, 20(4), 19–32. https://doi.org/10.5782/2223-2621.2017.20.4.19
  12. ADF. (2024, April 23). In Sierra Leone, Addicts Rob Graves to Produce ‘Zombie Drug’. Africa Defense Forum. https://adf-magazine.com/2024/04/in-sierra-leone-addicts-rob-graves-to-produce-zombie-drug/
  13. WHO. (2024, April 19). Tackling Substance Abuse: WHO Supports Efforts to Combat the Kush Epidemic in Sierra Leone. WHO. https://www.afro.who.int/countries/sierra-leone/news/tackling-substance-abuse-who-supports-efforts-combat-kush-epidemic-sierra-leone
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Authors: This brief was written by Abu Conteh (Sierra Leone Urban Research Centre, SLURC).

Acknowledgements: Contributions were made by Bintu Mansaray (Institute of Gender and Children’s Health Research), Desta Ali (Institute of Gender and Children’s Health Research), Catherine Grant (IDS), Annie Wilkinson (IDS) and Luisa Enria (LSHTM). This brief was reviewed by Laura Dean (LSTM).  Editorial support provided by Georgina Roche (SSHAP editorial team). This brief is the responsibility of SSHAP.

Suggested citation: Conteh, A. (2024). SSHAP West Africa Hub: Addressing the kush epidemic in Sierra Leone. Social Science in Humanitarian Action (SSHAP). www.doi.org/10.19088/SSHAP.2024.060

Published by the Institute of Development Studies: October 2024.

Copyright: © Institute of Development Studies 2024. This is an Open Access paper distributed under the terms of the Creative Commons Attribution 4.0 International licence (CC BY 4.0). Except where otherwise stated, this permits unrestricted use, distribution, and reproduction in any medium, provided the original authors and source are credited and any modifications or adaptations are indicated.

Contact: If you have a direct request concerning the brief, tools, additional technical expertise or remote analysis, or should you like to be considered for the network of advisers, please contact the Social Science in Humanitarian Action Platform by emailing Annie Lowden ([email protected]) or Juliet Bedford ([email protected]).

About SSHAP: The Social Science in Humanitarian Action (SSHAP) is a partnership between the Institute of Development Studies, Anthrologica , CRCF Senegal, Gulu University, Le Groupe d’Etudes sur les Conflits et la Sécurité Humaine (GEC-SH), the London School of Hygiene and Tropical Medicine, the Sierra Leone Urban Research Centre, University of Ibadan, and the University of Juba. This work was supported by the UK Foreign, Commonwealth & Development Office (FCDO) and Wellcome 225449/Z/22/Z. The views expressed are those of the authors and do not necessarily reflect those of the funders, or the views or policies of the project partners.

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