The rate of positive drug test results among America’s workforce reached its highest rate last year since 2001 and was up more than 30 percent in the combined U.S. workforce from an all-time low in 2010-12, according to a new analysis released by Quest Diagnostics, a provider of diagnostic information services.
The study, based on more than 11 million deidentified urine, hair and oral fluid drug test results collected between January and December 2021, offers revealing insights into workforce drug use as employers grapple with creating safe, healthful work environments amid an ongoing recruitment and retention crisis.
The overall positivity rate in the combined U.S. workforce, based on nearly nine million urine drug tests collected between January and December 2021, was up in 2021 to 4.6 percent compared to 4.4 percent in 2020 and up 31.4 percent from the all-time low of 3.5 percent just 10 years ago (2010-12). The combined U.S. workforce includes the general U.S. workforce of mostly company-policy testing by private employers, as well as the federally mandated, safety-sensitive workforce, which includes federal employees and the transportation and nuclear power industries, and can include workers such as pilots, truck drivers, train conductors and others required to drug test under federal legislation.
Overall positivity in the federally mandated, safety-sensitive workforce based on nearly 2.7 million urine drug tests stayed even year over year (2.2 percent in 2020 and 2021) and was 4.8 percent higher than 2017 (2.1 percent in 2017 versus 2.2 percent in 2021). In the general U.S. workforce, positivity increased 1.8 percent (5.5 percent in 2020 versus 5.6 percent in 2021) and was 12 percent higher than in 2017 (5.0 percent in 2017 versus 5.6 percent in 2021) and up each of the last five years.
“Our Drug Testing Index reveals several notable trends, such as increased drug positivity rates in the safety-sensitive workforce, including those performing public safety and national security jobs, as well as higher rates of positivity in individuals tested after on-the-job accidents,” says Barry Sample, Ph.D., senior science consultant for Quest Diagnostics.
“Employers are wrestling with significant recruitment and retention challenges as well as with maintaining safe and engaging work environments that foster positive mental and physical wellbeing,” says Keith Ward, general manager and vice president, Quest Diagnostics Employer Solutions. “Our Drug Testing Index data raises important questions about what it means to be an employer committed to employee health and safety. Eager to attract talent, employers may be tempted to lower their standards. In the process, they raise the specter of more drug-related impairment and worksite accidents that put other employees and the general public in harms’ way.”
Despite years of decline, positivity rates increased in several federally mandated, safety-sensitive workforce testing categories
After five years of steady declines in several drug categories, positivity rates based on urine drug tests for the federally mandated, safety-sensitive workforce increased in 2021. Of note, marijuana increased 8.9 percent (0.79 percent in 2020 to 0.86 percent in 2021), amphetamines increased 7.8 percent (0.64 percent in 2020 to 0.69 percent in 2021) and cocaine increased 5.0 percent (0.20 percent in 2020 to 0.21 percent in 2021).
“It is important for workers to know that certain employers are required to test for marijuana under federal law and if they use marijuana, they can still lose their jobs,” says Dr. Sample. “People who use drugs during working hours or before work can still be impaired and dangerous to co-workers, the general public and themselves.”
Positivity for marijuana continues upward climb in general U.S. workforce
Positivity rates for marijuana in the general U.S. workforce, based on more than 6 million urine tests, continued an upward climb, increasing 8.3 percent (3.6 percent in 2020 versus 3.9 percent in 2021), the highest positivity rate ever reported in the DTI. Over five years, positivity for marijuana in the general U.S. workforce increased 50 percent (2.6 percent in 2017 versus 3.9 percent in 2021).
In oral fluid testing, overall workforce drug positivity decreased, but increased for marijuana, methamphetamine and cocaine
In 2021, positivity in the general U.S. workforce based on oral fluid was 7.3 percent in 2021, a decline of 46.3 percent compared to 2020 (13.6 percent) and 29.8 percent compared to 2017 (10.4 percent). The drop in oral fluid-positivity (13.6 percent in 2020 versus 7.3 percent in 2021) was driven by a decline in the number of pre-employment tests that included marijuana. However, for those tests that included marijuana, the oral-fluid drug positivity rate for marijuana was 14.8 percent in 2021, an increase of 20.3 percent compared to 2020 (12.3 percent) and up 68.2 percent over five years (8.8 percent in 2017). At the same time, the positivity rate for cocaine increased 46.6 percent (0.58 percent in 2020 versus 0.85 percent in 2021), its highest spike since 2006, and methamphetamine increased 26.4 percent (0.53 percent in 2020 versus 0.67 percent in 2021), exhibiting year-over-year increases for the last five years.
Oral fluid tests generally have a shorter window of drug detection than urine, and can detect some drugs faster, in a matter of minutes versus hours. Oral fluid collection also has the advantage of being observed, making it harder to subvert the testing process.
Urine positivity rates for post-accident testing increased at a greater rate than pre-employment testing over five years, driven by higher positivity on post-accident tests for marijuana, cocaine, and semi-synthetic opiates
Over the last five years in general U.S. workforce urine drug testing, pre-employment positivity increased 17.4 percent (4.6 percent in 2017 versus 5.4 percent in 2021); while post-accident positivity increased 26 percent (7.7 percent in 2017 versus 9.7 percent in 2021).
Similarly, in federally mandated, safety-sensitive workforce urine drug testing, pre-employment positivity increased 9.5 percent since 2017 (2.1 percent in 2017 versus 2.3 percent in 2021), while post-accident positivity increased 41.9 percent (3.1 percent in 2017 versus 4.4 percent in 2021). In 2021, the post-accident positivity as compared to pre-employment positivity was 79.6 percent higher (9.7 percent versus 5.4 percent) in the general US workforce and 91.3 percent higher (4.4 percent versus 2.3 percent) in the federally mandated, safety-sensitive workforce.
“Drug use affecting the work environment is a complex problem that is not going away,” says Jenny Burke, vice president of Impairment Practice, National Safety Council. “When workers use impairing substances, it can create incidents that compromise the safety of other workers and, in some cases, the general public. Employers should have the right and ability to maintain a substance-free workplace and the use of drug testing, including oral fluid in addition to urine. NSC supports policies and procedures that ensure safe and healthy workplaces.”
In 2021, urine post-accident testing in the U.S. general workforce for the drugs marijuana and cocaine the positivity rate was 63.4 percent and 266.7 percent higher, respectively, as compared to pre-employment tests. For the two groups of semi-synthetic opiate drugs – opiates (hydrocodone/hydromorphone) and oxycodones (oxycodone/oxymorphone) – in these tests, post-accident positivity was 316.7 percent and 200 percent higher, respectively, than in pre-employment testing.
For federally mandated, safety-sensitive workforce urine drug testing in 2021, post-accident positivity for marijuana, cocaine, opiates (hydrocodone/hydromorphone) and oxycodones (oxycodone/oxymorphone) was 63.6 percent, 119 percent, 257.1 percent, and 194.1 percent higher, respectively, as compared to pre-employment tests.
Pre-employment drug tests are meant to be a deterrent in hiring workers whose drug-use behavior may cause unsafe work conditions or poor work performance. Post-accident testing is conducted to evaluate whether drug use may have played a role in the workplace incident prompting the drug test.
“The increase in post-accident positivity is alarming and suggests more drug-associated accidents may be occurring even with employers with pre-employment drug testing in place,” Dr. Sample says. “The high cost of work accidents cannot be understated. While employers often think of accidents in terms of wage and productivity losses, medical expenses, and administrative expenses, accidents also impact morale, competitiveness and recruiting. Given that employers are in a war for talent, creating a safe, healthful work environment is critical for attracting and retaining people.”
Mixed picture for cocaine positivity in the general U.S. workforce
Positivity for cocaine based on urine tests in the general U.S. workforce decreased 4.5 percent (0.22 percent in 2020 versus 0.21 percent in 2021) and positivity for cocaine over the past five years declined 30 percent (0.30 percent in 2017 versus 0.21 percent in 2021). Positivity rates for cocaine based on urine tests in the federally mandated safety, safety-sensitive workforce increased 5.0 percent (0.20 percent in 2020 versus 0.21 percent in 2021), the first increase in five years.
Positivity for opiates and oxycodones in the general U.S. workforce decreased last year and over five years
Positivity for opiates (codeine/morphine) based on urine drug tests in the general U.S. workforce decreased 19 percent (0.21 percent in 2020 versus 0.17 percent in 2021) and 56.4 percent over five years (0.39 percent in 2017 versus 0.17 percent in 2021). Positivity for opiates (hydrocodone/hydromorphone) in the general U.S. workforce decreased 3 percent (0.33 percent in 2020 versus 0.32 percent in 2021) and 37.3 percent over five years (0.51 percent in 2017 versus 0.32 percent in 2021). Positivity for oxycodones (oxycodone/oxymorphone) in the general U.S. workforce stayed the same in 2020 and 2021 (0.29 percent) and decreased 52.5 percent over five years (0.61 percent in 2017 versus 0.29 percent in 2021). View a U.S. map depicting positivity rates for different classes of opiates and oxycodone.
Positivity for 6-AM (heroin) in the general U.S. workforce decreased over five years
Positivity for 6-AM metabolite (heroin) based on urine tests in the general U.S. workforce decreased 27.8 percent (0.018 percent in 2020 versus 0.013 percent in 2021) and 56.7 percent over five years (0.03 percent in 2017 versus 0.013 percent in 2021). Positivity for the 6-AM metabolite (heroin) in the federally mandated, safety-sensitive workforce decreased 37.5 percent (0.008 percent in 2020 versus 0.005 percent in 2021) and 73.7 percent over five years (0.019 percent in 2017 versus 0.005 percent in 2021).
Retail Trade had highest positivity among key industries
The overall positivity rate increased in 16 out of 17 industries from 2017 to 2021. Retail Trade industry had the highest overall positivity rate in 2021, at 7 percent, an increase of 34.6 percent since 2017. This sector also experienced the only year over year rise in methamphetamine positivity from 2017 to 2021 of 55.6 percent (0.09 percent in 2017 to 0.14 percent in 2021).
Marijuana positivity increased in all industries and by double-digits in 15 from 2017 to 2021. The Accommodation and Food Service industry had the highest workforce positivity for marijuana at 7.5 percent, a relative increase of 114.3 percent over five years (3.5 percent in 2017 versus 7.5 percent in 2021).
In the Health Care and Social Assistance industry, results saw positivity for methamphetamine decrease year-over-year. Across the last five years, it decreased by 50 percent (0.18 percent in 2017 to 0.09 percent in 2021).
The Quest Diagnostics Drug Testing Index (DTI) is a series of reports that provide insights into trends in workforce drug use based on positivity rates of deidentified laboratory tests performed by Quest Diagnostics for a range of illicit, legal and prescription drugs. It examines test results according to three categories of workers: federally mandated, safety-sensitive workers; the general U.S. workforce; and the combined U.S. workforce. Federally mandated, safety-sensitive workers include pilots, bus and truck drivers, and workers in nuclear power plants, for whom routine drug testing is mandated by government agencies like the Department of Transportation, Nuclear Regulatory Commission and the Department of Defense.
The strengths of the DTI analysis include its large, nationally representative sample size, longitudinal monitoring, a testing population that is generally reflective of the U.S. workforce and the quality of the company’s drug testing services to confirm positive results. Limitations include analysis only of employers that perform drug testing with the company, and a lack of exact cross-specimen comparisons due to variations in substances for which employers test. Quest Diagnostics has analyzed annual workplace drug testing data since 1988 and publishes the findings as a public service.
Quest Diagnostics is a workforce drug testing provider, offering a broad range of drug testing options that allow employers to combine and customize a drug testing program that meets their unique business needs, all from a single, convenient provider. Employers seeking information on the company’s services should visit the company’s Employer Solutions page for more information.