Positive drug test results reach 20-year high, spiking from a decade ago

Positive drug test results among America’s workforce reached their highest rate last year since 2001 and were up more than 30 percent in the combined U.S. workforce from an all-time low in 2010-2012, according to a new analysis by Quest Diagnostics, the world’s leading provider of diagnostic information services.

Based on 11 million-plus deidentified urine, hair and oral fluid drug test results collected between January and December 2021, the study 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 9 million urine drug tests collected between January and December 2021, reached 4.6 percent compared to 4.4 percent in 2020 and up 31.4 percent from the all-time low of 3.5 percent 10 years ago. The sample universe spans the a) general U.S. workforce of mostly company-policy testing by private employers; and, b) federally mandated, safety-sensitive workforce, encompassing federal employees plus the transportation and nuclear power industries, and can include 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 2020-2021) and was 4.8 percent higher than 2017 (2.1 percent versus 2.2 percent). 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 versus 5.6 percent) and up each of the last five years.

“Our Drug Testing Index (DTI) 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 Quest Diagnostics Senior Science Consultant Barry Sample, PhD. 

“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,” adds Employer Solutions General Manager Keith Ward. “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 harm’s way.”

Following five years of decline, 2021 positivity rates increased in several federally mandated, safety sensitive workforce testing categories. Of note in 2021, rates based on urine drug tests for the federally mandated, safety-sensitive workforce: marijuana use increased 8.9 percent (0.79 percent in 2020 to 0.86 percent in 2021), amphetamine use increased 7.8 percent (0.64 percent in 2020 to 0.69 percent in 2021), and cocaine use 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,” observes 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.”

Quest Diagnostics Drug Testing Index findings across these and 13 other sectors were unveiled earlier this spring at the Drug & Alcohol Testing Association 2022 Conference in Louisville, Ky.

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 use 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 use. 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 the substance 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; methamphetamine use among those tested increased 26.4 percent (0.53 percent in 2020 versus 0.67 percent in 2021), exhibiting year-over-year increases dating to 2017.

Oral fluid tests generally have a shorter window of drug detection than urine, and can detect some drugs faster, in a matter of minutes instead of 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 preemployment 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 U.S. 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,” affirms National Safety Council Vice President of Impairment Practice Jenny Burke. “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.”