Overview

Data released on May 8th at the Federal Transit Administration Drug and Alcohol Program National Conference in Fort Lauderdale, Florida, shows that Americans are using cocaine, methamphetamine, and cannabis at higher rates than they have in more than a decade. Collected by Quest Diagnostics, the information has revealed alarming upward drug use trends in the USA.

Measured in 2016 and 2017, the drug test positivity rate for the combined and general US workforce was 4.2%, an increase of 3.5% from 2012, which represented a record 30 year low in positivity. The data collected in 2017 also shows that drug use patterns are shifting, with cocaine and methamphetamine rising in some areas of the country and cannabis positivity increasing in states that have recently implemented new laws for its recreational use.

Cocaine’s positivity rate in the workforce has increased for the last five years in all testing methods. In urinalysis, cocaine increased 7%, as well as up to 16% in oral fluid testing and 19% in hair testing. In areas of the US where only urine testing is permitted, cocaine increased by 11%, which marks the third year in a row that this particular workforce segment has increased its cocaine positivity. Particular increase in cocaine use was seen in positive urine testing between 2016 and 2017 in Nebraska (91%), Idaho (88%), Washington (31%), Nevada (25%), Maryland (22%), and Wisconsin (13%).

In the American Midwest and South, methamphetamine positivity has risen dramatically, with 16% increases recorded in the East North Central division of the Midwest (Illinois, Indiana, Michigan, Ohio, and Wisconsin), 10% in the East South Central division of the South (Alabama, Kentucky, Mississippi, and Tennessee), 150% in the Middle Atlantic division of the Northeast (New Jersey, New York, and Pennsylvania), and 140% in the South Atlantic division of the South (Delaware, District of Columbia, Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia, and West Virginia). Between 2016 and 2017 alone, the positivity percentage increase in these particular zones ranged from 9 to 25%.

 “Thirty years in, this year’s results again demonstrate the ever-evolving threat that substance abuse poses to workplace safety. With the prescription opiate crisis filling the headlines, the significant drop in opiate positivity is a promising sign; yet, the ten-year high in positivity rates–spurred by nationwide surges in cocaine and methamphetamine positivity as well as double-digit marijuana spikes in the states with newly implemented recreational laws–serves as a stark warning that efforts to prevent substance abuse in the workplace are as important today as ever.”

-Matt Nieman, General Counsel at the Institute for a Drug-Free Workplace and Principal, Jackson Lewis P.C.

Opioids

Kim Samano, Scientific Director at Quest Diagnostics, believes that efforts by policymakers, employers, and the medical community have resulted in the curtailed use of opioids, “at least among the working public.”

The data suggests this is the case, as the US national positivity rate for opiates in the general workforce declined by 17% between 2016 and 2017. While Quest’s workforce drug tests test for drugs and metabolites associated with prescription opiates and semi-synthetic opiates, they do not test for synthetic opiates like fentanyl and its synthetic analogs. Additionally, prescription opiates testing for the federally-mandated, safety-sensitive workforce has only been required since October of 2017, and only for certain government employees, but early data in the fourth quarter of 2017 shows that positivity rates are higher than what was recorded before the new morphine and codeine regulations were put into place. Oxycodone also declined by 12% in the same time period, with hydrocodone positivity declining by 17% and hydromorphone declining by 22%. All opiates, not including codeine, were measured at their lowest positivity rates in more than ten years. As well, the Center for Disease Control (CDC) has reported that prescriptions for opioids have fallen across the US to their lowest rate in the last decade.

Concern that a reformulation of opioid medication Oxycontin would increase heroin use across the country has proven to not be the case among America’s workforce populations, as positive drug tests for heroin have also declined (indicated by the presence of 6-acetylmorphine metabolite (6-AM)) by nearly 11% between 2016 and 2017.

“It’s unfortunate that we mark 30 years of the Drug-Free Workplace Act with clear evidence that drugs continue to invade the country’s workplaces. Not only have declines appeared to have bottomed out, but also in some drug classes and areas of the country drug positivity rates are increasing…These changing patterns and geographical variations may challenge the ability of employers to anticipate the ‘drug of choice’ for their workforce or where to best focus their drug prevention efforts to ensure and safe and healthy work environment.”

-Barry Sample, PhD, Senior Director of Science and Technology, Quest Diagnostics

Cannabis

Cannabis, on the other hand, has increased its positivity rate over the last five years in urine tests within the US workforce as well as within the federally-mandated, safety-sensitive workforce (including pilots, rail, bus and truck drivers, and workers in nuclear power plants), increasing by 4% generally and nearly 8% in the safety-sensitive workforce. These increases have been most obvious in states that have adopted new recreational cannabis use statutes, including Nevada, which increased by 43%, Massachusetts, which increased by 14%, California, which increased by 11%, and particularly in the segment of safety-sensitive workers, by 39%, 20%, and 11%, respectively.

According to Dr. Sample, “These increases are similar to the increases we observed after recreational marijuana use statutes were passed in Washington and Colorado. While it is too early to tell if this is a trend, our data suggests that the recreational use of marijuana is spilling into the workforce, including among individuals most responsible for keeping our communities safe. We encourage policy analysts to track these trends closely to determine whether a correlation between the state legalization of marijuana and increased workforce drug use, as suggested by our data, bears out in other research.”

Quest Diagnostics analyzes national workplace drug positivity trends based on its de-identified laboratory use and has been measuring drug use in the USA with its Drug Testing Index since 1988, when the USA signed the Drug-Free Workplace Act and American workers had an overall drug positivity rate of 13.6%. Quest’s Drug Testing Index analysis uses a large, nationally representative sample size, longitudinal monitoring, and a testing population that generally reflects the US workforce. Quest’s limitations include having access only to analysis of results generated by employers that perform testing within their companies, and an inability to cross-compare specimens due to variations in the substances being tested in each business.