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Drug Testing for Healthcare Staffing Workers

Facilities may require staffing agencies to drug test nurses, aides, and allied workers before placement. This kind of testing is non-DOT. The federal transportation rules do not apply to it. This guide explains where the requirement comes from, what common test panels cover, how state marijuana laws can limit testing, why a medical review officer matters, and how to keep results private. It is not legal advice. Check your state.

Updated October 3, 2026 · Checked against the official sources listed at the end

Is drug testing required by federal law?

For most private employers, no. The Substance Abuse and Mental Health Services Administration (SAMHSA) says there is no requirement for most private employers to have a drug-free workplace policy of any kind. The exceptions are federal contractors and grantees, and safety- and security-sensitive industries and positions.

Even the federal Drug-Free Workplace Act does not call for testing. A U.S. Department of Labor notice says neither the Act nor its rules authorizes drug testing of employees.

So for a private healthcare staffing agency, any requirement to test comes from somewhere else. It may be a facility contract, a state program, or your own policy.

Read each facility contract for its testing rules: when to test, which panel, who collects, and what result is acceptable.
Write your own policy and apply it the same way to everyone.
Check your state's drug testing laws before you test.

5-panel vs. 10-panel tests

A "panel" is the list of drugs a test looks for. Panel contents vary. One national lab says it offers hundreds of different combinations of drugs, test codes, and cutoff levels.

That lab says its most commonly requested urine test is a 5-panel that screens for amphetamines, cocaine, marijuana, opiates, and PCP.

The lab's sheet of commonly ordered urine panels (dated 2019) includes a 10-panel. Compared with the 5-panel above, it adds barbiturates, benzodiazepines, methadone, methaqualone, and propoxyphene. That 10-panel also tests for MDMA and related drugs, 6-acetylmorphine (a heroin marker), hydrocodone and hydromorphone, and oxycodone and oxymorphone. The sheet lists the cutoff level for each drug.

Ask the lab or collection vendor for the exact drug list and cutoffs for the panel you order.
Match the panel to what the facility contract requires.
The same lab also offers panels for a broader range of prescription drugs that are more accessible in healthcare settings.

Why a medical review officer matters

A positive lab result does not always mean misuse. Tennessee's drug-free workplace program notes that certain foods and medicines contain detectable amounts of controlled drugs. A worker may have a valid prescription.

A medical review officer (MRO) is a licensed physician who reviews positive results. In Tennessee's voluntary Drug-Free Workplace Program, for example, employers must use a lab that employs an MRO. The program says the MRO should review all positive tests with the employee or applicant before the employer is told the result.

The EEOC says many questions about lawful drug use are not allowed before a job offer, because they can reveal a disability. But if an applicant tests positive, the employer may ask about lawful drug use to check the result. With an MRO, that conversation happens with a doctor instead.

Use a lab and collection process that include MRO review of positives.
Ask what your vendor's MRO reports to you. Ideally it is a verified result, not the worker's medical details.

State marijuana laws

Several states protect off-duty marijuana use. These laws can limit when you test for marijuana and what you can do with a positive result. Three examples:

New York: Labor Law 201-d protects legal off-duty cannabis use, off the employer's premises and without the employer's equipment. Employers can still act if the law or a federal mandate requires it, if the worker shows specific signs of impairment while working, or if not acting would violate federal law or cost a federal contract or funding. The state Department of Labor's FAQ says an employer cannot test for cannabis unless one of those exceptions or another law allows it.

New Jersey: N.J.S.A. 24:6I-52, as enacted in 2021, says employers cannot take adverse action against a worker because they do or do not use cannabis, or solely because cannabis metabolites are found from lawful use. Employers may still test before hire, at random, for reasonable suspicion, or after an accident. The law says a drug test must include scientifically reliable testing and a physical evaluation of impairment by a certified person.

California: Government Code 12954, in effect since January 1, 2024, makes it unlawful to discriminate based on off-the-job cannabis use, or on a test that finds nonpsychoactive cannabis metabolites. Employers may still use pre-employment tests that do not screen for nonpsychoactive metabolites. Employers also may not ask applicants about prior cannabis use, with limited exceptions.

These laws do not let workers use or be impaired by cannabis at work.
Each law has exceptions. Read the exact text for your state.
Tell your lab which states you test in so the panel fits each state's rules.

State testing laws and drug-free workplace programs

SAMHSA says many states have their own laws on when and how workplace drug testing can be done. Some states allow testing in almost any business. Others limit who can be tested, how, and what happens after a positive test.

Some states also run voluntary drug-free workplace programs. Tennessee's program is one example. The state says employers are not required to join. Employers certified in the program get a 5% credit on their workers' compensation premium. The program also comes with rules, such as using an approved lab and an MRO.

Check the testing law in each state where you hire or place workers.
If you join a state program, follow its rules exactly. The benefits depend on it.

Keeping results confidential

Under the ADA rules, a test for illegal drug use is not a medical exam. But a test can reveal other medical information, such as a prescription. The ADA rules say that information, other than information about illegal drug use, is still covered by the ADA rules for medical exam results.

Those rules require medical information from post-offer medical exams to be kept on separate forms, in separate medical files, and treated as a confidential medical record. A simple way to stay safe is to store all drug test records the same way.

Keep drug test results out of the general personnel file.
Limit access to the people who need it.
Send facilities only what the contract requires, such as a negative or verified result.
Do not share the worker's medication or medical details with the facility.

Common questions

Does federal law require us to drug test healthcare staffing workers?

Not generally. SAMHSA says most private employers are not required to have a drug-free workplace policy at all. The exceptions are federal contractors and grantees, and safety- and security-sensitive industries and positions. Where an agency must test, the requirement may come from a facility contract, a state program, or its own policy.

What is the difference between a 5-panel and a 10-panel?

The number of drug groups tested. One national lab's 5-panel covers amphetamines, cocaine, marijuana, opiates, and PCP. Its 10-panel adds barbiturates, benzodiazepines, methadone, methaqualone, and propoxyphene. Panels vary by lab, so ask for the exact list.

Can we test for marijuana in New York?

Usually not. The New York Department of Labor says an employer cannot test for cannabis unless an exception in Labor Law 201-d(4-a) or another law allows it. Exceptions include a state or federal requirement and specific signs of impairment at work.

Can we still do a pre-employment drug test in California?

Yes, but California Government Code 12954 limits marijuana results. Employers may use pre-employment tests that do not screen for nonpsychoactive cannabis metabolites. They may not penalize someone for off-the-job cannabis use or for nonpsychoactive metabolites.

Do we need a medical review officer for non-DOT tests?

It depends on your state and any program you join. Tennessee's Drug-Free Workplace Program, for example, requires a lab that employs an MRO. Even when not required, an MRO helps sort out positives caused by valid prescriptions.

Can we tell the facility why a worker failed a test?

Share only what the contract requires. Treat medical details from a test, such as a prescription, as confidential medical information.

Sources

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