
2022 NPS 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, use of these substances by individuals may go undetected, which can interfere with prescribed therapy and could result in severe adverse events, including overdoses. In 2022, Aegis detected over 27,700 NPS analytes in healthcare samples when testing was ordered. This is an underrepresentation of actual positivity, as many samples received at Aegis do not include medical orders for NPS testing.
A map of states where NPS were detected in 2022 is included below:
* States with no NPS detected are reflective of provider ordering patterns. Knowledge of NPS use affords providers the opportunity to address potentially dangerous interactions with traditionally monitored substances.
The top 10 analytes detected represent seven parent drugs, with six known to cause CNS depression.
Most Detected Substances (by parent compound):
Parent Drug |
Class |
Fluoro Fentanyl |
Opioid |
Xylazine |
Sedative/Analgesic |
Clonazolam |
Benzodiazepine |
Bromazolam |
Benzodiazepine |
Flualprazolam |
Benzodiazepine |
Isotonitazene |
Opioid |
MDMB-4en-PINACA |
Synthetic Cannabinoid |
Designer Opioids
Aegis detected over 15,500 designer opioid analytes in 2022, with fluoro fentanyl the most detected parent drug. While fentanyl analogs are the most well-known designer opioids, new nitazene analogs continue to appear. There were nine fentanyl analogs and seven nitazene analogs accounting for the majority detected in 2022. If current trends continue, the regulation of illicitly manufactured fentanyl and fentanyl analogs may lead to further diversification of opioid classes found in the illicit drug supply.
Opioids Detected in 2022 (by parent, in order of most to least prevalent) |
|
1) Fluoro Fentanyl |
12) Flunitazene |
2) Isotonitazene |
13) Fluoroisobutyryl Fentanyl |
3) Metonitazene |
14) Carfentanil |
4) Valeryl Fentanyl |
15) 2-Methyl AP-237 |
5) Benzyl Fentanyl |
16) Dipyanone |
6) N-desethyl Isotonitazene |
17) Butonitazene |
7) Bromo Fentanyl |
18) 4-Trifluoromethyl U-47700 |
8) Brorphine |
19) Cyclopropyl Fentanyl |
9) Acryl Fentanyl |
20) N-piperidinyl Etonitazene |
10) Chloro Fentanyl |
21) U-47700 |
11) Protonitazene |
|
Designer Benzodiazepines
Aegis detected over 6,450 designer benzodiazepine analytes in 2022, with clonazolam, bromazolam, and flualprazolam most detected. Designer benzodiazepines are believed to carry at least similar risks as traditionally monitored prescription benzodiazepines. They are often sold as counterfeit versions of common prescription benzodiazepines, like alprazolam, however in some isolated cases they can contain opioids, such as fentanyl analogs.
Benzodiazepines Detected in 2022 (by parent, in order of most to least prevalent) |
|
1) Clonazolam |
7) Deschloroetizolam |
2) Bromazolam |
8) Phenazepam |
3) Flualprazolam |
9) Adinazolam |
4) Etizolam |
10) Diclazepam |
5) Flubromazolam |
11) Metizolam |
6) Flubromazepam |
|
Synthetic Cannabinoids
Aegis detected over 1,540 synthetic cannabinoid analytes in 2022, representing 21 unique parent compounds, with MDMB-4en-PINACA, 4F-MDMB-BUTINACA, and 5F-MDMB-PICA most detected.
Cannabinoids Detected in 2022 (by parent, in order of most to least prevalent) |
|
1) MDMB-4en-PINACA |
12) MDMB-5Br-INACA |
2) 4F-MDMB-BUTINACA |
13) JWH-018 |
3) 5F-MDMB-PICA/5F-EMB-PICA |
14) JWH-073 |
4) FUB-PB-22 |
15) MMB-4en-PICA |
5) ADB-BUTINACA |
16) ADB-4en-PINACA |
6) 4F-MDMB-BUTICA/4F-EMB-BUTICA |
17) MMB-4en-PINACA |
7) 4-CN-CUMYL-BUTINACA |
18) 5F-AMB |
8) ADB-FUBIATA |
19) ADB-HEXINACA |
9) 5F-PB-22 |
20) BZO-HEXOXIZID |
10) 5F-MDMB-PINACA |
21) CH-PIATA |
11) MMB-FUBICA |
|
Synthetic Stimulants
Aegis detected over 450 stimulant analytes in 2022, representing 21 different parent drugs, with pentylone, N,N-dimethyl pentylone and eutylone most frequently detected. Pentylone and N,N-dimethyl pentylone are frequently detected together in patient samples. Cathinones account for 17 of the 21 parent drugs.
Stimulants Detected in 2022 (by parent, in order of most to least prevalent) |
|
1) Pentylone |
12) N-ethyl Hexedrone |
2) N,N-dimethyl Pentylone |
13) 3/4-Fluoromethamphetamine |
3) Eutylone |
14) N-butyl Hexedrone |
4) Alpha-PiHP |
15) N-ethyl Pentylone |
5) N-cyclohexyl Methylone |
16) Benzylone |
6) Alpha-PHP |
17) N-ethyl Heptedrone |
7) Butylone |
18) Methylenedioxy-PV8 |
8) Dibutylone |
19) 2-Fluoroamphetamine |
9) TFMPP |
20) Dimethylone |
10) 4-Fluoromethylphenidate |
21) Methylone |
11) N-ethyl Pentedrone |
|
Miscellaneous NPS
Among other NPS substances tested at Aegis, xylazine is the most detected compound. Xylazine is a veterinary sedative frequently combined with illicit opioids, has CNS depressant activity, and is associated with skin and soft tissue infections, some which are severe. After xylazine, phenibut and tianeptine were the most frequently detected substances.
Other NPS Detected in 2022 (by parent, in order of most to least prevalent) |
|
Parent Drug |
Class |
1) Xylazine |
Sedative/Analgesic |
2) Phenibut |
Anxiolytic |
3) Tianeptine |
Antidepressant |
4) 2F-Deschloroketamine |
Hallucinogen/Dissociative |
5) 3-OH-PCP |
Hallucinogen/Dissociative |
6) 3F-PCP |
Hallucinogen/Dissociative |
7) Deschloroketamine |
Hallucinogen/Dissociative |
8) Deschloro-N-Ethylketamine |
Hallucinogen/Dissociative |
9) 2F-Deschloroketamine |
Hallucinogen/Dissociative |
10) Hydroxetamine |
Hallucinogen/Dissociative |
A map of states where xylazine was detected in 2022 is included below:
* States with no xylazine detected are influenced by provider ordering patterns for xylazine testing.