Substance use among incarcerated male population in Freetown, Sierra Leone: Prevalence, predictors, and risk profiles using the WHO ASSIST

This cross‑sectional study assessed the prevalence, predictors, and substance use risk profile among 333 incarcerated males at the Freetown Male Correctional Centre. The WHO-ASSIST tool was used for data collection. The risk of substance-related issues was categorised as low, moderate, or high. Logistic regression was done to identify predictors of lifetime substance use (Model I) and recent use within the past three months within or outside prisons (Model II). The prevalence of lifetime substance use was 88.6% (95% CI: 0.85-0.92), recent use 73.9% (95% CI: 0.69-0.79), and polysubstance use 77.2% (95% CI: 0.73-0.82). Tobacco (80.5%), cannabis (70.0%), alcohol (68.2%), and opioids (64.0%) were the most used substances. In adjusted models, older age, unmarried status, and rural residence were significant predictors of both lifetime and recent use, while education status was specifically associated with recent use. Risk profiles revealed a high level of dependence among tobacco users and moderate risk among most cannabis and opioid users. Substance use was notably high, with tobacco, cannabis, and opioids emerging as the primary substances of concern. These findings underscore the burden of substance use and highlight the need for targeted interventions and the integration of cessation programs within the correctional centre.