SECAUCUS, N.J. -- Nearly one in five workers in the general U.S. workforce (19.1 percent) tested positive for drug use based on an analysis of hair specimens collected in 2025, an increase of nearly 46 percent compared to 13.1 percent in 2021, finds the 2026 Quest Diagnostics Drug Testing Index™.

Over the past five years, overall hair test positivity for marijuana increased 58.9 percent (9.5 percent in 2021 vs. 15.1 percent in 2025). Pre-employment hair test positivity for marijuana increased 49.5 percent over the past five years (10.1 percent in 2021 vs. 15.1 percent in 2025). Random hair test positivity for marijuana increased 14.8 percent in the same period (18.3 percent in 2021 vs. 21.0 percent in 2025).

Marijuana also accounted for 52.5 percent of hair drug positives in 2025. By comparison, overall urine drug test positivity in the general U.S. workforce slightly declined to 4.3 percent in 2025 from 4.4 percent in the prior year.

The findings suggest that a sizeable minority of the American workforce uses drugs, principally marijuana, on a recurring or chronic basis. While traditional urine testing methods only capture drug use within a window of several hours or days, hair analysis provides an extended detection window that delivers a long-term history of substance use patterns over extended periods, offering insights into ongoing drug use behaviors.

"These findings demonstrate the importance of a comprehensive approach to impairment mitigation in the workplace," said Claire Bryant, Senior Program Manager of Workplace Wellbeing at the National Safety Council. "Employers play a critical role in addressing the root causes of substance misuse through supportive policies, benefits and recovery."

In addition to marijuana, hair test positivity for other substances also increased. In the general U.S. workforce, cocaine positivity was 4.0 percent in 2025 (up from 2.7 percent in 2021), a relative increase of 48.1 percent, while benzoylecgonine, the primary metabolite of cocaine, increased to 1.7 percent (up from 1.1 percent in 2021), an increase of 54.5 percent. Amphetamine (2.3 percent in 2025 vs. 1.8 percent in 2021), which can include prescription medications, were up 27.8 percent while positivity for the illicit class of methamphetamine was up 19.0 percent (2.5 percent in 2025 vs. 2.1 percent in 2021).

Overall workforce drug positivity holds above 4 percent for over a decade in urine drug tests, signaling persistent risk for employers.
Drug use positivity for the combined workforce held at 4.3 percent in 2025 in urine drug tests, a decrease of 2.3 percent compared to the rate of 4.4 percent in 2024. The rate was 4.6 percent from 2021 to 2023. The last year the rate was as low as 4.2 percent was 2017.

Marijuana continues to be the primary driver of positive drug tests across all specimen types and workforce segments.

In the general U.S. workforce, marijuana positivity reached 4.4 percent in urine testing and significantly higher levels in alternative collection methods, including 11.1 percent in oral fluid and 15.1 percent in hair testing.

In April 2026, the acting U.S. attorney general signed an order designed to change the federal classification of medical marijuana from Schedule I to Schedule III under the Controlled Substances Act (CSA) and also announced an expedited administrative hearing to more broadly assess whether all marijuana should be reclassified to Schedule III. Such reclassification could affect the ability to test for cannabis in federal programs.

Oral fluid testing showed substantially higher positivity rates than urine for marijuana, at 11.1 percent compared to urine at 4.4 percent.
Oral fluid positivity rates for random testing rose to 6.3 percent in 2025, an increase of 14.5 percent compared to 5.5 percent in 2021. Notably, both random testing and post-accident testing by oral fluid, at 10.2 percent, were higher than 4.4 percent for pre-employment testing.

Oral fluid testing has a shorter detection window, typically capturing very recent use, within hours, which may make it useful in post-accident, reasonable suspicion, and some random testing situations where recent use is a particular concern. Hair testing has the longest detection window, often reflecting patterns of repeated or chronic drug use over approximately 90 days, which can provide a broader view of longer-term substance use patterns. Urine testing generally detects drug use over the previous several days and is commonly used in workplace drug testing programs because of its long-standing role in employment testing.

Hair and oral fluid testing use collection methods that are substantially more resistant to tampering or substitution than urine testing, helping provide a clearer, more reliable picture of actual substance use patterns. Previous Quest Diagnostics DTI reports describe heightened substituted and invalid specimen positivity in urine testing, indicating that some U.S. workers are going to great lengths to attempt to subvert the drug testing process.

"Hair and oral fluid testing not only capture different windows of use but are also more resistant to tampering and substitution than traditional methods. This gives employers more accurate insight into safety risks," said Jason S. Hudson, PhD, Scientific Director and Laboratory Director, Workforce Solutions, for Quest Diagnostics. "That matters because substance use in the workplace doesn't just affect productivity; it can directly impact safety, decision-making, and the well-being of employees, particularly in safety-sensitive roles where even small lapses can have serious consequences."

Positivity varies by industry, with healthcare showing the highest positivity rate amid workforce growth
Industry-level data shows that drug positivity is not evenly distributed across the general workforce, with certain sectors facing higher rates and therefore potentially greater risk. Positive rates remained elevated in sectors such as Retail Trade (5.4 percent), and Professional and Technical Services (5.3 percent), while lower rates were observed in Manufacturing (4.2 percent) and Transportation and Warehousing (4.2 percent).

In 2025, overall positivity in the healthcare sector reached 5.8 percent, making it the highest-ranking industry for drug positivity and reflecting a notable increase over previous years (up from 5.1 percent in 2021, a relative increase of 13.7 percent). This trend was largely driven by marijuana, which remained the most commonly detected positive substance (2.9 percent in 2021 vs. 4.2 percent in 2025), followed by amphetamines (1.5 percent in 2021 vs. 2.3 percent in 2025).

Fentanyl workforce positivity drops
The company's report also highlights areas of progress, particularly in fentanyl positivity. Year-over-year fentanyl positivity declined by nearly half (49.1 percent) in the general U.S. workforce (0.55 percent in 2024 vs. 0.28 percent in 2025). This decline may indicate that employers are taking steps to address fentanyl use, often present alongside other substances such as marijuana, through expanded testing, education, and deterrence strategies.

"We're encouraged to see this significant decline in workforce fentanyl positivity, which reflects the collective impact of ongoing efforts to protect and champion employee health and safety," said Ms. Bryant.

For more information, visit www.QuestDiagnostics.com/DTI.