Overall Drug Positivity Holds Steady at Historically High Rates while Marijuana Positivity Continued Upward Climb in the General U.S. Workforce

Marijuana Positivity in the General U.S. Workforce Escalated in States That Have Legalized Recreational Marijuana as well as in Professional Office-Based Industries


SECAUCUS, N.J. – The percentage of employees in the general U.S. workforce whose drug test showed signs of tampering increased by more than six-fold in 2023 versus the prior year, the highest rate ever in more than 30 years of annual reporting.

This finding is part of a new analysis of nearly 9.8 million workforce drug tests released by Quest Diagnostics (NYSE: DGX), a leading provider of diagnostic information services.

To view the full report, visit www.QuestDiagnostics.com/DTI.

The increase in substituted urine specimens in the general U.S. workforce, a population of over 5.5 million, was 633 percent (0.015 percent in 2022 versus 0.11 percent in 2023). Invalid urine specimens in the general U.S. workforce increased 45.2 percent (0.31 percent in 2022 versus 0.45 percent in 2023). A result of substituted or invalid suggests a specimen has been tampered with in an attempt to conceal drug use.

The increasing rates of substituted or invalid specimens coincide with historically high rates of both general U.S. workforce drug positivity and post-accident marijuana positivity. Drug positivity in the general U.S. workforce was 5.7 percent in both 2022 and 2023. In 2023, in the combined U.S. workforce, urine drug positivity for all drugs was 4.6 percent, the same as in 2021 and 2022. This overall positivity is the highest level in more than two decades, up more than 30 percent from an all-time low of 3.5 percent in 2010-2012 and coincides with a sharp increase of 114.3 percent in post-accident positivity between 2015 and 2023 in the general U.S. workforce.

“The increased rate of both substituted and invalid specimens indicates that some American workers are going to great lengths to attempt to subvert the drug testing process,” said Suhash Harwani, Ph.D., senior director of science for workforce health solutions at Quest Diagnostics. “Given the growing acceptance and use of some drugs, particularly marijuana, it may be unsurprising that some people feel it necessary to try and cheat a drug test. It is possible that our society’s normalization of drug use is fostering environments in which some employees feel it is acceptable to use such drugs without truly understanding the impact they have on workplace safety.”

Similar trends were also seen in the federally mandated, safety-sensitive U.S. workforce, with substituted specimens increasing 370.6 percent (0.017 percent in 2022 versus 0.08 percent in 2023) and invalid rates increasing 36.7 percent (0.30 percent in 2022 versus 0.41 percent in 2023).

“Organizations must have sound policy and procedures to ensure employee drug testing programs have efficacy. Cheating on drug tests not only undermines workplace safety but also jeopardizes the safety of society as a whole,” said Katie Mueller, a senior program manager at the National Safety Council focusing on cannabis safety. “Companies, regulators and policymakers must prioritize accountability for the well-being of all individuals in our communities; lives depend on it.”

Marijuana Continues Upward Climb
Marijuana positivity in the general U.S. workforce increased 4.7 percent (4.3 percent in 2022 versus 4.5 percent in 2023). Over five years, marijuana positivity has increased 45.2 percent, with 2023 reaching a new peak compared to 2019 (3.1 percent in 2019 versus 4.5 percent in 2023).

Marijuana Drug Test Positivity Decreases in Federally Mandated, Safety Sensitive Workforce
In the federally mandated safety-sensitive workforce, marijuana positivity decreased nationally 3.1 percent year over year (0.98 percent in 2022 versus 0.95 percent in 2023).

Marijuana positivity stayed the same (1.1 percent in both 2022 and 2023) in states in which recreational marijuana is legal and decreased 2.2 percent (0.90 percent in 2022 versus 0.88 percent in 2023) in states in which medical marijuana is legal. In states in which neither recreational nor medical marijuana use is legal, marijuana positivity decreased 6.7 percent (0.89 percent in 2022 versus 0.83 percent in 2023) year over year and stayed the same over five years (0.83 percent in 2019 versus 0.83 percent in 2023).

“The federally mandated, safety-sensitive population has a lower rate of drug positivity, likely due to the fact that there is decreased drug use when there is an expectation of being drug tested. This is fundamentally the strength of having a drug testing program. The mere expectation of drug testing may be a deterrent, dissuading individuals from both drug use and applying for positions where such tests are standard practice,” said Dr. Harwani.

Post-accident Marijuana Positivity Continues to Climb
In 2023, post-accident marijuana positivity of urine drug tests in the general U.S. workforce was 7.5 percent. The new peak follows a steady increase in post-accident marijuana positivity every year from 2015 to 2023. In that 9-year time frame, post-accident marijuana positivity increased 114.3 percent.

The Quest data aligns with other reports associating marijuana legalization with workplace harms. A February 2024 study in the Journal of the American Medical Association (JAMA Health Forum) found recreational marijuana laws that allow recreational marijuana sales were associated with a 10 percent increase in workplace injuries among individuals aged 20 to 34 years.

“As the prevalence of marijuana positives in the workforce rises, our concern grows,” said Mueller. “The data show an increasing correlation between marijuana use and adverse workplace effects, prompting a call for heightened vigilance and comprehensive strategies to safeguard workplace safety and productivity.”

“Most employers are highly focused on productivity, which can be achieved by improving workforce health and wellness. A well-executed drug testing program can help an organization to maintain a healthier a workforce which, based on our data, could decrease the potential for accidents or other unsafe behaviors,” added Dr. Harwani.

Positivity Increased in Industries Associated with Office Work
Overall drug workforce positivity increased in industries associated with “office work,” such as administrative, managerial and clerical tasks within office environments. Workforce positivity increased in Real Estate and Lending by 17.0 percent (4.7 percent in 2022 versus 5.5 percent in 2023); Professional, Scientific and Technical Services by 9.3 percent (4.3 percent in 2022 versus 4.7 percent in 2023); Educational Services by 7.9 percent (from 3.8 percent in 2022 to 4.1 percent in 2023); and Public Administration by 5.0 percent (4.0 percent in 2022 to 4.2 percent in 2023).

Marijuana positivity increased in 13 out of 15 industries led by Finance and Insurance which increased 35.7 percent (2.8 percent in 2022 versus 3.8 percent in 2023); Public Administration which increased 23.5 percent (1.7 percent in 2022 versus 2.1 percent in 2023); and Real Estate Rental and Leasing which increased 22.2 percent (5.4 percent in 2022 versus 6.5 percent in 2023).

“It isn’t clear why we’re seeing an increase in overall and marijuana drug positivity in office workers, but it isn’t a stretch that a combination of unprecedented stress and isolation during the pandemic with work-from-home policies during and post-pandemic may be contributing to greater drug use in employees in traditionally white-collar fields,” said Sam Sphar, VP and general manager, workforce health solutions, Quest Diagnostics. “The results underscore the growing need for mental health support and drug education programs to ensure employees are safe and productive, whether working at home or in the office.”

Urine Drug Test Positivity Among Other Drug Types
Cocaine positivity in the general U.S. workforce increased 9.1 percent (0.22 percent in 2022 versus 0.24 percent in 2023). Amphetamines positivity remained flat (1.5 percent in 2022 and 2023) and 6-AM (heroin metabolite) positivity decreased 16.7 percent (0.006 percent in 2022 versus 0.005 percent in 2023).

Opiates (codeine/morphine) positivity decreased 12.5 percent (0.16 percent in 2022 versus 0.14 percent in 2023), Opiates (hydrocodone/hydromorphone) decreased 9.4 percent (0.32 percent in 2022 versus 0.29 percent in 2023) and Oxycodone (Oxycodone/Oxymorphone) also decreased 3.6 percent (0.28 percent in 2022 versus 0.27 percent in 2023), continuing a downward trend over five years for all three drug categories.

About the Quest Diagnostics Drug Testing Index™
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: the federally mandated, safety-sensitive workforce; 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, the 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. For more information, visit www.QuestDiagnostics.com/DTI.

About Quest Diagnostics Workforce Health Solutions
Through its workforce health solutions, Quest Diagnostics is a leading provider of laboratory testing and other services designed to optimize the health, safety, and wellbeing of employees. Quest workforce health solutions includes population health and biometric and laboratory screening services to identify and act on disease risks in the earliest stages; workplace drug testing services to help identify and pre-empt dangerous workplace drug use; and OSHA-required laboratory screening and vaccination services. Based on the industry leading diagnostics expertise of Quest Diagnostics, our solutions incorporate the latest science, technology and innovations in laboratory medicine and healthcare management to reveal the actions that will improve workforce health, for better medical care and lower costs. For more information, visit WorkforceHealthSolutions.com.

About Quest Diagnostics
Quest Diagnostics empowers people to take action to improve health outcomes. Derived from the world’s largest database of clinical lab results, our diagnostic insights reveal new avenues to identify and treat disease, inspire healthy behaviors, and improve health care management. Quest annually serves one in three adult Americans and half the physicians and hospitals in the United States, and our nearly 50,000 employees understand that, in the right hands and with the right context, our diagnostic insights can inspire actions that transform lives. www.QuestDiagnostics.com.