The number of workforce positive drug tests in the United States hit a 16-year high in 2019, according to Quest Diagnostics, a diagnostic testing and information services company. Specific regions, particularly the Midwest, experienced dramatic increases in positivity for cocaine and methamphetamine as well as marijuana.
“There is no question that before COVID-19, rates of workplace drug positivity were trending in the wrong direction, based on our data,” says Dr. Barry Sample, senior director of science and technology for Quest. “The enormous strain caused by COVID-19 may prove to be an accelerant on this disturbing trend. Organizations will need to consider the impact of COVID-19 not only on workplace safety but also as a health concern for their employees for some time to come.”
The national drug testing laboratory Millennium Health also found when it compared the period earlier this year from January 1 to when the national emergency was declared on March 13, to the period from then to the end of May an increase of 32% for nonprescribed fentanyl, 20% for methamphetamine, 12.5% for heroin and 10% for cocaine, accompanied by an 18% increase in suspected drug overdoses.
Public health officials across the country also are seeing spikes in drug overdose deaths during the COVID-19 pandemic, with more than 30 states reporting increases in opioid-involved overdose deaths, primarily related to illicit fentanyl.
The Quest findings for last year generally align with other research, the company notes. Drug deaths in the U.S. rose 5% in 2019, driven largely by methamphetamine, cocaine and fentanyl, following a decline in 2018. During the first few months of 2020, drug deaths increased about 13% compared with last year, attributed partly to social isolation and other disruptions caused by COVID-19.
In 2019, positivity rates in the combined U.S. workforce increased in urine drug tests, climbing to the highest level since 2003 (4.5%) and more than 28% higher than the 30-year low of 3.5% recorded between 2010 and 2012, according to Quest’s findings.
Over the last five years, methamphetamine positivity in the general U.S. workforce testing increased nearly 12% (0.17% in 2015 versus 0.19% in 2019). The Midwest region experienced year-over-year increases, driven primarily by double-digit increases in the East North Central region during this period.
Over the past five years, methamphetamine positivity in the Midwest increased nearly 78% (0.09% in 2015 versus 0.16% in 2019). Illinois (0.03% in 2015 versus 0.10% in 2019), Indiana (0.14% in 2015 versus 0.29% in 2019), Michigan (0.014% in 2015 versus 0.05 in 2019), and Ohio (0.04% in 2015 versus 0.11% in 2019) increased at least two-fold; while Wisconsin (0.05% in 2015 versus 0.09% in 2019) nearly doubled.
“While the national debate on drug misuse in the workforce has focused primarily on marijuana, increasing positivity rates for cocaine and methamphetamine are also cause for concern,” Sample stresses. “Positivity by drug and region can be random and unpredictable. [This] data is a reminder that it is important to remain vigilant about all drug misuse in the workforce.”
Between 2018 and 2019 methamphetamine positivity inched up nearly 6% (0.18% in 2018 versus 0.19% in 2019) in general workforce tests and fell 6.3% (0.15% in 2018 versus 0.16% in 2019) in federally mandated, safety-sensitive testing. Methamphetamine positivity changed little in the general workforce (up 12%) and was flat in federally mandated, safety sensitive testing over five years.
The increased positivity rates for methamphetamine in urine test results were bolstered by similar patterns in other specimen types. Oral fluid methamphetamine positivity, which also assesses recent use, was up 4.3% since 2018 and up 69% since 2015; while methamphetamine positivity from hair tests, which gauges a pattern of drug use over time, was up 20% since 2018 and 60% since 2015.
“Testing with multiple specimen types can reveal a fuller understanding of patterns of misuse than one alone,” Sample points out. “The data suggests that testing for methamphetamine with hair and oral fluid may be appropriate for employers with concerns about misuse of this particular drug to complement the standard urine drug screen.”
Cocaine Up, Opioids Down
Cocaine positivity in the general workforce testing increased in the Midwest and West regions over the past five years, Quest found. Cocaine positivity in the Midwest increased by 40% (0.20% in 2015 versus 0.28% in 2019) and in the West by 53% (0.15% in 2015 versus 0.23% in 2019). The Midwest was 20% less than the national rate in 2015 but 3.7% above the national rate in 2019, suggesting a surge in positivity in the region last year.
In the West, where cocaine positivity has been historically far lower, the rate rose from 40% below the national rate in 2015 to 14.8% below in 2019. The western increases were primarily driven by increasing positivity in Colorado (0.19% in 2015 versus 0.30% in 2019), Nevada (0.13% in 2015 versus 0.22% in 2019), and Oregon (0.09% in 2015 versus 0.13% in 2019).
In the general workforce, positivity for opiates in urine drug testing continues to decline across all opiate categories. Urine drug test positivity for opiates (primarily codeine and/or morphine) in the general workforce declined more than 19% (0.31% in 2018 versus 0.25% in 2019) and 49% over five years (0.49% in 2015 versus 0.25% in 2019).
Among the more specific tests for other prescription opiates, the positivity for the semi-synthetic opiates (hydrocodone and/or hydromorphone) dropped 26% over the past year (0.50% in 2018 versus 0.37% in 2019) and more than 45% over five years (0.68% in 2015 versus 0.37% in 2019). Similarly, positivity for oxycodones (oxycodone and/or oxymorphone) declined 21% (0.43% in 2018 versus 0.34% in 2019) over the past year and nearly 55% over five years (0.75% in 2015 versus 0.34% in 2019).
Marijuana continues to top the list of the most commonly detected illicit substances across all workforce categories (general workforce; federally mandated, safety-sensitive workforce; and combined U.S. workforce, which includes the prior two populations) and across different specimen types (urine, oral fluid and hair).
In the general workforce, marijuana positivity increased nearly 11% in urine testing (2.8% in 2018 versus 3.1% in 2019) and 29% since 2015 (2.4%). In the Midwest, marijuana positivity outpaced national increases in positivity in 2018 and 2019. Marijuana positivity increased in the Midwest by nearly 14% (2.9% in 2018 versus 3.3% in 2019).
The West region also outpaced national positivity and saw double digit increases, as compared to the previous year, in 2017 through 2019. Marijuana positivity increased in the West by 24% (3.3% in 2018 versus 4.1% in 2019) and 78% since 2015 (2.3%), Quest reports.
“Marijuana continues to be an enduring presence in the U.S. workforce. Changing attitudes toward its use could pose heightened risks, especially in safety-sensitive positions and those states exploring legalization,” Sample observes.
Positivity rates for heroin continue to decline in general U.S. and federally mandated, safety-sensitive workforce testing. Urine drug test results for the general U.S. workforce for heroin use, indicated by the presence of the 6-acetylmorphine (6-AM) metabolite, declined 33% (0.03% in 2018 versus 0.02% in 2019) and 50% decline since its peak in 2015 and 2016 (0.04%).
Positivity for 6-AM in the federally mandated, safety-sensitive workforce declined 15% between 2018 and 2019 (0.013% versus 0.011%), with a decrease of more than 45% since 2015 (0.02%).