How structural violence drives a synthetic cannabinoid crisis

Sierra Leone is currently facing a severe public health crisis centered on Kush, a synthetic cannabinoid compound that has driven a 4000% increase in drug-related psychiatric hospitalizations since 2020. This polydrug epidemic cannot be understood as merely an individual behavioral problem, but rather as a manifestation of structural violence—the accumulation of systemic inequalities rooted in the country's civil war, recurring epidemic shocks, and entrenched poverty. The paper argues that punitive policy responses focused on criminalization have failed to address the underlying sociopolitical conditions that make communities vulnerable to dangerous synthetic drug use.

The research draws critical parallels to Sierra Leone's successful community-centered response to the 2014 Ebola crisis to propose alternative approaches for addressing the current Kush epidemic. Rather than enforcement-focused strategies, the authors recommend five key interventions: centering community engagement and trust-building, investing in youth livelihoods, decriminalizing and reintegrating people who use drugs, integrating mental health into primary care, and galvanizing coordinated international support. These recommendations represent a fundamental shift from victim-blaming to addressing the structural conditions—poverty, lack of economic opportunity, and inadequate mental health infrastructure—that drive synthetic cannabinoid use.

This analysis has important implications beyond Sierra Leone, highlighting how health communication strategies must address the social determinants of drug use rather than targeting individuals for punishment. The paper demonstrates that effective public health responses to substance-related crises require understanding local contexts, building community trust, and providing rehabilitative rather than purely punitive frameworks.