Industry News

Workforce Drug Test Positivity Climbs to Highest Level in Two Decades

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% in the combined U.S. workforce from an all-time low in 2010-2012, according to a new analysis released today by Quest Diagnostics, the world's leading 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% compared to 4.4% in 2020 and up 31.4 percent from the all-time low of 3.5% just 10 years ago (2010-2012). 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% in 2020 and 2021) and was 4.8% higher than 2017 (2.1% in 2017 versus 2.2% in 2021). In the general U.S. workforce, positivity increased 1.8% (5.5% in 2020 versus 5.6% in 2021) and was 12% higher than in 2017 (5.0% in 2017 versus 5.6% in 2021) and up each of the last five years.

For an interactive map of the Drug Testing Index with positivity rates and trend lines by drug categories and three-digit ZIP code in the United States, visit

"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," said Barry Sample, PhD, 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," said 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."

The new findings of the Quest Diagnostics Drug Testing Index™ are being unveiled this week at the Drug & Alcohol Testing Association 2022 Conference taking place March 30-April 2 in Louisville, KY.

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% (0.79% in 2020 to 0.86% in 2021), amphetamines increased 7.8% (0.64% in 2020 to 0.69% in 2021) and cocaine increased 5.0% (0.20% in 2020 to 0.21% 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," said 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% (3.6% in 2020 versus 3.9% 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% (2.6% in 2017 versus 3.9% 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% in 2021, a decline of 46.3% compared to 2020 (13.6%) and 29.8% compared to 2017 (10.4%). The drop in oral fluid-positivity (13.6% in 2020 versus 7.3% 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% in 2021, an increase of 20.3 percent compared to 2020 (12.3%) and up 68.2% over five years (8.8% in 2017). At the same time, the positivity rate for cocaine increased 46.6% (0.58% in 2020 versus 0.85% in 2021), its highest spike since 2006, and methamphetamine increased 26.4% (0.53% in 2020 versus 0.67% in 2021), exhibiting year-over-year increases for the last 5 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% (4.6% in 2017 versus 5.4% in 2021); while post-accident positivity increased 26% (7.7% in 2017 versus 9.7% in 2021).

Similarly, in federally mandated, safety-sensitive workforce urine drug testing, pre-employment positivity increased 9.5% since 2017 (2.1% in 2017 versus 2.3% in 2021), while post-accident positivity increased 41.9% (3.1% in 2017 versus 4.4% in 2021). In 2021, the post-accident positivity as compared to pre-employment positivity was 79.6% higher (9.7% versus 5.4%) in the general US workforce and 91.3% higher (4.4% versus 2.3%) in the federally mandated, safety-sensitive workforce.

"Drug use affecting the work environment is a complex problem that is not going away," said 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% and 266.7% 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% and 200% 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%, 119%, 257.1%, and 194.1% 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 said. "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% (0.22% in 2020 versus 0.21% in 2021) and positivity for cocaine over the past five years declined 30% (0.30% in 2017 versus 0.21% in 2021). Positivity rates for cocaine based on urine tests in the federally mandated safety, safety-sensitive workforce increased 5.0% (0.20% in 2020 versus 0.21% 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% (0.21% in 2020 versus 0.17% in 2021) and 56.4% over five years (0.39% in 2017 versus 0.17% in 2021). Positivity for opiates (hydrocodone/hydromorphone) in the general U.S. workforce decreased 3% (0.33% in 2020 versus 0.32% in 2021) and 37.3% over five years (0.51% in 2017 versus 0.32% in 2021). Positivity for oxycodones (oxycodone/oxymorphone) in the general U.S. workforce stayed the same in 2020 and 2021 (0.29%) and decreased 52.5% over five years (0.61% in 2017 versus 0.29% in 2021). To see a U.S. map depicting positivity rates for different classes of opiates and oxycodone, visit

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% (0.018% in 2020 versus 0.013% in 2021) and 56.7% over five years (0.03% in 2017 versus 0.013% in 2021). Positivity for the 6-AM metabolite (heroin) in the federally mandated, safety-sensitive workforce decreased 37.5% (0.008% in 2020 versus 0.005% in 2021) and 73.7% over five years (0.019% in 2017 versus 0.005% 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%, an increase of 34.6% since 2017. This sector also experienced the only year over year rise in methamphetamine positivity from 2017 to 2021 of 55.6% (0.09% in 2017 to 0.14% 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%, a relative increase of 114.3% over five years (3.5% in 2017 versus 7.5% 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% (0.18% in 2017 to 0.09% in 2021).