Socioeconomic Impact of Synthetic Cannabinoid (“Kush”) Use and Its Effects on Basic Metabolic Panel Parameters Among Users in Three Districts of Sierra Leone: A Mixed-Methods Cross-Sectional Study

Abstract

Background: The synthetic cannabinoid “Kush” has emerged as a significant public health threat in Sierra Leone, with a 4,000% surge in hospital admissions between 2020 and 2023 prompting a national emergency declaration in April 2024. This study assessed the socioeconomic impact of Kush use and its effects on basic metabolic panel (BMP) parameters among users in three districts of Sierra Leone.  
Methods: A mixed-methods cross-sectional study was conducted in Western Area (Urban/Rural), Bo District, and Bombali District from May 15–31, 2025. Using snowball sampling, 286 Kush users (≥6 months use) completed structured questionnaires assessing socioeconomic impacts, reasons for use, and beliefs about the drug. Venous blood samples were analyzed using a CYAN SMART semi-automated biochemistry analyzer for liver function (SGPT, SGOT, ALP, bilirubin, total protein, albumin) and kidney function (creatinine, urea, uric acid) parameters. Quantitative data were analyzed descriptively using SPSS version 16.0; qualitative data were analyzed thematically.
Results: Participants were predominantly male (75.9%), aged 18–25 years (48.3%), and unemployed (36.4%). Most (53.8%) had used Kush for 1–2 years. Significant social impacts included homelessness (34.3%), community discrimination (69.2%), and stigmatization as thieves or mentally ill (47.6%). Economically, 48.6% spent NLE 1,200 monthly on Kush—exceeding the national average cost of living (NLE 915.45). Kidney function parameters were markedly Elevated: mean creatinine 2.34 mg/dL (reference: 0.6–1.4), mean uric acid 9.41 mg/dL (reference: 2.5–7.7), and mean urea 43.81 mg/dL (reference: 15–45). Liver function showed mild elevations in SGOT (43.8 U/L; reference: 3.12–38.0) and total bilirubin (1.28 mg/dL; reference: 0.2–1.0), with low total protein (6.45 g/dL; reference: 6.6–8.3) and albumin (3.43 g/dL; reference: 3.5–5.0).
Conclusions: Kush use in Sierra Leone is associated with severe socioeconomic consequences and significant renal dysfunction. The elevated creatinine and uric acid levels suggest nephrotoxic effects requiring urgent public health intervention. Community-based rehabilitation programs, health education, and regulatory policies targeting precursor chemicals are urgently needed