Drugs in Workforce at Highest in Decade But Opiates Decline: Quest Diagnostics

Drug use by the American workforce remains at its highest rate in more than a decade, driven by increases in cocaine, methamphetamine and marijuana. However, prescription opiate positivity rates have declined.

Nationally, the positivity rate for the combined U.S. workforce held steady at 4.2 percent in 2017, the same as in 2016. That is still a dramatic increase over the 3.5 percent positivity rate from 2012, which represented a 30-year low. The analysis of more than 10 million drug test results was done by Quest Diagnostics, a diagnostic information service.

The analysis of 2017 data shows shifting patterns of drug use, with cocaine and amphetamines positivity surging in some areas of the country and marijuana positivity rising sharply in states with newer recreational use statutes. Prescription opiate positivity rates declined dramatically on a national basis.

According to an interactive map, the positive drug rates vary by geography, with cocaine use up sharply in some areas, methamphetamine positivity skyrocketing in Midwest and South regions and marijuana positivity up in states that have legalized recreational use.

“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,” said Barry Sample, PhD, senior director, science and technology, Quest Diagnostics.

Sample said the changing patterns and geographical variations may make it difficult for employers to “anticipate the ‘drug of choice’ for their workforce or where to best focus their drug prevention efforts” to ensure a safe workplace.

Matt Nieman, general counsel, Institute for a Drug-Free Workplace, called the significant drop in opiate positivity is “a promising sign,” but warned that “the 10-year high in positivity rates—spurred by nationwide surges in cocaine and methamphetamine positivity as well as double-digit marijuana spikes in 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.”

The positivity rate for cocaine increased for the fifth consecutive year in the general U.S. workforce across every specimen type. In urine testing, the most common drug test specimen type, the positivity rate for cocaine increased seven percent in the general U.S. workforce (0.28% in 2016 versus 0.30% in 2017). Year-over-year increases were also observed in the general U.S. workforce in oral fluid testing (up 16%) and hair testing (19%).

In the federally-mandated, safety-sensitive workforce, for which only urine testing is permitted, cocaine positivity increased by eleven percent (0.28% in 2016 versus 0.31% percent in 2017), representing the third consecutive year of increases in this workforce segment.

A new pattern emerged in this year’s analysis, with cocaine positivity in urine testing increasing significantly in certain states among the general U.S. workforce. Double-digit year-over-year increases in at least four of the five past years were seen in Nebraska (91% increase between 2016 and 2017), Idaho (88% increase), Washington (31%), Nevada (25%), Maryland (22% increase), and Wisconsin (13%).

An analysis of trends in the general U.S. workforce based on the four U.S. Census regions identified large increases of methamphetamine positivity rates. Between 2013 and 2017, methamphetamine positivity increased: 167% in the East North Central division of the Midwest (Illinois, Indiana, Michigan, Ohio, Wisconsin);160% in the East South Central division of the South (Alabama, Kentucky, Mississippi, Tennessee); 150% in the Middle Atlantic division of the Northeast (New Jersey, New York, Pennsylvania); and 140% in the South Atlantic division of the South (Delaware, District of Columbia, Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia, West Virginia). The percentage increase in these four divisions ranged between nine and 25% between 2016 and 2017.

“The depth of our large-scale analysis supports the possibility that efforts by policymakers, employers, and the medical community to decrease the availability of opioid prescriptions and curtail the opioid crisis is working to reduce their use, at least among the working public,” said Kim Samano, PhD scientific director, Quest Diagnostics.

Nationally, the positivity rate for opiates in the general U.S. workforce in urine drug testing declined 17 percent between 2016 and 2017 (0.47% versus 0.39%). More notably, oxycodones (oxycodone and/or oxymorphone) positivity declined 12 percent between 2016 and 2017 (0.69% vs. 0.61%), hydrocodone positivity declined 17 percent (0.81% vs. 0.67%); and hydromorphone positivity declined 22% (0.59% vs. 0.46%). Opiates other than codeine were at their lowest positivity rate in more than a decade.

Workforce drug testing services generally do not test for synthetic opioids, such as fentanyl and its synthetic analogs.

Prescription opiate testing became mandatory in October 2017 for certain safety-sensitive U.S. government employees. Preliminary data in the fourth quarter of 2017 from the testing of these workers indicates a positivity rate slightly higher than for the opiate group prior to these new regulations which only included codeine and morphine. Prescription opiate testing for safety-sensitive transportation workers covered under U.S. Department of Transportation (DOT) rules went into effect in January 2018.

According to the Centers for Disease Control (CDC), the overall national opioid prescribing rate in 2017 fell to the lowest it had been in more than 10 years, though rates vary by state and are high in some areas of the country.i

Urine drug test results for heroin, indicated by the presence of the 6-acetylmorphine (6-AM) metabolite, also declined in the general U.S. workforce (0.033% positivity, a three-year low and down nearly 11 percent in 2017 compared to 2016).

Overall, marijuana positivity continued its five-year upward trajectory in urine testing for both the general U.S. workforce and the federally-mandated, safety-sensitive workforce. Marijuana positivity increased four percent in the general U.S. workforce (2.5% in 2016 versus 2.6% in 2017) and nearly eight percent in the safety-sensitive workforce (0.78% versus 0.84%).

Increases in positivity rates for marijuana in the general U.S. workforce were most striking in states that have enacted recreational use statues since 2016. Those states include: Nevada (43%), Massachusetts(14%) and California (11%). These three states also saw significant increases in marijuana positivity in federally-mandated, safety-sensitive workers: Nevada (39%), California (20%), and Massachusetts (11%). Federally-mandated, safety-sensitive workers include pilots, rail, bus and truck drivers, and workers in nuclear power plants, for whom routine drug testing is required by the DOT.

“These increases are similar to the increases we observed after recreational marijuana use statues were passed in Washington and Colorado,” said Dr. Sample. “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.”

The Quest Diagnostics Drug Testing Index (DTI) examines test results according to three categories of workers: federally-mandated, safety-sensitive workers; the general workforce; and the combined U.S. workforce. Federally-mandated, safety-sensitive workers include pilots, bus and truck drivers, and workers in nuclear power plants, for whom routine drug testing is mandated by the U.S. Department of Transportation and the Nuclear Regulatory Commission.

Quest Diagnostics has analyzed annual workplace drug testing data since 1988 and publishes the findings as a public service.

Source: Quest Diagnostics