Abstract

Stephen Monday*, Prof. Dr. H. K. Sidhu, Atul Khajuria, Shu-Achet Daniel Gimbason, Marche Saygee Toh

ABSTRACT

Background: Kush, a psychoactive substance comprised of synthetic cannabinoids, has become an increasing public health and socio-economic problem in Liberia. Its emergence has been associated with increasing physical and mental health decline, increased healthcare utilization, and the decline in productivity for the national workforce. The addictive quality of Kush, combined with its low cost and widespread access, has hastened its emergence among youth and working-age adults, creating a dual burden on health systems and the economy. As an important first step to developing policy solutions, it is important to understand Kush's measurable consequences for healthcare utilization, out-of-pocket (OOP) spending, and productivity. Methods: We conducted a cross-sectional survey of 998 respondents that we recruited in collaboration with non-government organizations (NGOs), community-based organizations (CBOs), international NGOs (INGOs), United Nations agencies, and civil society organizations. A structured questionnaire was designed to collect information on socio-demographic characteristics, frequency of Kush use, self-reported health status, healthcare service utilization, OOP medical costs associated with healthcare access, and productivity indicators in the workplace such as absenteeism and presenteeism. For all variables, descriptive statistics—means, standard deviations (SD), percentages—were calculated. Results: Of the participants, 72.6% were male, with a mean age of 29.4 years (SD 6.8). Past 30 day Kush use was reported by 64.8% of participants, with a mean of 18.2 days/month (SD 7.5). Forty-two point three percent of users reported at least one outpatient visit within the last month, and 18.7%, at least one hospitalization within the last year. The mean OOP monthly healthcare cost was 3,450 LRD (SD 1,290). The productivity analysis showed absenteeism of 14.6% and presenteeism of 28.9%, resulting in an overall productivity loss of 41.8%. Conclusion: Kush use is already a significant, measurable burden on Liberia’s healthcare system and economic output, highlighting the critical need for a coordinated approach in health, policy, and workplace initiatives.