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Moving Targets: The Shifting Nature of the Workforce Drug Problem

April 10, 2020
Safety and substance abuse policies that are preventive, rather than simply reactive, are a company’s best line of defense.

In 1987, a freight train in Chase, Md., ran through warnings and hit an Amtrak passenger train, killing 16 people and injuring 164 more. To this day, it is considered one of the worst disasters in U.S. railway history.

The National Transportation Safety Board investigation concluded that the accident was a result of an engineer who used marijuana. The incident added to a growing movement to curb accidents related to drug and alcohol use. The following year, the Drug-Free Workplace Act was enacted, requiring all federal grantees to provide drug-free workplaces as a precondition of receiving a contract or grant from a federal agency. Upon signing the Act, President Ronald Reagan declared that “drugs will not be tolerated in the federal workplace.”

At the time of the Drug-Free Workplace Act’s passage, the positivity rate for workforce drug use in the combined U.S. workforces was a staggering 13.6%, as measured by the first-ever Quest Diagnostics Drug Testing Index, which examines results of laboratory drug tests performed by Quest Diagnostics.

The new federally mandated drug testing guidelines also jumpstarted workplace drug testing among employers in the private sector. Today, approximately half of private U.S. companies utilize pre-employment drug testing to help keep their workplaces safe, and all federal workers in “safety-sensitive” positions are required to be tested.

While the overall drug test positivity rates have fluctuated, they have never again reached the 1988 high. But new data on workforce drug positivity raises concerns about shifts in the prevalence and type of workforce drug use—and fresh challenges for employers who seek to provide safe workplaces free of drug-related business risks.

Drugs in the Modern Workforce

Just as the laws and regulations governing safe workplaces have changed in the last 30 years, trends in societal drug use are different as well. The illicit use of cocaine, for example, peaked in the 1980s in the U.S., but one analysis of data from the National Survey on Drug Use and Health, survey and urinalysis test result data from the Arrestee Drug Abuse Monitoring Program, and multiple other data sets demonstrate consumption dropped by 50% between 2006 and 2010 according to peer-reviewed publication ADDICTION from the Society for the Study of Addiction. Similarly, according to the Centers for Disease Control, data overdose deaths related to opioids increased a staggering 71% from 2013 to 2017, but have declined since 2017. These and other trends in drug misuse have been mirrored in workforce drug testing results in many cases.

Now, new data suggest a troubling trajectory in workforce drug positivity rates. The 2019 Quest Diagnostics Drug Testing Index analysis found the rate of workforce drug positivity hit a 14-year high in 2018, with positivity rates in the combined U.S. workforce more than 25% higher than the 30-year low experienced between 2010 and 2012 (see Figure 1).

The increases in drug positivity rates pose growing challenges for employers. The National Safety Council notes that employers experience direct and indirect costs associated with employee drug use, including higher healthcare expenditures, decreased productivity and more frequent absenteeism.

Substance misuse also plays a role in workplace injuries and death. The most recent data from the Bureau of Labor Statistics’ annual National Census Of Fatal Occupational Injuries shows that unintentional overdoses due to the nonmedical use of drugs or alcohol while at work increased 25% between 2016 and 2017, the fifth consecutive year in which these deaths increased by at least 25%.

The Quest data also show the post-accident drug test positivity rate has risen annually in the general U.S. workforce and the federally mandated, safety-sensitive workforce since 2011 and 2010, respectively. Overall, the rate has surged nearly 81% between 2014 and 2018 (with the jump in 2018 largely driven by the addition of prescription opiates to federal testing panels).

Industry-Specific Findings and What They Mean for Workplace Safety Policies

A deeper examination of drug testing results provides insight into how workforce drug positivity presents differently in key industries.

In September 2019, Quest released an in-depth, multi-year analysis of more than 14 million urine drug test results for the general U.S. workforce grouped by industry, based on the North American Industry Classification System (NAICS) used by the U.S. Office of Management and Budget (OMB). This analysis of NAICS classifications showed one-third of U.S. industry sectors experienced year-over-year double-digit increases in workforce drug positivity between 2015 and 2018—including in manufacturing, construction and multiple professional services.

Six industry sectors experienced an overall four-year increase in general U.S. workforce positivity more than double that of the national increase (6.2%) over that period (see Figure 2): Transportation & Warehousing (34.5%); Other Services (except Public Administration) (33.3%); Wholesale Trade (20.0%); Retail Trade (14.9%); Construction (13.2%); and Administrative Support, Waste Management and Remediation Services (12.2%)

Marijuana: The Most Commonly Detected Drug

Marijuana was the most commonly detected drug, with the highest positivity rates, in the majority of sectors. Ten of the 17 industry sectors examined showed increases of greater than 25% between 2015 and 2018, and several of these industries directly intersect with the larger public, including Transportation & Warehousing (53.3% increase from 2015-2018), Mining (50%), Construction (46.7%), and Manufacturing (38.5%).

Some employers may be tempted to believe marijuana use by employees is largely unpreventable, given the increase in recreational usage and increasing societal acceptance. However, marijuana remains a significant concern for workforces, given it can affect judgement, memory and motor skills. It is worth emphasizing that marijuana is the illicit drug most frequently found in the blood tests of drivers who have been involved in vehicle crashes, including fatal ones.

The Quest Diagnostics analysis also found marked increases in drug positivity rates for certain drugs, such as cocaine and amphetamines in several industries. The Construction industry, for example, showed the highest positivity rate for cocaine for all sectors in each year of the analysis (2015-2018) and was more than 40% higher than the national rate in 2018. Construction was also the only sector with year-over-year increases in methamphetamine positivity (increasing 20% from 2015 to 2018), and was more than 30% higher than the overall national positivity rate.

Six sectors showed year-over-year double-digit increases in amphetamine positivity between 2015 and 2018: Information (22.5%); Construction (16.7%); Finance and Insurance (16.3%); Educational Services (14.5%); Retail Trade (13.5%); and Utilities (13.3%).

Amphetamine is a central nervous system stimulant and includes drugs such as Adderall, which may be prescribed for certain conditions; the amphetamines drug class also include methamphetamine, which is more typically used illicitly. In addition to health hazards, the misuse of amphetamine and amphetamines may increase the risk of injury and workplace accidents due to cognitive dissonance and risky behaviors.

The Quest industry report reported some favorable/interesting information: no sector experienced an increase in positivity for opiates (specifically codeine and morphine) from 2016 to 2017 or 2017 to 2018. While this is cause for celebration for employers as well as public health advocates, a declining positivity rate for opiates cannot eclipse the disturbing increases in rates of detection of other substances.

Focusing on the Right Goal 

The changing nature of workforce drug use pressures safety officers to consider measures to reduce risks among their employees.

Comprehensive approaches to reduce and eliminate workforce drug misuse and abuse should include clear and unequivocal substance abuse policies, employee education about the health hazards and employment risks of substance abuse, supervisor training to recognize the warning signs of drug use, drug screening and testing, and an employee assistance program (EAP) to help employees access mental and emotional support.

As companies design these programs and re-visit their policies, a drug-free workplace may be safer and more productive than an environment with more relaxed attitudes about drug use. Robert DuPont, MD, the first director of the National Institute on Drug Abuse and former White House Drug Chief, said, “When I look at a drug policy, I ask, ‘Does it reduce use, or does it not reduce use?’ That’s the most important question.”

Ultimately, safety and substance abuse policies that are preventive, rather than simply reactive, remain the best line of defense.

About the Author

Kimberly Samano

Kimberly Samano, PhD, is scientific director for the employer solutions business of Quest Diagnostics (, a provider of diagnostic information services, including for workplace drug testing.

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