Marijuana Workforce Drug Test Positivity Continues Double-Digit Increases to Keep Overall Drug Positivity Rates at Historically High Levels, Finds Latest Quest Diagnostics Drug Testing Index™ Analysis
First Large-Scale National Analysis of Workforce Drug Testing During the COVID-19 Pandemic, Based on More Than 9 Million Drug Tests in 2020
Stark Differences in Positivity Between States that Permit Recreational Marijuana Use with Either Medical Use and No Legal Marijuana States
Marijuana Positivity Rate of Post-Accident Test Results Grew Faster Than Rate for Pre-Employment Testing

SECAUCUS, N.J., May 26, 2021 /PRNewswire/ -- The COVID-19 pandemic did not dampen workforce drug testing positivity for marijuana, which continued to increase last year in the general U.S. workforce, according to a new analysis released today by Quest Diagnostics (NYSE: DGX), the world's leading provider of diagnostic information services. This study is thought to be the first large-scale analysis of de-identified results of laboratory workforce drug tests performed during the COVID-19 pandemic.

The overall positivity rate in the combined U.S. workforce based on more than seven million urine drug tests collected between January and December 2020 was down only slightly in 2020 (4.4%) compared to 2019 (4.5%, a sixteen-year high). Positivity in the federally mandated, safety-sensitive workforce based on more than 2 million urine drug tests declined 8.3 percent (2.4% in 2019 versus 2.2% in 2020) but was still 10 percent higher than the 2016 rate (5 years prior). In the general U.S. workforce, positivity increased 3.8 percent (5.3% in 2019 versus 5.5% in 2020) and was 12.2 percent higher than in 2016.    

As positivity for most drug categories, other than marijuana, declined or remained flat in the combined U.S. workforce over the past five years, amphetamines (which includes methamphetamine) persisted at 1.1 percent positive each year.

The new findings of the Quest Diagnostics Drug Testing Index™ were unveiled to coincide with the National Drug & Alcohol Screening Association (NDASA) 2021 Annual Conference taking place May 25-27 in St. Louis, MO.

"Driven largely by surging rates of marijuana general U.S. workforce positives and steady rates of amphetamines positives, the rate of drug positivity remained stubbornly high despite seismic shifts to the workplace caused by the COVID-19 pandemic," said Barry Sample, Ph.D., senior director of science and technology, Quest Diagnostics. "However, as we see upticks in hiring and many employees returning to the workplace, it is important that employers consider workforce drug testing as a way to keep the workplace, their customers and the community safe."

"Impairment, whether it be by drugs, alcohol, fatigue or stress, decreases the safety of the workforce," said Jenny Burke, senior director of impairment practice, National Safety Council. "The DTI results, reflecting decreases in many drug categories, occurred in a unique year. Even though these are down, we must continue to educate people about the impairing impacts of these substances. And, as states and the federal government consider changes to the legality of marijuana, we can't take for granted that they also understand the impairing impact of THC. The safety of people who share the roadways and workplaces with impaired people needs to be a priority."

For an interactive map with positivity rates and trend lines by three-digit zip code in the United States, visit

Positivity down or flat for most drug categories, but increase for ecstasy

Urine drug test results in the general U.S. workforce declined in eight drug categories but stayed the same in two drug categories (excluding propoxyphene, which was withdrawn from the U.S. market a decade ago). Positivity for cocaine declined 18.5 percent (0.27% in 2019 versus 0.22% in 2020), the semi-synthetic opiates (hydrocodone/hydromorphone) declined 10.8 percent (0.37% in 2019 versus 0.33% in 2020), oxycodone group of opiates (oxycodone/oxymorphone) declined 14.7 percent (0.34% in 2019 versus 0.29% in 2020) and benzodiazepines declined 9.3 percent (0.43% in 2019 versus 0.39% in 2020). While the positivity for MDMA/MDA 3,4-Methylenedioxymethamphetamine (commonly known as ecstasy) increased by 25 percent (0.008% in 2019 versus 0.010% in 2020) and has demonstrated small, year-over-year increases, the positivity rate remains very low at 1 in every 10,000 (0.010%) tests.

Positivity rates declined in federally mandated, safety-sensitive workforce testing categories

Urine drug test results for the federally mandated, safety-sensitive workforce declined in all drug categories other than phencyclidine (PCP), which remained at 0.011 percent, same as in 2019. Of note, positivity for marijuana declined 10.2 percent (0.88% in 2019 versus 0.79% in 2020), cocaine declined 20 percent (0.25% in 2019 versus 0.20% in 2020), semi-synthetic opiates (hydrocodone/hydromorphone) declined 14.3 percent (0.35% in 2019 versus 0.30% in 2020) and the oxycodone group of opiates (oxycodone/oxymorphone) declined 19.2 percent (0.26% in 2019 versus 0.21% in 2020).

Marijuana continued double-digit year-over-year increases in the general U.S. workforce, with lower positivity rates in states with only medical marijuana use or no form of legalized marijuana use versus states with legalized recreational statutes

Marijuana positivity surged ahead in 2020 in the U.S. general workforce and across specimen types (urine, oral fluid, and hair). In the U.S. general workforce, marijuana positivity increased 16.1 percent in urine testing (3.1% in 2019 versus 3.6% in 2020), 35.2 percent in oral fluid testing (9.1% in 2019 versus 12.3% in 2020) and 22.5 percent in hair testing (7.1% in 2019 versus 8.7% in 2020).

The Drug Testing Index data also showed stark differences between states that have legalized recreational marijuana use versus states that have only legalized medical marijuana use or no form of legal marijuana use.  Marijuana positivity surged in states with legal recreational use statutes 118.2 percent from 2012-2020 (2.2% in 2012 versus 4.8% in 2020). In states with only medical marijuana statutes, marijuana positivity increased 68.4 percent (1.9% in 2012 versus 3.2% in 2020). In states with no medical or recreational marijuana statutes, marijuana positives increased 57.9% percent (1.9% in 2012 versus 3.0% in 2020).

"Our data suggest that marijuana positivity has increased sharply nationwide since states began to legalize marijuana in 2012. However, it appears that states where medical marijuana use alone is legal are not experiencing much higher rates of increase than states where neither medical nor recreational use is legal," Dr. Sample said.

The positivity rate of post-accident test results grew faster than the rate of positivity for pre-employment testing

Between 2012, when the first state legalized recreational marijuana, and 2020, the gap between pre-employment and post-accident marijuana positivity increased each year. In the U.S. general workforce, in 2012, marijuana pre-employment positivity was 1.9 percent and post-accident positivity was 2.4 percent (a 26.3% difference). In 2020, pre-employment marijuana positivity was 3.7 percent and post-accident 6.4 percent (a 73% difference).

"The Drug Testing Index data shows states with recreational marijuana statutes have significantly higher positivity and the year-over-year differences between recreational states and states with medical and no legalization statutes has grown. In addition, while urine drug testing cannot determine whether an individual is under the influence or impaired at the time of test, our post-accident data suggests that marijuana use may play a role in those workplace incidents prompting a drug test," Dr. Sample said.

Cocaine positivity lowest since 2012 general U.S. workforce

Urine drug test positivity for cocaine in the general U.S. workforce dropped to the lowest level since 2012. Positivity for cocaine declined 18.5 percent (0.27% in 2019 versus 0.22% in 2020). Positivity for cocaine over the past five years declined 21.4 percent (0.28% in 2016 versus 0.22% in 2020).

Workforce positivity increased significantly in multiple industries

The Quest Diagnostics Drug Testing Index™ Industry Insights of general U.S. workforce positivity rates, based on more than 17 million urine drug test results between 2016 and 2020, shows year-over-year increases in overall workplace drug positivity in 6 of the 17 sectors reported. The Retail Trade industry had the highest overall positivity rates for all drug categories across all five years of the analysis (5.1% in 2016, 5.2% in 2017, 5.4% in 2018, 5.5% in 2019 and 6.2% in 2020). Accommodation and Food Services tied with Retail Trade for the highest positivity in 2020 alone (4.7% in 2016, 4.6% in 2017, 4.9% in 2018, 5.1% in 2019 and 6.2% in 2020). The Accommodations and Food Service category had the highest workforce positivity for marijuana at 6.3 percent, a relative increase of 96.9 percent over five years (3.2% in 2016 versus 6.3% in 2020).

Workforce Drug Testing Webinar

Barry Sample, PhD, senior director of science and technology, for Quest Diagnostics, will discuss the latest data from the Drug Testing Index and an analysis of workforce marijuana testing via webinar on Wednesday, June 16 at 12 pm EDT/11 am CDT. Click here to register and attend.

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 de-identified 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 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 the U.S. Department of Health and Human Services.

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. Additionally, COVID-19 and regulatory changes may have also impacted hiring and the way in which employers tested – for example, in 2020 for the federally mandated safety-sensitive workforce, the percentage of specimens tested for pre-employment purposes declined while those for random tests increased. Quest Diagnostics has analyzed annual workplace drug testing data since 1988 and publishes the findings as a public service.

In addition to workplace drug testing, Quest is a leader in clinician-ordered drug testing services through its Clinical Drug Monitoring program to aid the detection of potentially dangerous forms of prescription and illicit drug use. For more information on Quest's drug monitoring services for healthcare providers, visit

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. Our 50,000 employees understand that, in the right hands and with the right context, our diagnostic insights can inspire actions that transform lives.

SOURCE Quest Diagnostics

For further information: Kim Gorode, Quest Diagnostics (Media),; Shawn Bevec, Quest Diagnostics (Investors), 973-520-2900