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Lebanon’s Recovering Drug Addicts Struggle With the Aftermath of War

During Israel’s bombing campaign, many feared they would lose access to treatment, a prospect that is pushing some to consider leaving the country for good

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Lebanon’s Recovering Drug Addicts Struggle With the Aftermath of War
Reset Clinics, a center for opioid replacement therapy in Lebanon. (Anagha Nair)

Wearing a gray-white hoodie, Ali sits in a clean, wide room characteristic of medical centers. In front of him are sunlit windows and Carla Chaoul, head of Reset Clinics’ psychology department. Behind him is a past he is striving to make a distant memory. 

Ali is 33 and once spent his life struggling with the iron grip of heroin. He was about 18 when he first used it, introduced to its snares by a former friend. In the 15 years that followed, he says that his mind often toyed with the idea of quitting, but his final push toward a new life happened to be after the start of the Israel-Hezbollah war in October 2023.

At Reset Clinics, Ali started opioid substitution treatment, which has been adopted by Lebanon’s Ministry of Health. The treatment offers buprenorphine, a substance that helps those suffering from opioid addiction by reducing their withdrawal and cravings, letting them lead a more functional life. 

Ali speaks to Carla Chaoul, head of Reset Clinics’ psychology department. (Anagha Nair)

In Lebanon, buprenorphine sales are highly regulated, and the medicine is only legally available in government hospitals. The treatment helps addicts cope with their dependency on dangerous opioids like heroin. Over time, an individual can be weaned off of the substitute under medical supervision. 

At Reset, patients are given prescriptions every week or two to restock their supplies of the drug. One of the few places where buprenorphine can be bought legally is Beirut’s Rafik Hariri University Hospital, near the site of a deadly Israeli strike in late October. The strike was part of a wider escalation of the war, from the south to the capital and in other parts of the country. 

The strike added to Ali’s existing angst about getting his medicine on time. His aunt, who lives in Canada, used to call him frequently, urging him to try and source the medicine on the black market — an illegal endeavor that could land both the seller and buyer in prison. She, like him, was desperate to keep heroin from regaining control over his life. “The feeling heroin brought to me is indescribable. It becomes a medicine you can’t live without,” he says. “It’s the worst in the world.” 

Ali ended up avoiding the black market, but Chaoul explains that the prospect of running out of medication evokes fear in many recovering addicts. “For a lot of people, it was very anxiety-inducing,” she says. “How would they acquire their medication if the surroundings of the hospital were being bombed? It was a constant fear that they had.”

Issa, whose name has been changed to preserve his anonymity, describes similar thought spirals. A resident of Dahiyeh, the southern suburb of Beirut that was severely impacted by the war, the 27-year-old was no stranger to midnight evacuation orders, which preceded attacks that would send massive buildings in his area crumbling to the ground. 

Issa, 27, at the Reset clinic. (Anagha Nair)

“Sometimes, there’d be gunfire warning people to leave their houses,” he explains, twiddling his fingers as he speaks. “Once, I had to leave my house with my fiance at 5 in the morning, and we had to stay outside in the dark till 7 a.m.” Compounding these familiar worries, faced by most residents of Beirut’s southern suburbs, was Issa’s persistent anxiety over whether he could secure his medicine on time. “I’d wonder if the hospital would close, or close early. I’d worry a lot,” he says. 

He explains that even going to collect the medicine was a challenge, as bus drivers would hesitate to take the road to the hospital, calling it “dangerous.” “I’d imagine being left without the medicine, and it was like my mind was laughing at me,” he says. 

The most recent official statistics on drug use in Lebanon are from a 2017 situation report by the country’s Ministry of Public Health. It states that 3,669 people were arrested for using substances in 2016, a 108% increase over 2011 figures. The study acknowledges, however, that one of its limitations is underreporting, partly due to the social stigma associated with drug use. It also acknowledges “limited data and studies availability” in the five years preceding 2017. 

Psychologists at multiple rehabilitation centers, including Reset, say that a lack of newer data is one of the problems that they face. Lebanon’s Ministry of Public Health did not respond to multiple requests for comment or updated statistics. 

The war, and the constant pressure it brought, also disrupted recovering people’s routines, forcing them to change their dosages. 

Ali, like Issa, lives in Beirut’s heavily bombed southern suburb of Dahiyeh. The mental strain of living in a war zone, where the situation was highly unstable, meant that Ali needed more buprenorphine during the bombing. “When I felt stressed, I had to take more,” he says. “I’d leave the house, they’d bomb. I’d return to the house to sleep, another evacuation order would follow, and I’d leave again,” he explains. “Then I’d think about the medicine, and I’d want more.” 

The war dealt him multiple blows. Following the escalation in September, Ali lost not just his house, but also those of his aunt, uncle and grandfather to Israeli strikes. The losses left Ali devastated. “I’d have preferred to die in the house than to return and not find it,” he says. His home was hundreds of years old, and even the smallest details held memories and emotional value. “Near the house, there was a pine tree that fell,” he says gloomily. “I felt really sad for the tree.” 

Issa says he forced himself to ration his supply of buprenorphine by taking a lower dosage, overwhelmed by the possibility of not being able to source more in time. Despite the stress of living in an active war zone, Issa couldn’t bring himself to relocate. “I didn’t leave because of my house. My family did, but I couldn’t. I’m very attached to my house.” 

Elie Daou, executive manager at the clinic, who himself is a recovered patient, says that following the 2006 Israel-Hezbollah war, drug use skyrocketed among populations that had been subjected to frequent bombing. 

“In areas like Metn and Keserwan, for every 10 people exposed, we had one or two from Beirut’s Dahiyeh, Beqaa or Baalbek,” he says, mentioning sites of regular fighting. After the war, “it became the opposite — for every one patient from Metn, Mount Lebanon or Keserwan, it became 10 from Beirut’s Dahiyeh.”

He says that he expects to see a similar pattern following this round of conflict. Chaoul, who spends a lot of time talking to patients like Ali on a personal level, says that the war was omnipresent in conversations during that period. 

“People were affected very negatively by the war, especially those from the south and Dahiyeh,” she says. “What we observed mainly was stress and anxiety that overwhelmed the patients, especially people living in the suburbs and the zones of direct attacks.” 

She lays out multiple obstacles to addiction recovery. A major one is an overburdened government, especially following the deadly war. “I think there’s a lot of things that need to be done, but the government has a lot on their plate, which means addiction recovery is not a priority. It’s very sad because those people are among the most in need and most vulnerable right now,” she says. 

She also explains how societal stigma against drug addicts could chip away at their motivation to go clean. “They come to the center, work around bettering their professional, social and familial life, but they find it very hard to be part of communities that are accepting of them,” she says. She adds that criminal records, which can follow recovering addicts for years, make it very difficult for them to find employment — “one of the primary reasons why patients could relapse.”

“They’re punished for mistakes that they have made a very long time ago,” she explains. “If those past mistakes follow them until today, it’s very hard even within their recovery to start a new life.” 

For people like Ali, however, a new life means moving far from Lebanon, which, to him, presents a grim future. He hopes to move to Canada to live with his aunt. “I used to think that we could build the country, but there’s no progress,” he says. “I wish only the best for my country, but what’s happened is like a drop in the ocean of what’s yet to come. This country is impossible to fix.” 


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