ResearchPublications

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.