Fentanyl and workforce health

The United States is in the throes of a deadly opioid epidemic fueled in large part by fentanyl. In fact, the fentanyl problem has become so severe that President Donald Trump designated fentanyl as a “weapon of mass destruction” in 2025.¹

Tragically, no sector of society is outside fentanyl’s reach, including the workplace.

According to the Quest Diagnostics 2025 Drug Testing Index™ (DTI), the percentage of employees in the general US workforce testing positive for fentanyl in random drug tests was 707% higher than pre-employment positives for fentanyl (1.13% vs. 0.14%). Over the past five years, fentanyl positivity in random testing has been 400% higher than pre-employment.²

According to the DTI’s official report, the “sharp increase in fentanyl in random drug checks suggests more workers are using the highly addictive opioid after they have passed pre-employment screens.”

The 2025 DTI reported on the results of more than 8 million drug tests performed by Quest Diagnostics (NYSE: DGX), a leading provider of diagnostic information services.  As a unique and valuable public service, Quest has analyzed and published annual workplace drug testing data since 1988. Services available through Quest’s Workforce Health Solutions help to optimize the health, safety, and well-being of employees. For more information, visit WorkforceHealthSolutions.com.

The fentanyl positivity figures from the Quest DTI provide employers with valuable insights on a substance abuse trend that may not normally be associated with the workplace, but one that is clearly having an impact on businesses.

The DTI illuminates another troubling trend involving fentanyl—polysubstance abuse. About 60% of fentanyl-positive tests are also positive for at least one other substance. Additionally, marijuana co-positivity rose from 10% in 2020 to 22% in 2024, while amphetamine co-positivity rose from 11% to 16% during that same period.

Federal reports align with the DTI

The Quest data is supported by data from the federal government. According to a 2025 report from the Centers for Disease Control (CDC), an exploratory analysis of multiple cause of death data from 2022 found that employees who use opioids reported increasing stimulant co-use, perhaps in an effort to maintain. Of 69,893 fatal synthetic opioid overdoses, 53.6% involved stimulants.³

The CDC also reported: “Occupation and industry groups with the highest percentages of synthetic opioid overdose deaths co-involving psychostimulants with abuse potential . . .  were typically physically demanding (eg, construction and extraction occupations), whereas categories with highest percentages of cocaine co-involvement were generally less physically strenuous (eg, business and financial occupations); these patterns might reflect differences in desired drug effects, cost, and geographic availability.”³

It is worth noting that fentanyl is up to 50 times stronger than heroin and 100 times stronger than morphine.² Sadly, many people unknowingly consume the drug when purchasing illicit drugs laced with fentanyl, significantly increasing the risk of harm including overdose. 

Drug testing for fentanyl

The Substance Abuse and Mental Health Services Administration (SAMHSA) updated its “Mandatory Guidelines for Federal Workplace Drug Testing Programs – Authorized Testing Panels” to include fentanyl when federal employees are drug tested. The U.S. Department of Transportation (DOT) is also in the process of evaluating such a policy change to align itself with SAMHSA. Some state drug testing laws require employers to follow the federal drug and alcohol testing guidelines and as such could de facto mandate testing for fentanyl along with other dangerous drugs like marijuana, cocaine, and heroin.

According to Current Consulting Group’s 2025 Employer Drug Testing Survey, co-sponsored by Quest Diagnostics, 44% of respondents indicated they were already testing for fentanyl.  

Conclusion

As substance abuse trends continue to evolve and affect the workplace, employers can rely on the Quest Diagnostics Drug Testing Index™ to help them stay informed so they can make educated decisions about their drug-free workplace and employee wellness programs.

Quest Workforce Health Solutions includes population health and biometric and laboratory screening services to help employers

• Identify and act on disease risks in the earliest stages
• Apply drug testing services to help identify and preempt dangerous workplace drug use
• Comply with OSHA-required laboratory screening and vaccination requirements

Based on industry-leading diagnostics expertise, Quest Diagnostics offers solutions that incorporate the latest science, technology, and innovations in laboratory medicine and healthcare management, all of which employers can take advantage of to improve workforce health. For more information, visit WorkforceHealthSolutions.com.

Written by Bill Current, President, Current Consulting Group