One thing is certain in Freetown, Sierra Leone’s capital, says 18-year-old Abdullah: you are never far from a kush dealer. Some call its impact the “kush devil”. For Abdullah, addiction resulted in him dropping out of school and begging on the street. Now he is staying at the City of Rest Rehabilitation Centre, one of Sierra Leone’s only rehab facilities.
A single joint of kush can cost 5 leones (20p), which can add up quickly when buying multiple joints a day – in a country where youth unemployment stands at 60%, one of the highest in west Africa.
Looking at the floor, Abdullah says he hasn’t used kush for the two weeks he has been at the rehab centre – but it’s everywhere. “Anywhere you go you see kush, there’s more dealers than users.”
He alleges that even some in the police are in on the trade in Sierra Leone. Almost all the centre’s 16 patients are struggling with kush addiction, yet for a drug that appears so plentiful in Sierra Leone, its origin and composition remain a mystery.
Authorities have likened kush to a synthetic cannaboid product – akin to the so-called “zombie drug” spice – that can be smoked, but no one appears to be sure what’s in it. Kush users and the doctors treating them have suggested there are dangerous potential ingredients including fentanyl and tramadol, and also formalin, a chemical most often used to preserve human bodies. Shoe polish is another mooted element.
Many people who spoke to the Guardian cited horrifying stories of human bones being crushed up into kush, with local media reporting arrests for gravedigging for this purpose, although this has not been verified.
The rehab centre, a single-storey concrete block in one of Freetown’s hilly suburbs, offers an initial 90-day programme, with medication for detoxification from the drug as well as counselling, and an aftercare plan to deal with potential relapses. But part of the building lies in rubble after a fire partially gutted it a few months ago, drastically reducing capacity.
“Kush destroyed my life,” says 21-year-old Tejan, who stopped using two weeks previously. “I smoked it to feel a release, but it made me lose myself.”
Tejan used the college lunch money his parents gave him to buy kush, which was easy to find as there was a dealer behind his house. “It’s the worst problem currently in Sierra Leone,” he says.
Augusta Johnny, the centre’s programme co-ordinator, has seen a “drastic” increase in use of the drug in the past five years. It appears to be a “profitable business”, she says, although no one is sure who is ultimately profiting.
“There’s speculation it’s imported, but we really don’t know the source of it,” she says, adding that they have treated patients from neighbouring Liberia, and frequently get calls from families in Guinea who are hoping to obtain treatment for their loved ones. “Even though we’re trying to help them as much as we can, resources are limited, and we have little to no support from the government.” She says most of their funding is from private donations.
“Some people have been jailed when found smoking kush,” says Johnny. “That’s not a solution. Users should be rehabilitated, not imprisoned.”
Ahmed, 29, is one of those who found himself behind bars for using. People buy kush instead of food, he says, almost spitting at the drug’s mention. “It’s like you’re smoking poison.” The drug is behind him now, he says, patting his arms and legs, noting that he has regained weight in the months since he stopped using.
Ahmed speaks to the complexity of the kush origin story and how widespread the problem is. He started using a kush-like substance while living in the US. After returning to Freetown, his addiction worsened as the drug was easy to get hold of. “Our country is poor, and we take it to feel good,” he says.
In July, the inflation rate was at nearly 45%. Ahmed says he knows young people who have turned to the drug as they struggle to find work. Nearly everyone at the centre has a story of people dying from the drug. Ahmed is no exception: he has friends who have lost their lives, though he doesn’t go into detail.
“Kush destroyed my life,” he says, adding that the authorities should be “locking down the cartels and the dealers and helping young boys get a job”.
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Kush use is not confined to the dark corners of the city. It happens in plain sight. On a warm July morning, a young man lies in the middle of the pavement near one of the city’s most expensive hotels in Lumley beach, the northern peninsula of Freetown. People step carefully around him as he stares up at the sky with a glazed look.
Many say this is the desired sedative effect they crave when taking the drug, a moment of release, although some videos circulating online show users staggering around after smoking it, and there are stories of people being killed accidentally by walking into oncoming traffic.
Dr Jusu Mattia, acting medical superintendent at the Sierra Leone Psychiatric Teaching hospital in Freetown, says you only need walk through the city’s parks to see the extent of the problem. “If you randomly select 10 people, seven of them will be on kush,” he says. “It’s so alarming. It needs attention.”
The hospital, upgraded significantly in recent years thanks to support from the international nonprofit Partners In Health, has seen a big rise in the numbers of patients it is treating for kush addiction. In 2020, 47 people were identified as users. In 2022, it was 1,101. Most of them are men between 18 and 25.
More than 95% of the men currently admitted to the hospital are using substances, and many are kush users.
Part of this huge increase in kush users can be attributed to the reduced stigma around seeking treatment for addiction, staff at the hospital say. But Mattia is troubled by the drug’s prevalence, which appears to be infiltrating every level of Sierra Leonean society. “That is a very ominous development for the country, especially since it targets the youth, the leaders of tomorrow,” he says.
There are only five psychiatrists currently in Sierra Leone for a country of about 8.4 million, according to the World Health Organization.
Sitting around a table in the hospital, some of the doctors and psychiatrists puzzle over what kush contains. Currently, they say, there is no definitive answer – an additional reason for concern. Some users, for example, present with swelling and infections, leading to open wounds on their legs, but there is no clear medical explanation.
Caroline Ofovwe, a clinical psychologist at the hospital, says it’s not all bad news: “The kush journey is not always geared towards a doomsday.” She notes that there are patients who have been supported by their families to go clean and serve as role models to others. In a small room in the hospital, a group of recovering addicts say they now spread awareness to others. The hospital also plans to open a drug detox centre soon.
Joshua Abioseh Duncan, the country director at Mental Health Coalition – Sierra Leone, says he’s often woken at night by calls from people seeking treatment for kush. The coalition principally offers talking therapies but can refer people for medication if needed.
Duncan cites the socioeconomic issues and underlying anxieties driving often very young people to use kush. “We cannot stop the water from boiling without putting out the fire,” he says. “Let’s pause the blaming and talk about reacting to the impact. Let’s ask where is it coming from? Who has their hands in it? How can we tackle it from our level?”
Dr Carol Labor, a special adviser for mental health at the health ministry, says: “As a government and a ministry, we’re very concerned because of the high rates of kush and other drug usage. We’re currently establishing a mental health secretariat.”
Labor says the government is looking at raising awareness and finding reliable data on the drug’s composition and long-term effects, including a case study on its availability, impact and how to improve access to treatment.
Help is available, Labor insists, to those who need it. Better data is key to provide individuals with the treatment and counselling they need, she says. “We’re doing all we can, and we are very concerned about the next generation and how this may impact their lives.”
In the City of Rest, Ahmed is preparing to leave soon, and hopes to get a job so that he can provide for his baby daughter. But he knows others aren’t so lucky. “Kush,” he says, “is destroying Sierra Leone.”
Some names have been changed to protect identities
