Know better. Do better.

The policy:

Sierra Leone’s President Julius Maada Bio in April declared a national emergency on substance abuse to tackle the spiralling use of an often deadly – and psychiatrically damaging – synthetic drug known locally as kush. Bio said a new agency, the National Task Force on Drugs and Substance Abuse, would be set up and that centres would be opened in every district to help addicts.

The impact:

Bio’s announcement was dramatic. Kush, he said, was an “existential crisis” for Sierra Leone.

“We are witnessing the destructive consequences of kush on our country’s very foundation: our young people,” he said.

It’s hard to overstate how bad the problem has become.

Addicts in a stupor, suffering with physical ailments such as swollen limbs, have become a common sight on the streets of the capital Freetown as well as in other towns and cities.

Kush, not to be confused with the drug of the same name in the US, is a mixture of cannabis, fentanyl, tramadol, formaldehyde and, according to some reports, ground down human bone.

In fact, cemeteries are reported to have asked for police protection to stop skeletons being dug up.

“It was introduced in Sierra Leone in 2015,” Mercy Kamara, of local charity AdvocAid, told me. “But the emergence of it as a health issue started three years ago around 2021.”

Over the last three years, Kamara has watched young people across the country, including some she works with, get hooked on kush to blot out issues such as unemployment, poverty, and depression. 

“We used to have mining companies in Sierra Leone which engaged these young people, but because of the economy most of them closed,” Kamara said. “And an idle mind is the devil’s workshop.”

Unemployment is indeed a huge problem. Some estimates put youth joblessness as high as 60 percent and more than a quarter of the country’s population lives in poverty.

“The cost of living is so expensive,” she said. “With those challenges, it is easy for people to fall into depression.”

The young people she works with just want to forget about what they see as a lack of a future. 

So, in steps the dirt cheap kush with joints of the drug selling for a relative pittance. But, while the price to buy it may be low, the costs to the addicts are significant.

The high is said to cause a pounding sensation in the head, and pain in the neck and joints.

Heavy users forego basic hygiene, drop out of school, and avoid going to work. Addicts often resort to theft to fund their habit. Immune systems are weakened, and sores develop on the body. It can cause liver, kidney, and respiratory problems, and for many, its use ends in death.

Although there is no official death toll, one doctor in Freetown told the BBC that in recent months he’s watched as hundreds of young men had died from organ failure caused by the drug. 

Kamara said she’s most concerned about the mental health impact.

Between 2020 and 2023, kush-related admissions to the country’s only psychiatric hospital jumped by almost 4,000% to 1,865, the hospital said.

“And those are only the people whose families can afford services,” Kamara told me, noting that most people can’t afford care. 

Though the government has said it wants to help - not punish - addicts, there are concerns that punishment has become the go-to measure.

Kamara says that, instead of the support for addicts promised as part of the emergency measures, she has mostly seen people being arrested for possessing or buying and selling kush. 

Like other drugs, kush is illegal to use, possess, and manufacture under the 2001 Pharmaceutical Act and the 2008 National Drug Control Act. 

“They started criminalising kush in 2021,” Kamara said, adding that often people were fined and then released.

“But the seriousness of the offence has increased at the end of 2023. There are more arrests now, and most are then incarcerated. Some of them are given up to three years in prison.” 

The criminalisation approach makes things worse, Prince Bull-Luseni, Executive Director at the West Africa Drug Policy Network, told me.

“It converts people into criminals,” he said. “A criminal is convicted, which limits chances of employment, increases stigma and discrimination, and reduces opportunities.” 

In Sierra Leone’s prisons, there are no rehabilitation programmes for addicts. 

“You could get mixed up with people who may be hardcore criminals,” Bull-Luseni said. “The likelihood you may be influenced by them is high, and so is the possibility of taking drugs in prison.”

There are also fears, activists say, that criminalisation could push drug users underground and deter them from accessing medical and mental health support as promised in the emergency measures.

Bull-Luseni thinks that legal regulation is the way forward and that drug education is needed so that people can make informed decisions about the substances they take.

And, for those already dependent, treatment and rehabilitation is needed.

The jury is still out on the measures introduced in April as part of the national emergency and whether they will work. But Kamara is clear where the emphasis should be.

“This is a public health emergency,” she said. “Not a criminal one.”

Any views expressed in this newsletter are those of the author and not of Context or the Thomson Reuters Foundation.