2022 NPS Summary

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.