Quest Diagnostics unveiled its new confirmatory testing service for novel psychoactive substances (NPS).

The new panel, which tests for 88 compounds, covers a broad array of drug classes, such as designer opioids, designer benzodiazepines, designer stimulants, fentanyl analogs, synthetic cannabinoids, and other illicit additives. Two of these classes are rapidly accelerating America’s overdose crisis: other illicit additives (xylazine) and fentanyl analogs (acetyl fentanyl). The new test panel is designed to help healthcare providers detect potential drug misuse in patients prescribed controlled medications, such as opioids and other substances, amid a proliferation of synthetic or “designer” drugs in the nation’s drug supply.

NPS are versions of established prescription and illicit drugs that are routinely chemically altered to enhance drug effects and evade tracking by law enforcement. As their chemical composition frequently evolves, conventional point-of-care and laboratory test methods may fail to detect NPS, increasing risks for individual patients and challenging efforts to understand their long-term health effects or prevalence in communities.

The Quest panel uses definitive liquid chromatography with advanced tandem mass spectrometry-based testing to establish NPS misuse. Quest’s team of toxicologists, medical experts and data analysts will periodically review and update the panel to include the most relevant and prevalent substances present in communities, as reflected by trends in the company’s nationally representative Health Trends dataset and the latest reports from public health, academic research, and law enforcement organizations.

Quest developed the panel to address the changing drug epidemic, as revealed by its nationally representative Health Trends report, “Drug Misuse in America 2023: The Growing Crisis of Novel Psychoactive Substances.” Based on more than 3.6 million clinical laboratory drug tests performed by Quest Diagnostics in 2022, the report provides insights into the drug crisis and its shifts from misuse of prescription opioids and fentanyl to NPS. The report also includes analysis of 3,730 randomly selected “remnant” specimens tested using a pilot version of the new NPS test panel.

Approximately 13.1% of remnant specimens tested were positive for at least one NPS. Of these, the animal tranquilizer xylazine was found in 8.1%, or nearly 1 in 12 specimens tested, making it the most prevalent single NPS. Yet, non-xylazine substances, including fentanyl analogs and designer benzodiazepines, were found in 5% of remnant specimens tested, or roughly 40% of all NPS-positive test results.

These findings align with a recent report from the U.S. Centers for Disease Control and Prevention (CDC) highlighting the increasing connection between xylazine and opioid overdose deaths while also revealing growing misuse of other NPS.

Additional key findings include:

  • Xylazine positivity among fentanyl-positive specimens was most prevalent in the Southeast (~90%), Northeast (~80%) and Eastern (~60%) U.S. regions. Results in the Southwest (<30%) and on the West Coast (<20%) suggest xylazine has yet to fully penetrate these U.S. regions.
  • One third (32.7%) of fentanyl positive specimens were also positive for xylazine and nearly all (97.7%) specimens positive for xylazine were also positive for fentanyl.
  • Nearly 1 in 5 (19%) amphetamines-positive specimens showed fentanyl combining.
  • Heroin use rapidly declined, as positivity overall fell from 1.1% in 2021 to 0.4% in 2022.

The Health Trends analysis also found that specimens in areas with demographics linked to low income levels were nearly seven times more likely to test positive for nonprescribed fentanyl than those linked to high-income communities. The researchers theorize that these differences are due to comparatively higher quality of care and generally greater access to resources in high-income communities. 

To access the full Health Trends report, click here.

“Our Health Trends data demonstrates the importance of considering all possible NPS, not just xylazine, in clinical drug testing,” says Harvey W. Kaufman, MD, medical director and head of the Health Trends research program. “The faster public health and policy makers catch up with the growing problem of synthetic drugs, the greater the likelihood of curbing a dangerous and evolving drug epidemic before more lives are lost and more families and communities suffer irreversible harm.”

Quest Diagnostics Health Trends studies are performed on aggregate deidentified laboratory data in compliance with applicable privacy regulations and the company’s strict privacy policies, and follow procedures approved by the WCG Institutional Review Board. The present study’s strengths include its large data set, geographic scope, and validated testing by the highly reliable mass spectrometry method. Its limitations include geographic disparities and inability to validate or contextualize test results with medical records. The terms high- and low-income communities refer to certain geographies that have median income levels that fall in the highest and lowest quintile as determined by the U.S. Census Bureau.