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Page last updated June 26, 2022 by Doug McVay, Editor.

1. Positivity Rates of Workers in the US Subjected to Drug Use Testing, by Category

According to Quest Analytics, the positivity rates in 2021 of workers in the US who were subjected to drug use testing in the context of employment are:
Federally Mandated, Safety-Sensitive Workforce: 2.2%
General US Workforce: 5.6%
Combined US Workforce: 4.6%

Quest Diagnostics (2022). Drug Testing Index and Industry Insights: 2022 Annual Report and Industry Insights.

2. Prevalence and Types of Pre- and Post-Employment Drug Testing of Workers in the US

"Drug and alcohol screening tests remain a prominent part of the background check process, with 63% of responding organizations conducting this type of screening. That rate has remained relatively consistent over the last 10 years, except for an uptick in testing in 2012 and 2013 (78%)."

According to HireRight's 2018 survey, 51% of companies that responded said that they used an electronic Chain of Custody (eCOC) form; 42% said that they do not and had not plan to do so; and 7% said that they do not but plan to do so in the future.

Of the companies that test for alcohol or other drugs, 95% perform urine testing, 11% perform oral fluid (saliva) testing, 7% perform hair testing, and 3% use other tests.

"Employment Screening Benchmark Report, 2018 Edition," HireRight, Inc., 2018.

3. Prevalence of Employment-Related Testing for Use of Alcohol or Other Drugs

"While almost two-thirds of respondents drug test all candidates, the remainder of companies drug test only candidates for specific positions. The percentage of companies with a policy to test all candidates dropped by 12% since our 2018 survey."

Companies That Subject Workers to Tests for Alcohol or Other Drugs:
All job candidates: 62%
Candidates for safety/ security concerned roles: 10%
Candidates for non-exempt/ hourly positions: 10%
Candidates for director and manager positions: 7%
Candidates for positions dealing with finances: 6%
Candidates for C-suite/ executive positions: 5%
Temporary or contingent workers: 5:
Independent contractors: 3%
Interns: 2%
Volunteers: 1%
Vendors: 1%
Other: 21%

"Employment Screening Benchmark Report, 2019 Edition," HireRight, Inc., 2019.

4. Price of Tests

"As expected the average price for a drug test reported by the majority of respondents (67%) ranges between $20-$50. This would vary depending upon the drugs being tested, collection and shipping fees, and Medical Review Officer (MRO) services. The low end cost of $10-$20 reported by 15% of the respondents was most likely in-house instant urine tests."

Fortner, Neil A.; Martin, David M.; Esen, S. Evren; and Shelton, Laura, "Employee Drug Testing: Study Shows Improved Productivity and Attendance and Decreased Workers’ Compensation and Turnover," Journal of Global Drug Policy and Practice (2011), Volume 5, Issue 4.

5. Positivity Rates for Methamphetamine Among People in the US Subjected to Drug Use Testing in the Context of Employment

"Amphetamines (which includes amphetamine and methamphetamine) positivity continued its year-over-year upward trend, increasing more than eight percent in urine testing in both the general U.S. and federally-mandated, safety-sensitive workforces compared to 2015. Throughout the last decade, this rise has been driven primarily by amphetamine use which includes certain prescription drugs such as Adderall®.

"Although methamphetamine positivity in urine testing declined between 2005 and 2008, the positivity rate plateaued between 2008 and 2012, and has increased steadily since. Between 2012 and 2016, it climbed 64 percent in the general U.S. workforce and 14 percent among federally-mandated, safety-sensitive workers. In oral fluid, methamphetamines positivity increased 75 percent between 2013 (0.24%) and 2016 (0.42%)."

"Quest Diagnostics Drug Testing Index™ Full year 2016 tables," Quest Diagnostics, Table 2, last accessed Nov. 13, 2017.

"Increases in Illicit Drugs, Including Cocaine, Drive Workforce Drug Positivity to Highest Rate in 12 Years, Quest Diagnostics Analysis Finds," Quest Diagnostics, May 16, 2017.

6. Employee Drug Testing Triggers

"Incumbent worker programs commonly include at least one of four testing triggers. Under 'reasonable cause' testing, an individual worker may be tested if her behavior reasonably gives rise to the suspicion of drug use. 'Comprehensive' testing involves the periodic, scheduled testing of all employees, such as during routine physical exams. 'Random' testing involves testing all employees (or particular groups of workers) on an unannounced and variable schedule (Hartwell et al., 1996). Finally, 'post-accident' drug testing (PADT) subjects any employee who reports a workplace accident (and sometimes co-workers who were directly involved) to a drug test at the time the report is made, regardless of whether the reporting worker’s conduct precipitated the incident."

Morantz, Alison D., & Mas, Alexandre, "Does Post-Accident Drug Testing Reduce Injuries? Evidence from a Large Retail Chain," American Law and Economics Review (Cary, NC: American Law and Economics Association, August 23, 2008) , Vol. 10, No. 2.

7. Prevalence of Marijuana Use Among Full-Time Workers in the US

"• An estimated 6.4 percent, or 7.3 million, of full-time workers reported use of marijuana during the past month (Tables 2.2 and 2.3).
"• Adults aged 26 to 34 were only about half as likely as 18- to 25-year-olds to be past month marijuana users (8.0 vs. 15.9 percent). Past month use of marijuana was lower with increasing age (Table 2.2).
"• The prevalence of past month marijuana use was higher for males than females (7.9 vs. 4.3 percent, respectively) (Table 2.2).
"• An estimated 11.0 percent of workers reporting two or more races used marijuana during the past month. This was higher than among non-Hispanic white adults (6.9 percent). Fewer Hispanic adults (4.6 percent) reported past month marijuana use than non-Hispanic white adults who reported two or more races (Table 2.2).
"• Higher educational attainment and higher family income were associated with a lower prevalence of current marijuana use (Table 2.3)."

Larson, S. L., Eyerman, J., Foster, M. S., & Gfroerer, J. C. (2007). Worker Substance Use and Workplace Policies and Programs (DHHS Publication No. SMA 07-4273, Analytic Series A-29). Rockville, MD: Substance Abuse and Mental Health Services Administration, Office of Applied Studies, pp. 15-16.
http://adaiclearinghouse.org/…

8. Prevalence of Illicit Drug Use Among Full-Time Employees in the US,

"• The prevalence of past month illicit drug use among adult full-time workers was 8.2 percent (Figure 2.3 and Tables 2.2 and 2.3).
"• Nearly one out of five (19.0 percent) workers aged 18 to 25 used illicit drugs during the past month. This was a higher percentage than among the 26-to-34 (10.3 percent), 35-to-49 (7.0 percent), and 50-to-64 (2.6 percent) age groups (Figure 2.3 and Table 2.2).
"• Males were more likely than females to report past month illicit drug use (9.7 vs. 6.2 percent). Males accounted for about two thirds (6.4 million) of the workers who reported past month illicit drug use (Figure 2.4 and Table 2.2).
"• The prevalence of past month illicit drug use for white adults was 8.8 percent, higher than the prevalence for Asian (2.2 percent) or Hispanic (6.7 percent) adults, and lower than that reported for adults who reported two or more races (13.5 percent). The prevalence of past month illicit drug use by Asians was lower than that reported by all other racial/ethnic groups reported here (Figure 2.5 and Table 2.2)."

Larson, S. L., Eyerman, J., Foster, M. S., & Gfroerer, J. C. (2007). Worker Substance Use and Workplace Policies and Programs (DHHS Publication No. SMA 07-4273, Analytic Series A-29). Rockville, MD: Substance Abuse and Mental Health Services Administration, Office of Applied Studies, p. 12.
http://adaiclearinghouse.org/…

9. Reported Educational Achievement and Income of Drug Using Versus Non-Using Full-Time Workers

"• Workers with a college education had a lower prevalence of current illicit drug use compared with those without a college education. The prevalence of past month use of illicit drugs was lower among those with higher levels of education than those with less education (college graduate [5.7 percent] vs. less than high school [11.2 percent]) (Figure 2.6 and Table 2.3).
"• The prevalence of current illicit drug use was lower among workers with higher family incomes than among workers with lower family incomes. An estimated 13.2 percent of workers who reported family income that was less than $20,000 had used illicit drugs during the past month. In contrast, 6.0 percent of workers who reported income in the highest category––$75,000 or more––had used illicit drugs during the past month (Figure 2.7 and Table 2.3).
"• Residents of noncore counties had a lower prevalence of current illicit drug use (4.5 to 6.2 percent) compared with residents of micropolitan statistical area (7.1 percent), small metropolitan statistical area (MSA; 8.8 percent), and large MSA (8.3 percent) counties (Table 2.3)."

Larson, S. L., Eyerman, J., Foster, M. S., & Gfroerer, J. C. (2007). Worker Substance Use and Workplace Policies and Programs (DHHS Publication No. SMA 07-4273, Analytic Series A-29). Rockville, MD: Substance Abuse and Mental Health Services Administration, Office of Applied Studies, pp. 12-15.
http://adaiclearinghouse.org/…

10. Prevalence of Illicit Drug Dependence or Abuse Among Full-Time Workers in the US

"• Approximately 3 million full-time workers (2.6 percent) aged 18 to 64 met the criteria for past year illicit drug dependence or abuse (Figure 2.3 and Table 2.4).

"• Approximately 7.5 percent of 18- to 25-year-old workers had past year illicit drug dependence or abuse. This was higher than among all other age groups studied (26- to 34-year-olds [3.3 percent], 35- to 49-year-olds [1.9 percent], and 50- to 64-year-olds [0.7 percent]) (Figure 2.3 and Table 2.4).

"• Males were nearly twice as likely as females to meet the criteria for past year illicit drug dependence or abuse (3.3 vs. 1.8 percent) (Figure 2.4 and Table 2.4).

"• Hispanics (3.2 percent) had a higher prevalence of past year illicit drug dependence or abuse than non-Hispanics (2.6 percent) (Figure 2.8 and Table 2.4).

"• Within non-Hispanic subgroups, Asians had the lowest prevalence of past year illicit drug dependence or abuse (1.1 percent). This was lower than non-Hispanic white adults (2.5 percent), black (2.9 percent) adults, American Indian or Alaska Native (4.5 percent) adults, and adults reporting two or more races (4.3 percent) (Figure 2.8 and Table 2.4)."

Larson, S. L., Eyerman, J., Foster, M. S., & Gfroerer, J. C. (2007). Worker Substance Use and Workplace Policies and Programs (DHHS Publication No. SMA 07-4273, Analytic Series A-29). Rockville, MD: Substance Abuse and Mental Health Services Administration, Office of Applied Studies, p. 17.

11. Prevalence of Heavy Alcohol Use Among Full-Time Workers in the US

"• An estimated 8.8 percent, or 10.1 million, of full-time workers reported past month heavy alcohol use (Figure 2.3 and Tables 2.2 and 2.3).

"• Past month heavy alcohol use was related to age. Among younger workers (18 to 25 years old), 16.3 percent reported past month heavy alcohol use compared with 10.4 percent of 26- to 34-year-olds, 8.1 percent of 35- to 49-year-olds, and 4.7 percent of 50- to 64-year-olds (Figure 2.3 and Table 2.2).

"• Males were three times as likely as females to be past month heavy alcohol users (12.3 vs. 4.1 percent) (Figure 2.4 and Table 2.2).

"• An estimated 10.1 percent of white adults reported heavy alcohol use in the past month. This was higher than the percentage among black adults (5.4 percent), Asian adults (2.9 percent), Hispanic adults (6.9 percent), and adults reporting two or more races (7.5 percent) (Figure 2.5 and Table 2.2).

"• Residents of noncore rural counties had a lower prevalence of past month heavy alcohol use (7.5 percent) compared with residents of micropolitan statistical area (9.2 percent), small MSA (9.8 percent), and large MSA (8.1 percent) counties (Table 2.3).

"• Workers with a college education had a lower prevalence of past month heavy alcohol use compared with those without a college education. Past month heavy alcohol use was lower among those with higher levels of education than those with less education (college graduate [6.7 percent] vs. less than high school [10.8 percent]) (Figure 2.6 and Table 2.3)."

Larson, S. L., Eyerman, J., Foster, M. S., & Gfroerer, J. C. (2007). Worker Substance Use and Workplace Policies and Programs (DHHS Publication No. SMA 07-4273, Analytic Series A-29). Rockville, MD: Substance Abuse and Mental Health Services Administration, Office of Applied Studies, p. 16.

12. Post-Accident Drug Testing Discourages Accident Reporting

"If a substantial portion of the observed drop in [worker's compensation] claims [after implementation of the PADT - post-accident drug testing program] is driven by underreporting, however, PADT’s net effect on the Company and its employees is less clear. Not only may the administration of the PADT program itself be costly to the Company, but unreported workplace hazards could fester and, over the long term, impose even higher costs. Meanwhile, PADT may make accident reporting so costly for some workers that they opt to pay for medical care out-of-pocket or simply endure injuries that would otherwise be treatable through workers’ compensation. If many workers are covered by health insurance plans—particularly if they are covered on a family member’s plan—the costs of treatment could be shifted from the Company onto other benefits providers."

Morantz, Alison D., & Mas, Alexandre, "Does Post-Accident Drug Testing Reduce Injuries? Evidence from a Large Retail Chain," American Law and Economics Review (Cary, NC: American Law and Economics Association, August 23, 2008) , Vol. 10, No. 2, p. 296.
http://www.princeton.edu/~ama…

13. Trends in Prevalence of Employee Drug Testing

The American Management Association conducted surveys of workplace surveillance and medical testing throughout the 1990s and into the 2000s. In 1991, drug testing of some kind was conducted by 63% of companies surveyed, growing to 81% in 1996, falling to 66% in 2000 and then to 62% in 2004. Drug testing of new hires was conducted by 48% of companies in 1991, growing to 68% in 1996, falling to 61% in 2000 and then to 54.5% in 2004. Drug testing of current employees was conducted by 52% of companies surveyed in 1991, rising to 70% in 1996, falling to 47% in 2000 and then to 44.3% in 2004.

American Management Association, "AMA 2004 Workplace Testing Survey: Medical Testing" (New York, NY: American Management Association, 2004), p. 2.
http://www.amanet.org/trainin…
A 2000 AMA Survey: Workplace Testing: Medical Testing: Summary of Key Findings (New York, NY: American Management Association, 2000), p. 3.

14. Drug Testing vs Impairment Testing

Impairment Testing

"Few employers have used impairment testing, and information concerning that experience is very limited and extremely difficult to obtain. The available information, however, indicates that impairment testing is not just a better answer on paper, but in practice as well. Employers who have used impairment testing consistently found that it reduced accidents and was accepted by employees. Moreover, these employers consistently found that it was superior to urine testing in achieving both of these objectives."

National Workrights Institute, "Impairment Testing: Does It Work?" (Princeton, NJ: NWI, undated).
http://workrights.us/?product…

15. Limited Use, Availability of Impairment Testing

"Collecting information about the performance of impairment testing proved extremely difficult because the field is so small. Only a handful of companies have ever marketed impairment testing systems and there is no list of their names. However, the Institute conducted an extensive networking program based on our contacts in the field that identified what we believe to be every company that has ever marketed impairment tests. There are only 10 such companies. Of these, only 6 manufactured systems for employers. Three of these 6 are now out of business. This means that there are only 3 companies currently in business that provide impairment testing systems for employers.
"By contacting these employers, we were able to identify 18 employers who had used impairment testing. Of these, 14 employers participated in our study. One employer that had used impairment testing is now out of business. The remaining 3 employers declined to participate."

National Workrights Institute, "Impairment Testing: Does It Work?" (Princeton, NJ: NWI, undated).
http://workrights.us/?product…

16. Federal Legislative History

Workplace Drug Testing Laws & Policies

"In 1986, an Executive Order initiated the Federal Drug-Free Workplace Program that defined responsibilities for establishing a plan to achieve drug-free workplaces. In 1987, Public Law 100-71 outlined provisions for drug testing programs in the Federal sector. In 1988, Federal mandatory guidelines set scientific and technical standards for testing Federal employees. In 1989, the U.S. Department of Transportation (DOT) issued regulations requiring the testing of nearly 7 million private-sector transportation workers in industries regulated by DOT."

"Clinical Drug Testing in Primary Care," Technical Assistance Publication (TAP) 32, Substance Abuse and Mental Health Services Administration, Clinical Drug Testing in Primary Care (Rockville, MD: U.S. Departent of Health and Human Services, 2012), p. 4.
http://www.kap.samhsa.gov/pro…

17. Drug Testing and "Employment At Will"

"The allowance of employer drug testing is founded in the idea that employers have a legitimate interest in workplace safety.22 The employment relationship comes from the common law doctrine of 'employment at will' — that both parties to the employment contract can terminate the contract for any reason, at any time, unless otherwise specified in the contract."

Smith, Melissa K., "Drug Testing: A Solution Looking for a Problem," Michigan League FOR Human Services (Lansing, MI: March 2012), p. 5.
http://www.milhs.org/wp-conte…