Workforce drug testing positivity climbed to its highest rate since 2004, according to the latest report of the Quest Diagnostics Drug Testing Index™ (DTI) released this spring. According to the report, 2018 positivity rates in the combined U.S. workforce increased to 4.4% in urine tests, an increase of nearly 5%. Overall positivity is now 25% higher than the 30-year low of 3.5% recorded between 2010-2012. As workforce positivity rates continue to rise, are the same trends reflected in life insurance drug use positivity rates?

Marijuana dominates in the general U.S. workforce and life insurance drugs of abuse positivity rates

The DTI reports that marijuana continues to top the list of most commonly detected illicit substances among American workers. As marijuana is legalized in more states, positivity rates are rising for life insurance applicants, as well. Marijuana positivity for the general U.S. workforce was 2.8%, and even higher in the life insurance population, with a 4.03% positivity rate.

Marijuana in the insurance population remains near its all-time high in 2017.

ExamOne’s data analytics experts also recently published other emerging insights on the magnitude of marijuana risk from a life insurance underwriting perspective. The ExamOne study revealed higher mortality risk among male marijuana users.

Misuse of other drugs impacts both employers and insurance companies

For other drugs of abuse, insurance positivity rates do not differ substantially from those seen in workforce testing. Cocaine, which had a 0.28% positivity rate in urine testing among the general U.S. workforce tested by Quest in 2018, had a 0.17% positivity rate within the life insurance population. Furthermore, amphetamines, which had a 1.2% positivity rate in the same workforce category showed a comparable 0.84% positivity rate in the life insurance subset.

Drug use affects people of all walks of life, including those who work, who have families and who apply for life insurance. Misuse of drugs and addiction can cause workplace accidents and, according to a 2018 article in the Journal of the American Medical Association, among individuals 20-55 years of age “substance abuse, suicides, and diabetes drove a rise in premature deaths in nearly half of the U.S.”

Impact of these losses is shared by employers, insurance companies, and especially families.

See where the highest overall workplace drug positivities are located on this interactive map. And to learn more about adding a drug panel to your life insurance laboratory requirements, please contact your Strategic Account Executive or email:

As of April 2019, recreational marijuana is legal in 10 U.S. states and medical marijuana in an additional 23. Despite the substantial departure from long-standing drug policy which this represents, until quite recently there have been relatively few direct studies on the mortality implications of marijuana use in the general population. While the scientific consensus remains incipient relative to other well-established underwriting criteria such as tobacco, a review of the available literature, in concert with ExamOne’s own original research, does reveal a number of emerging consistencies on the magnitude and origin of marijuana risk from a life insurance underwriting perspective.

ExamOne study reveals higher mortality risk among male marijuana users

Last year, ExamOne completed the most comprehensive review of marijuana mortality risk in an insurance applicant population that we have undertaken to date. With over 1.7 million not-for-cause urine screens for THC, and 8,100 deaths, the study was designed to probe the interaction of marijuana use with applicant age, gender and tobacco status.

Interestingly, the ExamOne study found no statistically significant relationship between THC status and mortality risk in females, but a fairly strong (HR: 1.97, CI: 1.63 – 2.39) effect in males. This finding (marijuana risk in males, but not females) has been replicated in the published literature.1

In broad strokes, the most commonly suggested etiologies for marijuana-linked mortality fall into three categories:

  1. Direct medical effects of marijuana use – particularly respiratory cancers
  2. Direct behavioral effects – principally impaired-driving motor vehicle accidents and, in some studies, suicide
  3. Indirect lifestyle correlates – including other recreational drug use and some observed increase in high-risk infectious disease (HCV and HIV) prevalence.

Interestingly, both categories (2) and (3) would probably be expected to generate disproportionate risk in males. Additionally, ExamOne data does seem to offer some support to the lifestyle correlates thesis; in our data, THC positivity was positively correlated with all tested drugs of abuse except barbiturates.

While some of this correlation is attributable to demographic factors (e.g., the heightened tendency of young males to use both THC and cocaine), the relationships persist even when controlling for this effect.  Odds ratios were notably higher for illegal drugs (PCP, cocaine and methamphetamine), reinforcing the notion of a meaningful sociocultural barrier between legal and illegal drug users. It should be noted, however, that the PCP correlation likely reflects the fact that smoking marijuana/PCP combinations is among the more common consumption modalities for PCP – it is more a fact about (very rare) PCP users than (much more common) marijuana consumers.

While ExamOne generally lacks the data to directly test the behavioral effects hypothesis, a growing number of studies have established a statistical link between marijuana legalization and state level motor vehicle accident rates.2 The Highway Loss Data Institute estimates that legalization is associated with a 6% increase in collision rates; if these excess collisions are concentrated among male users, then impaired driving alone could plausibly account for the bulk of the two-fold increase in risk noted in the ExamOne findings.

What to consider when underwriting marijuana users

While marijuana use might still prove to be a long-term mortality risk in its own right, the most immediate and well-established risk factors for the drug appear to be its correlation with impaired driving, and the abuse of more inherently dangerous illegal drugs. Particularly when underwriting male users, insurers are probably well advised to pay careful attention to driving histories, and any indications of broader recreational drug use.

For more information on drug positivity rates in the U.S., read about Quest Diagnostics’ latest publication of the Drug Testing Index™ (DTI). The DTI, which is the country’s foremost analysis of workforce drug use, found the rate of workforce drug positivity hit a 14-year high in 2018.

1Sidney S, et al. Marijuana use and mortality. Am J Pub Health. 1997;87(4):585-590.
2HLDI Bulletin. Recreational marijuana and collision claim frequencies. 2018;35(8):1-14.

Seeing through the smoke: The correlation of tobacco, marijuana and drugs of abuse

November 15, 2018 Carriers

Smoking raises red flags for insurers across the board – applicants are usually rated if they produce a positive cotinine test. Further, tobacco use can lead to the potential onset of additional health risks, such as cancer, heart disease, stroke, diabetes and/or lung diseases. Aside from these health concerns, studies show a correlation of tobacco […]

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Ask the Expert: Drug trends in America

October 3, 2018 Ask The Experts

During one of our summer webinars, Betsy Sears, Executive Vice President, Laboratory Strategy and Sales, and Dr. Barry Sample, Quest Diagnostics Senior Director, Science and Technology, examined two of America’s populations for drug positivity rates by various drug classes. This included a workforce population and ExamOne life insurance applicants. Understanding the drug trends and positivity […]

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