The Kush Drug Epidemic in Sierra Leone: Public Health Implications, Socioeconomic Drivers and Health System Responses

ABSTRACT Background Kush, a synthetic drug combining cannabinoids and nitazene opioids, has emerged as a major public health concern in Sierra Leone, with reported prevalence and clinical severity increasing markedly as it was first identified. This review examines the health consequences of Kush use, the socioeconomic and structural drivers underpinning its spread, and the adequacy of health system and policy responses across the Mano River Basin. Methods A narrative review was conducted using structured searches of PubMed/MEDLINE, Scopus, Web of Science and Google Scholar (2016–2025). Grey literature, including government policy documents, reports from international organisations, civil society publications and credible media sources, was systematically reviewed. Eligible sources addressed Kush or related synthetic drug use in Sierra Leone and the wider West African subregion, with emphasis on health outcomes, socioeconomic determinants, health system capacity and policy responses. Results Kush exhibits unpredictable toxicity and high dependence potential, with documented associations including acute psychosis, cognitive impairment, severe morbidity and rising mortality. Weak surveillance systems likely underestimate its burden. Structural drivers include entrenched youth unemployment, poverty, rapid urbanisation, post‐conflict trauma and limited access to education and mental health services. Regional dynamics across Sierra Leone, Liberia, Guinea and The Gambia reinforce its transnational spread. Responses since 2024 have intensified but remain disproportionately focused on law enforcement, whereas prevention, treatment and workforce development remain critically under‐resourced. Conclusion The Kush crisis exemplifies a complex, cross‐border public health emergency. Addressing it requires integrated, evidence‐informed strategies that strengthen health systems, expand community‐based interventions, improve toxicological surveillance and enhance regional coordination under ECOWAS frameworks.