One in Five U.S. Workers Tested Positive on Hair Drug Tests in 2025, While Fentanyl Positivity Fell by Nearly Half
核心洞察
Nearly one in five U.S. workers (19.1%) tested positive for drug use on hair specimens collected in 2025, up nearly 46% from 13.1% in 2021, according to the 2026 Quest Diagnostics Drug Testing Index.
Marijuana was the primary driver, accounting for 52.5% of hair drug positives, with hair-test positivity rising 58.9% over five years to 15.1% in 2025.
Year-over-year fentanyl positivity declined by nearly half (49.1%) in the general U.S. workforce, from 0.55% in 2024 to 0.28% in 2025.
Nearly one in five workers in the general U.S. workforce (19.1%) tested positive for drug use based on an analysis of hair specimens collected in 2025, an increase of nearly 46% compared to 13.1% in 2021, according to the 2026 Quest Diagnostics Drug Testing Index. The findings, released July 10, 2026, 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. Hair testing has the longest detection window, often reflecting patterns of repeated or chronic drug use over approximately 90 days.
Marijuana Drives Rising Positivity Across Specimen Types
Marijuana continues to be the primary driver of positive drug tests across all specimen types and workforce segments. Over the past five years, overall hair test positivity for marijuana increased 58.9%, rising from 9.5% in 2021 to 15.1% in 2025. Pre-employment hair test positivity for marijuana increased 49.5% over the same period (10.1% in 2021 vs. 15.1% in 2025), while random hair test positivity for marijuana increased 14.8% (18.3% in 2021 vs. 21.0% in 2025).
Marijuana accounted for 52.5% of hair drug positives in 2025. In the general U.S. workforce, marijuana positivity reached 4.4% in urine testing and significantly higher levels in alternative collection methods, including 11.1% in oral fluid and 15.1% in hair testing. Marijuana positivity following workplace accidents remained high at 7.4% in 2025, just slightly below the record high of 7.5% in 2023.
Other Substances Show Mixed Trends
In addition to marijuana, hair test positivity for other substances also increased. In the general U.S. workforce, cocaine positivity was 4.0% in 2025, up from 2.7% in 2021, a relative increase of 48.1%. Benzoylecgonine, the primary metabolite of cocaine, increased to 1.7% from 1.1% in 2021, an increase of 54.5%. Amphetamine positivity, which can include prescription medications, rose 27.8% to 2.3% in 2025 from 1.8% in 2021, while positivity for the illicit class of methamphetamine was up 19.0% (2.5% in 2025 vs. 2.1% in 2021).
By comparison, overall urine drug test positivity in the general U.S. workforce slightly declined to 4.3% in 2025 from 4.4% in the prior year. Drug use positivity for the combined workforce held at 4.3% in 2025 in urine drug tests, a decrease of 2.3% compared to the rate of 4.4% in 2024. The rate was 4.6% from 2021 to 2023, and the last year the rate was as low as 4.2% was 2017.
Fentanyl Positivity Declines Sharply
The report also highlights areas of progress, particularly in fentanyl positivity. Year-over-year fentanyl positivity declined by nearly half (49.1%) in the general U.S. workforce, falling from 0.55% in 2024 to 0.28% 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 Claire Bryant, Senior Program Manager of Workplace Wellbeing at the National Safety Council (搜索).
Industry-Level Variation in Drug Positivity
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. In 2025, overall positivity in the healthcare sector reached 5.8%, making it the highest-ranking industry for drug positivity and reflecting a notable increase over previous years (up from 5.1% in 2021, a relative increase of 13.7%). This trend was largely driven by marijuana, which remained the most commonly detected positive substance (2.9% in 2021 vs. 4.2% in 2025), followed by amphetamines (1.5% in 2021 vs. 2.3% in 2025).
Positive rates remained elevated in sectors such as Retail Trade (5.4%) and Professional and Technical Services (5.3%), while lower rates were observed in Manufacturing (4.2%) and Transportation and Warehousing (4.2%). Retail trade had the highest marijuana positivity among worker categories, at 7.6%.
Testing Methods and Regulatory Context
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. 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. 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.
Oral fluid positivity rates for random testing rose to 6.3% in 2025, an increase of 14.5% compared to 5.5% in 2021. Notably, both random testing and post-accident testing by oral fluid, at 10.2%, were higher than 4.4% for pre-employment testing.
"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."
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.
"These findings demonstrate the importance of a comprehensive approach to impairment mitigation in the workplace," said Claire Bryant. "Employers play a critical role in addressing the root causes of substance misuse through supportive policies, benefits and recovery."