ToxIC NOSE Report #20 | A Stimulant on the Rise: “Pink Cocaine”

The ToxIC NOSE (Novel Opioid and Stimulant Exposure)
Report #20 from ToxIC’s Rapid Response Program for Emerging Drugs of Abuse

A Stimulant on the Rise: “Pink Cocaine”

Samantha Gaetani, MD & Kim Aldy, DO, MS, MBA

“Pink Cocaine,” also known as “Tusi” or “Tucibi,” refers to a street drug marketed as a pink powder that is composed of widely varying psychoactive substances.

It emerged in response to the demand for 4-bromo-2,5-dimethoxyphenethylamine (2C-B), a hallucinogenic phenethylamine known for producing euphoria and visual hallucinations similar to methylenedioxymethamphetamine (MDMA) and lysergic acid diethylamide (LSD). During the 1990s and early 2000s, 2C-B gained popularity in raves and the party scene. As demand outpaced the supply, 2C-B was increasingly adulterated with cheaper and readily available substances such as ketamine, MDMA, and caffeine. This new product was sold as Tusi, the phonetic translation of 2C. Although ketamine, MDMA, and caffeine are commonly detected in Tusi, the composition varies widely across samples. Methamphetamine, amphetamines, cocaine, tramadol, lidocaine, diphenhydramine, oxycodone and other psychoactive substances have also been found in Tusi. The powder may appear in colors other than pink. In the United States, Tusi use has been reported primarily in night clubs and particularly in large cities such as New York, Los Angeles, and Miami. Since 2020, the United States Drug Enforcement administration(DEA), has seized a total of 960 pink powders, however only 4 contained 2C-B.

The clinical effects of Tusi are highly variable. Individuals that use Tusi seek euphoria or hallucinations. Unfortunately, there are reports of respiratory depression, sedation, seizures, agitation, hypertension, tachycardia, rhabdomyolysis, and kidney injury from Tusi use. Deaths associated with Tusi have been documented, likely from the different combination of stimulants, sedatives, and opioids mixed in these products.