Pink Cocaine, Why Tusi Is It Becoming Popular

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What Is Tusi (Pink Cocaine)? Why This Pink Powder Is Becoming Popular

A new drug in the form of a bright pink powder has been working its way through nightclubs across Latin America and Europe, and it's been in American cities for a few years now. On the street it goes by tusi, sometimes spelled tuci or tucibí, and in English speaking places it usually gets called pink cocaine. It comes in small bags, it often carries a faintly sweet candy smell, and in some markets a gram runs about ten dollars. It has a reputation as an upscale designer party drug. That reputation is doing a lot of work, because almost everyone buying it is wrong about what's inside. Most have no idea this is a drug cocktail.

By 2024, laboratories run by the United States Drug Enforcement Administration, the federal agency most people know as the DEA, had tested roughly 960 seized samples of pink powder. Four of them contained 2C-B, the substance the powder is named after. That's well under one percent. The cocaine half of the name is just as fictional, since most pink cocaine sold in this country contains no cocaine at all. New York City turns out to be an exception, and I'll come back to that.

What people are actually buying is ketamine most of the time, mixed with MDMA and whatever else the person making it had access to that week. Both of those get abbreviated everywhere and explained almost nowhere, so here they are in plain terms. Ketamine is a dissociative anesthetic, a surgical and veterinary drug that makes a person feel detached from their own body and surroundings. MDMA stands for methylenedioxymethamphetamine, and it's the same drug sold as ecstasy or Molly.

First, What 2C-B and "2C" Actually Mean

2C-B is a real drug. The DEA lists it under its full chemical name, 4-Bromo-2,5-Dimethoxyphenethylamine, and classifies it as a Schedule I controlled substance, which is the government's most restricted category and means it has no accepted medical use in the United States. The chemist Alexander Shulgin made it in a laboratory around 1974 and published the first human research on it in 1975, describing a state of heightened senses that fell short of full hallucination. On the street it has also gone by Nexus, Bromo, Spectrum and Venus.

"2C" is the family name for a group of closely related lab-made chemicals that all share the same basic structure. Think of 2C as the surname and the letter after the dash as the first name, so the B in 2C-B points to bromine, the atom that separates this one from its chemical cousins. All of them belong to a larger group of compounds called phenylethylamines, which is simply the chemical family they were built from. When researchers write "2C series," they mean that whole set of related drugs rather than any single one.

What 2C-B actually does to a person depends heavily on the amount taken. Small amounts leave people relaxed and more aware of sights, sounds, smells and touch. Medium amounts act like a stimulant and produce a fully intoxicated state. Larger amounts produce hallucinations closer to LSD, the drug most people know as acid, sometimes with disturbing and distorted thinking. Effects start within twenty to thirty minutes, peak around one and a half to two hours, and can last as long as eight hours. That long duration is part of why it caught on in rave and party scenes during the 1980s and 1990s, and by the early 2000s law enforcement had run into it in 48 states.

So 2C-B is a genuine drug with genuine effects, and it almost never appears in the product named after it.

What Tusi Actually Contains

The cleanest data comes from Energy Control, a Spanish drug checking service that tested 470 samples sold as tusi between 2020 and 2024. Ketamine turned up in 93.2 percent of them and MDMA in 92.1 percent, while actual 2C-B appeared in 3.6 percent. Across those 470 samples, laboratory staff identified 36 different substances. Colombia's numbers look almost identical, where out of 162 tusi samples sent for testing in 2021, three contained 2C-B. Chile tested 2,093 samples submitted as "2C" and found that 99 percent were ketamine based. The pattern holds on every continent where anyone has bothered to check.

American samples tell the same story. A drug checking service analyzed 19 pink powders labeled tusi or 2C-B between 2019 and 2022 and found ketamine in 94.7 percent, a ketamine ingredient in 84.2 percent, MDMA in 63.2 percent and caffeine in 52.6 percent. Not one of the nineteen contained a 2C series drug. Methamphetamine showed up in 15.8 percent, and cocaine, oxycodone, MDA and eutylone each appeared in about one in ten samples. Two more names worth defining there. MDA is a close chemical relative of MDMA with more hallucinogenic effects. Eutylone is a designer drug the DEA groups with the synthetic stimulants sold on the street as bath salts, it has no approved medical use in this country, and the class it belongs to is known for causing agitation, racing heart, dangerously high body temperature, seizures and death.

Where the Misleading Name Came From

Tusi is a phonetic translation of "2C." Say it out loud and you'll hear it. The pink coloring started as a practical fix, because 2C-B tastes harsh, so sellers added food coloring or colored baking powder to make snorting it tolerable. Some batches still carry a sweet smell left over from that additive. Then demand outran supply, and as real 2C-B became harder to source, suppliers cut it with ketamine and MDMA to copy the effect. Eventually the 2C-B fell out of the recipe entirely and the pink stayed. What survived was the color, the name and the reputation. Reviewing all of this in Current Addiction Reports, Abukahok, Fitzgerald and Palamar cite an assessment that tusi's popularity has "more to do with its image than its chemistry," which is about as neatly as anyone has put it.

Tusi first appeared in Colombia in the late 2000s, then spread through Chile, Argentina and Uruguay before reaching Europe and North America. Spain has reported ketamine and MDMA mixtures sold as tucibí since roughly 2018, and Latin America and Europe have been tracking it far longer than we have. What spread was the idea rather than the product itself, since the mixture gets made locally wherever it lands instead of being shipped from one source. That distinction matters for anyone trying to stop it, because there's no single supply chain to cut.

Give the Street Chemists Their Due

I've practiced addiction medicine for 26 years, and I'm going to say something that may sound strange coming from a physician. The people building these products are genuinely inventive. They took a controlled substance nobody could reliably get, kept the brand name, swapped the entire contents and then sold far more of the imitation than the original. They understood something about how buyers think that most pharmaceutical marketing departments would pay a fortune for, which is that a cheerful color does more sales work than any claim about the product ever could. Pink reads as fun and harmless, and it buries what's underneath. Imagine what these chemist could do if they put their mind to something beneficial to mankind.

And they are always ahead of us. Regulators schedule a compound and the chemists modify a molecule. Public health finally builds a system to track one drug, and by then the market has already moved to a mixture that no tracking system knows how to count. We did this with bath salts, with flakka, with xylazine and with nitazenes. Let's not forget kratom and 7-oh. Every single time, the official response arrives years after the damage is done, and every single time we act surprised. Admiring the cleverness and condemning the product are not in conflict. I do both.

Who Is Using Tusi, and Where

The best American data comes from a 2024 study of 1,465 adults entering electronic dance music nightclubs in New York City, where past-year tusi use came in at 2.7 percent of that population. The number climbs sharply with how often someone goes out, so that among people attending clubs weekly or more, 16.6 percent reported tusi use in the past year, compared to 1 percent among those who never attend. Men had roughly four times the odds of women. Hispanic participants had about five times the odds of white participants, which tracks with the drug's Colombian origin and its presence in Latin American music and nightlife culture. Past-year MDMA use raised the odds more than six fold, ketamine more than three fold, and prior 2C series use nearly fifteen fold. In plain terms, the people using tusi are already using other club drugs, and availability may predict use more than preference does.

Spanish survey data fills in the setting. Among people reporting tusi use, 84.6 percent were partying when they used it, with nightclubs accounting for 51.2 percent and raves for 42.5 percent. Average age at first use was 24. Most people used it between one and five times a year, usually snorting small amounts rather than taking it by mouth, and 64.2 percent said they always mixed it with something else. This is a nightlife substance found in urban club scenes, at festivals and at private parties in those same social circles. It is not, so far, a drug that follows people home into daily use the way opioids or methamphetamine do.

The Composition Varies by City

Geography changes the answer to "what's in it." In Spain and Colombia, tusi is mostly ketamine and MDMA, and cocaine is relatively uncommon. In New York the ingredients shift, because among nightclub attendees who reported tusi use and gave a saliva sample, 73.8 percent tested positive for cocaine and 57.1 percent for ketamine. Ketamine plus cocaine was the single most common combination there, appearing in about two thirds of everyone who tested positive for anything. The researchers believe New York's product genuinely differs from what's sold in South America or Spain, which means the honest answer to what pink cocaine contains depends on which city you're standing in and on which batch you happened to buy. Even within one city, no two bags are guaranteed to match, and that is the core problem with this substance. Nobody making it is working from a recipe, so the pink color ends up being the only thing every batch reliably has in common.

The Danger People Aren't Expecting

The sharpest finding in the New York study had nothing to do with what people took on purpose. Among tusi users who denied any methamphetamine use in the past year, 11 percent tested positive for methamphetamine. Among those who denied ketamine use, 43.8 percent tested positive for ketamine. And 41.7 percent of everyone who reported using tusi didn't report using ketamine at all, despite ketamine being in nearly every sample ever tested anywhere in the world. People are taking a surgical anesthetic alongside a powerful stimulant, and they have no idea they're doing it.

Mixing stimulants with dissociatives can drive body temperature to dangerous levels, cause breathing problems and put real strain on the heart. Someone who believes they took a mild hallucinogen and then drinks heavily on top of unrecognized ketamine is set up for a bad night at minimum. Polydrug use in party settings compounds all of it, because people who are already impaired take larger amounts than they planned and combine things they never intended to combine. Ketamine also carries real dependence potential that most recreational users badly underrate, along with bladder and urinary tract damage that shows up with repeated use, and withdrawal symptoms that people don't connect to a drug they didn't know they were taking.

The overdose data is thin but pointed. Poison centers recorded five pink cocaine exposures across four states between January and October 2024, and all five needed medical attention, three were hospitalized and one possible death was noted. Florida investigators identified eight colored powder overdose deaths in South Florida. A Miami-Dade case series examined 14 mostly pink powders and found ketamine in all of them alongside MDMA, cocaine, methamphetamine, oxycodone, Xanax and lidocaine in various combinations. Overdose deaths involving these mixtures are almost certainly undercounted, because toxicology systems record which substances were detected rather than what the product was called on the street. A death from a ketamine and MDMA mixture gets recorded as multiple drug toxicity, and nobody writes tusi on a death certificate. We made this exact mistake early in the fentanyl crisis, when deaths were blamed on heroin long after fentanyl had taken over the supply.

About Fentanyl in Pink Cocaine

You'll read that pink cocaine contains fentanyl. The evidence doesn't support that claim yet, and I'd rather give you the accurate version. What actually exists is a California seizure of pink powder containing a chemical used to make fentanyl, which researchers describe as mostly inactive on its own. There are Miami-Dade decedents with high fentanyl levels in their blood where fentanyl was absent from the powder found at the scene, meaning it came from somewhere else. And in the New York study, exactly one of 84 tusi users tested positive for fentanyl, no different from people who never touched the drug.

Palamar's own commentary frames fentanyl as something that may begin appearing in tusi rather than something already in it, and the 2025 review takes the same position. That's the right read. Fentanyl has already contaminated the cocaine supply in much of the country, and there's no reason it won't reach this one eventually. The day it does, a drug that currently sends people to the emergency department starts killing them instead. So treat it as a forecast rather than a finding, and then act like the forecast is correct anyway, because the cost of being wrong in the other direction is a funeral.

Harm Reduction When the Product Is Unknowable

I'm going to be direct, because the usual harm reduction advice runs into a wall with this substance. Fentanyl test strips tell you about fentanyl and nothing else, so they say nothing about the methamphetamine, the bath salts or the ketamine dose. Drug checking services exist in Spain and Colombia and barely exist here. And knowing that a bag contains ketamine and MDMA doesn't tell you how much of each, which is the part that determines whether you wake up.

The one strategy that reliably works with pink cocaine is not starting. I'm making that claim on arithmetic rather than morality. Most street drugs at least let a person form expectations about what a given amount will do, and tusi takes even that away, because there's no consistent product to build an expectation around. If someone is going to use anyway, the basics still apply and still save lives. Never use alone, and don't mix it with alcohol, since unrecognized ketamine plus alcohol increases the risk of accidental overdose. Carry naloxone even though this isn't an opioid, because you don't know what's in the bag and neither does the person who sold it. Start with far less than you think you need, since the same visual amount can differ tenfold in strength between batches. And if you're using it monthly or more, which describes 61.2 percent of tusi users surveyed in Colombia, that stopped being recreational a while ago and is worth talking to someone about.

What I'm Doing Differently in My Own Practice

Honest admission. I haven't seen tusi in Tulsa, and I also haven't been looking for it. I hadn't asked patients about it by name, and I hadn't been reading urine drug screens with this particular mixture in mind. A ketamine positive in someone who also uses cocaine or methamphetamine is easy to read as two separate choices when it might have been one pink bag. That's changing. So, as of the day I am writing this article, I plan to alert my staff about it tomorrow and starting examining my toxicology reports with tusi in mind.

For physicians reading this, the practical first step is small. Ask about tusi and pink cocaine by name, since patients won't volunteer a word they assume you've never heard of. And when ketamine shows up unexpectedly on a drug screen in someone who goes out at night, consider that they may not know they took it. Parents should understand that pink powder is not a novelty item and the color is pure marketing, chosen precisely because it doesn't look like what it is. And anyone using this themselves deserves to know that the substance in the bag is probably a dissociative anesthetic, whatever the person who sold it called it.

Frequently Asked Questions

What is tusi made of? Tusi is a powdered mixture of substances, most often ketamine combined with MDMA. Testing across Spain, Colombia, Chile and the United States consistently finds ketamine in more than 90 percent of samples. Caffeine, methamphetamine, cocaine, MDA, oxycodone, synthetic stimulants and local anesthetics appear in smaller percentages. The exact contents change from batch to batch and from city to city.

Is pink cocaine actually cocaine? Usually not. Pink cocaine is a misleading name, and most samples tested worldwide contain no cocaine. The powder is dyed pink. New York City appears to be a partial exception, where cocaine shows up far more often in people who use tusi than it does in samples from Spain or Colombia.

Is 2C-B a real drug, and does tusi contain it? 2C-B is a real, specific compound. Its full chemical name is 4-Bromo-2,5-Dimethoxyphenethylamine, and the DEA classifies it as a Schedule I controlled substance with no accepted medical use in the United States. It rarely appears in tusi. Of roughly 960 pink powder samples tested by DEA laboratories through 2024, four contained 2C-B, and Spanish drug checking found it in 3.6 percent of 470 samples. The name survived after the ingredient disappeared from the recipe.

Is pink cocaine addictive? Yes. Ketamine, the most common ingredient, produces tolerance and dependence with repeated use, along with documented bladder and urinary tract damage. MDMA and any stimulants present carry their own risk of use that becomes hard to control. Because users often don't know ketamine is in the product, they also don't recognize ketamine withdrawal symptoms when those appear.

Can pink cocaine contain fentanyl? It can, but current testing suggests it usually doesn't. Researchers treat fentanyl contamination as a serious future risk rather than a present feature of the drug, based on what has already happened to the cocaine supply. Carrying naloxone remains reasonable, since nobody can verify the contents of an illicit powder.

References

1. Abukahok N, Fitzgerald ND, Palamar JJ. An Update on the Epidemiology of Tusi ("Pink Cocaine"). Current Addiction Reports. 2025;12(1):90. doi:10.1007/s40429-025-00706-y. PMID: 41583387

   
   

2. Palamar JJ. Tusi: a new ketamine concoction complicating the drug landscape. The American Journal of Drug and Alcohol Abuse. 2023;49(5):546-550. doi:10.1080/00952990.2023.2207716. PMID: 37162319

   
   

3. Palamar JJ, Abukahok N, Acosta P, Krotulski AJ, Walton SE, Stang B, Cleland CM. Tusi use among the New York City nightclub-attending population. Addiction. 2025;120(8):1646-1654. doi:10.1111/add.70069. PMID: 40254751

   
   

4. Drug Enforcement Administration, Diversion Control Division, Drug & Chemical Evaluation Section. 4-Bromo-2,5-Dimethoxyphenethylamine (Street Names: 2C-B, Nexus, 2's, Toonies, Bromo, Spectrum, Venus). https://www.deadiversion.usdoj.gov/drug_chem_info/bromo_dmp.pdf

   
   

5. Drug Enforcement Administration, Diversion Control Division, Drug & Chemical Evaluation Section. 1-(1,3-Benzodioxol-5-yl)-2-(ethylamino)butan-1-one (Eutylone). Street Names: "Bath salt," bk-EBDB. https://www.deadiversion.usdoj.gov/drug_chem_info/eutylone.pdf

   
   

6. Shulgin AT, Carter MF. Centrally active phenethylamines. Psychopharmacology Communications. 1975;1(1):93-98. PMID: 1223994

About the author:

Harold Pierre, MD, is a board-certified anesthesiologist, board-certified addiction medicine specialist, and a concierge addiction doctor with over 27 years of experience. He is board-certified by the American Board of Anesthesiology, the American Board of Preventive Medicine and has extension experience managing hormones. He is licensed in Florida, Texas, Oklahoma, Missouri (soon), Louisiana, and Arizona. If you are seeking care, you may schedule an appointment with him by calling or texting 918-518-1636. LinkedIn

Disclaimer: This blog post is for informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of your doctor or other qualified health provider with any questions you may have regarding your health or a medical condition.

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