Test Guide - Quest Test Directory

Drug Monitoring, Novel Psychoactive Substances (NPS), Qualitative, Urine

This panel is used to assess misuse of novel/new psychoactive substances (NPS).

Test Summary

Drug Monitoring, Novel Psychoactive Substances (NPS), Qualitative, Urine

Test code: 13086

Clinical use

Assess misuse of novel/new psychoactive substances (NPS)

Clinical background

NPS, also known as designer or synthetic drugs or “legal highs,” are designed to have similar effects to illicit drugs while circumventing national and international drug scheduling laws.1,2 NPS popularity began to rise in the mid-2000s1 and their use has been reported worldwide.3 Modifications introduced into NPS allow for a large number of diverse chemical structures and make detection using routine drug testing panels challenging.3 NPS can be present in counterfeit drugs; can be more potent than, and/or have potential interactions with, other drugs (prescribed and/or illicit); and have been implicated in overdose and mass poisoning events.1,2 Thus, assessing their presence is important for patient management and public health.

NPS have been defined as natural, synthetic, or semisynthetic substances available in preparations, mixtures, or pure form and fulfilling certain criteria (Table 1).2,4 Signs and symptoms of NPS use can vary based on the type of designer drug (Table 2).1 Perceived legality, affordability, and novelty of NPS can put certain individuals at high risk for NPS misuse and harm (Table 3).1

Table 1. Criteria for Defining NPS

Criteria (must satisfy at least 1) 2

Discovered or first synthesized since the mid-2000s and used regardless of degree of psychoactive effect (eg, designer opioid N-pyrrolidino etonitazene and synthetic cannabinoid MDMB-4en-PINACA)

Previously discovered, synthesized, or reported but, for the first time in >10 years, observed in the illicit drugs supply or identified in patient specimens (eg, designer opioids 2-methyl AP-237 and isotonitazene)

Used in a new or different way from its intended use since the mid-2000s (eg, xylazine "tranq" was approved for veterinary purposes)

Previously not well described or studied but now increasingly popular due to an altered toxicological profile (eg, BTMPS in pharmaceutical packaging4)

Not controlled by the United Nations drug conventions but with a toxicological profile similar to those listed in the conventions (eg, antipsychotic quetiapine and opioid O-desmethyltramadol)

Table 2. NPS Signs and Symptoms

Classes	Examples of signs and symptoms1
Most classes	Anxiety, agitation, delirium, hallucination, hypertension, nausea or vomiting, psychosis, and tachycardia
Designer benzodiazepines and opioids	Aggression, central nervous system depression, confusion, depression, disorientation, paranoia, reduced consciousness, respiratory arrest, respiratory depression, and tachycardia
Synthetic cannabinoids	Acute kidney injury, catatonia, chest pain, confusion, heart palpitations, hyperthermia, liver dysfunction, myocardial infarction, nausea or vomiting, panic attacks, renal dysfunction, respiratory distress, restlessness, rhabdomyolysis, seizure, stroke, and suicidal ideation

Table 3. Persons at High Risk for NPS Misuse and Harms

Groups1

Persons who use counterfeit prescriptions or inject drugs

Persons who are incarcerated or experiencing homelessness or unstable housing

School-aged young people

Men who have sex with men under influence of drugs (“chemsex”)

Definitive testing for characterized NPS is done using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Presumptive testing (eg, immunoassays targeting common, non-NPS, drugs) may detect NPS if there is cross-reactivity; however, confirmatory definitive drug tests will produce negative results. For example, designer benzodiazepines may be detected using benzodiazepine kits but differences in masses between the NPS and the targeted drugs/metabolites will cause presumptive positivity not to be definitively confirmed by LC-MS/MS. To assess whether NPS testing is appropriate when cross-reactivity is suspected, please contact a Quest Diagnostics toxicology specialist as described in the Interpretive Information section below.

Panel testing that simultaneously identifies a broad array of NPS classes using definitive LC-MS/MS-based testing is a means of establishing NPS misuse. Quest offers the Drug Monitoring, Novel Psychoactive Substances (NPS), Qualitative, Urine Panel (test code 13086), which assesses the presence of different NPS classes (available separately with the test code listed), including

Designer benzodiazepines (test code 13793)
Designer fentanyl analogs (test code 13794)
Designer opioids (test code 13795)
Designer stimulants (test code 13796)
Other illicit additives (test code 13798)
Synthetic cannabinoids (test code 13797)

However, as the list of NPS is rapidly evolving, updates to our tested drug list will be sometimes made based on clinical patient trends, scope recommendations, and trend reports from the Center for Forensic Science Research5 and Quest surveillance data (the NPS-positivity report is downloadable from QuestDiagnostics.com/Healthcare-Professionals/About-our-Tests/Drug-Testing/Novel-Psychoactive-Substances).

Individuals suitable for testing

Patients exhibiting signs or symptoms of NPS poisoning (eg, drug-induced psychosis; Table 2), especially those identified as high risk (Table 3)
Patients with positive presumptive immunoassay results for known benzodiazepines, opioids, and/or fentanyl but negative confirmatory, definitive LC-MS/MS results
Patients being considered for opioid therapy or a change in treatment
Patients who need advocacy to verify their abstinence
Patients in recovery from substance-use disorder

Method

LC-MS/MS
Qualitative, class reporting: "positive," "negative," or "interference"
Individual analyte cutoffs: 1 to 20 ng/mL
No interference from most common illicit and licit drugs of abuse, as well as related compounds; however, structurally similar NPS may preclude detection of ≥1 drugs in the panel

Interpretive information

A “positive” result for a drug class indicates that at least 1 drug or its metabolite has been definitively detected at, or above, the cutoff value for that drug or metabolite. A “negative” result for a drug class indicates that no drugs or metabolites were detected at levels above the cutoff value for those drugs or metabolites.

Cutoffs for individual drugs and their metabolites vary from 1 to 20 ng/mL, but NPS class cutoffs on the report are listed as the highest cutoff within a class (ie, 10 ng/mL with the exception of other illicit additives, which has a highest cutoff of 20 ng/mL for phenibut and BTMPS; Table 4).

Table 4. Specific Analytes and Cutoffs Within the Drug Monitoring, Novel Psychoactive Substances (NPS), Qualitative, Urine Test
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An “interference” result for the drug class indicates drug/chemical interference of ≥1 drugs within a drug class, and that results for all other NPS are negative.

These panels are not designed to determine clinical impairment. Assessment of impairment due to NPS misuse should be based on clinical presentation.

For any questions regarding this information or assistance with interpreting these drug test results, please contact a Quest toxicology specialist at 1.877.40.RX TOX (1.877.407.9869). Specialists are available to assist Monday through Friday from 8 AM to 10 PM ET.

References

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
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
What are NPS? UNODC Early Warning Advisory on New Psychoactive Substances. Accessed July 25, 2025. https://www.unodc.org/LSS/Page/NPS.
BTMPS. Center for Forensic Science Research & Education. Updated September 3, 2024. Accessed August 5, 2025. https://www.cfsre.org/nps-discovery/monographs/bis2266-tetramethyl-4-piperidyl-sebacate
Trend reports. Center for Forensic Science Research & Education. Updated 2024. Accessed August 20, 2025. https://www.cfsre.org/nps-discovery/trend-reports

Content reviewed 8/2025

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Related tests (7)

13795 - Drug Monitoring, Designer Opioids, Qualitative, Urine

Designer Opioids are compounds designed to mimic the effects of prescription drugs, evade detection by typical drug testing methodologies, and avoid regulation. They are a part of a class of drugs known as Novel Psychoactive Substances (NPS). NPS can also be referred to as legal highs, spice, Benzo Dope, Tranq Dope, or in products labelled "not for human use". NPS markets rapidly change in response to regulation from national and international agencies. These drugs are not typically detected by presumptive, immunoassay point-of-care or desktop analyzer drug tests. NPS may potentiate drug interactions with prescription medications, leading to unintended overdoses. Individuals may be exposed to illicit fentanyl or analogs, designer opoids, stimulants, and benzodiazepines, or xylazine, knowingly, or unknowingly through counterfeit prescription drugs intended to mimic common drugs such as oxycodone, hydrocodone, and alprazolam, among others. Updates and enhancements to our tested drug list are made from time to time based on surveillance data from the Center for Forensic Science Research and Education (CFSRE) and clinical patient trends. A complete and up to date list of the analytes contained in each drug class can be found at the bottom of each report and in our online FAQ.

13796 - Drug Monitoring, Designer Stimulants, Qualitative, Urine

Designer Stimulants are compounds designed to mimic the the effects of prescription drugs, evade detection by typical drug testing methodologies, and avoid regulation. They are a part of a class of drugs known as Novel Psychoactive Substances (NPS). NPS can also be referred to as legal highs, spice, Benzo Dope, Tranq Dope, or in products labelled "not for human use". NPS markets rapidly change in response to regulation from national and international agencies. These drugs are not typically detected by presumptive, immunoassay point-of-care or desktop analyzer drug tests. NPS may potentiate drug interactions with prescription medications, leading to unintended overdoses. Individuals may be exposed to illicit fentanyl or analogs, designer opoids, stimulants, and benzodiazepines, or xylazine, knowingly, or unknowingly through counterfeit prescription drugs intended to mimic common drugs such as oxycodone, hydrocodone, and alprazolam, among others. Updates and enhancements to our tested drug list are made from time to time based on surveillance data from the Center for Forensic Science Research and Education (CFSRE) and clinical patient trends. A complete and up to date list of the analytes contained in each drug class can be found at the bottom of each report and in our online FAQ.

13798 - Drug Monitoring, Other Illicit Additives, Qualitative, Urine

Other Illicits are compounds designed to mimic the effects of prescription drugs, evade detection by typical drug testing methodologies, and avoid regulation. They are a part of a class of drugs known as Novel Psychoactive Substances (NPS). NPS can also be referred to as legal highs, spice, Benzo Dope, Tranq Dope, or in products labelled "not for human use". NPS markets rapidly change in response to regulation from national and international agencies. These drugs are not typically detected by presumptive, immunoassay point-of-care or desktop analyzer drug tests. NPS may potentiate drug interactions with prescription medications, leading to unintended overdoses. Individuals may be exposed to illicit fentanyl or analogs, designer opoids, stimulants, and benzodiazepines, or xylazine, knowingly, or unknowingly through counterfeit prescription drugs intended to mimic common drugs such as oxycodone, hydrocodone, and alprazolam, among others. Updates and enhancements to our tested drug list are made from time to time based on surveillance data from the Center for Forensic Science Research and Education (CFSRE) and clinical patient trends. A complete and up to date list of the analytes contained in each drug class can be found at the bottom of each report and in our online FAQ.

13797 - Drug Monitoring, Synthetic Cannabinoids, Qualitative, Urine

Synthetic Cannabinoids are compounds designed to mimic the effects of prescription drugs, evade detection by typical drug testing methodologies, and avoid regulation. They are a part of a class of drugs known as Novel Psychoactive Substances (NPS). NPS can also be referred to as legal highs, spice, Benzo Dope, Tranq Dope, or in products labelled "not for human use". NPS markets rapidly change in response to regulation from national and international agencies. These drugs are not typically detected by presumptive, immunoassay point-of-care or desktop analyzer drug tests. NPS may potentiate drug interactions with prescription medications, leading to unintended overdoses. Individuals may be exposed to illicit fentanyl or analogs, designer opoids, stimulants, and benzodiazepines, or xylazine, knowingly, or unknowingly through counterfeit prescription drugs intended to mimic common drugs such as oxycodone, hydrocodone, and alprazolam, among others. Updates and enhancements to our tested drug list are made from time to time based on surveillance data from the Center for Forensic Science Research and Education (CFSRE) and clinical patient trends. A complete and up to date list of the analytes contained in each drug class can be found at the bottom of each report and in our online FAQ.

13086 - Drug Monitoring, Novel Psychoactive Substances (NPS), Qualitative, Urine

Novel psychoactive substances (NPS) are compounds designed to mimic the effects of prescription drugs, evade detection by typical drug testing methodologies, and avoid regulation. NPS can also be referred to as legal highs, Spice, Benzo Dope, Tranq Dope, or in products labelled "not for human use". NPS markets rapidly change in response to regulation from national and international agencies. These drugs are not typically detected by presumptive, immunoassay point-of-care or desktop analyzer drug tests. NPS may potentiate drug interactions with prescription medications, leading to unintended overdoses. Individuals may be exposed to illicit fentanyl or analogs, designer opioids, stimulants, and benzodiazepines, or xylazine, knowingly, or unknowingly through counterfeit prescription drugs intended to mimic common drugs such as oxycodone, hydrocodone, and alprazolam, among others. Updates and enhancements to our tested drug list are made from time to time based on surveillance data from the Center for Forensic Science Research and Education (CFSRE) and clinical patient trends. A complete and up to date list of the analytes contained in each drug class can be found at the bottom of each report and in our online FAQ.

13793 - Drug Monitoring, Designer Benzodiazepines, Qualitative, Urine

Designer Benzodiazepines are compounds designed to mimic the effects of prescription drugs, evade detection by typical drug testing methodologies, and avoid regulation. They are a part of a class of drugs known as Novel Psychoactive Substances (NPS). NPS can also be referred to as legal highs, spice, Benzo Dope, Tranq Dope, or in products labelled "not for human use". NPS markets rapidly change in response to regulation from national and international agencies. These drugs are not typically detected by presumptive, immunoassay point-of-care or desktop analyzer drug tests. NPS may potentiate drug interactions with prescription medications, leading to unintended overdoses. Individuals may be exposed to illicit fentanyl or analogs, designer opoids, stimulants, and benzodiazepines, or xylazine, knowingly, or unknowingly through counterfeit prescription drugs intended to mimic common drugs such as oxycodone, hydrocodone, and alprazolam, among others. Updates and enhancements to our tested drug list are made from time to time based on surveillance data from the Center for Forensic Science Research and Education (CFSRE) and clinical patient trends. A complete and up to date list of the analytes contained in each drug class can be found at the bottom of each report and in our online FAQ.

13794 - Drug Monitoring, Designer Fentanyl Analogs, Qualitative, Urine

Designer Fentanyl Analogs are compounds designed to mimic the effects of prescription drugs, evade detection by typical drug testing methodologies, and avoid regulation. They are a part of a class of drugs known as Novel Psychoactive Substances (NPS). NPS can also be referred to as legal highs, spice, Benzo Dope, Tranq Dope, or in products labelled "not for human use". NPS markets rapidly change in response to regulation from national and international agencies. These drugs are not typically detected by presumptive, immunoassay point-of-care or desktop analyzer drug tests. NPS may potentiate drug interactions with prescription medications, leading to unintended overdoses. Individuals may be exposed to illicit fentanyl or analogs, designer opoids, stimulants, and benzodiazepines, or xylazine, knowingly, or unknowingly through counterfeit prescription drugs intended to mimic common drugs such as oxycodone, hydrocodone, and alprazolam, among others. Updates and enhancements to our tested drug list are made from time to time based on surveillance data from the Center for Forensic Science Research and Education (CFSRE) and clinical patient trends. A complete and up to date list of the analytes contained in each drug class can be found at the bottom of each report and in our online FAQ.

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