Drug Positivity Rates Highest Rate in 12 Years – Driven by Cocaine and Marijuana Use

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Quest Diagnostics recently released their annual Drug Testing Index which reports on patterns of drug use among the American workforce.

This year’s findings show increased rates of drug positivity for the most common illicit drugs across virtually all drug testing specimens.

Marijuana Detection is on the Rise

The national urine positivity rate for marijuana in the general U.S. workforce increased four percent (2.4% in 2015 compared to 2.5% in 2016) which continues the trend that Quest Diagnostics has seen over the past 5 years.  Among the federally-mandated, safety-sensitive workforce, marijuana positivity increased nearly ten percent (0.71% in 2015 versus 0.78% in 2016), the largest year-over-year increase in five years.  The positivity rates for marijuana outpaced the national average in 2016 for Colorado and Washington, the first states which decriminalized recreational marijuana. The increase was greater in Colorado, which increased 11 percent (2.61% in 2015 versus 2.90% in 2016), than in Washington, which increased nine percent (2.82% in 2015 versus 3.08% in 2016).

Oral fluid testing for marijuana positivity increased nearly 75 percent, from 5.1 percent in 2013 to 8.9 percent in 2016 in the general U.S. workforce. This is truly an impressive increase since oral fluid only has a one day window of detection.  One could surmise that the donors who tested positive for marijuana in oral fluid are not sporadic weekend users, but rather, chronic daily users.  Furthermore, this impressive positive rate shows the power of an observed collection without undue notice that allows preparation for the drug screen collection.

Marijuana positivity also increased in hair testing (7.0% in 2015 versus 7.3% in 2016).  Hair as a drug testing specimen, despite the longer detection window, does not do a good job at detecting sporadic marijuana usage.  Once again, it is easily surmised that the positive hair testing donors were/are habitual marijuana users.

As a side note, despite the increases in lab detection rates across all specimens for marijuana in 2016, the overall marijuana positive rate is lower than 10%.  This proves that despite decriminalization in many states, the average drug screening donor is not abusing marijuana.  I believe (and the above data supports) the media articles stating that decriminalization of marijuana has caused companies who drug screen not to be able to find candidates is a hyperbole.  Just because individuals may have decriminalized access to marijuana, it does not mean that they are using it.

Cocaine Usage Increases

The urine positivity rate for cocaine increased for the fourth consecutive year in the general U.S. workforce. Cocaine positivity increased 12 percent in 2016, reaching a seven-year high of 0.28 percent, compared to 0.25 percent in 2015 in the general U.S. workforce. The positivity rate for cocaine in post-accident urine drug tests was more than twice that of pre-employment drug tests, and was also higher than the rate in random drug tests.

Just as in urine testing, the rate of cocaine positive tests in oral fluid and hair specimens rose approximately 37 percent (from 0.46% in 2015 to 0.63% in 2016) and 4 percent (from 2.6% in 2015 to 2.7% in 2016) respectively.

Amphetamines Continue to Surge Upward

Amphetamines (which include amphetamine and methamphetamine) increased more than eight percent in urine testing in both the general U.S. and federally-mandated, safety-sensitive workforces compared to 2015. In fact, amphetamine testing as a class has the second highest overall lab positive rate (with marijuana being number 1) in combined workplace testing.  One point that is particularly interesting is when federal safety sensitive worker testing is looked at the amphetamines and marijuana lab positive rates are almost equivalent (29.94% and 36.70% respectively).

To future illustrate the amphetamine problem, the methamphetamine positivity declined between 2005 and 2008, and plateaued between 2008 and 2012. However, positivity rates have increased steadily since 2012. Between 2012 and 2016, it rose 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%).

Heroin and Prescription Opiate Detection Down

After four years of increases, this year’s study found that positivity rates for heroin declined slightly among federally-mandated, safety-sensitive workers. Prescription opiate positivity (including hydrocodone, hydromorphone and oxycodone) declined in urine testing among the general U.S. workforce. Oxycodone dropped 28 percent from 0.96 percent to 0.69 in 2012 and 2016 respectively. This may be due in large part to continued efforts to curtail opiate prescriptions supported by both the state and federal government regulatory bodies.

It should come as no surprise that continued due-diligence in drug testing is needed to make sure that your workplace does not pose a safety risk. While there is a lot of hype around marijuana and opiate, please be aware that stimulants (like cocaine and amphetamines) has its’ own form of troubling side-effects, especially among safety-sensitive jobs. As a best practice recommendation, you should annually review your drug screening policy. Evaluate urine, oral fluid and hair testing methods to determine which best meets your needs. To decide among methods, consider cost, whether testing can be done on-site, and the length of the detection window.

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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 in 2018. Dr. Simo came to HireRight with a decade of experience in the medical consulting arena. Before that he was Medical Director at 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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