By Dr. Mark Villoria, Senior Manager of Scientific Affairs, Abbott
Workplace drug testing programs are often viewed as stable. However, consistent testing volumes, specimen types and positivity rates may not reflect underlying risk.
Substance use patterns, workforce behaviors and regulatory expectations evolve, but organizations may mistake stable outputs for control and overlook changes beneath the surface.
The illusion of stability
Recent Abbott data* show minimal change in testing trends.1 Urine remains the dominant specimen type, while oral fluid testing has grown, and hair testing continues to decline. Positivity rates and panel selection appear unchanged.
Yet, preemployment testing has declined slightly, while reasonable suspicion, post-incident and follow-up testing have increased. In practice, testing is triggered after something has gone wrong, rather than identifying risk early.
On paper, programs look stable. In reality, the underlying risk profile may be shifting.
*Dataset consists of internal Abbott testing data aggregated nationally, with results reviewed and adjudicated by certified medical review officers. MRO review removes legitimate medical explanations, yielding finalized results that inform employer decisions. As a result, positivity rates may appear lower than raw laboratory data but more accurately reflect workplace outcomes.
The unmeasured reality
Drug testing detects substances at a point in time but doesn’t capture the full scope of substance use.
Public health data indicates that about 25.5% of individuals (aged 12 and older) reported illicit drug use in 2024, while 16.4% of adults (aged 26 and older) meet criteria for a substance use disorder.2 Among young adults entering the workforce, prevalence is even higher – 38.1% reported illicit drug use, and 25.9% met criteria for a substance use disorder. Yet, workplace drug-testing positivity rates typically remain in the single digits.1
This doesn’t mean testing is failing – it’s being asked questions it wasn’t designed to answer. Detection windows, testing frequency and panel design define what can be seen. A negative test may simply mean that use occurred outside the detection window – not that risk is absent.
Stigma further widens this gap. Employees may avoid disclosing substance use because of fear of judgment, disciplinary action or job loss.3 Risk often remains hidden until it appears as a performance issue or incident. When testing is perceived as punitive instead of protective, engagement drops and organizations lose visibility into emerging risk.
Timing matters
Timing presents a major challenge, as results are often not available when they’re needed most.
For example, post-incident testing may occur hours or days after an event, making it difficult to assess whether use occurred near the incident. Similarly, supervisors may observe concerning behavior without immediate access to objective data.
Delays in reporting – especially in paper-based workflows – further reduce the usefulness of results. By the time results are available, decisions are often already made.
Aligning testing with decision-making
Addressing these gaps requires moving away from a one-size-fits-all view of drug testing toward a more targeted, decision-driven approach.
Different testing methods offer distinct insights: 4
- Urine identifies historical use over days or weeks
- Oral fluid captures more recent use within hours to days
- Hair reflects longer-term patterns
For incident-driven scenarios, the key question is whether substance use occurred recently. Shorter detection windows offer more relevant insight.
Oral fluid testing detects parent drug compounds rather than metabolites5 and aligns more closely with recent use. It doesn’t replace urine testing but can complement it – giving organizations flexibility to match the testing method to the decision at hand.
From detection to insight
Equally important is how quickly results are delivered. Digital workflows can reduce turnaround times, improve accuracy and increase visibility. Faster access to results supports more timely responses.
But detection alone isn’t enough. Effective programs do more than identify positive results – they support better decisions. This includes using trend data to identify patterns, aligning testing strategies with specific use cases, and creating environments where employees feel safe engaging with the system.
Moving forward
The most effective workplace drug testing programs are defined by alignment.
When testing methods, timing and response strategies are aligned with real-world decision needs, organizations gain clearer insight into risk. When stigma is addressed and engagement improves, hidden risks become visible earlier.
Ultimately, workplace safety depends less on what’s detected than on how quickly and effectively organizations act on that information.
- Questions about this article? Email Dr. Villoria at [email protected] for more information.
References
1Internal Abbott data on file. 2Substance Abuse and Mental Health Services Administration. (2025). Key substance use and mental health indicators in the United States: Results from the 2024 National Survey on Drug Use and Health (Center for Behavioral Health Statistics and Quality, HHS Publication No. PEP25-07-01-001, NSDUH Series H-60). U.S. Department of Health and Human Services. samhsa.gov 3National Institute on Drug Abuse. (2024). Stigma and discrimination. U.S. Department of Health and Human Services. [Accessed 27 March, 2026: https://nida.nih.gov/research-topics/stigma-discrimination#research]. 4Lighthouse. (2026). How long do different drugs stay in your system? Complete detection timeline. [Accessed 1 June, 2026: https://lighthouserecoverytx.com/how-long-do-different-drugs-stay-in-your-system-complete-detection-timeline/] 5Cone, Edward J., and Marilyn A. Huestis. “Interpretation of Oral Fluid Tests for Drugs of Abuse.” Annals of the New York Academy of Sciences, vol. 1098, March 2007.
