Why Workplace Drug and Alcohol Testing is Essential to Safety 

This is Part 1 of a WorkCare series on workplace drug and alcohol testing programs. In this post, we discuss consequential national substance use and testing trends and the benefits of a comprehensive approach.  

Substance use in the U.S. population has far-reaching impacts. Data on user trends indicate that comprehensive workplace drug and alcohol testing programs are more essential than ever to help detect substance-related impairment on the job and prevent related productivity loss, accidents, injuries, and fatalities. 

Drug and alcohol screening and test-result follow-ups by a certified Medical Review Officer (MRO) are required by federal agencies for employees in safety-sensitive jobs. Employers who are not subject to federal regulations are encouraged to adopt similar best practices. Regardless of the type of industry and the regulations that may apply, a company that tests for substance use has the opportunity to prevent costly incidents, discourage frequent users from applying for jobs, and gain recognition as a safe place to work. 

The Magnitude of the Problem

The use of illegal drugs and misuse of prescription drugs, particularly opioids, is identified as a persistent public health risk in a March 5, 2025, report by the U.S. Government Accountability Office. The National Council on Alcoholism and Drug Dependence has estimated that substance abuse costs U.S. employers a $81 billion+ per year. And in a study, the National Safety Council and NORC at the University of Chicago found that U.S. employers annually spent an average of $8,817 per employee with an untreated substance use disorder (SUD), while they could have saved $8,500 on an employee with a SUD by supporting recovery interventions. (Refer to the NSC+NORC Substance Use Cost Calculator for Employers to estimate costs in your workplace.) 

Data provide insights into the ways Americans might use legal and illegal substances, including for recreational purposes, as sleep aids, or to help relieve pain or symptoms of depression, anxiety, or stress. An estimated 30 million Americans – about one in 10 adults – face challenges with substance use, according to the National Survey on Drug Use and Health. 

 The survey shows that in 2023: 

• 70.5 million Americans used illicit drugs 
• 8.8 million people used hallucinogens 
• 8.6 million people misused prescription pain relievers  

In one month during 2023: 

• 47.5 percent (134.7 million people, including adolescents) drank alcohol  
• 16.8 percent (47.7 million people) used an illicit drug 
• 15.4 percent (43.6 million people) used marijuana 

Despite robust national and community-based prevention efforts, friends, family members, and co-workers continue to die of drug overdoses and alcohol-related diseases or suffer from costly substance-related disorders.  

The 2024 National Drug Threat Assessment prepared by the U.S. Drug Enforcement Administration found that a shift from plant-based drugs to synthetic drugs such as fentanyl and methamphetamine was responsible for nearly all fatal drug poisonings in the U.S.; controlled prescription drugs were the fourth leading cause of fatal poisoning in 2022.   

Preventable loss of life includes: 

• 88,000 deaths annually attributed to excessive alcohol use alone, making it the third leading lifestyle-related cause of death in the nation (National Council on Alcoholism and Drug Dependence)  
• 82,059 overdose deaths nationwide for the 12-month period ending November 2024 (Centers for Disease Control and Prevention provisional data) 
• 525 workplace deaths due to overdoses in 2022, a 13 percent increase compared to 2021 (Bureau of Labor Statistics)  

In some cases, employees and bystanders are killed or seriously injured in work-related incidents in which substance use is a contributing factor. Repeated studies show that employees with SUDs have higher than average rates of accidents, injuries, turnover, and absence, as well as higher healthcare and workers’ compensation insurance costs when compared to those who do not have SUDs. Risk-taking behaviors and/or co-morbid conditions often compound the problem. 

Workplace Drug Testing Results Reveal Trends 

Findings from the Quest Diagnostics 2024 Drug Testing Index, an analysis of nearly 10 million lab tests conducted by Quest in 2023, reveal some disturbing trends that employers can take definitive steps to address. 

• Overall, drug positivity in the general U.S. workforce was 5.7 percent in 2023 among the 9.8 million workforce drug tests that were analyzed, an historic high. 
• Marijuana use continued an upward climb in the general U.S. workforce, in states that have legalized recreational marijuana, and in professional, office-based settings.  
• The percentage of employees whose urine sample showed signs of tampering increased by more than six-fold in 2023 compared to 2022, the highest rate in more than 30 years of annual reporting.  
• Cocaine positivity in the general U.S. workforce increased by 9.1 percent in 2023 in comparison to 2022. 

With regard to rising rates of specimen tampering, Suhash Harwani, Ph.D., senior director of science for Workforce Health Solutions at Quest Diagnostics, said “…it is possible that our society’s normalization of drug use is fostering environments in which some employees feel it is acceptable to use such drugs without truly understanding the impact they have on workplace safety.” 

Who Gets Tested? 

An estimated 12 to 14 million U.S. employees are subject to federal testing requirements, including about 6 million in transportation, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). Non-compliance with federal regulations, such as those enforced by the Federal Motor Carrier Safety Administration, can result in steep fines and other penalties for covered employers.   

SAMHSA’s Division of Workplace Programs oversees federal drug-free workplace functions and the National Laboratory Certification Program. SAMHSA’s Drug-Free Workplace Programs and its Drug-Free Workplace Toolkit are useful resources for both regulated and unregulated workplaces. 

Passage of the Drug-Free Workplace Act of 1988 got the ball rolling. It requires federal agencies and non-federal workplaces with federal contracts worth at least $100,000 to implement a Drug-Free Workplace Program. The Omnibus Transportation Employee Testing Act was enacted in 1991 to require drug and alcohol testing for certain employees who work under the purview of the Department of Transporation (DOT). Mandatory testing applies to federal agencies that oversee aviation, trucking, railroads, mass transit, pipelines, and other transportation industries, the Department of Defense (national security), and the Nuclear Regulatory Commission. Mandatory testing is also required for law enforcement and other public safety personnel, construction workers, heavy machine operators, and some healthcare providers. 

Guidelines for mandatory federal workplace drug testing programs now include one version for urine specimen testing and the other for oral fluid testing. Revisions to Schedule I and II drug panels for federal workplace urine or oral drug testing will take effect on July 7, 2025. They do not apply to drug testing programs regulated by the DOT, U.S. Coast Guard, or the Nuclear Regulatory Commission, which are being developed separately. (Learn more in our fact sheet on Federal Workplace and DOT Drug Testing Rules and Forms.)  

We Support Drug-free Workforce Programs

WorkCare provides a comprehensive suite of substance testing solutions for regulated and unregulated workplaces, including pre-placement, annual, periodic, post-accident, random, for-cause, and reasonable suspicion. We offer convenience and rapid turnaround times via our national network of secure specimen collection sites and a national lab partner. We also support time-of-need alcohol testing. Contact us to learn more about our workplace drug and alcohol testing services.