Quest Diagnostics analyzed more than 11 million deidentified urine, hair and oral fluid drug test results collected between January and December 2021. The overall positivity rate in the combined U.S. workforce was up to 4.6% in 2021 compared to 4.4% in 2020 and up 31.4% from the all-time low of 3.5% just 10 years ago. Overall positivity in the federally mandated, safety-sensitive workforce urine drug tests stayed even year over year and was 4.8% higher than 2017. In the general U.S. workforce, positivity increased 1.8%, was 12% higher than in 2017 and was up each of the last five years.

Among other findings:

• Despite years of decline, positivity rates increased in several federally mandated, safety-sensitive workforce testing categories.
• Positivity for marijuana continues its upward climb.
• In oral fluid testing, overall workforce drug positivity decreased, but it increased for marijuana, methamphetamines and cocaine.
• 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.
• Cocaine positivity in the general U.S. workforce was mixed.
• Positivity for opiates and oxycodones in the general U.S. workforce decreased last year and over five years.
• Positivity for heroin in the general U.S. workforce decreased over five years.
• The retail trade had the highest positivity among key industries.

"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 of Quest Diagnostics Employer Solutions. "Our Drug Testing Index data raise 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."