The Urgency of Addressing Substance Use Disorder among Young People in Sierra Leone

Substance use disorder (SUD) among young people in Sierra Leone has become a major public health concern that requires immediate intervention. Following the reported trends of substance abuse and increasing cases of substance related admissions, the country officials declared the rampant use of substances a national public emergency on the 4th of April 2024, emphasising the need for the situation to be brought under control. ^{[1, 2]} The government established a National Task Force with five strategic priorities: prevention through awareness, care and treatment, social support, law enforcement, and community partnerships. ^[3] The first three of the listed strategies are concisely categorised as a public health response, while the latter is a law enforcement response. While some progress has been made in the law enforcement response, the government continues to struggle with implementing public health measures. ^[4] The country’s only psychiatric hospital has seen a 4000% increase in inpatient admissions reported since 2020. ^{[1, 2, 5]} Until recent times, there were only two specialised psychiatrists, two clinical psychologists, and 19 mental health nurses, along with one pharmacist serving a country of about 8 million people. This shortage of mental health professionals means radical measures and prevention strategies must be in place to bridge this gap. This commentary aims to provide evidence on the current state of substance use disorder in the country, its consequences, and to offer evidence based strategies for prevention and intervention.

The growing use of synthetic drugs, particularly kush, has emerged as a key driver of the SUD crisis. Kush, a combination of synthetic opioids such as nitazenes and synthetic cannabinoids, first appeared around 2016 and has since become the most widely abused drug among young people.[7] The drug’s low cost and high potency make it highly accessible to young people, contributing to widespread addiction and severe health complications, including organ failure and mental health disorders. Beyond kush, other commonly abused substances include tramadol, ecstasy, and cannabis, which are often used in combination, leading to dangerous patterns of polysubstance use. ^[8]

Socioeconomic factors play a significant role in fueling substance use among young people. Widespread unemployment and limited access to education and vocational opportunities have created an environment where drug use becomes a coping mechanism for economic hardship and psychological distress. Historical events, including the civil war (1991–2002) and the Ebola epidemic (2014–2016), have left a lasting impact on the mental health of young people, increasing their vulnerability to substance use. ^[9] The social consequences of SUD in Sierra Leone are profound. Young people with substance use disorders face increased rates of school dropout, family breakdown, and social isolation. The lack of adequate social support systems and the pervasive stigma around mental health issues discourage many from seeking help, worsening their condition. Additionally, substance use is linked to an increase in criminal activity, with reports of drug-fueled violence, theft, and sexual assault contributing to insecurity in communities. ^[10]

The rising prevalence of SUD in Sierra Leone stems from multiple socio-economic and structural factors. High youth unemployment, which affects over 60% of young people in Africa, has left many without viable career paths, leading them to engage in substance use and drug-related activities. ^[11] Additionally, limited access to quality education and the absence of structured drug education programmes make young people more vulnerable to drug use. ^[12] Many also struggle with untreated psychological trauma from past conflicts, compounded by societal stigma against mental health issues. ^[12] Existing literature estimates that Sierra Leone has one of the highest prevalence rates of mental health disorders in Africa. ^{[14, 15]} Recent studies have also reported the increasing trend of SUD-related admissions. One of the studies, which was done by Sinnah et al, revealed that SUD accounted for about 60.7% of the 3,241 admitted cases of mental health disorders between 2020 and 2023. ^[15] For most of the studies on SUD in the country, a similar pattern of higher rate of the condition among male youths without a history of employment has been seen. ^{[15, 16]} The consequences of SUD extend far beyond individual health, affecting families, communities, and national development. ^[17, It leads to cognitive impairment, increased suicide risk, and higher rates of infectious diseases such ^[18, It leads to cognitive impairment, increased suicide risk, and higher rates of infectious diseases such as HIV/AIDS due to risky behaviours. ^19] By 2050, SUDs are projected to contribute to 45 million Years Lived with Disability globally. ^[20] Young people struggling with addiction often face school dropouts, domestic conflicts, and social isolation, limiting their opportunities for rehabilitation. ^[21] Moreover, substance use reduces workforce productivity, places financial strain on healthcare systems, and worsens the existing mental health crisis due to limited government investment in mental health services. ^[22] All of these mentioned, including weak healthcare infrastructure and the lack of national policies dedicated to preventing substance use among young people, further exacerbate this crisis.

Addressing Substance Use Disorder (SUD) in Sierra Leone requires a multi-sectoral approach that aligns with the five strategic priorities established by the National Task Force: prevention through awareness, care and treatment, social support, law enforcement, and community partnerships. ^[3] Strengthening the healthcare system through task-shifting models, such as training teachers and community leaders to deliver basic mental health support directly, supports the care and treatment priority by improving access to mental health services, especially in underserved areas. ^[23] Additionally, digital tools like the SIMBIHealth app can enhance awareness and early intervention by providing mental health literacy to young people, supporting the prevention strategic priority. ^[24] Education and awareness are essential for preventing substance use. Implementing evidence-based prevention programmes in schools and communities helps young people understand the risks associated with drug use, reinforcing the prevention through an awareness strategy. ^[25] Furthermore, economic empowerment initiatives such as vocational training and entrepreneurship programmes provide alternative sources of income, reducing the financial appeal of the drug trade and strengthening social support systems. Establishing community-based therapy and peer support groups creates safe spaces for individuals in recovery, thereby contributing to two of the National Task Force’s strategic priorities, including care and treatment, and community partnerships.

To effectively address the escalating crisis of Substance Use Disorder (SUD) among young people in Sierra Leone, the following evidence-based recommendations should be implemented:

1. Strengthen Public Health Infrastructure: Increasing the number of trained mental health professionals is essential to addressing the current shortage in Sierra Leone. Implementing task-shifting models, which involve training non-specialist health workers to deliver basic mental health care, has proven effective in similar low-resource settings.23 Providing specialised training for community leaders, community health workers, and teachers will enhance mental health service delivery. Establishing regional mental health centres will reduce the burden on the country’s only psychiatric hospital and improve access to care. ^[6]
2. Enhance Prevention and Awareness Programmes: Developing and implementing evidence-based substance use prevention and mental health literacy programmes in schools and communities is also critical for early intervention. ^[25] Integrating mental health and substance use prevention education into the national school curriculum will increase awareness and promote healthier behaviours among young people. Utilising digital platforms, such as the SIMBIHealth app, can also provide accessible and scalable mental health resources. ^[24]
3. Expand Social Support Systems: Establishing community-based support groups and peer counselling programmes creates safe spaces for young people struggling with substance use. ^[26] Strengthening partnerships with religious and community leaders will help reduce stigma and encourage early intervention. ^{[27] [28]}
4. Reinforce Law Enforcement and Policy Reform: Introducing stricter regulations on the production, sale, and trafficking of synthetic drugs like ‘kush’ is essential to reducing drug availability. ^[3] Shifting from punitive measures to rehabilitation-focused approaches can also improve treatment outcomes and reduce incarceration rates among young people. A balanced approach that combines enforcement with treatment and rehabilitation is necessary for long-term success. ^[4]
5. Improve Research and Data Collection: Conducting nationwide epidemiological studies to assess substance use trends, risk factors, and treatment outcomes will provide valuable data for targeted interventions. Developing a national database for tracking SUD cases will enhance monitoring and evaluation, enabling more responsive and effective policy adjustments. Furthermore, strengthening partnerships with international organisations, such as the World Health Organisation (WHO) and the United Nations Office on Drugs and Crime (UNODC), will provide access to technical expertise and funding to expand community-based intervention programmes.
   Conclusion

   Addressing Substance Use Disorder (SUD) among young people in Sierra Leone requires a multifaceted approach that strengthens public health infrastructure, enhances prevention programmes, and expands social support networks. Effective policy implementation must balance law enforcement with rehabilitation while improving data collection to inform targeted interventions. A sustained, collaborative effort from the government, educational sector, healthcare sector, community leaders, and international partners is essential to curbing SUD and safeguarding the well-being of Sierra Leone’s youth.

Not applicable This research received no specific grants from any funding agency in the public, commercial, or not-for-profit sectors. The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. None. The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.