Kush Addiction: A Clarion Call for Psychiatric Research and Intervention

Dear Editor, The growing trend of Kush addiction in West Africa, particularly Sierra Leone, is raising significant public health concerns and underscores the need for expanded research. As a potent strain of cannabis, Kush is increasingly being combined with other harmful substances, intensifying its effects and addictive potential. Alarmingly, some variants of Kush now contain substances as hazardous and ethically troubling as human bones. This disturbing development in drug abuse demands thorough research into its composition, effects, and treatment options, as well as a coordinated response from health professionals and policymakers to address its widespread impact. Kush, derived from the Cannabis indica family, is traditionally a type of marijuana, but the variant used by Sierra Leone’s youth includes a mixture of cannabis, fentanyl, tramadol, formaldehyde, and pulverized human bones, smoked similarly to a cigarette. The combination of cannabis and an opioid-like fentanyl is known to produce more euphoria than either substance alone. However, the inclusion of human bones raises serious concerns. It is hypothesized that the sulfur content in bones contributes to the heightened high.[1] The practice of mixing human bones has escalated to the point where grave robbing has become widespread. This grave robing violates cultural norms surrounding death and burial practices and legal statutes, desecrating burial sites, and dishonoring the deceased. Beyond legal repercussions, it reflects a disregard for human dignity that poses public health risks and ethical concerns in handling death-related matters. This widespread practice prompted the Sierra Leone government to declare a national emergency and label it the “zombie drug crisis.”[2] Kush addiction has become so widespread in Sierra Leone that admissions to the country’s sole psychiatric hospital have surged by 4000% from 2020 to 2023, totaling 1865 admissions. A report indicates that 63% of those admitted to drug rehabilitation centers in Sierra Leone are there primarily because of Kush.[3] These patients typically present either in an intoxicated state, behaving erratically, such as suddenly falling asleep while standing, or they exhibit psychotic symptoms. In addition, cases of infections and organ failure among users have been observed. The allure of Kush among the youth is largely attributed to extreme poverty, inexpensive rate, and unemployment, driving those who previously used marijuana and cocaine to turn to Kush as a source of relief. One user expressed, “I am not happy to smoke Kush, but it is the only thing that gives me strength, courage, and power to do my work;”[4] another user reported, “It makes me forget the stress.”[5] The issue of Kush addiction is now spreading to Guinea, Sierra Leone’s neighbor, which is also struggling to manage the rising consumption of Kush.[6] Research on the escalating Kush addiction crisis in Sierra Leone, particularly its disturbing inclusion of human bones, requires a multifaceted approach to understand and address the issue comprehensively. First, it is imperative to ascertain the extent of the problem through surveys and interviews with relevant stakeholders, including health-care professionals, law enforcement agencies, and affected individuals. Concurrently, chemical analysis of Kush samples should be conducted by forensic experts to determine their exact composition. Furthermore, medical researchers and public health experts should collaborate to assess the health implications associated with Kush consumption, focusing on both physical and mental health impacts. Psychosocial exploration, employing qualitative research methods, is vital for uncovering the sociocultural factors driving Kush addiction, including attitudes toward the use of human bones in the substance. In parallel, efforts should be made to evaluate existing legal frameworks and policies related to drug trafficking and substance abuse in Sierra Leone, identifying potential gaps, and proposing policy recommendations to address them. Ethical considerations must be paramount throughout the research process, ensuring the dignity and autonomy of research participants, especially those affected by addiction. In addition, collaboration with harm reduction specialists and community organizations is essential for developing and implementing interventions aimed at reducing the harm associated with Kush addiction. These interventions may include outreach programs, education campaigns, and access to treatment and rehabilitation services tailored to the needs of affected populations. Finally, research findings should be disseminated widely through various channels, including academic publications, policy briefs, and public awareness campaigns, to inform stakeholders and facilitate evidence-based decision-making. Building local research capacity in Sierra Leone through collaborative efforts is crucial for sustaining long-term solutions to the Kush addiction crisis. Kush addiction in Sierra Leone may propagate similar drug trends globally due to the inclusion of commonly used harmful substances such as fentanyl and tramadol, raising significant public health concerns. The interconnected nature of the global drug trade could facilitate the spread of Kush addiction to other countries or continents, potentially leading to increased drug-related crimes. Sierra Leone’s experience underscores the importance of global health preparedness to address emerging public health crises associated with substance abuse. The socioeconomic factors contributing to Kush addiction in Sierra Leone are prevalent in other regions, necessitating holistic approaches to address addiction vulnerabilities worldwide. Ethical and legal considerations surrounding including human bones in Kush production may prompt other countries to review regulatory frameworks to prevent the emergence of similarly hazardous substances and practices. In conclusion, the Kush addiction crisis in Sierra Leone, exacerbated by the inclusion of human bones in its composition, presents a grave public health challenge requiring urgent attention and action. The surge in admissions to psychiatric facilities and drug rehabilitation centers underscores the urgent need for comprehensive research and intervention strategies. By adopting a multifaceted approach encompassing chemical analysis, medical research, psychosocial exploration, policy evaluation, and community engagement, we can better understand the problem and develop practical solutions to mitigate its impact. This crisis provides insights applicable to broader drug abuse issues worldwide. It highlights the risks of polydrug use, innovative drug formulations, socioeconomic drivers of substance abuse, and the importance of tailored treatment approaches. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.