GUEST WRITER: Kush the Fast-Running Plague of Addiction


By Dr. Manal Ghazzawi

Kush is a synthetic marijuana often called spice or K2. A Spice/K2 user is much more likely to experience serious adverse effects than a person smoking natural cannabis. These adverse effects may include psychotic symptoms such as paranoia and hallucinations, in addition to anxiety, aggression panic attacks to name a few. Kush itself and its metabolites have a very strong binding capacity to receptors in the brain and many other organs compared to natural cannabis, which is what makes it very dangerous and very hard to get rid of by the body.

Long-term Effects of Kush

There are reported effects including reduced blood flow to the heart (myocardial ischemia), abuse of these substances can lead to severe and lasting heart conditions like, stroke, brain damage and possibly death. In as much as the use of Kush has become widely desired by Sierra Leoneans for its euphoric effect, let us be reminded of its long-term effects and the fact that it is even much more addictive and 100 times more dangerous than that of natural marijuana. Each Kush brought into the country could be potentially mixed with different chemical substances (which is unregulated and frequently changing)!

Kush Dependence

Unlike marijuana, synthetic cannabinoids like Kush frequently elicit withdrawal symptoms—some quite severe. Withdrawing from Kush/Spice can be extremely uncomfortable, with symptoms including:

  • Headache.
  • Diaphoresis (sweating).
  • Tremors.
  • Drug cravings.
  • Psychotic symptoms, such as paranoia and hallucinations.
  • Mood change/depression
  • Suicidal ideation.

Since the overuse of Kush and its devastating effects is gaining momentum as an epidemic in Sierra Leone, it is high time a holistic harm reduction approach is adopted. Sierra Leone comprises of approximately 2.5 million youths of its 8 million population, and it is projected to increase to 4.1 million by 2050. It is known that at the age of 25 years a human brain develops fully, so we can already imagine the harmful consequences of using drugs at a very young age. It means school dropouts and poor academic achievements – a recipe for disaster for a thriving nation! If measures of harm reduction are not put in place, it means we are ready to lose the future of a promising land! It means we are to face and battle a rising endemic explosion of HIV, Hepatitis B and C, and mental illnesses to name a few. Kush or recreational drugs are not only used by the young men we see in the streets, but by women who are hiding in corners and by students (primary, secondary and college students). Ecstasy drug commonly known as “Molly” has also been introduced into the country!

What is Harm Reduction (HR) and how impactful it could be?

HR is a very wide concept and there is no one definition that fits all its principles. According to Harm Reduction International (HRI), an organization which advocates for HR worldwide, HR refers to policies, programs and practices that aim to minimize negative health, social and legal impacts associated with drug use, drug policies and drug laws”. HRI focuses on positive change” by working with people “without judgement, coercion, discrimination” and without requirement that they “stop using drugs as a precondition of support”. HR Coalition adds that “HR is a movement for social justice built on a belief in, and respect for, the rights of people who use drugs”.

The use of drugs does not mean people forfeit their human rights – they remain entitled to the right to life, to the highest attainable standard of health, to social services, to privacy, to freedom from arbitrary detention and to freedom from cruel, inhuman, and degrading treatment, among others. HR is rooted in a commitment to addressing discrimination and ensuring that nobody is excluded from the health and social services they may need because of their drug use, their race, their gender, their gender identity, their sexual orientation, their choice of work, or their economic status. HR policies and practices are informed by a strong body of evidence that shows interventions to be practical, feasible, effective, safe, and cost-effective in diverse social, cultural, and economic settings. The Lancet Commission on public health and international drug policy (2016) identified the excessive use of incarceration as one of the greatest impacts of drug prohibition which indirectly increases the risk of violence, HIV, hepatitis C & C, overdose, discrimination of the vulnerable, and inequalities.

Multiple countries have started to move away from criminalisation. The decriminalisation of drug offences in the Czech Republic and Portugal, for instance, have been associated with significant financial savings, less incarceration, significant public health benefits, and no significant increase in drug use. The Government of Sierra Leone can learn from Portugal’s and Czech Republic’s success stories of the adoption of HR. It is not about formulating policies which we are very good at, but to implement those policies into a more meaningful practice.

The Importance of Community Involvement in Rendering HR Services

Harm reduction services is a public health approach that does not only involve government or health care workers alone but working with people who use drugs themselves and the community. HR works best when it meaningfully involves people who use drugs, as it serves as a tool of empowerment. Community based and community led HR is key to successful HR, as it means that the insights, inputs, and involvement of communities- who are directly impacted by policies, programs, and services- are valued. Drug users will not only be clients to HR services, but service providers, advocates, and managers. This approach is person centered, adaptable and innovative. Meaningful community led partnerships in HR are much more than an intervention, it is about social justice, by firmly putting people seen as subjects only in the driver’s seat. It’s much about human rights, power shifting, self-determination, as it is about health care. While community led HR services is a social justice movement, it challenges the marginalization and stigmatization of people who use drugs. Who are we to judge people who use drugs, beat them up? Forcing people to stop using Kush or any drug will make things worse, such interventions have failed in many countries and created a vicious cycle, let us think of a more pragmatic, non-judgmental, and empowering approach – the solution to fight this plague of endemic addiction. This is no longer an epidemic but an endemic situation; and it is time to ACT NOW!

After all that has been said, the question we should ask ourselves is, what could we practically do to improve the community involvement in our local context, while authorities’ arms are folded being spectators to the ‘Kush Torture’ show? What practical measures we can adopt to help rescue our communities! How can we impact new law reforms and policies to help save our family and friends from the damages Kush has caused? What can we do to prevent the use of Kush or any illegal drug in our communities?!

Dr. Manal Ghazzawi is a clinical pharmacist, CEO of CitiGlobe Pharmacies Ltd and KnowHep Foundation Sierra Leone. She has great passion for writing on health issues afflicted by Sierra Leoneans apart from her contribution in the fight against Hepatitis B in Sierra Leone.


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