NPS Q4 2021 Summary

NPS Q4 2021 Summary

Healthcare providers throughout the United States who chose to utilize Aegis’ expansive NPS testing menu were afforded the opportunity to address the use of various designer substances with their patients, with a summary of identified substances provided below.

Aegis offers healthcare providers the opportunity to evaluate their patients’ substance use more completely by offering
testing for numerous classes of novel psychoactive substances (NPS). Without advanced testing, individuals may use
these substances undetected, which can interfere with prescribed therapy and could result in severe adverse events,
including overdoses.

Figure 1. In the fourth quarter of 2021, Aegis detected over 1,500 NPS analytes in healthcare samples
when the testing was ordered. This is an underrepresentation of actual positivity, as many samples do
not include medical orders for NPS testing. Designer opioids were detected most frequently, followed
by designer benzodiazepines, synthetic cannabinoids, “other NPS” and synthetic stimulants. In many
instances, samples included multiple analytes from one drug class and/or analytes from multiple classes,
such as designer benzodiazepines and designer opioids.


The following figures are intended to provide a detailed analysis of the NPS detected as part of
Aegis’ enhanced drug testing options:

Figure 2. The designer opioids are commonly referred to as fentanyl analogs, or fentalogs, however other
non-fentalogs are increasingly observed. Fluoro fentanyl was detected in 727 samples in the fourth quarter.
Despropionyl fluorofentanyl is often detected with fluoro fentanyl and is believed to be either a process
impurity from manufacture or a metabolite of fluoro fentanyl. Of particular interest, markers of
isotonitazene, metonitazene, and etazene have been detected in the fourth quarter. Over the last year,
there have been increasing reports of non-fentanyl opioids found in the illicit drug supply. This is believed
to be a response by clandestine labs to circumvent increased regulation of the fentalogs by both US and
international drug scheduling bodies.


Figure 3. Designer benzodiazepine(s) were detected in 494 samples in the fourth quarter. Clonazolam
and etizolam are detected most frequently, followed by bromazolam and flualprazolam. Designer
benzodiazepines are often found as counterfeit versions of commonly recognized prescription
benzodiazepines, such as alprazolam 2mg “bars” and, in many cases, more than one designer
benzodiazepine is present in these counterfeit tablets.


Figure 4. Synthetic cannabinoids were detected 136 times in the fourth quarter. FUB-PB-22 was the
most detected compound, detected in 48 samples in the fourth quarter. MDMB-4-en-PINACA continues
to be frequently detected, in 42 samples this quarter. 5F-MDMB-PICA, and 5F-MDMB-PINACA complete
the top five cannabinoids detected.


Figure 5. Aegis began offering testing for additional NPS in the second quarter of 2021. While testing
has only been available for a few months, at least one analyte was detected in 107 samples in the fourth
quarter. Xylazine, which is approved as a veterinary tranquilizer, has been most often detected in Aegis
samples. It is a common adulterant found in heroin and illicitly manufactured fentanyl, where it is
sometimes referred to as “tranq-dope” and is increasingly identified in overdose deaths involving
illicit opioids. Tianeptine is used as an approved antidepressant elsewhere in the world but is
only available in the US as a supplement. It is typically misused due to its ability to mimic the effects of
opioids. Phenibut is also approved outside of the US but is used in the US as a supplement for its action
at GABA receptors, with a similar action as benzodiazepines. Deschloroketamine is a ketamine analog
which is purported to have a longer duration of action and be more potent than ketamine and was
identified for the first time in the fourth quarter.  


Figure 6. Eutylone continues to be the most detected stimulant in Aegis’ synthetic stimulant testing, which
reinforces trends observed by many other surveillance sources, such as the DEA. Pentylone and butylone
round out the top three stimulants detected in the quarter; collectively, these are classified as cathinones.
Interestingly, there were four non-cathinone stimulants identified, which were all analogs of amphetamines.
These analytes were, p-methoxymethamphetamine, 3,4-fluoromethamphetamine, 2-fluoroethamphetamine,
and 2-fluoroamphetamine. 




If you are a Healthcare Provider seeking information please contact your Regional Sales Manager or Client Services team at 1.800.533.7052 or email