The invention discloses a method for determining the content of narcotics and metabolites thereof in sewage, which comprises the following steps: step 1, adjusting the pH value of a sewage sample to be less than 2, and filtering impurities for analysis; step 2, solid-phase extraction: activating a solid-phase extraction column by using methanol and ultrapure water in sequence before extraction, uniformly mixing the mixed deuterated internal standard working solution with a sample to be detected, transferring into the solid-phase extraction column, leaching by using ultrapure water, vacuumizing the solid-phase extraction column, eluting by using a 5% ammonia methanol solution, vacuumizing the solid-phase extraction column, and collecting eluent; blowing the eluent to be nearly dry, adding and evenly mixing 0.1% formic acid aqueous solution, wherein a 0.22-micron nylon microfiltration membrane is used for filtering, and the eluent is used as a detection material sample extracting solution for instrument detection; and step 3, carrying out liquid chromatography-tandem mass spectrometry analysis on the sample extracting solution, and detecting the contents of the drugs and the metabolites thereof. The invention basically comprises various drugs involved in the existing case, so as to meet the requirements of actual work.