Hair test positivity among American workers reached 19.1% in 2025, potentially reflecting recurring or chronic drug use
15.1% of workers screened for drugs using a hair test were positive for marijuana – up 58.9% from five years ago
Overall workforce urine drug positivity remained above 4% for more than a decade
Healthcare workers scored highest for overall drug positivity, at 5.8%; retail trade had the highest marijuana positivity among worker categories, at 7.6%
Fentanyl positivity declines by nearly half in the general U.S. workforce

SECAUCUS, N.J., July 10, 2026 /PRNewswire/ -- Nearly one in five workers in the general U.S. workforce (19.1%) tested positive for drug use based on an analysis of hair specimens collected in 2025, an increase of nearly 46% compared to 13.1% in 2021, finds the 2026 Quest Diagnostics Drug Testing Index™. For more information, visit www.QuestDiagnostics.com/DTI.

Over the past five years, overall hair test positivity for marijuana increased 58.9% (9.5% in 2021 vs. 15.1% in 2025). Pre-employment hair test positivity for marijuana increased 49.5% over the past five years (10.1% in 2021 vs. 15.1% in 2025). Random hair test positivity for marijuana increased 14.8% in the same period (18.3% in 2021 vs. 21.0% in 2025).

Marijuana also accounted for 52.5% of hair drug positives in 2025. By comparison, overall urine drug test positivity in the general U.S. workforce slightly declined to 4.3% in 2025 from 4.4% in the prior year.

The findings suggest that a sizeable minority of the American workforce uses drugs, principally marijuana, on a recurring or chronic basis. While traditional urine testing methods only capture drug use within a window of several hours or days, hair analysis provides an extended detection window that delivers a long-term history of substance use patterns over extended periods, offering insights into ongoing drug use behaviors.

"These findings demonstrate the importance of a comprehensive approach to impairment mitigation in the workplace," said Claire Bryant, Senior Program Manager of Workplace Wellbeing at the National Safety Council. "Employers play a critical role in addressing the root causes of substance misuse through supportive policies, benefits and recovery."

In addition to marijuana, hair test positivity for other substances also increased. In the general U.S. workforce, cocaine positivity was 4.0% in 2025 (up from 2.7% in 2021), a relative increase of 48.1%, while benzoylecgonine, the primary metabolite of cocaine, increased to 1.7% (up from 1.1% in 2021), an increase of 54.5%. Amphetamine (2.3% in 2025 vs. 1.8% in 2021), which can include prescription medications, were up 27.8% while positivity for the illicit class of methamphetamine was up 19.0% (2.5% in 2025 vs. 2.1% in 2021).

Overall workforce drug positivity holds above 4% for over a decade in urine drug tests, signaling persistent risk for employers.

Drug use positivity for the combined workforce held at 4.3% in 2025 in urine drug tests, a decrease of 2.3% compared to the rate of 4.4% in 2024. The rate was 4.6% from 2021 to 2023. The last year the rate was as low as 4.2% was 2017.

Marijuana continues to be the primary driver of positive drug tests across all specimen types and workforce segments.

In the general U.S. workforce, marijuana positivity reached 4.4% in urine testing and significantly higher levels in alternative collection methods, including 11.1% in oral fluid and 15.1% in hair testing.

In April 2026, the acting U.S. attorney general signed an order designed to change the federal classification of medical marijuana from Schedule I to Schedule III under the Controlled Substances Act (CSA) and also announced an expedited administrative hearing to more broadly assess whether all marijuana should be reclassified to Schedule III. Such reclassification could affect the ability to test for cannabis in federal programs.

Oral fluid testing showed substantially higher positivity rates than urine for marijuana, at 11.1% compared to urine at 4.4%.

Oral fluid positivity rates for random testing rose to 6.3% in 2025, an increase of 14.5% compared to 5.5% in 2021. Notably, both random testing and post-accident testing by oral fluid, at 10.2%, were higher than 4.4% for pre-employment testing.

Oral fluid testing has a shorter detection window, typically capturing very recent use, within hours, which may make it useful in post-accident, reasonable suspicion, and some random testing situations where recent use is a particular concern. Hair testing has the longest detection window, often reflecting patterns of repeated or chronic drug use over approximately 90 days, which can provide a broader view of longer-term substance use patterns. Urine testing generally detects drug use over the previous several days and is commonly used in workplace drug testing programs because of its long-standing role in employment testing.

Hair and oral fluid testing use collection methods that are substantially more resistant to tampering or substitution than urine testing, helping provide a clearer, more reliable picture of actual substance use patterns. Previous Quest Diagnostics DTI reports describe heightened substituted and invalid specimen positivity in urine testing, indicating that some U.S. workers are going to great lengths to attempt to subvert the drug testing process.

"Hair and oral fluid testing not only capture different windows of use but are also more resistant to tampering and substitution than traditional methods. This gives employers more accurate insight into safety risks," said Jason S. Hudson, PhD, Scientific Director and Laboratory Director, Workforce Solutions, for Quest Diagnostics. "That matters because substance use in the workplace doesn't just affect productivity; it can directly impact safety, decision-making, and the well-being of employees, particularly in safety-sensitive roles where even small lapses can have serious consequences."

Positivity varies by industry, with healthcare showing the highest positivity rate amid workforce growth

Industry-level data shows that drug positivity is not evenly distributed across the general workforce, with certain sectors facing higher rates and therefore potentially greater risk. Positive rates remained elevated in sectors such as Retail Trade (5.4%), and Professional and Technical Services (5.3%), while lower rates were observed in Manufacturing (4.2%) and Transportation and Warehousing (4.2%).

In 2025, overall positivity in the healthcare sector reached 5.8%, making it the highest-ranking industry for drug positivity and reflecting a notable increase over previous years (up from 5.1% in 2021, a relative increase of 13.7%). This trend was largely driven by marijuana, which remained the most commonly detected positive substance (2.9% in 2021 vs. 4.2% in 2025), followed by amphetamines (1.5% in 2021 vs. 2.3% in 2025).

Fentanyl workforce positivity drops

The company's report also highlights areas of progress, particularly in fentanyl positivity. Year-over-year fentanyl positivity declined by nearly half (49.1%) in the general U.S. workforce (0.55% in 2024 vs. 0.28% in 2025). This decline may indicate that employers are taking steps to address fentanyl use, often present alongside other substances such as marijuana, through expanded testing, education, and deterrence strategies.

"We're encouraged to see this significant decline in workforce fentanyl positivity, which reflects the collective impact of ongoing efforts to protect and champion employee health and safety," said Ms. Bryant.

About Quest Diagnostics Workforce Health Solutions

Through its Workforce Health Solutions (WHS), Quest Diagnostics is a leading provider of laboratory testing and other services designed to optimize the health, safety, and well-being of employees. Quest Diagnostics' WHS include population health and biometric and laboratory screening services to identify and act on disease risks in the earliest stages; workplace drug testing services to help identify and pre-empt dangerous workplace drug use; and OSHA-required laboratory screening and vaccination services. Based on the industry-leading diagnostics expertise of Quest Diagnostics, our solutions incorporate the latest science, technology and innovations in laboratory medicine and healthcare management to reveal the actions that will improve workforce health, for better medical care and lower costs. For more information, visit WorkforceHealthSolutions.com.

About Quest Diagnostics

Quest Diagnostics works across healthcare to create a healthier world, one life at a time. We connect people, from clinicians to consumers, with laboratory insights that illuminate a path to better health. With a focus on delivering smarter, simpler testing, we help reveal new avenues to identify and treat disease, empower healthy behaviors, and improve healthcare management. Quest Diagnostics serves half the physicians and hospitals in the United States and one in three American adults each year, and our nearly 57,000 employees work together to deliver diagnostic insights that inspire actions to transform lives. www.QuestDiagnostics.com

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