What Is Pink Cocaine (Tusi)?: Effects, Risks and Addiction

Pink cocaine is a synthetic powder blend, not cocaine. Called “tusi” on the street, it typically contains MDMA, ketamine, and other adulterants. Dyed pink for branding, it produces stimulant and dissociative effects at the same time, making its risks unpredictable and dangerous without medical support.

 

What Is Tusi and What Does It Contain?

The name “tusi,” a phonetic spelling of “2C”, originally referred to the psychedelic phenethylamine 2C-B, synthesized in the 1970s. Today’s street product rarely contains 2C-B at all [1]. Research finds that most samples are a varying blend of MDMA, ketamine, caffeine, lidocaine, and other adulterants, with no consistent formula between batches [2].

Tusi has spread rapidly through US cities, particularly in nightclub and party environments [3], from its origins in Latin American nightlife. A 2025 study of New York City nightclub attendees showed that tusi use has increased year over year. Most users were unaware of the drug’s actual chemical composition [3]. 

Users typically snort the powder, though some mix it into drinks. Because there is no standard recipe, each dose carries a different and unknown risk profile.

The social impact is significant, with emergency department visits tied to novel psychoactive substance mixtures continuing to rise. Most users who reported adverse effects from substances such as tusi in one multi-city study had not sought medical help, suggesting harm is widely underreported [4]. 

The illicit market exploits tusi’s premium branding to charge higher prices than standard street drugs, targeting younger and higher-income nightlife populations.

 

Short-Term Effects

Because tusi usually combines stimulants with a dissociative anesthetic, it produces a wide range of effects that can shift quickly [1]:

• Euphoria, increased energy, and heightened sensory perception from the MDMA component
• Dissociation, distorted perception of time and space, and numbness from ketamine
• Rapid heart rate and elevated blood pressure
• Nausea, teeth grinding (bruxism), and sweating
• Confusion, anxiety, and paranoia, especially as the drug wears off

The combination of stimulant and dissociative effects is unpredictable. A person cannot know in advance how their body will respond, and the presence of unknown adulterants raises the risk of overdose.

 

Health Risks and Long-Term Consequences

Researchers have documented a pattern of serious medical consequences that tusi poses with both immediate and long-term health dangers [5].

• Cardiac damage: A 2026 study identified a newly described condition called “TUSI valve,” a drug-induced heart valve disease, in regular tusi users [6].
• Neurotoxicity: Long-term changes in serotonin pathways, affecting mood regulation and memory, are associated with the use of MDMA.
• Ketamine-related bladder and kidney damage: Severe urinary tract injury can result from heavy or repeated exposure to ketamine.
• Mental health effects: After regular use, persistent anxiety, depressive episodes, and flashback-like symptoms can develop [4].
• Overdose risk: Dosing is impossible to judge, increasing accidental overdose risk.

 

Can Tusi Cause Addiction?

Yes. Ketamine has an established risk of addiction in which users may develop cravings, tolerance, and withdrawal symptoms. MDMA creates strong psychological reinforcement, especially in social settings, driving repeated use even as negative consequences mount [1].

Research confirms that tusi users are more likely to also use cocaine, alcohol, and opioids, raising the risk of polysubstance dependence [3]. This pattern makes assessment and treatment more complex — and more important to pursue with professional support.

 

Tusi vs. What Users Expect

What Users Expect	What Research Shows
Contains 2C-B (a specific psychedelic)	Most samples contain no 2C-B at all [1]
Consistent effects each time	Batch composition varies widely; there is no standard formula [2]
Lower risk than “harder” drugs	Linked to cardiac valve damage, neurotoxicity, and dependence [6]
Non-addictive party drug	Ketamine and MDMA both carry significant dependence liability [1]

Treatment and Recovery

There is no single approved medication for tusi dependence, but evidence-based programs address its component substances effectively. Treatment typically begins with a medical evaluation to assess which substances are present, followed by a structured plan tailored to the person’s specific use pattern and any co-occurring mental health conditions [5].

 

Common Treatment Approaches

• Medical detox to manage ketamine withdrawal symptoms safely
• Cognitive Behavioral Therapy to address patterns of use, cravings, and triggers
• Motivational Enhancement to build readiness for change
• Dual-diagnosis treatment when anxiety, depression, or trauma co-occur with substance use
• Outpatient or residential programs depending on the severity of use and support at home

It is possible to recover. People who engage in structured treatment for polysubstance use show meaningful reductions in use and improvements in mental health outcomes. Reaching out to a provider, even if you are unsure whether you are “addicted,” is always the right first step.

 

Key Takeaways

• Tusi is not cocaine. It is an unregulated synthetic powder blend, most often containing MDMA and ketamine, with no consistent formula from batch to batch.
• Its unpredictable contents create serious short-term risks — overdose, cardiac events, and acute mental health crises — and long-term risks including heart valve damage, neurotoxicity, and dependence.
• Tusi use is growing in US nightlife settings, especially among young adults who often use multiple substances together, increasing the complexity of harm.
• Evidence-based treatment addresses tusi dependence effectively — if you or someone you care about is struggling, speaking with a healthcare provider today is a meaningful, achievable step forward.

 

Welcome to Top-Tier Residential Drug and Alcohol Recovery

For those seeking a high-level of specialized, integrated care in the San Francisco Bay area, Alta Mira Recovery Programs is a high-end, top-tier residential addiction center specializing in the treatment of substance use disorders and complex co-occurring mental health issues. 

Contact our compassionate admissions team to learn more.

 

Frequently Asked Questions

Is tusi the same as 2C-B?

No. The name tusi comes from “2C” but lab testing consistently shows most street samples contain no 2C-B. The actual contents vary by batch and typically include MDMA and ketamine.

Can you become addicted to tusi?

Yes, tusi’s core ingredients, ketamine and MDMA, both carry a risk of dependence and with cravings, tolerance, and withdrawal symptoms. Psychological dependence is especially common in social use patterns.

What are the most dangerous short-term risks?

The most dangerous short-term risks are accidental overdose from unknown contents, dangerous elevation of heart rate and blood pressure, overheating (hyperthermia), and severe psychological reactions such as panic or psychosis.

What treatment approaches are used for tusi dependence?

Treatment includes medical detox, Cognitive Behavioral Therapy, and Motivational Enhancement. Programs vary from outpatient (several hours per week) to residential care. Co-occurring mental health conditions are addressed within the same program.

Does insurance cover treatment for tusi use disorder?

Most US insurance plans under the Mental Health Parity Act, including Medicaid and Medicare, cover substance use disorder treatment. Coverage details vary by plan, so the first step is to contact Alta Mira admissions or your insurer to verify benefits.

What happens at an intake assessment?

A clinician asks about your substance use history, physical health, and mental health. No one is judged. The goal is to understand your needs so the team can recommend the right level of care for you.

Can tusi harm my heart even with occasional use?

Possibly. Cardiac risks — including acute arrhythmia and the newly documented TUSI valve disease — have been reported in users. There is no established “safe” level of use given the unpredictable and variable contents of each batch.

 

Sources

[1]	Palamar, J. J. (2023). Tusi: a new ketamine concoction complicating the drug landscape. The American Journal of Drug and Alcohol Abuse, 49(5), 546–550.
[2]	Abukahok, N., Fitzgerald, N. D., & Palamar, J. J. (2025). An update on the epidemiology of tusi (“pink cocaine”). Current Addiction Reports, 12.
[3]	Palamar, J. J., et al. (2025). Tusi use among the New York City nightclub-attending population. Addiction, 120(8), 1646–1654.
[4]	Fitzgerald, N. D., Palamar, J. J., & Cottler, L. B. (2026). Self-reported adverse effects associated with new psychoactive substance use in a sample of adults from 20 US cities. Drug and Alcohol Review, 45(2), e70119.
[5]	Fitzgerald, N. D., Abukahok, N., & Palamar, J. J. (2025). When pink powders shift the drug landscape: tusi (“pink cocaine”) and other colored powders. The International Journal on Drug Policy, 146, 105044.
[6]	Vasquez-Rodriguez, J. F., et al. (2026). TUSI valve: echocardiographic and pathologic correlates of a novel drug-induced valvular disease — a case series. CASE, 10(4), 136–142.