Drug Testing Positivity Rates Increase to Highest Level Since 2004

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Drug Positivity Rates

According to the recently released Quest Diagnostics Drug Testing Index, drug positivity rates for 2018 climbed to the highest level since 2004. The analysis examines test results for a range of various illicit and prescription drugs from more than ten million workplace drug test results. The study is broken down into three categories: federally mandated, safety-sensitive workers (such as pilots, bus and truck drivers); the general workforce and the combined U.S. workforce.

Urine positivity rates in the combined U.S. workforce increased approximately five percent (4.2% in 2017 versus 4.4% in 2018); a 25% increase from the thirty-year low of 3.5% between 2010 and 2012.

Interestingly, a marked increase was shown in the percentage of urine specimens that were invalid (a term the drug screening industry uses when the urine specimen received does not meet the criteria established for normal urine). Between 2017 and 2018, the percentage of invalid results in the federally mandated, safety-sensitive workforce soared by 80 percent (0.15% versus 0.27%), and increased 40 percent in the general workforce (0.15% versus 0.21%).  Since by definition, the invalid result category includes specimens that contain an unidentified adulterant or unidentified, interfering substance, there is strong evidence to suggest that donors are attempting to subvert their drug tests.

Marijuana Most Detected Illicit Substance

Marijuana has traditionally been the substance with the highest positive rate. This year is no exception. Further, marijuana positivity increased in all workforce categories and specimen types (urine, oral fluid and hair).The rate of marijuana positivity for the general workforce population increased approximately eight percent in urine testing (2.6% in 2017 versus 2.8% in 2018) and almost 17 percent since 2014 (2.4%). For the safety-sensitive group, positivity rates grew five percent during this same timeframe (0.84% versus 0.88%) and nearly 24 percent since 2014 (0.71%).

Webinar: Drug Testing Trends & Challenges for 2019

Opiate Positivity Rates Declines

For the general workforce, positivity rates for opiates (mostly codeine and morphine) declined nearly 21 percent between 2017 and 2018 (0.39% versus 0.31%), the largest drop in three years and nearly 37 percent since 2015 (0.49%). Quest Diagnostics saw a two percent decline for semi-synthetic opiates (hydrocodone and hydromorphone) between 2017 (0.51%) and 2018 (0.50%) and a 43 percent drop since 2014 (0.88%). The positivity for oxycodones (oxycodone and oxymorphone) declined more than 29 percent; 2017 (0.61%) and 2018 (0.43%).

Changes were made in January 2018 to the Federal rules adding opioid testing (hydrocodone, hydromorphone, oxycodone, and oxymorphone) to the panel for the federally mandated, safety-sensitive workforce. The positivity rates for hydrocodone/hydromorphone and oxycodone/oxymorphone were 0.45 percent and 0.34 percent respectively, slightly less than the general workforce.

The decrease in the positive rate is good news. This reduction of laboratory positives is in all likelihood a result of the measures that have been put into place in states to monitor opioid prescription utilization.

Heroin Rates Decline in All Specimen Testing Types

Heroin positivity rates declined for both the general and safety-sensitive workforce groups. Urine drug tests for the general workforce for heroin declined six percent from 2017 (0.033%) to 2018 (0.031%) and more than 16 percent in 2015 and 2016 (0.037%).

For the federally mandated, safety-sensitive workers, heroin positivity decline almost 32 percent between 2017 and 2018 (0.019% versus 0.013%), and significantly decreased by more than 43 percent since 2015 (0.023%).

Stimulant Positivity Rates Remain Essentially Unchange

Cocaine positivity rates declined for both the general and safety-sensitive workforce groups. Cocaine positivity declined about seven percent in urine and more than 19 percent in oral fluid testing; however, it increased in hair testing (6.3%).

The same trend for cocaine is seen for the federally mandated, safety-sensitive workers.  Cocaine decreased by nearly ten percent during the 2017 to 2018 period (0.31% versus 0.28%).

As the cocaine positivity rate is declining, the amphetamine class of stimulants shows evidence of increasing.  Amphetamine and methamphetamine positive rates increased in oral fluid year over year by 11% and 7% respectfully, whereas in urine and hair, the rate of amphetamine class positives have remained unchanged.

The trend of one stimulant class increasing as another decreases shows that the overall demand for stimulant medications does not radically change year over year; rather, the stimulant of choice changes based on external factors.

Post-Accident Positivity Increases

Of considerable concern is the increase in post-accident positivity rates in both the general U.S. workforce and the safety-sensitive groups. These startling statistics demonstrate that employers may want to consider adjusting their drug free workplace programs. One great deterrence is to add random drug testing. Another measure is evaluating if one of the alternative specimens (either hair or oral fluid) may offer a better deterrent value.

In the federally mandated, safety-sensitive workforce, positivity for post-accident urine testing increased significantly by more than 51 percent; (3.1%) in 2017 versus (4.7%) in 2018 and increased approximately 81 percent between 2014 and 2018. This increase was driven by the addition of prescription opioids to the panel – positivity for the hydrocodone/hydromorphone was 1.1 percent and for oxycodone/oxymorphone was 0.77 percent.

Post-accident positivity in the general U.S. workforce increased as well by nine percent (7.7% in 2017 versus 8.4% in 2018), and 29 percent over the past five years.

Something to take particular note of is the fact that the post-accident positivity rate has risen the past few years since 2011 in the general U.S. workforce and since 2010 in the federally mandated, safety-sensitive workforce.

What Does All This Mean for Employers?

Quest Diagnostics data shows a clear year over year increase in the overall lab positive rate.  This increase is primarily driven by an increase in the marijuana positive rate.  Couple Quest Diagnostics’ data along with the National Survey on Drug Use and Health, it is easy to opine that illicit drug use in the US is increasing.

Employers who have a drug free workplace policy already appreciate the financial reasons they have put these programs in place, but reviewing the reasons are always beneficial.

Substance abuse directly costs employers billions of dollars per year and results in:

  • Higher health care expenses for injuries and illnesses
  • Higher rates of absenteeism
  • Reductions in job productivity and performance
  • More workers’ compensation and disability claims
  • Safety and other risks for employers

Employees with substance abuse issues often1:

  • Fail to fulfill major role obligations at work
  • Use substances in situations where it is physically hazardous (e.g. driving an automobile or operating a machine when impaired by substance use)
  • Have recurrent substance-related legal or financial problems
  • Continue to use substances despite persistent social or interpersonal problems that are a result of the substance use

Employers need to evaluate their drug-free workplace programs for effectiveness. The basis of a good program is deterrence. To provide appropriate deterrence, employers need detection.  Each specimen (urine, oral fluid, and hair) has their own unique value propositions. I recommend working with a drug screening vendor that can offer you all the various, available specimens, as well as, offering solutions that maximize your return in your workplace testing program.

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1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (4th edition). Washington, DC: American Psychiatric Association; 1994


Dr. Todd Simo

Dr. Simo is the Chief Medical Officer and the Managing Director of Transportation at HireRight. He served as HireRight’s medical director starting in 2009 and was promoted to chief medical officer in 2015. Dr. Simo was also appointed to the role of managing director of transportation and drug & health screening in 2018. Dr. Simo came to HireRight with a decade of experience in the medical consulting arena. Before that he was the medical director for an occupational health clinic in Virginia and owned a consulting firm providing medical director services to employers across the United States

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