2022 NPS Q3 Summary

2022 NPS Q3 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 the third quarter of 2022, Aegis detected over 8,000 NPS analytes in healthcare samples when testing was ordered (Figure 1). While these figures may seem overwhelming, it is still an underrepresentation of actual positivity, as many samples received at Aegis do not include medical orders for NPS testing. Designer opioids were detected most often, followed by designer benzodiazepines, miscellaneous NPS, synthetic cannabinoids, 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 supply a more granular analysis of the NPS detected as part of Aegis’ enhanced NPS testing options.

 

Figures 2a and 2b. Designer opioids are sometimes referred to as fentanyl analogs (fentalogs) however, other non-fentalogs are increasingly detected in Aegis’ testing. Fluorofentanyl and despropionyl fluorofentanyl continue to be the most frequently observed analytes and were detected in 2,184 and 1,445 samples in the third quarter, respectively (Figure 2a). Other fentanyl analogs of note include carfentanil, valeryl fentanyl, benzyl fentanyl, and bromo fentanyl. Non-fentalog designer opioids continue to be detected, including analytes of isotonitazene, metonitazene, flunitazene, protonitazene, and brorphine (Figure 2b). The increasing detection of non-fentanyl opioids found in the illicit drug supply may be a response by clandestine labs to circumvent the increased regulation of fentalogs by both US and international drug scheduling bodies.

Figure 3. The most frequently detected designer benzodiazepine analyte in the third quarter was 8-aminoclonazolam, a metabolite of clonazolam. In all, markers of 11 different designer benzodiazepine parent drugs were detected in the quarter. 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 counterfeit tablets.

 

Figure 4. A synthetic cannabinoid marker was detected 399 times in the third quarter. A metabolite of MDMB-4en-PINACA was detected in 151 samples, with lesser quantities of 5F-MDMB-PICA, and 4F-MDMB-BUTINACA. A newly added cannabinoid, ADB-BUTINACA was also one of the most frequently detected. In total, there were approximately 20 different synthetic cannabinoids were detected, many of which were newly added to the test menu in the quarter. Recent bans from other countries have impacted the production and availability of synthetic cannabinoids. This is believed to be the reason for newer compounds appearing in the recreational drug supply.

 

Figure 5. Aegis began offering testing for additional NPS in the second quarter of 2021. Xylazine, which is approved as a veterinary tranquilizer, continues to be most often detected in Aegis samples from this group. The parent drug was detected in 626 samples in quarter three, while the metabolite was detected in 195. Xylazine is a common adulterant found in heroin and illicitly manufactured fentanyl, where it is sometimes referred to as “tranq-dope” and is increasingly named in overdose deaths involving illicit opioids. It poses a particular danger because it does not respond to naloxone reversal. Phenibut, tianeptine, 3F-PCP and 3-OH-PCP, PCP analogs, were detected in lesser quantities, along with a ketamine analog, 2F-deschloroketamine.

Figure 6. Pentylone was the most frequently detected stimulant in the first two quarters and is believed to be present in the majority of cases as a metabolite of other parent cathinones. The downward trend in Eutylone detection continues, with quantities decreasing from quarter one to two. In all, 14 different stimulants were detected in the first half of 2022, including the non-cathinones 4-Fluoromethylphenidate, which is a methylphenidate analog, and analytes of a methamphetamine analog.