Tatyana Sleiman, Executive Director at Skoun Lebanon, is a psychologist and advocate for equitable wellbeing opportunities and human rights. She works at the intersection of drug policy reform, mental health and the rights of marginalized communities through a transformative justice lens.

Lebanon’s compounded crises since 2019 have necessitated a reevaluation of healthcare delivery, particularly for vulnerable populations facing problematic drug use. This case study highlights Skoun’s approach to integrating substance use disorder (SUD) treatment and harm reduction (HR) interventions within public primary healthcare centers (PHCCs) in Lebanon.
This integrated model decentralizes access to care, using the crisis as a catalyst to reshape public health systems to be more inclusive of key populations. Drawing on existing literature, the pilot adapted integrated mental health care models to the local context, guided by mental health and harm reduction specialists.
The integration process involved embedding HR and SU services into PHCC frameworks. Our approach included securing support from local actors, engaging donors and international NGOs, and advocating for the inclusion of these services in the Ministry of Public Health’s (MOPH) national strategy. Key outcomes of the pilot include the expansion and decentralization of opioid agonist therapy (OAT) programs into rural regions, increased collaboration with local health and protection programs, and strengthened advocacy for the rights of people who use drugs and marginalized communities.
Beyond its immediate impact, this model fostered a broader network of allies and paved the way for discussions around integrating services such as sexual and reproductive health rights (SRHR) and gender-based violence (GBV) interventions.
Data from evaluations conducted throughout the pilot demonstrate improved access to care, enhanced public awareness, and reduced stigma surrounding drug use. The case study further underscores the agility and adaptability of this integrated model in a crisis context, offering a framework for other regions facing similar challenges. Additionally, it highlights the pressing need for decriminalization and the value of a holistic, inclusive approach to drug use and health crises.