Fentanyl Positivity in Random Workplace Drug Tests Exceeds Pre-Employment Screens

A new 2025 Quest Diagnostics Drug Testing Index report reveals that fentanyl detection in random workplace drug tests is more than seven times higher than in pre-employment screenings (1.13% vs. 0.14%). [1] This finding emphasizes the growing importance of ongoing fentanyl workplace drug testing beyond pre-employment screenings.

Key findings include:

• Overall urine drug positivity in the U.S. workforce dipped slightly in 2024, from 4.6% to 4.4%, yet fentanyl workplace drug test data shows use among employees remains a growing concern. [1]
• Among specimens testing positive for fentanyl, about 60% also showed presence of other substances. Fentanyl and marijuana co-positivity doubled between 2020 and 2024 (from ~10% to ~22%), while amphetamine co-positivity increased to 16% in 2024, up from 11% in 2020. [1]
• Marijuana remains the most frequently detected drug in the workforce, with post-accident drug testing statistics showing consistently high (7.3% in 2024). [1]
• While some categories (like post-accident, for-cause, return-to-duty) showed modest declines in positivity rates, they remain elevated. For instance, “for-cause” testing among general workforce dropped from 39.4% in 2023 to 33.1% in 2024. [1]

The report underscores the risk of fentanyl use after employees pass pre-employment drug screens especially given its potency and the safety implications when combined with other drugs. Employers who rely solely on pre-employment screening may underestimate the true risks of synthetic opioids and polysubstance use pose to workplace safety after their initial hire.

In 2024, 60% of specimens were positive for fentanyl in the U.S. general workforce and tested positive for other drugs. About 22% were also positive for marijuana, a rate that has doubled since 2020, while 16% were also positive for amphetamines compared to 11% in 2020. [1]

Fentanyl’s growing presence—and its frequent overlap with other substances—underscores the need for ongoing random, post-accident, and for-cause testing. Employers should regularly review and update their testing policies to reflect current needs and industry trends. Providing supervisors with training and tools to recognize signs and symptoms of substance use can help prevent incidents and promote workplace awareness. Employers may also consider whether their policies support a second-chance or recovery-friendly approach, which more organizations are adopting. Establishing clear procedures not only strengthens program success but also enhances the well-being of employees, co-workers, and their families.

Reference:

[1]Quest Diagnostics. (2025, September 2). Fentanyl Positivity Is More Than Seven Times Higher in Random Tests vs. Pre-Employment Drug Screening, Finds 2025 Quest Diagnostics Drug Testing Index. Quest Diagnostics Newsroom. https://newsroom.questdiagnostics.com/2025-09-02-Fentanyl-Positivity-Is-More-Than-Seven-Times-Higher-in-Random-Tests-vs-Pre-Employment-Drug-Screening,-Finds-2025-Quest-Diagnostics-Drug-Testing-Index