When pink powders shift the drug landscape: tusi (“pink cocaine”) and other colored powders

Introduction

“Tusi,” also known as “tusibí” or “pink cocaine,” is a powder drug concoction that has grown in popularity in nightlife scenes across Latin America, parts of Europe, and, increasingly, in parts of the US. Despite its common names, tusi typically contains neither the psychedelic phenethylamine 2C-B nor cocaine (Palamar, 2023). Instead, tusi typically contains a combination of drugs such as ketamine, MDMA, and caffeine, which are mixed with dyes to create the powder’s distinctive colored appearance (most frequently pink) (Échele Cabeza, 2023; Fernández Piedra et al., 2025). While these three drugs are most commonly detected in tusi, a wide variety of other substances have also been identified, including methamphetamine, cocaine, synthetic cathinones, common cutting agents (e.g., lidocaine), and even prescription opioids (Moore et al., 2025; Palamar, 2023). The very nature of tusi as a polydrug powder means that people who use tusi are using multiple drugs simultaneously, and its unpredictable composition means that those who use can be exposed to a number of substances of unknown type and quantity via a single dose. Altogether, tusi can pose serious health risks, and it has become a growing concern among public health officials and law enforcement agencies. In this viewpoint, we briefly summarize the history of tusi, the increased prevalence of novel drug concoctions, reports about tusi received by the US National Drug Early Warning System (NDEWS; Cottler et al., 2020), and our recommendations for future research.

Brief history of tusi

In the 2010s, 2C-B became popular in Latin America, particularly in Colombia’s nightclub scene, as an “elite drug” (Fernández Piedra et al., 2025; Ford, 2022). However, when demand for 2C-B began to outpace supply, vendors began cutting and bulking the powder with caffeine and with the cheaper and more readily available ketamine and MDMA. Eventually, the product sold as tusi (the phonetic translation of “2C”) contained almost no actual 2C-B (Ford, 2022). Besides the novel branding of tusi, its export to other regions and countries has also been novel in that the export is more of a brand or idea than of an actual drug product: the idea that combinations of locally available drugs could be mixed in powder form, dyed pink, and sold as tusi or pink cocaine (Ford, 2022). Since then, the tusi brand has evolved, with reports of some drug vendors adding an “individual touch” to their tusi products (Ford, 2022), which can involve unique drug mixtures, colors, and specific logos on drug-containing plastic bags. There has also been a recent appearance of powders sold as tusi in colors other than pink, including purple, green, and yellow (Échele Cabeza, 2023; Ford, 2022; Moore et al., 2025); while research is limited, different “brands” or colors of tusi may suggest different formulations (e.g., with information from our key informants suggesting that some colors may indicate the tusi being more “speedy” than others).

While still most popular in Latin America and parts of Europe (particularly in Spain; European Union Drugs Agency, 2025a), tusi has now spread to other regions, including Australia and the US. In Australia, police first reported a seizure of “pink cocaine” in 2020 and more recently reported seizing 133kg of pink cocaine between March and July 2024 (Australian Federal Police, 2024). Several Australian drug checking services have also disseminated drug alerts regarding pink powders that were found to contain mixtures of ketamine and MDMA (Victorian Pill Testing Service, 2025), including one alert where the product was purchased as 2C-B (CanTEST, 2023). In the US, tusi is becoming more common particularly in nightclub scenes in metropolitan areas such as Miami, New York City (NYC), and Los Angeles (US Drug Enforcement Administration [DEA], 2025). Regarding availability, the US DEA reports that tusi is often produced locally rather than trafficked into the US, and local law enforcement are more likely to encounter pink cocaine at the retail level (US DEA, 2025). The US DEA reports seizing 960 pink powders since 2020, with only four exhibits containing 2C-B (US DEA, 2025); however, without knowing what these drugs were sold as, it is unclear whether these were seizures marketed as tusi. Some data are also beginning to be collected regarding tusi use and associated poisonings in the US. Among a sample of nightclub attendees in NYC surveyed in 2024 (n=1465), an estimated 2.7% used tusi in the past year, with those reporting use more likely to have their saliva test positive for cocaine, ketamine, MDMA, methamphetamine, and/or synthetic cathinones (Palamar et al., 2025). Importantly, those reporting past-year tusi use were also more likely to have tested positive for cocaine, ketamine, or methamphetamine after not reporting past-year use of these substances (Palamar et al., 2025). America’s Poison Centers also released a public health alert regarding pink cocaine in 2024 which noted that 18 pink cocaine case exposures had been reported across four states since January 2024, with 83% of patients receiving medical treatment (America’s Poison Centers, 2024).

Drug concoctions changing the drug landscape

The often-unpredictable mixture of substances contained in tusi poses health risks for people who use this concoction, and we currently lack important supply-level data to inform prevention and public health responses. As the evolution of tusi has shown, there is a critical need for drug surveillance to systematically monitor not only the number and quantity of tusi seizures, but also their (1) color, (2) composition (including identifying which substance[s] are present and quantifying amounts present), (3) packaging and branding, and (4) what the drug was sold as. While most evidence shows that most tusi contains ketamine, MDMA, and caffeine (Échele Cabeza, 2023; Fernández Piedra et al., 2025; Palamar, 2023), some detected combinations—such as ketamine and opioids like tramadol (Moore et al., 2025)—are perhaps more concerning than others, especially in cases where the individual has no tolerance to opioids. Recently, there has been discussion regarding the possibility of tusi products containing fentanyl. The US DEA has reported that fentanyl has been detected in pink powders, but without any additional information provided (US DEA, 2025). Further, a recent study of 8 fatalities involving pink powders and ketamine positivity (Moore et al, 2025) could have missed decedents who used pink powders that did not contain ketamine. Of note, in one case, the decedent’s blood tested positive for fentanyl that was not detected in pink powders found at the scene of death. In addition, NYC nightclub attendees have submitted reports to NDEWS that cheap tusi from unknown dealers is more likely to test positive for fentanyl (based on their test strip results).

While there is still uncertainty regarding tusi possibly containing fentanyl in the US, as of March 2025 in Canada, law enforcement agencies have reported an increase in drug samples submitted containing a combination of fentanyl and ketamine (Criminal Intelligence Service Alberta, 2025). Many of these samples were also found to contain a novel benzodiazepine (e.g., bromazolam), and 95% were described as colored powders or grainy substances, with colors including “purple, pink, blue, orange, red, multi-colored, beige, bronze, and yellow” (Criminal Intelligence Service Alberta, 2025). While key informants have reported to us that these fentanyl–ketamine mixtures appear to be sold as “down” and not tusi, those purchasing “down” are likely expecting an opioid, not a dissociative anesthetic like ketamine. As such, we believe that the Canadian trend is fentanyl adulterated with ketamine, not ketamine adulterated with fentanyl. This nuance reinforces the need for better drug supply data in North America to monitor the continued proliferation of colorful powdered drug concoctions and patterns of both ketamine and fentanyl adulteration. Thus far, in the US, we at NDEWS have begun to receive reports of opioids adulterated with ketamine in Michigan, and tusi sold as a non-colorful fentanyl product in Florida. As the unregulated drug supply continues to evolve in complexity and volatility, drug surveillance needs to move beyond tracking individual drugs to capture specific polydrug combinations and contexts.

Recommendations for epidemiologic data collection and future research

Trends involving tusi and other colored powdered drug products also impact drug research. For surveys on self-reported drug use, ketamine and other drugs commonly identified in tusi (e.g., ketamine) are being underreported among people who use tusi (Palamar et al., 2025). In fact, we further estimate based on our NYC nightclub data that 41.7% of attendees that report tusi use underreport ketamine use. Tusi’s common misleading names also add to the potential for confusion among respondents: some might endorse use of 2C-series substances thinking that these refer to tusi, or the use of cocaine thinking that pink cocaine in fact contains cocaine. Surveys should include information describing tusi, specifically (e.g., a powder, often pink, that contains a mixture of stimulant and hallucinogenic drugs), and should anticipate confusion and thus differentiate tusi from 2C. The pairing of survey data with testing of biological specimens is more valuable than ever to confirm drug exposure in an increasingly unpredictable drug supply, and we encourage triangulating results from multiple sources.

Finally, given the appearance of other colored powders, including those not sold as tusi, research on the geographical and temporal patterns of drug product combinations in local drug supplies are increasingly needed. Specifically, as the branding of these products evolves, there is a need for more contextual data on packaging, formulation, and drug appearance. Understanding the composition of these powders over space and time is important: while ketamine appears to be a common ingredient in the majority of tusi products, the recent data from Canada suggest that not all colored powders containing ketamine are sold as tusi (Criminal Intelligence Service Alberta, 2025), which impacts studies attempting to examine outcomes related to tusi use. However, not all seizure data systematically track or report this information. Drug checking services (DCS) can uniquely address this gap in supply-level surveillance while also providing tailored education and harm reduction advice to those who submit samples for analysis (Maghsoudi et al., 2022). In Europe, for example, the Trans European Drugs Information (TEDI) network collects standardized drug checking data from participating DCS to understand city-level trends in drug contents, purity, and adulteration, with additional contextual information provided by consumers (e.g., what the drug was expected to contain) (European Union Drugs Agency, 2025b). Legal and funding barriers have prevented widespread adoption of DCS in the US (Davis et al., 2022), but given the rapidly shifting unregulated drug supply and the continued emergence of novel drug concoctions like tusi, community-level DCS can address a critical need for surveillance while also providing opportunities to reduce harm among consumers. We urgently need more comprehensive supply-level data on composition, characteristics, and contexts of these colored powders, as this will allow us to stay ahead of the rapidly changing landscape of drug concoctions to prevent drug-related harms.