Fentanyl surge and high marijuana positivity in random workplace tests have employers worried

Fentanyl

Employers have long used pre-employment drug screening as a key safeguard to protect workplace safety and control workers compensation costs. Historically, differences between pre-employment and random drug testing results have been modest across most substances. However, data from the Quest Diagnostics Drug Testing Index suggests this is changing.

Over the past five years, random (unannounced, unscheduled testing of existing employees) positivity rates for fentanyl have averaged 400 percent higher than pre-employment rates. And the trend is getting worse. According to Quest’s latest findings, fentanyl positivity among the general workforce was a staggering 707 percent higher in random drug tests than in pre-employment tests. In 2024, 1.13 percent of random drug tests were positive for fentanyl, compared with just 0.14 percent of pre-employment screenings. Further, over 60 percent of workforce specimens that tested positive for fentanyl also contained other drugs, significantly increasing impairment and the risk of accidents.

Given the extreme potency of fentanyl, the risk of on-the-job impairment, accidents, and overdoses significantly increases. Recognizing the growing threat of fentanyl in the workplace, in July, the Department of Health and Human Services’ Federal Drug-Free Workplace Program added fentanyl to the list of authorized testing substances. The Halt Fentanyl Act was signed into law on July 16, permanently classifying the fentanyl-related substances as Schedule 1 drugs.

The Department of Transportation (DOT) is in the process of making similar updates for safety-sensitive transportation workers and on September 2, published a Notice of Proposed Rulemaking (NPRM)  program regulation. The new rule would add fentanyl to both urine and oral fluid testing panels, and its metabolite, norfentanyl, to the urine testing panel.

Employers who maintain their own testing programs should review and update testing panels, vendor contracts, and policies to include fentanyl detection. Confirm that your testing provider adheres to the latest HHS and DOT standards. Reassess random and post-accident testing programs. The dramatic difference between pre-employment and random test positivity rates demonstrates that random testing is essential for identifying active drug use among current employees.

Marijuana     

     Marijuana continues to be a top concern and thorny issue for employers. According to the Quest report, it remains the most detected substance at 4.5 percent. Post-accident marijuana positivity stayed high at 7.3 percent, just below the record 7.5% in 2023.

Retail trade continues to top the list of positivity rates at eight percent, followed by real estate rental and leasing at 6.2 percent and transportation and warehousing at six percent. Among federally mandated, safety-sensitive workers, marijuana positivity declined slightly to 0.87 percent from 0.95 percent in 2023.

Coupled with the limitations of traditional testing to prove impairment, varying and complex state laws around medical and recreational marijuana use make it harder for employers to manage risk consistently, especially for companies with employees in multiple states. As a result, employers have been trying alternative testing methods that measure an employee’s actual impairment rather than just the presence of THC metabolites, such as marijuana breathalyzers, eye-tracking technology, psychomotor testing, and training managers on direct observation techniques.

     With the changing legal landscape, crafting policies that respect employee privacy while ensuring a safe work environment is essential. Many employers have updated their drug policies to focus on impairment rather than zero tolerance and clarify on-duty vs. off-duty use to align with state laws. Stricter “drug-free” rules often remain in effect for roles that involve operating heavy machinery, driving, or handling hazardous materials.

Other findings from Quest

• While “for-cause” testing (triggered by observed impairment or suspicion) positivity dropped from 39 percent in 2023 to 33 percent in 2024, it is striking that one in three employees tested for cause was positive.
• Overall drug positivity declined slightly, from 4.6 percent in 2023 to 4.4 percent in 2024, marking the first dip in three years — but positivity remains elevated, with rates above four percent persisting for a decade.
• Certain industries, such as retail and transportation, have some of the highest positivity rates according to a comparative industry analysis.
• Amphetamines continued to climb, increasing from 1.5 percent to 1.7 percent.
• Cocaine positivity remained stable at 0.24 percent while heroin (6-AM metabolite) and prescription opiates continued to decline.
• Federally mandated, safety-sensitive workers, who are typically subject to stricter testing protocols, had lower rates of positivity: for-cause positivity 12.6 percent, post-accident positivity 4.5 percent, and return-to-duty positivity 4.8 percent.

Proactive strategies beyond testing

     It’s clear that substance abuse remains a serious threat to workforce health and safety. Testing and enforcement alone are not enough; they must be reinforced with education, support, and empathy. Expanding prevention and awareness initiatives, improving access to recovery resources, addressing workplace stressors that contribute to substance misuse, and fostering a culture where employees can seek help without fear of reprisal are essential steps. These measures reduce the likelihood of serious incidents and costly claims, demonstrating a sustained commitment to workforce well-being and regulatory compliance.