Data: Fentanyl positivity 7x higher in random workplace drug tests than in pre-employment tests

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AUSTIN (KXAN) — A new report from Quest Diagnostics, a diagnostic testing and health information services provider, revealed the percentage of employed people who test positive for fentanyl in random drug tests “far exceeded” those in pre-employment testing.

According to the 2025 Quest Diagnostics Drug Testing Index, or DTI, the general U.S. workforce positivity for fentanyl was 707% higher in random tests than in pre-employment tests in 2024. Meanwhile, Quest data showed that random and pre-employment positivity rates for other types of drugs are drastically lower than fentanyl.

For example, data from the last five years shows that the marijuana positivity rate in the general U.S. workforce was 42% lower in random testing than it was for pre-employment testing. The fentanyl positivity rate in random testing has been 400% higher than in pre-employment testing over the past five years, the release said.

Quest reported that, overall, positive results on work-related urine drug tests declined slightly year over year, from 4.6% in 2023 to 4.4% in 2024. More than 8 million drug tests were analyzed, according to Quest.

The report pointed out that the increase in fentanyl in random drug tests suggests that more people are using the drug after they’ve passed pre-employment drug screenings.

“The new Quest data indicates a worrying increase in fentanyl positivity in random drug tests as well as fentanyl drug-combing among the nation’s workforce in day-to-day work environments,” said Suhash Harwani, PhD, Senior Director of Science for Workforce Health Solutions at Quest Diagnostics, in the release.

The data also found that 60% of specimens that were positive for fentanyl were also positive for other drugs. Also, about 22% of fentanyl-positive workforce drug tests were also positive for marijuana. In 2020, only 10% of fentanyl positives were also positive for marijuana. There was also a large percentage of fentanyl positive tests that were positive for amphetamines as well: 16% in 2024, compared to just 11% in 2020.

“It is disturbing to see increased use of fentanyl on-the-job and in combination with other drugs, given fentanyl’s extreme potency, which can increase risk of impairment, accidents, and potential overdose,” Harwani added. “It also raises concern that employees are turning to a dangerous drug like fentanyl after they’ve passed a pre-employment drug screen, putting the overall wellness of the workforce at risk.”

Harwani said that the data collected from random testing and pre-employment testing could help employers understand what drugs their employees may be using and help determine how to implement drug testing.

“When you look at the testing, pre-employment drug tests can be studied from many avenues. You could abstain from use for a week because you know you’re going to get drug tested from that standpoint, but the fact that we’re seeing this higher positivity for fentanyl in random tests indicates that there is more use going on in the US workforce, and we’re not catching it at the pre-employment stage,” Harwani said.

“So, it really is an indicator to employers that maybe random testing really has a large value play in terms of what they [have as part of their] drug testing programs,” Harwani continued. “A lot of programs might be pre-employment only, or pre-employment and post-accident only, and may not have a random component to them.”

Harwani said 2024 was the first year that Quest Diagnostics reported fentanyl positivity in the general U.S. workforce. Previously, only pre-employment positivity rates were reported. He said overall positivity rates for fentanyl increased by about 15% for the general U.S. workforce from 2023 to 2024.

“That’s one sticking point — just knowing where random positivity sits… that’s generally not a trend we see,” Harwani said. “But when you look at it, pre-employment positivity is not generally that… far disparate from random testing positivity. They’re generally in line, slightly lower or higher, but not 700% difference.”

Harwani said that the data collected through Quest’s annual DTI has been used in the past by the federal government’s Drug Testing Advisory Board, but that board was terminated at the end of March.

Quest Diagnostics has analyzed annual workplace drug testing data since 1988 and publishes the findings as a public service, according to its website. More information about the reports can be found online.

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