Sierra Leone’s Polydrug Crisis is an Epidemic of Structural Violence: Community Engagement During the Ebola Response May Offer a Viable Framework for Communication Interventions

Sierra Leone is confronting an escalating polydrug epidemic centered on Kush, a synthetic cannabinoid compound whose proliferation has produced a 4000% rise in drug-related psychiatric hospitalizations since 2020 in a context of acute mental health resource scarcity. Dominant policy responses have privileged punitive containment over rehabilitative and harm-reduction frameworks, recapitulating victim-blaming discourses that obscure the structural antecedents of polydrug use. This commentary establishes why the polydrug crisis is an epidemic rooted in structural violence and situates its emergence within Sierra Leone's intersecting legacies of civil war, recurrent epidemic shocks, and entrenched poverty. Drawing on critical pragmatism and the culture-centered tradition in critical health communication, we demonstrate how community mobilizations from past public health crises can provide insights for global health communication practitioners. We extract five health communication insights from Sierra Leone's 2014 Ebola response: 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. Leaning on these theoretical and experiential insights can guide communication interventions toward addressing the sociopolitical conditions in which the polydrug crisis emerges, as well as the individuals that use Kush.