Key Points

  • Quest Diagnostics’ 2026 Drug Testing Index found that 19.1% of workers who had a hair specimen test were positive for drug use in 2025, a relative increase of 46% since 2021, with hair analysis capturing a roughly 90-day window that points to recurring use rather than one-time incidents.
  • Positive rates were highest in retail trade, healthcare and social assistance, administrative support and waste management, and construction; substances differed by sector, with cocaine most prevalent in construction and opiates highest in healthcare.
  • A University of Pennsylvania study published in the Review of Economics and Statistics found that service members who received a first opioid prescription in the emergency department were 34% more likely to test positive for opioids the following year and saw a 5% drop in promotion likelihood.
  • Career harm showed up in behavior before physical decline: the same service members had a 12% rise in disciplinary actions and a 9% increase in job separations, while physical fitness scores held steady throughout.
  • Dr. Sylvie Stacy notes that opioid-related cognitive changes often surface as work problems first (tardiness, missed deadlines, diminished reliability) and that this pattern can be mistaken for a conduct issue rather than recognized as a health one.
  • The Family and Medical Leave Act provides job-protected unpaid leave for eligible employees seeking addiction treatment regardless of which substance is involved, and most private plans plus Medicaid and Medicare are required to cover addiction treatment services under mental health parity law.

Addiction News Weekly Episode 1.10

In This Episode:

Episode Transcript

Welcome to Addiction News Weekly by Rehab.com, where we break down the biggest stories in addiction, recovery, and public health. This week, the theme is the part of addiction that shows up at work, in careers, and in the drive for money. Starting with new data on how many workers are testing positive for drug use and which industries are most affected, research tracking what happens to a career after a first opioid prescription, and new science on the dopamine system that may explain why the compulsion to accumulate wealth can look a lot like an addiction. Let’s get into it.

Nearly One in Five U.S. Workers Tested Positive in 2025

We start with the workplace numbers. Quest Diagnostics, one of the largest clinical laboratory networks in the country, released its 2026 Drug Testing Index, and it showed a sharp rise over the past four years.1

Close to one in five tested workers had a positive result for drug use based on hair analysis across Quest’s U.S. client base. Positive tests rose 46% since 2021, even as fentanyl-specific positives declined over that same period.1 The testing method is what matters here. Hair analysis captures roughly a 90-day window, a much wider net than standard urine screening, and Quest said that this points to a pattern of long-term recurring use rather than occasional use among many workers who tested positive.

Broken out by industry, retail trade led at 5.9%, followed by healthcare and social assistance at 5.6%, administrative support and waste management at 5.2%, and construction at 5.1%. The substances differed by field. Cocaine was highest among construction workers, opiates were highest among healthcare workers, and amphetamines were highest in educational services and healthcare.1

One important caveat: a positive test does not by itself mean someone has a substance use disorder, but the chronic recurring patterns that their testing picks up can be an early signal that treatment, rather than discipline alone, is the more useful next step. For workers in these higher-rate industries who are worried about their own use or a co-worker’s, evidence-based options range from outpatient counseling to medication-assisted treatment for opioid use disorder, and federal job protections apply in some circumstances for people who need to take time away to get care.

One Opioid Prescription and What Follows for a Military Career

Our second story follows that thread from a drug test into an actual career. A new study published in the Review of Economics and Statistics tracked what happened to U.S. military service members in the two years after they received their first opioid prescription in an emergency department.2 The research was led by University of Pennsylvania economist Abby Alpert, using more than a decade of linked military personnel and medical records.2,3

The study’s design is worth pausing on. Because service members at military hospitals cannot choose their treating physician, the researchers could isolate the effect of how freely a given doctor prescribed, rather than the patient’s own preferences. Service members who happened to be treated by heavier-prescribing physicians were more likely to receive an opioid prescription, and those who did were 34% more likely to test positive for opioids on a random drug screen the following year.2 The career effects followed. Promotion likelihood fell 5% in the year after that first prescription. Disciplinary actions, including tardiness and unexcused absences, rose 12%. Job separations increased 9%, with discipline-related exits accounting for nearly half of that rise.2

For the clinical read on what that means, here is Rehab.com Chief Medical Officer Dr. Sylvie Stacy. A finding in this study that I keep coming back to is that physical fitness scores of the participants didn’t decline. These were service members with regularly measured physical performance and that physical performance held steady while the people’s promotions and attendance and disciplinary records all moved in the wrong direction. So that tells us the harm showed up behaviorally before it showed up physically. In practice, that’s often really how this presents. Someone is not visibly unwell, but maybe they’re late more often. They’re less reliable, harder to reach, and people around them might read it as a work ethic problem rather than a health issue.

And this is similar to a common scenario that I see in my own patients. Patients who have been on long-term opioid therapy or who have opioid dependence from drug use, they pretty often will report that their memory feels less sharp or that they’re struggling with a persistent brain fog that makes daily tasks more challenging for them. When I bring up the possibility that opioids themselves might be contributing to these cognitive changes, it’s not usually well received right off the bat. People naturally prefer to hear a simple organic cause of their complaints, like thyroid disease, which I understand. We all want to believe that we can fix our issues with something like a medication or fix a vitamin deficiency and that will improve our mental clarity.

And it’s true that we should always investigate for organic contributors. We can’t ignore the evidence on opioids. We have to be clear about the fact that opioids can have significant long-term effects on executive functioning, attention, and memory. A challenge for clinicians is how to have this conversation with patients without sounding dismissive. If I just tell a patient that their medication is the problem, I risk losing their trust. I do try to make this into part of a broader health conversation in which I say that we’ll absolutely check things like labs and do an assessment to try to rule out other factors that may be contributing, but we also do need to consider the long-term impact of opioids.

We also need to be more proactive in discussing these cognitive side effects early on with patients. In fact, discuss them before opioids are even prescribed rather than waiting for them to become a source of frustration. And we need to be sure we’re offering patients non-opioid alternatives. And for some people with problematic opioid use, I’d like to get better at differentiating between the drug noise that is common in active addiction and the potential long-term cognitive impact of opioids, including the medications that we use to treat it like Suboxone and methadone.

Cannabis Testing Policies Have Not Caught Up to the Law

Our third story is about the rules themselves and how quickly they’re changing.4 Cannabis is legal in some form across most of the country, with medical use legal in about 40 states and recreational use legal in 24 states plus Washington, D.C. Federal law has yet to catch up. A proposed move from Schedule I to Schedule III has not been finalized, which means cannabis remains federally illegal even where state law permits it.

That gap is forcing employers to rewrite drug policy and the effects reach well beyond recreational users. A pass-or-fail drug test cannot distinguish between someone using cannabis under a state medical program, someone who used it off the clock days ago, and someone whose use has become a problem that needs treatment. THC can stay detectable for days or weeks, so a positive result often reflects past use rather than current impairment.4

Industry experts quoted in reporting on this describe employers still running binary testing systems built for an earlier era and warn that the mismatch creates legal and insurance risk. Meanwhile, industries that once tested strictly, including retail, hospitality, logistics, and construction, have been loosening cannabis policies to compete for workers. There is also a newer trend of state laws protecting off-duty cannabis use when there is no on-the-job impairment, though those protections are not universal and typically carve out safety-sensitive positions and federal contractors. Transportation and other federally regulated industries are not expected to loosen testing even if rescheduling goes through.

Here is what matters if you are someone caught in the middle of all of this. None of that legal uncertainty changes your options. The Family and Medical Leave Act can provide job-protected, unpaid leave for eligible employees who need time away for addiction treatment, regardless of which substance is involved, and that protection exists independently of how cannabis is scheduled. Most private plans, along with Medicaid and Medicare, are required to cover addiction treatment services under mental health parity law. Policy confusion is a reason to get clear information before deciding, not a reason to put off care.

Conclusion

Put these stories together and addiction looks different than it does in most headlines. It shows up in a quarterly lab report, in promotion records and attendance files, and in the gap between what state law allows and what the company handbook says. The through line is that work is often where substance problems become visible first, and it is also where people have more protection than they realize. Job-protected leave and insurance parity do not depend on which substance is involved or how the policy landscape shifts next.

If you or someone you love is looking for treatment, Rehab.com lists thousands of verified centers across the country, and free, confidential support is available anytime through the SAMHSA National Helpline at 1-800-662-4357. And if you’re in crisis, you can call or text 988 at any time.

Those are the top stories in the news. For more, visit Rehab.com. We will be back next week. I’m Kay, and thank you for listening.

You Might Also Like

  1. Alcohol and Drug Rehab for Working Professionals and Executives — Covers flexible, confidential treatment options for people navigating recovery while maintaining a career, directly relevant to this episode’s workplace theme.
  2. Using FMLA for Rehab — Explains how the Family and Medical Leave Act provides job-protected leave for addiction treatment, the key protection discussed in the cannabis policy segment.
  3. Opioid Addiction and Treatment Options — Core guide to opioid addiction, its mechanisms, and treatment pathways, the foundation for understanding the military career study findings.
  4. Marijuana Abuse and Addiction — Overview of cannabis use disorder, detection windows, and treatment, directly relevant to the workplace cannabis testing discussion.

Sources in This Episode

  1. Quest Diagnostics. One in Five American Workers Tested Had a Positive Hair Drug Test in 2025, Signaling Persistent Long-Term Substance Use Patterns. Quest Diagnostics Newsroom. Published July 10, 2026. https://newsroom.questdiagnostics.com/2026-07-10-One-in-Five-American-Workers-Tested-Had-a-Positive-Hair-Drug-Test-in-2025,-Signaling-Persistent-Long-Term-Substance-Use-Patterns. Accessed August 4, 2026.
  2. Alpert A, Schwab SD, Ukert B. Opioid use and employment outcomes: evidence from the U.S. military. Rev Econ Stat. 2025. https://ldi.upenn.edu/our-work/research-updates/opioid-prescriptions-can-lead-to-misuse-and-poor-job-performance/. Accessed August 4, 2026.
  3. Leonard Davis Institute of Health Economics, University of Pennsylvania. Opioid Prescriptions Can Lead to Misuse and Poor Job Performance. Published 2025. https://ldi.upenn.edu/our-work/research-updates/opioid-prescriptions-can-lead-to-misuse-and-poor-job-performance/. Accessed August 4, 2026.
  4. Robinson B. Cannabis Laws Quietly Creating 6 Surprising Workplace Changes In 2026. Forbes. Published April 6, 2026. https://www.forbes.com/sites/bryanrobinson/2026/04/06/cannabis-laws-quietly-creating-6-surprising-workplace-changes-in-2026/. Accessed August 4, 2026.
Dr. Sylvie Stacy
By Dr. Sylvie Stacy
Published on August 4, 2026
Sylvie Stacy, MD, MPH, Medical Officer at Rehab.com, is a board-certified addiction medicine specialist with over a decade of experience treating individuals with addictions in diverse clinical settings including residential treatment programs, detox centers, outpatient clinics, and correctional facilities.