Employee Drug Testing: Weighing the Costs and Benefits

Board approved icon
Medically Reviewed by Expert Board.

This page was fact checked by our expert Medical Review Board for accuracy and objectivity. Read more about our editorial policy and review process.

This article was last modified on
Learn more about...

In the United States, work life generally represents one-third of our time. What is done outside of the work environment can have an impact on what happens within – including drug use. It’s for this reason employee drug testing has become common among many employers.

Employee drug testing is done in all industries but is routine where employee focus is essential to safety and security. Companies commonly choose to drug test if employees operate heavy machinery, drive vehicles on the job, or handle hazardous materials. Organizations that have an impact on the health and safety of others have a responsibility to the community, their shareholders, and to the rest of their workforce to encourage a drug-free workplace. Other companies use drug testing to ensure productivity and to limit absenteeism. In these environments, the practice of workplace testing is controversial.

Drug-testing critics argue that drug use outside of the workplace is a private matter that does not impair job performance. They point to the high rate of false positives as well as to results that reflect usage from hours, days, or even weeks before the test is administered to support their assertion that the tests are invasive, unnecessary, and morally wrong, especially when used to determine employment status.

Employee drug testing may make sense for some employers, but in all cases, test use needs to reflect a thoughtful approach that considers all of the costs and benefits.

I. Common Workplace Drug Testing Situations

Employers that make use of drug testing generally do so based on the specific needs, circumstances, and values of their organization or industry. An estimated 40% of U.S. workers are asked to submit to a drug test as part of their hiring process. Some industries are required to maintain drug-free work environments under state or federal laws, and lack of compliance can lead to lawsuits or penalties for compliance failures. Many are driven by liability concerns, while others focus on the positive change that a drug-free environment can create, including better morale and decreased absenteeism. There are also discounts on workers’ compensation insurance for companies that establish Drug-Free Workplace Programs.

Though some view drug testing as an indication of employer mistrust, there are others who praise random drug testing as a proactive measure that discourages drug use and who insist that positive tests can lead to employees getting much-needed help. The wide range of reasons that drug tests are applied is evidenced by the various types of tests that are administered:

Pre-employment testing

Pre-employment drug testing happens when an employer offers a job to a candidate, but before they sign an employment contract or begin working. There are many reasons why employers require these tests. Statistics show that drug-free environments lead to reduced employer costs for direct medical costs, improved productivity, and reduced absenteeism, workplace accidents, and injuries. Compliance with industry-specific regulations is also a common reason.

The tests usually rely on urine, hair, blood, or saliva specimens. The laws surrounding pre-employment drug testing vary from state to state, but employers are permitted to drug test potential employees as a condition of employment, even with no reason to believe the candidate has been taking drugs. The tests cannot be assigned on a case-by-case basis: they must be administered to all incoming employees, and some states are required to alert applicants that drug testing is required within their job postings.

Job candidates have the option to refuse pre-employment drug testing but doing so may result in a job offer being revoked, required drug-abuse education, and other consequences.

Post-accident testing

Post-accident testing occurs after an accident that occurred during work time or on company property that harmed or could have harmed employees, caused damage to an organization’s assets or injured others outside of the company. Workplaces that use post-accident testing must have clearly stated policies that require employees to submit to testing if there is good reason to believe that drugs or alcohol contributed to a workplace accident. Compliance with industry-specific regulations is also a common reason.

Every employer can establish their own criteria for when post-accident testing is appropriate. For most, testing is pursued whenever an accident involves a fatality, injuries requiring medical assistance, police citations, or damages to property valued at a specified monetary amount. It is important that post-accident drug testing not be viewed as retaliation for reporting a workplace injury: OSHA has indicated that policies and procedures surrounding post-accident testing must be reasonable and limited to situations in which employee drug use very likely caused the injury or illness.

Post-accident testing is generally completed within 12 hours of the incident. Testing usually uses urine or saliva for the testing specimen because they are the tests that most reliably detect very recent drug use.

Employees who have been involved in accidents and are asked to submit to post-accident testing are usually asked to stop working until the results of their tests have been received. The same company policies that indicate when post-accident testing is required should also indicate the consequences for refusing to provide a sample for testing, including disciplinary action for engaging in activities that hinder or invalidate testing or for leaving the scene of an accident.

Periodic testing

Periodic drug testing is done on a predictable schedule that employees are aware of and can anticipate. Organizations that employ periodic drug testing generally mandate that every member of their staff undergo drug testing on a regular basis, with some using quarterly testing and others incorporating testing into required annual physical examinations. Each organization can determine its own interval for testing based on its perceived needs.

For employers, the perceived benefits of period testing include a sense that they are furthering their safety, health, morale, and productivity goals in a way that is more acceptable and less intrusive for employees. Where employees test positive or have previously struggled with substance abuse, periodic testing can provide an incentive to avoid drug use.

Employees of companies that utilize periodic testing have generally agreed to the protocol within their employment contracts. Though employees who use drugs can alter their use to avoid testing positive, the process is generally viewed as acceptable because it is less intrusive than random testing and inclusive of the entire staff.  Employees who have agreed to periodic drug testing at the time of their employment who later choose not to participate are subject to consequences in the company’s drug and alcohol policy, which may include counseling or termination.

Random testing

Random drug testing is done without specific warning, though companies that utilize random testing need to give notice that all employees are subject to drug testing at any time. The selection process is unbiased and is often administered by either a third-party administrator or a computer. Some states have outlawed random testing, requiring that employers either limit their use to employees who serve in positions designated as high-risk or safety-sensitive or where there is a reasonable suspicion of substance abuse.

Where random drug testing is permitted, executed in a truly random fashion, and combined with detailed workplace policies regarding drug use, it is an extremely effective deterrent because employees know that there is always the possibility of being picked, but don’t know when it will happen.

Random drug tests are generally administered using urine, hair, blood, or saliva specimens. To ensure accuracy, there needs to be a limited amount of time between notifying an employee that they have been selected and the test is administered.

Employees have the right to refuse to participate in a random selection, but doing so generally comes with consequences in the company’s drug and alcohol policy, which may include counseling or termination.

Reasonable suspicion testing

Reasonable suspicion testing is conducted in response to direct observation of erratic or abnormal behavior, disorientation, confusion, an inability to complete routine tasks or evidence of illicit substances or related paraphernalia. These triggers can be reported by either another employee or a supervisor – either is viewed as justification of “for-cause” testing. Employers using reasonable suspicion testing should train management to identify signs of drug abuse on the job, document it immediately, and respond to it quickly.

Signs that can act as a catalyst to “for-cause” testing include physical signs such as slurred speech or an unsteady walk; behavioral signs such as a decline in performance or withdrawal from engagement with colleagues or management; or psychological signs such as unexplained changes in personality or attitude, angry outbursts, or inability to focus.

Reasonable suspicion testing is generally included within a company’s drug-free workplace policy, notifying employees that they are subject to testing where signs and symptoms suggest it is needed. Employees asked to submit to reasonable suspicion drug testing are generally not permitted to drive themselves to a testing lab.

Reasonable suspicion testing generally consists of saliva or urine testing, which provides reliable results of recent drug use. Employees who are asked to submit to reasonable suspicion testing have the right to refuse to take a workplace drug test but can be fired for that refusal.

Follow-up testing

Follow-up drug testing is conducted after an employee has participated in a substance abuse program and comes back to the workplace after having successfully passed a return-to-work test. It is a random drug testing program used to ensure that they have discontinued the use of illicit substances, and its implementation is generally part of a return-to-work agreement.

Substance abuse is a powerful addiction, and follow-up drug testing both supports the employee’s continued success with remaining drug-free and ensures that the workplace is safe. Follow-up drug screening programs can be tailored to the individual employee’s needs in coordination with their recovery advisors, but usually consist of an established number of tests over a specific period of time. Tests can be periodic or random, with negative unannounced follow-up tests considered a requirement of continued employment.

The tests usually rely on urine, hair, blood, or saliva specimens. Employees have the option to refuse follow-up testing, but doing so will likely result in job loss or required return to substance abuse counseling.

Understanding drug test circumstances

Employers: Pre-employment drug testing and employee drug testing can be extremely effective tools for maintaining a drug-free environment. Testing can increase safety and productivity, boost morale, reduce your premiums for workers’ compensation, and protect your organization from liability for injuries, fatalities, or property damage. Unfortunately, testing can also engender ill will from employees who feel distrusted and intruded upon. It is essential that all drug testing practices and consequences are implemented in conjunction with well-documented drug-free workplace policies and in keeping with state and federal regulations.

Employees: Though many employees resent workplace drug testing, others welcome it as a way to ensure their safety. Job candidates who refuse to participate in pre-employment drug testing may find their job offer withdrawn, and employees who opt-out of periodic, random, reasonable suspicion, or follow-up drug testing may be terminated in keeping with their company’s stated policies.

II. Types of drug tests

Drug tests rely on biological samples – usually urine, saliva, sweat, hair or blood – which are exposed to chemical analysis to reveal drug use over the previous hours, days, or weeks. The tests specifically look for drugs with the potential for abuse, including some prescription drugs and alcohol.

Almost all employment drug testing occurs at reputable, certified laboratories that use a two-step process, though rapid screening can be performed at the workplace in order to allow detection of drugs that metabolize quickly and that would not be detectable at a later screening.

Samples analyzed at professional laboratories are first subjected to immunoassay and gas chromatography tests. If those tests deliver negative results, no further testing is done, but if they deliver a non-negative result, further analysis with higher levels of sensitivity and specificity is used before reporting a positive result to the employer.

Each type of sample delivers different results. Urine and saliva tests are the two that are most commonly used, and urine is the only substance approved for testing for federally mandated drug tests. Both reliably reveal substance abuse that occurred within hours or days of the test being conducted, thus defeating efforts to camouflage or defeat test accuracy.

Understanding drug test types

Employers: When deciding what type of workplace drug testing is appropriate for their workplace, employers should consider factors including state regulations, industry requirements, substances to be tested for, and whether they want to conduct tests onsite or to have them professionally conducted at laboratories equipped to ensure quality control, split samples and chain-of-custody. Employers also need to understand that different samples detect substance use over different periods of time. While urine and saliva samples reveal recent use that may have an impact on job performance, hair samples will detect drug use from up to a month earlier.

Employees: Employees subject to testing should be aware that some types of drug tests will detect substance abuse from weeks earlier. That may not have any impact on job performance.

III. Most Commonly Tested Drugs

Drug testing’s goal is to detect the use of substances that impair thinking, judgment, and physical health. Though many substances are subject to abuse, some are far more readily available, affordable, and commonly used. These are the drugs that employers are most concerned about, and which drug tests are designed to detect.

Understanding commonly tested drugs

Employers: Choosing which drugs to test for depends on your industry, your staff, and your business needs. The most common drug test is a standard 5-panel urine drug test that detects marijuana, cocaine, opiates, phencyclidine (PCP), and amphetamines, which are the most commonly abused street drugs. Larger panel tests will detect abuse of prescription drugs and painkillers. Understanding your workforce will also help, as wealthier workers may require testing for more expensive drugs meant to improve focus.

Employees: Knowing what drugs your employer is testing for may guide your personal behaviors. If you test positive for a drug for which you have a legal prescription, you should be prepared to provide proof of your prescription.

IV. Benefits of Workplace Drug Testing

Drug abuse is a problem that has a direct and profoundly negative impact on the workplace. From the direct effects of the drugs themselves to employee preoccupation with obtaining or using drugs, occupational studies indicate that drug abuse costs employers over $80 billion a year. Those costs are in lost productivity, absenteeism, injuries, fatalities, theft, and low employee morale, as well as in increased health care costs, greater risks of legal liability, and increased workers’ compensation costs.

Drug testing serves as a potent deterrent to keep employees from using drugs in and out of the workplace, as well as an effective way to identify employees who are struggling with substance abuse and who need support.

Drug testing can promote safety

Working under the influence of drugs or alcohol can lead to on-the-job accidents. Testing, combined with employee assistance and education, can support a safer workforce, reducing accidents, injuries, and workers’ compensation claims.

Drug testing can support employee health

Recreational drugs can create serious health issues. Depending on the drugs used, the individual’s health, how much and how often they use, and other factors it can lead to short-term effects including harmful shifts in heart rate and blood pressure, insomnia, changes in appetite, stroke, psychosis, overdose, and death. Potential long-term effects include heart or lung disease, cancer, mental illness, hepatitis, addiction, and more.

When workplace drug testing is introduced, it has a direct deterrent effect on employee drug use. Drug testing can improve employees’ health by identifying workers who require support to overcome substance abuse problems.

Understanding the benefits of workplace drug testing

Employers: Employers want their workplace to be successful, and to achieve that employees need to be safe, focused, productive, and healthy. Workplace drug testing discourages activities that work against those goals.

Employees: Employees are aware of the problems that drug use can create in the workplace, including negatively affecting attendance, productivity, morale, and safety. They generally support drug testing of workers, especially those in safety-sensitive jobs.

V. Drawbacks of Workplace Drug Testing

For all of its potential benefits, workplace drug testing introduces a risk of incurring significant costs that go beyond the actual expense of administering the program. Many workplaces that require testing experience difficulty in attracting qualified employees who might not have caused any problems, or end up losing otherwise excellent workers.

Testing has been complicated by marijuana’s medicinal use and legalization, and the possibility that some employees may face consequences with an employer for the same actions allowed by others. Perhaps more than any other drawback, many employees view mandatory workplace drug testing as an indication of distrust or as an intrusion on their privacy that can have a detrimental impact on employee morale.

Drug testing can erode employee relationships

Employee morale is a key performance indicator for business success, and though some employees appreciate the need for workplace drug testing, many others find it insulting, intrusive, and an invasion of their privacy. The resentment of having to periodically or randomly submit to a urine test can have a significant negative impact on the level of trust between employees and management. and terminating a much-loved colleague as a result of a positive drug test can lead to discontent. It also might leave employees in need of treatment without anywhere to turn.

Drug tests aren’t always accurate

There are numerous types of drug tests available, and employers are encouraged to choose carefully based on the risks faced by their workplace and industry, the substances most frequently abused by their workforce, the laws within their state, and other considerations. Drug testing has become so sophisticated that custom tests can be created if needed. Though most companies use the same 5-panel test that is used by the U.S. Department of Transportation when testing employees in the industries that they regulate, others use a 10-panel test that detects additional substances.

Despite the overall reliability of these tests, false-positive results do happen.

False-positive is the term used when a test appears to detect a substance that isn’t actually found in the sample. It can be caused by byproducts of over-the-counter and prescription medications, nutritional supplements, and even some foods that have chemical similarities to the substances being tested for. These are just some of the substances known to cause false positives:

  • Amitriptyline (Amitril): An antidepressant.
  • Bupropion (Wellbutrin): An antidepressant.
  • Dextromethorphan (Robitussin, Delsym): Found in many over-the-counter cough suppressants.
  • Diltiazem (Cardizem): Used to treat hypertension (high blood pressure) or to slow heart rate.
  • Diphenhydramine (Benadryl): An antihistamine found in allergy medications or sleep aids.
  • Ibuprofen (Motrin, Advil) and naproxen (Aleve): Over-the-counter anti-inflammatory pain medications.
  • Metformin (Glucophage): A common oral medication for diabetes.
  • Fluoxetine (Prozac) and trazodone: Used to treat depression.
  • Pseudoephedrine (Sudafed): Used for sinus and nasal congestion.
  • Labetalol (Trandate): Used for blood pressure control.
  • Methylphenidate (Ritalin): Used to treat ADHD.
  • Doxylamine: Found in over-the-counter sleep aids.
  • Sertraline (Zoloft): An antidepressant.
  • Tramadol (Ultram): Used for pain treatment.
  • Quetiapine (Seroquel): An antidepressant.
  • Phentermine (Adipex-P): Weight loss medication.
  • Oxaprozin (Daypro): Anti-inflammatory medication used to treat arthritis.
  • Venlafaxine (Effexor XR): An antidepressant.
  • Proton pump inhibitors (omeprazole, esomeprazole, pantoprazole): Used to treat gastroesophageal reflux disease (GERD) and heartburn symptoms.
  • Quinolone antibiotics (levofloxacin, ofloxacin): Used to treat urinary tract infections, pneumonia, sinus infections, and more.

Additionally, there are numerous strategies posted on social media and other websites advising savvy employees on how to circumvent tests and create false-negative tests despite actually having used illicit substances. Though professional laboratories have implemented processes meant to avoid these tactics, motivated employees can find a way.

Detection depends on drug clearance rates

Different drugs clear out of the human body at different rates, so the accuracy of a workplace drug test will depend in large part on when the test is administered in relation to when the drug has been used. Employers who are trying to assess whether specific drugs have been taken should be aware of the following clearance rates:

Random testing isn’t conclusive

Many companies drug test for the purpose of ensuring that employees are not under the influence while at work rather than trying to achieve a drug-free workplace. Because many drug tests will detect substance use that occurred several days prior to testing, there can be a significant difference between having used and actually being under the influence at work. As a result, random testing can lead to results that demand consequences that may not be appropriate.

Understanding the drawbacks of workplace drug testing

Employers: Though employers have good reasons for wanting to drug test employees, they need to be aware that doing so may engender distrust among employees. Responses to positive results need to be thoughtful and measured in order to accomplish positive change in a fair and compassionate way.

Employees: Employees who are subjected to workplace drug testing need to be mindful of the various advantages that a drug-free workplace offers. They also need to be aware of their rights, particularly in the event that a test results in a false positive.

VI. State Workplace Drug Testing Laws

Though there are a few industries for which drug testing is regulated by federal agencies, private employers are subject to the laws and regulations established by their individual states. These are far from universal, with some addressing the specific situations under which testing is permitted and some specifying testing methodology. The list below indicates which states permit employers to administer drug tests to job applicants and employees.

VII. Resources for Workplace Drug Testing

There are many resources available to provide additional information on workplace drug testing. Here are a few of the ones that are most helpful:

Substance Abuse and Mental Health Services Administration (SAMHSA): A division of the U.S. Department of Health and Human Services dedicated to public health efforts to reduce the impact of substance abuse.

Substance Abuse Program Administrators Association (SAPAA): Organization that promotes standards of quality, integrity, and professionalism for providers of products and services related to the administration of substance abuse and drug testing programs in the workplace.

Drug and Alcohol Testing Industry Association (DATIA): Provides information about technologies and products regarding drug and alcohol testing.

Substance Abuse Program Administrators Association (SAPAA): Trade association of alcohol and drug testing service agents and administrators working towards creating high standards of quality and integrity in substance abuse testing and prevention.

Workplace Fairness: Organization dedicated to the fair treatment of workers and providing unbiased information about workers’ rights.

VIII. Learn More from Our Sources