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North Carolina

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Reducing Harm • Training systems and pharmacists to connect people to harm reduction services • Making the naloxone kits more widely available to the most burdened • Communities

Connecting to Care • Expanding access to treatment and recovery support • Addressing the needs of justice-involved populations

North Carolina law (N.C.G.S. Sec. 108A-29.1) requires, if there is reasonable suspicion, substance use screening and drug testing (urine toxicology) for the illegal use of controlled substances for each Work First program adult applicant or recipient is a condition of eligibility to receive assistance. Adult applicants or recipients will complete a verbal substance use questionnaire designed to determine if an adult applicant or recipient is at risk for alcohol and/or substance use disorders. When the results indicate illicit substance use, this meets criteria of ‘reasonable suspicion’ and a drug test is required within a period of time as specified by the Department. In order to establish eligibility to apply for Work First all applicants must have a background check completed by Work First to determine if there is a criminal conviction relating to an illegal controlled substance within the past three years. If there is, this is the second criteria that meets ‘reasonable suspicion’ and requires a toxicology test. The results of drug tests will remain confidential and will not be released to law enforcement. If an adult refuses to be screened initially for substance use, the adult is ineligible for Work First Cash Assistance. If otherwise eligible, the remaining household members can receive cash assistance.

When an applicant or recipient is determined to be at risk for an alcohol use disorder, they are referred to a Qualified Professional in Substance Abuse (QPSA) for a substance use disorder assessment and referred to substance used disorder treatment if indicated. Additionally, individuals who are engaged in or have completed substance use disorder treatment, are referred to the QPSA to have participation or completion confirmed, in part to support establishing eligibility for application or continued receipt of Work First program benefits. Individuals who are required to get drug testing to establish eligibility for Work First also have the opportunity to meet with a QPSA to gain information on substance use and substance use disorder treatment. A voluntary mental health screening is offered to all adult Work First applicants and recipients as part of the interview process. If the screening indicates the adult is at risk for mental health issues, the applicant/recipient may be referred to a Qualified Professional in Substance Abuse (QPSA) for further assessment.

If appropriate, a substance use or mental health referral is made through the Local Management Entity-Managed Care Organization (LME-MCO) to identify a provider for treatment, and then a treatment plan is developed. The QPSA serves as the care coordinator to track the adult’s engagement in treatment. The QPSA and the Work First case manager jointly develop a plan for the family to ensure success. If the adult fails to comply with the treatment plan without good cause; the adult is ineligible for Work First.