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Novel Psychoactive Substances: At the epicenter of an unrelenting drug epidemic

Known as designer or synthetic drugs, NPS are designed to mimic the effect of controlled substances and/or illicit drugs, are routinely chemically altered to enhance drug effects, and can evade tracking by law enforcement.2,3

NPS have been implicated in overdose and mass-poisoning events,1 and there has been a dramatic increase in NPS detection in the US,4 posing a growing public health threat to our communities.

Traditional testing may miss Novel Psychoactive Substances

NPS may supplement traditional drugs of abuse and can be more potent and harder to detect.1,2 As new compounds continually appear on the drug market, detecting them via presumptive immunoassay or point-of-care testing is challenging because they:

Comprehensive, definitive testing in a fast-paced NPS market

The Drug Monitoring, NPS panel simultaneously identifies a broad array of NPS classes using definitive liquid chromatography-tandem mass spectrometry (LCMS/MS)-based testing and reports out at the class level to help identify misuse.


Current drug classes include:


  • Designer benzodiazepines, ie BZS, clonazolam
  • Designer fentanyl analogs, ie carfentanil, chlorofentanyl
  • Designer opioids, ie nitazenes
  • Designer stimulants, ie fluorexetamine
  • Synthetic cannabinoids, ie ADB-5Br-PINACA
  • Other illicit additives, ie xylazine, tianeptine

Two NPS of concern: xylazine and fentanyl

Two NPS classes—other illicit additives (xylazine) and fentanyl analogs (acetyl fentanyl)—are frequently found in specimens and contribute to the nation’s misuse crisis.6 As part of the process of bringing the NPS panel to market, we conducted a national NPS surveillance study, retesting nearly 4,000 specimens and identifying6:

  • Xylazine was found in nearly 1 in 12 specimens (8.1%) tested, making it the most prevalant single NPS
  • One-third (32.7%) of fentanyl-positive specimens were also positive for xylazine
  • Nearly all (97.7%) specimens positive for xylazine were also positive for fentanyl

Updates based on current surveillance data

As the substances present in communities continue to evolve, Quest Diagnostics is committed to updating the Drug Monitoring, NPS panel periodically, without changing test codes or requiring EHR updates, based on:

Go inside the rising Novel Psychoactive Substances crisis

Our latest Health Trends report found that approximately 13.1% of remnant specimens tested were positive for at least 1 NPS,6 highlighting the importance of utilizing clinical drug monitoring to identify misuse.


Download Drug Misuse in America 2023: The Growing Crisis of Novel Psychoactive Substances for an overview of the shifting drug crisis from misuse of prescription opioids and fentanyl to NPS.


Download the Health Trends® report

Fill out the form below to download our latest Health Trends report, Drug Misuse in America 2023: The Growing Crisis of Novel Psychoactive Substances.

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1. Iwersen-Bergmann S, Lehmann S, Heinemann A, et al. Mass poisoning with NPS: 2C-E and Bromo-DragonFly. Int J Legal Med. 2019;133(1):123-129. doi:10.1007/s00414-018-1882-9
2. Peacock A, Bruno R, Gisev N, et al. New psychoactive substances: challenges for drug surveillance, control, and public health responses. Lancet. 2019;394(10209):1668-1684. doi:10.1016/s0140-6736(19)32231-7
3. Mohr ALA, Logan BK, Fogarty MF, et al. Reports of adverse events associated with use of novel psychoactive substances, 2017–2020: a review. J Anal Toxicol. 2022;46(6):e116-e185. doi:10.1093/jat/bkac023
4. Trend Reports. The Center for Forensic Science Research & Education. 2024. Accessed February 9, 2024.
5. Neoh MJY, Carollo A, Lim M, et al. The novel psychoactive substances epidemic: A scientometric perspective. Addiction Neuroscience. 2023(5):100060. doi:10.1016/j.addicn.2022.100060
6.Quest Diagnostics Health Trends. Drug misuse in America 2023: the growing crisis of novel psychoactive substances. December 23, 2024. Accessed February 12, 2024.