Opioid Agonist Therapy Outcomes and Their Association with Mental-Health Symptoms and Service Engagement in Lebanon

Abstract

Opioid agonist therapy (OAT) is an evidence-based intervention for opioid use disorder; however, sustaining engagement in treatment remains a major challenge, particularly in resource-limited and crisis-affected settings such as Lebanon. Mental health conditions are highly prevalent among individuals receiving OAT and may influence treatment continuity, yet evidence from the Middle East and North Africa region remains limited. This study examined the association between mental health factors and duration in OAT among beneficiaries enrolled in a program at the Society for Inclusion and Development in Communities (SIDC) in Lebanon. A cross-sectional analytical study was conducted using routine program data for 182 participants, linked to primary survey data (PHQ-9 and GAD-7) available for a subset (n = 151). Duration in OAT was analyzed as both a log-transformed continuous variable and as quartiles. Bivariate and multivariable linear and ordinal logistic regression models were used to assess associations. Engagement in mental health services was consistently associated with longer duration in OAT in both unadjusted (β = 0.56, 95% CI: 0.27–0.86) and adjusted analyses (β = 0.39, 95% CI: 0.06–0.72), corresponding to approximately 48% longer duration. Similar findings were observed using ordinal models (adjusted OR = 2.43, 95% CI: 1.18–5.02). Associations between depressive symptoms and duration were not consistently observed across models, although participants with moderately severe/severe depressive symptoms had higher odds of being in longer duration categories in adjusted ordinal analyses. Anxiety symptoms were not significantly associated with duration. Higher-risk clinical and behavioral characteristics, including HCV positivity and needle-sharing, were associated with shorter duration. Sensitivity analyses yielded consistent results. These findings highlight the importance of engagement in mental health services, rather than symptom severity alone, in supporting sustained participation in OAT. Strengthening integrated care approaches that promote mental health service engagement may improve treatment retention, particularly in resource-constrained settings.