01 Nov Aegis’s Novel Psychoactive Substances Testing Menu Update
In September, Aegis updated both urine and oral fluid novel psychoactive substance (NPS) test menus as a continued commitment to offering providers a contemporary testing option for NPS. The updates involve the addition of analytes which are newly circulating since the existing menu was deployed, as well as the deletion of analytes which are no longer circulating in the illicit drug supply. In this round of updates, there were additions and removals to designer opioids, designer benzodiazepines, synthetic cannabinoids, synthetic stimulants, and hallucinogen/dissociatives.
In September and October, Aegis detected 6,200 NPS analytes in healthcare samples when testing was ordered. While these figures may seem daunting, it is still an underrepresentation of actual positivity, as many samples received at Aegis do not include medical orders for NPS testing. A description of detection frequency and emphasis on new analytes detected in each class is included below.
Designer Benzodiazepines
Since September 1st, 8-aminoclonazolam is the most detected analyte, followed by bromazolam, and alpha-hydroxy flualprazolam. Newly added benzodiazepines detected include: 7-aminomeclonazepam and metizolam.
| 8-Aminoclonazolam | 458 |
| Bromazolam | 253 |
| alpha-Hydroxyflualprazolam | 226 |
| Flualprazolam | 134 |
| alpha-Hydroxyetizolam | 121 |
| Clonazolam | 50 |
| Etizolam | 48 |
| alpha-Hydroxyflubromazolam | 20 |
| Flubromazolam | 19 |
| Deschloroetizolam | 16 |
| Flubromazepam | 7 |
| 7-aminomeclonazepam | 3 |
| Delorazepam | 2 |
| Metizolam | 1 |
Designer Opioids
Since September 1st, fluoro fentanyl continues to be the most detected analyte, followed by despropionyl fluorofentanyl, and 4-hydroxy nitazene. Newly added designer opioids detected include: dipyanone, flunitazene, and N-piperidinyl etonitazene.
| Fluoro Fentanyl | 1438 |
| Despropionyl Fluorofentanyl | 1004 |
| 4-Hydroxy Nitazene | 254 |
| Valeryl Fentanyl Mtb | 156 |
| Metonitazene | 134 |
| N-desethyl Isotonitazene | 59 |
| Despropionyl Bromofentanyl | 49 |
| Benzyl Fentanyl | 39 |
| Valeryl Fentanyl | 36 |
| Acryl Fentanyl | 12 |
| Despropionyl Chlorofentanyl | 5 |
| Dipyanone | 3 |
| Fluoroisobutyryl Fentanyl | 3 |
| Protonitazene | 3 |
| Brorphine | 2 |
| Flunitazene | 2 |
| Butonitazene | 1 |
| Isotonitazene | 1 |
| N-piperidinyl Etonitazene | 1 |
Synthetic Cannabinoids
Since September 1st, MDMB-4en-PINACA BA continues to be the most detected synthetic cannabinoid analyte, followed by ADB-BUTINACA NBA (new), 4F-MDMB-BUTINACA, and 5F-MDMB-PICA M7. Other newly detected analytes include: ADB-BUTINACA, ADB-FUBIATA metabolite, MDMB-5Br-INACA, ADB-FUBIATA BA, and ADB-HEXINACA NHA.
| MDMB-4en-PINACA BA | 158 |
| ADB-BUTINACA NBA | 34 |
| 4F-MDMB-BUTINACA N-BA | 23 |
| 5F-MDMB-PICA M7 | 23 |
| 4F-MDMB-BUTINACA BA | 17 |
| 4F-MDMB-BUTINACA N-BA | 15 |
| FUB-PB-22 3CI | 9 |
| 5F-MDMB-PICA M8 | 6 |
| ADB-BUTINACA | 6 |
| ADB-FUBIATA Metabolite | 6 |
| MDMB-5Br-INACA | 6 |
| MMB-FUBICA M3 | 6 |
| 5F-PB-22 3CI | 5 |
| ADB-FUBIATA BA | 4 |
| ADB-PINACA PA | 4 |
| MDMB-4en-PINACA | 3 |
| 5F-MDMB-PICA/5F-EMB-PICA | 2 |
| 4F-MDMB-BUTINACA N4HB | 1 |
| 4F-MDMB-BUTINACA N4HB | 1 |
| 5F-EMB-PICA HP/5F-MDMB-PICA M2 | 1 |
| 5F-MDMB-PICA M4 | 1 |
| ADB-HEXINACA NHA | 1 |
| MMB-4en-PINACA BA | 1 |
Synthetic Stimulants
Since September 1st, a newly added analyte, N,N-dimethyl pentylone is the most detected synthetic stimulant, followed by pentylone and eutylone. N-cyclohexyl methylone is another newly detected stimulant.
| N,N-dimethyl Pentylone | 40 |
| Pentylone | 31 |
| Eutylone | 11 |
| Alpha-PiHP | 10 |
| N-cyclohexyl Methylone | 5 |
| Alpha-PHP | 2 |
| TFMPP | 2 |
| Butylone | 1 |
Hallucinogens/Dissociatives
Since September 1st, 3-OH-PCP is the most detected hallucinogen/dissociative, followed by 3F-PCP, and 2F-Deschloronorketamine. There were no new analytes detected since September 1st.
| 3-OH-PCP | 20 |
| 3F-PCP | 10 |
| 2F-Deschloronorketamine | 7 |
Miscellaneous NPS
Xylazine continues to be the most detected miscellaneous NPS, followed by phenibut and tianeptine. There were no new additions to this class in this update.
| Xylazine | 784 |
| 4-Hydroxyxylazine | 296 |
| Phenibut | 48 |
| Tianeptine | 40 |
Aegis’s NPS offerings are developed to allow providers the ability to more completely identify substance use and afford them the opportunity to provide more informed care and minimize the potential for these unregulated substances to contribute to adverse events, including overdose deaths. This timely testing expansion increases the utility of oral fluid as an alternative to urine by allowing testing for NPS, which go undetected in traditional definitive testing.
Click here for our full NPS Testing Menu
NOTICE: The information above is intended as a resource for health care providers. Providers should use their independent medical judgment based on the clinical needs of the patient when making determinations of who to test, what medications to test, testing frequency, and the type of testing to conduct.