Fentanyl Positivity Is More Than Seven Times Higher in Random Tests vs. Pre-Employment Drug Screening, Finds 2025 Quest Diagnostics Drug Testing Index

Core Insights - The Quest Diagnostics Drug Testing Index reveals a significant increase in fentanyl positivity among the U.S. workforce, particularly in random drug tests compared to pre-employment tests [1][2][3] Drug Use Trends - Overall workplace urine drug positivity slightly declined to 4.4% in 2024 from 4.6% in 2023, but fentanyl positivity in random tests was 707% higher than in pre-employment tests [2][3][7] - Fentanyl positivity in random testing was 1.13%, while pre-employment testing showed only 0.14% [3] - Marijuana positivity remained steady at 4.5%, with post-accident positivity at 7.3% in 2024 [6] Co-positivity Rates - In 2024, 60% of fentanyl-positive specimens also tested positive for other drugs, with 22% also positive for marijuana, a rate that has doubled since 2020 [4][5] - Amphetamines positivity increased to 1.7% from 1.5% in 2023, while cocaine positivity remained unchanged at 0.24% [9] Safety and Compliance - The report indicates ongoing concerns regarding drug use in the workplace, with a notable increase in fentanyl use after employees have passed pre-employment screenings [5][8] - The Department of Health and Human Services added fentanyl to the authorized drug testing panel starting July 7, 2025, reflecting the growing concern over opioid-related overdoses [5] Testing Positivity Variations - For-cause testing positivity declined to 33.1% in 2024 from 39.4% in 2023, while post-accident testing positivity fell slightly from 10.4% to 10.2% [11][12] - Among federally mandated, safety-sensitive workers, for-cause positivity was 12.6%, down from 14.5% in 2023, indicating effective compliance programs [13]