The positive rate for urine tests indicating the presence of the synthetic opioid fentanyl was 1.13% in 2024. That is up from 0.91% in 2023 and double the rate in 2020, according to a recent analysis of more than eight million drug tests by Quest Diagnostics, one of the U.S.'s largest drug-testing labs.
"We're seeing trends that are outside of the norm that we see for other drugs historically," said Suhash Harwani, senior director of science for workforce-health solutions at Quest Diagnostics.
Surprise random tests are a clearer indication of opioid use among workers than pre-employment screening, which subjects can prepare for ahead of time and even game to achieve negative results. Fentanyl-positive results were more than seven times higher in random tests for the general U.S. workforce than in drug screening taking place during the hiring process, the analysis showed.
Overall, the positive rate for the various substances Quest Diagnostics tested for declined last year, to 4.4% from 4.6% in 2023, after three years of rising.
The findings on fentanyl come as the nation continues to grapple with an opioid-addiction epidemic. Deaths involving synthetic opioids -- a category largely fueled by fentanyl -- declined 2% to about 74,700 last year, according to preliminary data from the Centers for Disease Control and Prevention, as overall overdose deaths in the U.S. fell for the first time in years. The CDC has estimated that seven of every 10 U.S. overdose deaths involved synthetic opioids.
Attorney General Pam Bondi discussing synthetic opioids containing fentanyl.
The opioid epidemic has been a persistent concern for workplaces, especially in occupations in the construction, mining and transportation industries. Unintentional overdoses from nonmedical use of drugs or alcohol rose for the 10th straight year in 2022, the latest figures available from the Bureau of Labor Statistics. Unintentional overdoses include from stimulants such as methamphetamine and from opioids such as fentanyl.
The new results suggest workers were using fentanyl after getting hired, having passed the screenings they went through when they were job candidates, raising concerns about the risk of accidents, impairments, absenteeism and overdoses.
In contrast, marijuana's positivity rate in random testing was 42% lower than its positivity rate in pre-employment testing over the past five years.
In some cases, workers may have cheated by substituting specimens to pass the initial drug screening for fentanyl. In other cases, life events may have played a role.
Another reason for the gap between pre-employment positive fentanyl tests and random ones: the shorter period of time a user would have to refrain from using the drug so that it wouldn't be detected in urine.
"Fentanyl is shorter-lived than cannabis; it doesn't stay in the bloodstream or remain detectable nearly as long," said Alexandria Macmadu, assistant professor in the department of epidemiology at the Brown University School of Public Health.
The drug can disappear from the system within hours versus up to three days for other substances, so a job candidate can control for not using it, say, the day before.
More Quest Diagnostics corporate clients are requesting the company add fentanyl in their testing panels, Harwani of Quest Diagnostics said.
Companies are increasingly requesting a full suite of tests for all drugs rather than just testing for, say, marijuana, said Julie Schweber, knowledge adviser at human-resource trade group SHRM.
At the same time, more companies are stepping up random drug tests. "We're starting to see a bit more of a shift into reasonable suspicion, random-type testing and post-incident testing," said Janet LaQuintano, vice president of growth and strategic initiatives at staffing agency ManpowerGroup.