Equipping Liberia’s Largest Hospital with Medicines to Reverse Overdose

The medicine could save an overdose patient's life. The problem was finding the money to buy it.

As overdose cases rose last year at John F. Kennedy Medical Center, Liberia's largest referral hospital, young people were being carried in from the streets of Monrovia and beyond, some unconscious, some abandoned at the entrance by people who left before staff could ask questions.

Naloxone, a drug used to reverse overdoses, is the go-to treatment. But Lawrence Stepney, a pharmacist and the hospital's pharmacy director, said many patients could not afford it. JFK Hospital could not afford to provide it for free at the rate patients were arriving.

To solve the problem, the hospital decided to pull funding from other departments, including imaging and surgery, to buy naloxone.

The hospital has become one of the places where the country's worsening substance-use crisis collides with a fragile health care system already strained by chronic disease, infectious disease, and limited public funding. Stepney noted that Liberia is still recovering from decades of instability, including two civil wars between 1989 and 2003 that devastated the country's institutions, as well as poverty and decades of underinvestment.

In January 2024, President Joseph Boakai declared drug and substance abuse a national public health emergency. Last summer, when Stepney said the surge had started to become visible, Liberia launched its first National Anti-Drug Action Plan for 2025-2030, framing the crisis as a public health and security issue tied to a range of societal problems like child neglect and lost educational opportunities.

Liberian officials and regional drug-control researchers have identified kush and tramadol as two of the country's most urgent drug concerns. Kush is a synthetic drug mixture that can contain synthetic cannabinoids and powerful synthetic opioids. Tramadol is an opioid painkiller frequently misused outside medical settings.

Stepney said drug use is particularly challenging for young people, leaving families and communities overwhelmed.

JFK Medical Center Steps Up to Address Monrovia's Health Challenges

As the cost of the medicine became harder for the hospital to absorb, Stepney reached out to Direct Relief and submitted a proposal for support. Within about a month, the Santa Barbara-based humanitarian aid organization approved a grant to help the hospital purchase a substantial amount of naloxone.

The grant, Stepney said, means overdose patients can be treated free of charge, and the hospital can ease pressure on other departments.

"Every time the goal is to save lives," Stepney said.

But overdoses are only one part of the pressure on JFK.

Stepney said Liberia is carrying a double burden of communicable diseases and noncommunicable diseases, including hypertension, diabetes, and cardiovascular conditions. Those chronic illnesses require steady access to medicine, but many patients cannot afford even basic prescriptions.

Before donations arrived, doctors could diagnose patients and write prescriptions, Stepney said, only for families to discover the medicines were unaffordable. Some patients did not return for follow-up. Others came back after a month or two in worse condition because they had been unable to control their disease.

He cited rivaroxaban, a blood thinner, as one example, saying a 28-tablet supply can cost about $70 locally. Diabetes medicines can also run about $65, he said, far beyond what many families can manage. The WHO said in a 2023 report that non-communicable diseases (NCDs) are a "significant problem" in Liberia. In 2019, 32% of all deaths were due to NCDs.

Expanding Patient Access with Free Lifesaving Medicine

"When Direct Relief came, I asked Jeffrey because this was draining us," Stepney said, referring to Direct Relief staff member Jeffrey Samuel, Direct Relief's Africa Regional Director, whom he met previously when Samuel was visiting for a solar power project opening at F.J. Grante Memorial Hospital.

A Direct Relief shipment earlier this year included cardiovascular medicines, diabetes medicines, chemotherapy drugs, medical supplies, and more. Patients are told when medicines are available and can return for refills.

"Most patients come back to the hospital because medications are available now," he said.

JFK's annual budget is about $9 million. Stepney said the hospital's patient catchment is over 4 million, but patients come from all 15 counties because the hospital offers specialized care unavailable elsewhere in the country. The hospital has asked Liberia's national Legislature for about $20 million.

Stepney said the hospital cannot raise prices to make up to budget shortfalls since many patients simply cannot pay more. That makes outside support critical. External support is especially important for mothers, newborns, and young patients whose lives can be altered, or ended, by lack of access to basic treatment.

Referring to babies and young children, he said, "You don't know their dream. You don't know who they'll become."