Cheap, plentiful and devastating: The synthetic drug kush is walloping Sierra Leone

It's barely 9 a.m. but the cramped alleyways of Kaduna in the western end of Sierra Leone's capital, Freetown, are already packed with young men. They sit hunched over on low wooden benches, their eyes closed, heads lolling. Periodically, one lights up a skinny joint, takes a few drags and slumps back down again. Through the open doorway of a rusting metal shack, the unmoving body of a man lies sprawled in the dirt, flies crowding around the basket of bread he was supposed to be hawking.

The men are on kush, a form of synthetic cannabinoid that has taken this West African nation by storm since it first appeared on the scene six years ago. Routinely cut with an array of additives including acetone, the opioid tramadol and formalin, a toxic chemical commonly used to preserve bodies in mortuaries, kush is both potent and dangerously unpredictable. It's also easily accessible and dirt-cheap, and has proved irresistible to a generation of unemployed young Sierra Leoneans seeking an escape from lives of grinding poverty.

"It makes you forget," says 21-year-old kush user Salifu Kamara, who estimates that roughly 80% of the young people in his neighborhood are now taking the drug. "We're under such strain. There's no work. There's nothing here."

Kamara, who once had dreams of becoming an electrician, makes around a dollar a day carrying loads for the merchants in a nearby market. Since taking up kush two years ago, he's been spending nearly all his earnings on the drug.

"Before, if we had money we'd spend it on food or clothes," he says. "Now we just buy kush. It makes you want to cry, but it's not easy to stop."

As the men smoke, a woman passes by carrying a large bucket of rice. Her name is Elizabeth Sankoh, and she is fed up with the impact kush is having on her neighborhood.

"Men don't help their families anymore. They're always smoking at all hours of the day. And they spend all the money on kush," she rails. "I have to do everything now!"

Sankoh says she now supports her family singlehandedly, selling bowls of rice with a spicy cassava leaf sauce to people in the street. Lately, though, she says her customers have been coming up with all manner of excuses to avoid paying her. And once they've finished their meals, they steal her plastic bowls and spoons.

"They just want to sell them so they can buy more kush," she complains.

The country's cash-strapped government has no accurate data on the number of people using the drug, but officials are concerned. In his office on the fourth floor of a dark, concrete building in Freetown, Ibrahim Kargbo, the acting deputy director of the country's Drug Law Enforcement Agency, says the situation is bad and getting worse.

"It's a crisis, and we won't shy away from saying so," says Kargbo. "I was born and raised in Freetown and I've never seen anything like this before. It's overwhelming."

Over the past two years, there have been increasing reports that kush is taking hold in neighboring Liberia and Guinea, both of which share porous land borders with Sierra Leone.

"Liberia is seriously affected," said Feyi Ogunade, a Nigeria-based researcher for the Institute for Security Studies, who's currently preparing a report on the rise of kush. "It could even be more serious there than in Sierra Leone. But there are no figures, no analysis. I suspect soon it will spread to other countries [in the region] if these governments don't do something about it. But to me, that seems unlikely to happen. In essence, very little is being done."

Meager resources for enforcement, treatment

Kush is a depressant. It offers relief from the everyday stresses of life, but at a heavy cost. Users say the high is often accompanied by a pounding sensation in the head and pain in the neck and joints. And the typical trajectory for heavy users is all too familiar: Those still in school drop out. Those with jobs stop turning up to work. In time, many turn to theft to fund their habit. They start to forego basic hygiene. Their immune systems become weakened. Sores fester, and many complain of severe swelling in the feet and lower legs.

Kargbo says the drug also causes liver, kidney and respiratory problems, and almost everyone NPR talked with who uses kush said they had friends who had lost their lives to the drug.

Kargbo's agency has its work cut out, but like many government entities in Sierra Leone, it operates with an impossibly tight budget. The agency's entire annual expenditure, says Kargbo, amounts to barely $50,000, less than the average salary of a single Drug Enforcement Administration officer in the U.S. Much of this meager budget is spent on outreach through everything from radio shows to community meetings. As Kargbo talks, a police vehicle fitted with a loudspeaker plies the streets outside, blasting out a newly released Afrobeat song with lyrics warning of the dangers of kush.

Sierra Leone also has extremely limited capacity for drug treatment and rehabilitation. The U.S. non-profit Partners in Health has set up a new mental health hotline that kush users can call to speak to a counsellor. Kargbo says the government has plans to build three new rehab facilities in the Freetown area in response to the rise of kush. But for now, the country has only two institutions catering to drug users. One, the City of Rest Rehabilitation Centre, set in the hills above Freetown, had only two patients at the time of writing. Most of it was burned down in April by a patient being held there against his will, according to the center's director.

The only other option for drug rehabilitation services is the National Psychiatric Teaching Hospital in the east end of Freetown, where, according to acting director Jusu Mattia, some 70% of the patients are now kush users, many of them suffering from forms of psychosis or other mental illness.

"Between 2021 and now [kush has] been rampant," says Mattia. "Especially this year, it's been an exponential increase."

Once notorious for chaining its patients to their beds, the hospital has come a long way in recent years with help from Partners in Health. Yet it remains constrained by a lack of trained staff. There are only a handful of qualified psychiatrists working in the country. Mattia himself is still in training. And ultimately, it is one hospital trying to address the mental health needs of a population of 8 million that not only struggles with widespread poverty and joblessness but has lived through a decade-long civil war and the world's deadliest Ebola outbreak. Now, it must deal with the fallout from the kush epidemic, too.

"It's not just Freetown, it's the whole country," says Mattia. "It's an appalling situation. And we're deeply worried about all the people we're not seeing and the people in other parts of the country. We don't have enough hands to help everyone."

Part of what makes kush so dangerous is that users can never be certain what's in it. Local media have reported on widespread rumors that some producers add ground-up human bones, though no direct evidence of it has emerged.

Officials in the capital believe the raw materials of the drug are being shipped into Freetown from overseas before being mixed in makeshift labs throughout the country. But much about the sources of the supply is still unknown. In the meantime, authorities have launched a nationwide crackdown on dealers and users of the drug, known as "Operation Zero Tolerance."

A police crackdown

On a Monday in September in the bustling market town of Waterloo, near Freetown, Operations Officer Septimus Vandi of the Sierra Leone Police Force briefed his combined task force of soldiers and policemen. Already that morning they had seized some 40 packets of kush. Now, they readied themselves to head back into action.

"There's no place for [kush users] here," said Vandi, who spent two years training the Somali police force in Mogadishu under United Nations auspices. "They can't run."

Vandi handed out banknotes to two plainclothes officers and sent them off into some of the estimated 100 kush dens, locally known as "ghettos," that have sprung up in the town and surrounding villagers. Their task: to identify the dealers. Half an hour later Vandi's officers, many clutching AK-47s, climbed into the back of their trucks and sped off through the streets on their first raid of the afternoon.

As they arrived at the site, young men began to flee in all directions. The officers jumped down from their trucks and chased them through a maze of dirt streets. Others surrounded the house where the dealer was believed to be living, pushed their way inside and ransacked it. They emptied cupboards, overturned furniture, stripped off bedding and eventually climbed up into the attic. There they found a large haul of kush, together with the apparatus for dividing it and parceling it out for sale.

This pattern continued through the afternoon. Within three hours, Vandi and his men had rounded up 10 suspected dealers, all in little more than a square mile. Amid a torrential downpour, they dragged the men into Waterloo police station for processing. All would end up in court, Vandi said, though he expected that this would come at a personal cost. Many small-time dealers were working for powerful politicians or members of the security services, he said, adding that in recent years his zeal for the job has earned him several death threats.

He believes his men can make a difference, but it's an uphill battle. The demand for kush continues to grow, and the profits to be made are hard to resist.

Not just in the poor neighborhoods

"If I could get a job I'd stop this," says one dealer, a former plumber who began selling kush three years ago in the Murray Town neighborhood of Freetown. The man, who spoke on condition of anonymity to avoid attention from the authorities, runs his operation from a rickety wooden shack built on stilts over a stream clogged with plastic bags, used diapers and other trash. He buys the kush in bulk, he explains, then divides it into tiny parcels which he measures by eye before wrapping them in scraps of paper and selling them for 5,000 Leones (25 cents) apiece.

"My customers come from all walks of life — men, women, old, young," he says. "But there are more and more young people doing it. It reduces their stress, takes their mind off their problems."

Neither is it only the poor who are drawn to the appeal of kush. Videos on social media show civil servants and policemen using the drug. Some who use, like 30-year-old Ahmed Kang, even come from the country's wealthy elite. Kang was born in a Freetown suburb but spent most of his childhood in Columbus, Ohio, where his family lived a comfortable life.

"We were well-off," said Kang, who at the time was one of the handful of patients still living in what remained of the fire-damaged City of Rest rehab center. "We had a 100-inch TV."

Kang had moved back to Freetown from the U.S. at the age of 22 and had three daughters. After two of them died of disease, he sank into depression and turned to drugs and alcohol. At first, he took whatever he could get his hands on. Then kush arrived in Sierra Leone.

"It destroyed my family," said Kang. "It's so addictive, and it costs less than a pack of chewing gum. How can you even control that?"

By the time his mother eventually managed to force him into City of Rest with the help of 10 police officers, Kang says he had been living on the streets for a year. He credits the facility's staff with saving his life, but getting clean has been tough. This is his third stint in rehab. If he can get clean for good, he plans to open a driving school in Freetown.

"I'm lucky to have a mum who loves me and can pay for me to be here," says Kang. "Most people don't have that."

The center charges 2.5 million Leones ($127) per month, putting it well out of reach for most in a country with an average annual income of barely $500. Even so, the demand for their services far outstrips what they can provide.

"There are so many people out there on the streets who need rehab," said Augusta Johnny, the City of Rest's coordinator. "But there's nowhere for them to go. Kush has flooded the market."

For Salifu Kamara, the aspiring electrician making barely a dollar a day whose life was derailed by kush two years ago, treatment at a rehab center is little more than a distant dream.

"It's gotten out of control," he said. "The government should stop the people who are bringing it here. So many people have died. I'm afraid for our country."

Tommy Trenchard is an independent photojournalist based in Cape Town, South Africa. He has previously contributed photos and stories to NPR on the Mozambique cyclone of 2019, Indonesian death rituals and illegal miners in abandoned South African diamond mines.