Every summer, Quest Diagnostics publishes its Drug Testing Index, a yearly look at the results of workplace drug tests processed by its labs. The 2026 edition, released in July, came with a headline that got attention fast: 19.1% of U.S. workers who took a hair drug test in 2025 tested positive, up from 13.1% in 2021. That works out to roughly one in five. Quest notes that hair testing often reflects repeated use over about 90 days, so the number says more about ongoing habits than about a single weekend.
For employers, the harder question is what to do with numbers like these. A positive test is a data point, not a diagnosis. It shows that a substance was present, and Quest itself points out that some amphetamine positives can include prescription medications. That is one reason some employers pair testing with a confidential referral through an employee assistance program (EAP), where a counselor can help figure out what kind of support, if any, makes sense. Care can range from weekly outpatient counseling to a residential stay, and some employees referred to luxury inpatient rehab services in Malibu or similar programs step away from work for a period of focused treatment before returning.
Here is what the 2026 report found, and what it suggests for workplaces of every size.
Three Testing Methods, Three Different Pictures
Quest reports its results by specimen type, and each type measures a different window of time. According to the report, urine generally detects use over the previous several days, oral fluid typically captures very recent use within hours, and hair reflects use over approximately 90 days.
That difference explains why the numbers can look so far apart. Urine testing, still the most familiar method, showed a slight improvement. Urine positivity in the general U.S. workforce was 4.3% in 2025, down from 4.4% in 2024. It sat at 4.6% from 2021 to 2023, and the last time it was as low as 4.2% was 2017. Hair testing, meanwhile, showed the sharp increase that made the headlines.
Jason S. Hudson, PhD, scientific director and laboratory director for Workforce Solutions at Quest Diagnostics, said in the release that “hair and oral fluid testing not only capture different windows of use but are also more resistant to tampering.”
Marijuana Drives Most of the Increase
Marijuana accounted for 52.5% of positive hair drug tests in 2025, according to Quest. Overall hair positivity for marijuana climbed from 9.5% in 2021 to 15.1% in 2025, a 58.9% increase. In pre-employment hair testing, it rose from 10.1% to 15.1%. In random hair testing, it went from 18.3% to 21.0%.
The specimen type still matters here. Marijuana positivity in the general workforce was 4.4% in urine, 11.1% in oral fluid, and 15.1% in hair. In oral fluid random testing, marijuana positivity reached 6.3% in 2025, up 14.5% from 5.5% in 2021. Quest also reported that random and post-accident oral fluid results came in higher than pre-employment results.
Policy is moving too. The release notes that in April 2026, the acting U.S. Attorney General signed an order to move medical marijuana from Schedule I to Schedule III under the Controlled Substances Act, and announced an expedited hearing on whether all marijuana should be reclassified. Quest says such a change could affect cannabis testing in federal programs.
Fentanyl Falls While Stimulants Climb
The most encouraging number in the report involves fentanyl. Positivity in the general U.S. workforce fell 49.1% year over year, from 0.55% in 2024 to 0.28% in 2025. Quest connects the drop to employer efforts such as expanded testing, education, and deterrence. “We’re encouraged to see this significant decline in workforce fentanyl positivity,” said Claire Bryant, senior program manager of Workplace Wellbeing at the National Safety Council.
Stimulants moved the other way in hair testing. Cocaine positivity was 4.0% in 2025, up from 2.7% in 2021, a relative increase of 48.1%. Amphetamine positivity rose from 1.8% to 2.3%, and methamphetamine went from 2.1% to 2.5%.
Which Industries Stood Out
Healthcare ranked highest for overall positivity, at 5.8% in 2025, up from 5.1% in 2021. Quest reports that marijuana in the sector rose from 2.9% to 4.2%, and amphetamines from 1.5% to 2.3%. Retail trade followed at 5.4% and had the highest marijuana positivity among worker categories, at 7.6%. Professional and technical services came in at 5.3%, while manufacturing and transportation and warehousing were both at 4.2%.
What the Numbers Signal for Employers
A report like this is easy to skim for the scary figure and move on. Read more closely, it points to several practical takeaways for HR teams and managers.
- Test choice shapes the result: Because hair, urine, and oral fluid cover different time windows, an employer switching methods may see very different positivity rates without any real change in behavior.
- Random testing turns up more: Quest’s figures show higher marijuana positivity in random hair testing than in pre-employment testing, which suggests pre-hire screening alone gives an incomplete picture.
- Post-accident results need context: Oral fluid picks up very recent use, which is why Quest describes it as suited to post-accident situations, but a result is still one piece of an incident review.
- Prescriptions are part of the story: The U.S. Equal Employment Opportunity Commission (EEOC) says employers should give people subject to drug testing a chance to explain lawful use of prescribed opioids.
- Marijuana rules are in flux: With federal rescheduling underway, employers in regulated programs will want to watch how testing requirements change.
None of these points argue against testing. They argue for treating test results as information that starts a conversation, rather than as the end of one.
Pairing Testing With a Supportive Response
Bryant said the findings “demonstrate the importance of a comprehensive approach to impairment mitigation in the workplace.” Part of that approach is knowing what help is available and what the law says.
EAPs are often the first stop. The U.S. Office of Personnel Management describes federal EAPs as offering employees the chance to speak with a licensed clinician or counselor 24/7, along with referrals to professional and community resources for longer-term help.
Federal law also plays a role. The EEOC explains that the Americans with Disabilities Act (ADA) allows employers to act based on an employee’s current illegal drug use, but that an employer might still be required to hold a job while a worker takes leave for treatment or recovery. The U.S. Department of Labor states that Family and Medical Leave Act (FMLA) leave may be taken for substance abuse treatment provided by a health care provider, though absence caused by using the substance, rather than by treatment, does not qualify. The Department also notes that an employer can still apply an established, nondiscriminatory policy that has been communicated to all employees.
Frequently Asked Questions (FAQs)
1. Why is hair test positivity so much higher than urine test positivity?
The two tests look at different time periods. According to Quest Diagnostics, urine generally detects use over the previous several days, while hair reflects use over approximately 90 days. A longer window catches more use, which is why the 2025 hair positivity rate of 19.1% sits well above the 4.3% urine rate.
2. Did fentanyl positivity in workplace tests really drop by half?
Yes. Quest reported that fentanyl positivity in the general U.S. workforce fell 49.1%, from 0.55% in 2024 to 0.28% in 2025. The company links the decline to employer efforts including expanded testing, education, and deterrence.
3. Can an employee use FMLA leave to attend addiction treatment?
Possibly. The U.S. Department of Labor says FMLA leave may be taken for substance abuse treatment provided by a health care provider, as long as the employee meets the eligibility rules. Absence caused by the use of the substance itself does not qualify, and the EEOC notes that eligibility generally requires at least 1,250 hours worked in the past 12 months for an employer with 50 or more employees.
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