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In Lebanon, economic collapse, political instability, and a strained public health system have left people who use drugs (PWUD) with minimal access to care, while stigma and punitive drug laws further prevent their willingness to seek help. In this fragile context, integrating mental health and substance use care within primary healthcare centers (PHCCs) represents a promising approach to addressing unmet needs by leveraging existing infrastructure to deliver accessible, coordinated, and stigma-reducing care. To address this gap, Skoun and Médecins du Monde (MdM) introduced substance use and mental health services into PHCCs. Skoun was responsible for integrating substance use care and delivering treatment services. The intervention employed a three-pronged strategy: (1) training healthcare providers at PHCCs, (2) establishing institutional partnerships and co-management with PHCCs, and (3) developing locally contextualized clinical and operational guidelines. Two pilot community mental health and substance use centers (CMH-SUCs) were established within existing PHCCs. The early outcomes are promising, as reflected in the number of people who benefited from Skoun's services and in the improved capacity of PHCC providers to understand harm reduction and manage substance use within primary care. The pilot project demonstrated that integrating substance use disorder (SUD) care within PHCCs is feasible and effective, even in fragile settings. It enhanced access to services and strengthened coordination between governmental and non-governmental sectors. However, persistent barriers, such as stigma, restrictive drug laws, workforce instability, and fragmented funding, underscore the need for systemic reform. Embedding SUD services within primary care, supported by national policy change and sustainable financing, may offer a pathway toward equitable, rights-based, and cost-efficient drug policy reform in Lebanon and similar contexts.