The percentage of employees in the general U.S. workforce testing positive for marijuana following an on-the-job accident increased to its highest level in 25 years in 2022, according to a new analysis released by Quest Diagnostics (NYSE: DGX), the world's leading provider of diagnostic information services.

In 2022, post-accident marijuana positivity of urine drug tests in the general U.S. workforce was 7.3%, an increase of 9% compared to 6.7% in 2021. The new peak follows a steady increase in post-accident marijuana positivity every year from 2012 to 2022. In that 10-year time frame, post-accident marijuana positivity increased 204.2%. From 2002 to 2009, post-accident marijuana workforce positivity declined.

These increases in post-accident marijuana positivity correspond with legalization of marijuana in certain states. In 2012, Colorado and Washington became the first states to legalize marijuana for recreational use. Since then, 19 additional states and the District of Columbia have legalized the recreational use of marijuana and 38 states (plus the District of Columbia) have legalized medical use, although either kind of use remains illegal under federal law.

"Intoxicating cannabis products, including marijuana, can have a major impact on safety at work and have been proven to slow reaction time, impact memory and impair skills essential to driving. State legalization of the drug creates new challenges for employers," said Katie Mueller, a senior program manager at the National Safety Council focusing on cannabis safety. "The Quest data provide compelling evidence that increased use of cannabis products by employees can contribute to greater risk for injuries in the workplace. It is imperative employers take the proper steps to create and maintain a policy that addresses cannabis use, build a safety-focused culture and educate the workforce to keep all workers safe on and off the job."

In 2022, the combined U.S. workforce urine drug positivity for all drugs persisted at 4.6% – the highest level in two decades. The 2021 and 2022 positivity rates were the highest since 2001, up more than 30% from an all-time low in 2010-2012.

While marijuana was the main driver of workforce positivity increases in the general U.S. workforce, amphetamines positivity also contributed to the increase. Positivity for marijuana in the general U.S. workforce increased 10.3% (4.3% positivity in 2022 versus 3.9% positivity in 2021) and amphetamines positivity increased 15.4% (1.5% positivity in 2022 versus 1.3% positivity in 2021). While the company's amphetamines data does not differentiate between prescribed medications and illicit drug use, the increase correlates with other data suggesting that the use of amphetamines, prescribed or illicit, has grown in recent years in the U.S.

The rising overall drug positivity rate for general workforce urine testing was observed widely across U.S. industries. Over the past five years, the workforce positivity rate climbed in most industry sectors, led by Accommodation and Food Services increasing 42.9% (4.9% in 2018 versus 7.0% in 2022), Retail Trade increasing 42.6% (5.4% in 2018 versus 7.7% in 2022), and Finance and Insurance increasing 38.5% (2.6% in 2018 versus 3.6% in 2022). 

"Our 2022 Quest Diagnostics analysis shows that the overall U.S. workforce positivity rate continued to be at a historically elevated level in 2022, even as much of the nation's workforce returned to the office post-pandemic," said Keith Ward, General Manager and Vice President for Employer Solutions at Quest Diagnostics. "This historic rise seems to correspond with sharp increases in positivity for marijuana in both pre-employment and post-accident drug tests, suggesting that changing societal attitudes about marijuana may be impacting workplace behaviors and putting colleagues at risk. The increase in amphetamines positivity is also notable, given the addictive potential and health risks associated with this class of drugs."

"Year-over-year and five-year data point to continuously higher workforce drug positivity overall, by industry, and across multiple drug categories," said Suhash Harwani, PhD, Senior Director of Science for Employer Solutions at Quest Diagnostics. "As employers express concern for employee health, wellness and safety, they may want to consider these data as a warning sign, particularly as a growing body of science demonstrates the risks of marijuana to mental and physical health."

The new Quest Diagnostics Drug Testing Index™ (DTI) report is based on more than 10.6 million deidentified urine, hair and oral-fluid drug test results reported between January and December 2022, aimed at providing insight into behavior seen in workers across the combined U.S. workforce by industry and drug type. 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.

The new findings will be presented at the National Drug & Alcohol Screening Association (NDASA) 2023 Conference taking place May 23-25 in Bellevue, WA.

Marijuana positivity in states that permit recreational and medical use continued to climb

In the general U.S. workforce, marijuana positivity increased 10.3% year over year (3.9% in 2021 versus 4.3% in 2022). Marijuana positivity increased 11.8% (5.1% in 2021 versus 5.7% in 2022) in states in which recreational marijuana is legal and 8.3% (3.6% in 2021 versus 3.9% in 2022) in states in which medical marijuana is legal. In states in which neither recreational nor medical marijuana is legal, marijuana positivity increased 3.3% (3.0% in 2021 versus 3.1% in 2022) year over year and 14.8% over five years (2.7% in 2018 versus 3.1% in 2022).

In the federally mandated safety-sensitive workforce, marijuana positivity increased nationally 14% year over year (0.86% in 2021 versus 0.98% in 2022). Marijuana positivity increased 17% (0.94% in 2021 versus 1.1% in 2022) in states in which recreational marijuana is legal. Marijuana positivity increased 5.9% (0.85% in 2021 versus 0.90% in 2022) in states in which medical marijuana is legal. In states in which neither recreational nor medical use marijuana is legal, marijuana positivity increased 12.7% (0.79% in 2021 versus 0.89% in 2022) year over year and 1.1% over five years (0.88% in 2018 versus 0.89% in 2022).

"In the general U.S. workforce, states that have legalized recreational and medical marijuana use exhibit higher positivity rates than the national average. States that have not legalized marijuana appear to have positivity rates below the national averages," said Dr. Harwani. "Overall, post-accident and pre-employment positivity test rates among the federally mandated, safety-sensitive population have always been lower, suggesting the expectation of testing may be a deterrent."

Urine positivity rates for post-accident testing increased over five years

The rise in marijuana post-accident positivity among private employers mirrored an increase in overall drug positivity in individuals tested post-accident. In the general U.S. workforce, rates of post-accident drug positivity increased both year over year and over the past five years in nearly all specimen types tested. Over the last five years, in general workforce urine testing, overall post-accident positivity increased 22.6% (8.4% in 2018 versus 10.3% in 2022). Specifically, post-accident positivity as compared to pre-employment tests in urine specimens tested for marijuana and cocaine in the general U.S. workforce was higher by 58.7% and 230%, respectively.

Additionally, post-accident urine positivity for marijuana among the federally mandated safety-sensitive population increased year over year by 16.7% (1.8% in 2021 versus 2.1% in 2022) and over five years by 40% (1.5% in 2018 versus 2.1% in 2022). Pre-employment positivity for marijuana also increased 18.2% for this group (1.1% in 2021 versus 1.3% in 2022) and 30% over five years (1.0% in 2018 versus 1.3% in 2022).

Post-accident testing is conducted to evaluate whether drug use may have played a role in a workplace incident prompting the drug test. Both post-accident and pre-employment drug testing aim to protect non-drug using workers from others who may use drugs in the workplace and pose a danger.

U.S. workforce positivity plateaued at 20-year high

The overall positivity rate in the combined U.S. workforce, based on more than nine million urine drug tests, was 4.6% in 2022 and 2021, an increase of 31.4% from the all-time low of 3.5% just 11 years ago (2010-2012). In the general U.S. workforce, positivity increased 1.8% (5.6% in 2021 versus 5.7% in 2022) and was 11.8% higher than in 2018 (5.1% in 2018 versus 5.7% in 2021).

Overall positivity in the federally mandated, safety-sensitive workforce based on more than 2.9 million urine drug tests climbed 9.1% year over year (2.2% in 2021 and 2.4% in 2022). While the positivity rate dropped 11.1% since 2018 (2.7% in 2018 to 2.4% in 2022), 2018 marked the introduction of testing for certain prescription opioids. Positivity rates based on urine drug tests in certain drug categories for the federally mandated, safety-sensitive workforce increased in 2022. Of note, marijuana increased 14% (0.86% in 2021 to 0.98% in 2022) and amphetamines increased 8.7% (0.69% in 2021 to 0.75% in 2022).

"Safety-sensitive jobs, like pilots and some federal positions, carry responsibilities that have higher potential risk of harm to public safety than most private-sector jobs," said Dr. Harwani. "Employers need help identifying individuals who are capable, competent and fully focused to perform their duties – and it is discouraging to see such a steep increase in drug positivity for workers in safety-sensitive roles."

Positivity for marijuana continued upward climb in the general U.S. workforce

Positivity rates for marijuana in the general U.S. workforce, based on more than 6.3 million urine tests, continued an upward climb, increasing 10.3% (3.9% in 2021 versus 4.3% in 2022), the highest positivity rate ever reported in the DTI, and 53.6% over the past five years (2.8% in 2018).

Increase in 5-year positivity in every industry; 9 of 15 increased year over year

Year-over-year positivity based on urine drug tests among the general workforce increased in 9 of 15 industries reported (industries are based on the North American Industry Classification System [NAICS] standard used by federal statistical agencies in classifying business establishments). Positivity in Health Care and Social Assistance increased year over year by 3.9% (5.1% in 2021 versus 5.3% in 2022) and by 14.3% in Public Administration (3.5% in 2021 versus 4.0% in 2022).

Over five years, workforce positivity increased in every industry category. Accommodation and Food Services led the way with a 42.9% increase in positivity (4.9% in 2018 versus 7.0% in 2022). Retail Trade positivity was close behind at 42.6% increase (5.4% in 2018 versus 7.7% in 2022). Positivity in Finance and Insurance increased 38.5% (2.6% in 2018 versus 3.6% in 2022). Positivity in Transportation and Warehousing increased 35.9% (3.9% in 2018 versus 5.3% in 2022). Construction increased 14.6% (4.1% in 2018 versus 4.7% in 2022). Manufacturing increased 21.6% (3.7% in 2018 versus 4.5% in 2022).

Marijuana, cocaine and amphetamines showed widespread increases across industry sectors

Marijuana positivity was highest in Retail Trade and Accommodation and Food Services, at 8.1% in 2022. Over five years, marijuana positivity in Retail Trade increased 131.4% (from 3.5% in 2018 versus 8.1% in 2022). Marijuana positivity in Accommodation and Food Services increased 102.5% (from 4.0% in 2018 versus 8.1% in 2022). Cocaine positivity increased in 12 of 15 industries year over year and was highest in construction at 0.33%. Amphetamines positivity increased 15.4%, driven by increases in 14 of 15 industries, and was highest in Education Services, at 2.1%.

Cocaine positivity was mixed in the general U.S. workforce

Positivity for cocaine based on urine tests in the general U.S. workforce ticked up 4.8% (0.21% in 2021 versus 0.22% in 2022) and positivity for cocaine over the past five years declined 21.4% (0.28% in 2018 versus 0.22% in 2022). Positivity rates for cocaine based on urine tests in the federally mandated safety-sensitive workforce stayed even (0.21% in 2021 and 2022) and were down 25% over five years (0.28% in 2018 versus 0.22% in 2022). 

Positivity for 6-AM (heroin) in all urine drug tests decreased over five years

Positivity for 6-AM metabolite (heroin) in the general U.S. workforce decreased 53.8% (0.013% in 2021 versus 0.006% in 2022) and 80% over five years (0.03% in 2018 versus 0.006% in 2022). Positivity for the 6-AM metabolite (heroin) in the federally mandated, safety-sensitive workforce decreased 40% (0.005% in 2021 versus 0.003% in 2022) and 76.9% over five years (0.013% in 2018 versus 0.003% in 2022).

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: federally mandated, safety-sensitive workers; 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.

Quest Diagnostics is the leading workforce drug testing provider, offering a broad range of drug testing options that allow employers to combine and customize a drug testing program that meets their unique business needs, all from a single, convenient provider. Employers seeking information on the company's services should visit the company's Employer Solutions page for more information.

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.