The commissioning and organization arrangements of services for drug misusers vary substantially across and sometimes within the treatment systems in many countries. Against this background of diversity there is a growing recognition of the importance of effective co-ordinated action across health, social care, and criminal justice agencies. Additionally, special initiatives are required alongside targeted prevention and treatment interventions aimed at high-risk groups. Effective needs assessment can play an important role when determining the required array of services and their capacity. In all nations with developed treatment systems, specialist drug services are the main providers of care. Complex referral and assessment procedures are used to determine the appropriate setting for treatment and there are resultant case-mix differences with clients of residential treatments generally having longer and more severe drug use histories. (59) The importance of ensuring direct provision or referral access to advice agencies, harm minimization services, and treatment and rehabilitation programmes is paramount. Securing a seamless 'patient pathway' with interagency co-operation over time according to need is a core objective for developed treatment systems.
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