Coordination at local and government levels

The treatment service commissioning process necessitates involvement and partnership of a diverse range of agencies spanning specialist and generalist health care, social services, criminal justice, and non-statutory bodies as well as various community bodies.

Appraisal of the health-care needs of the target populations and commissioning of strategic service responses should be flexible and adaptive to changing circumstances, including the following:

1. variations and new trends in drugs use and consumption patterns;

2. the geographical distribution and concentration of local drug use;

3. variations in demand for services;

4. the changing relationship between drug use and other conditions, notably HIV infection and blood-borne viral hepatitis;

5. changing policy in response to drug strategy and to changes in organization of health services;

6. the evidence for and availability of new treatment responses.

In many communities a continuum of care should be made available, including direct provision or access to harm-minimization services (needle/syringe exchange, vaccination programmes and safer injecting, and drug use advice), community substitution treatment (methadone or other appropriate opiate agonist prescribing services for stabilization, maintenance, and detoxification), and inpatient and residential programmes (detoxification, therapeutic communities and other rehabilitation programmes, and after-care support). Services providing advice, information, assessment, and referral are an important resource and valuable point of contact for individuals, friends, and families. Structured provision of counselling and support are often made available by these services. Additional gateway services (e.g. outreach services seeking to identify problem users not in touch with treatment services and encouraging referral) are also useful elements of an integrated system.

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