{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T07:58:45Z","timestamp":1790668725851,"version":"4.1.0"},"reference-count":89,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Public Health Challenges"],"published-print":{"date-parts":[[2026,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Kush, a synthetic drug combining cannabinoids and nitazene opioids, has emerged as a major public health concern in Sierra Leone, with reported prevalence and clinical severity increasing markedly as it was first identified. This review examines the health consequences of Kush use, the socioeconomic and structural drivers underpinning its spread, and the adequacy of health system and policy responses across the Mano River Basin.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A narrative review was conducted using structured searches of PubMed\/MEDLINE, Scopus, Web of Science and Google Scholar (2016\u20132025). Grey literature, including government policy documents, reports from international organisations, civil society publications and credible media sources, was systematically reviewed. Eligible sources addressed Kush or related synthetic drug use in Sierra Leone and the wider West African subregion, with emphasis on health outcomes, socioeconomic determinants, health system capacity and policy responses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Kush exhibits unpredictable toxicity and high dependence potential, with documented associations including acute psychosis, cognitive impairment, severe morbidity and rising mortality. Weak surveillance systems likely underestimate its burden. Structural drivers include entrenched youth unemployment, poverty, rapid urbanisation, post\u2010conflict trauma and limited access to education and mental health services. Regional dynamics across Sierra Leone, Liberia, Guinea and The Gambia reinforce its transnational spread. Responses since 2024 have intensified but remain disproportionately focused on law enforcement, whereas prevention, treatment and workforce development remain critically under\u2010resourced.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The Kush crisis exemplifies a complex, cross\u2010border public health emergency. Addressing it requires integrated, evidence\u2010informed strategies that strengthen health systems, expand community\u2010based interventions, improve toxicological surveillance and enhance regional coordination under ECOWAS frameworks.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/puh2.70388","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T07:49:16Z","timestamp":1790668156000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Kush Drug Epidemic in Sierra Leone: Public Health Implications, Socioeconomic Drivers and Health System Responses"],"prefix":"10.1002","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-6831-6848","authenticated-orcid":false,"given":"Alvin","family":"Turay","sequence":"first","affiliation":[{"name":"Faculty of Medicine European University  Tbilisi Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2603-9989","authenticated-orcid":false,"given":"Ahmed","family":"Vandy","sequence":"additional","affiliation":[{"name":"Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences University of Sierra Leone  Freetown Sierra Leone"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-2000-7451","authenticated-orcid":false,"given":"Uthman Okikiola","family":"Adebayo","sequence":"additional","affiliation":[{"name":"Department of Medical Laboratory Services Federal University of Health Sciences Teaching Hospital  Ila\u2010Orangun Nigeria"},{"name":"Department of Public Health, Faculty of Medicine and Health Sciences Hormuud University  Mogadishu Somalia"},{"name":"Department of Digital Health Global Health Focus Africa  Kigali Rwanda"},{"name":"Department of Public Health Daffodil International University  Dhaka Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-5949-7960","authenticated-orcid":false,"given":"Marie Ibranatu","family":"Kolipha\u2010Kamara","sequence":"additional","affiliation":[{"name":"Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences University of Sierra Leone  Freetown Sierra Leone"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0226-841X","authenticated-orcid":false,"given":"Augustus","family":"Osborne","sequence":"additional","affiliation":[{"name":"Institute for Development of the Western Area  Freetown Sierra Leone"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8605-3407","authenticated-orcid":false,"given":"Michael","family":"Lahai","sequence":"additional","affiliation":[{"name":"Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences University of Sierra Leone  Freetown Sierra Leone"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/PUH2.70031"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1080\/17441692.2026.2654242"},{"key":"e_1_2_10_4_1","doi-asserted-by":"crossref","unstructured":"R. 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