"Pink Cocaine", Otherwise Known As Tusi

"The tusi phenomenon complicates the drug landscape because it has the potential to confuse both people who use and researchers alike. With respect to people who use, given the drug concoction’s name, people may assume the drug is 2C/2C-B. Since many partiers are unfamiliar with 2C series drugs (14), there is also potential for people to simply think this is a new (and perhaps benign) drug – especially given that the powder is pink with a sweet scent. The concoction’s other name, “pink cocaine,” may also lead some to believe this is a form of cocaine. This is an issue because cocaine is often used to balance out the effects of alcohol and unintentional ketamine use combined with alcohol use can lead to adverse reactions (21,22). Regardless of what people who use believe is in this concoction, batches tend to greatly fluctuate regarding which drugs and how much of them are mixed in. As such, this concoction may lead to unpredictable effects. Pre-mixed combinations of various drugs can also interact and have synergistic effects. This situation is even further complicated by the fact that many people in scenes that use tusi (e.g., party scenes) engage in polydrug use (19) which can lead to larger than planned doses or even further unintentional drug combinations. Tusi can also contain highly potent stimulants such as methamphetamine, which can be particularly dangerous or unpleasant if unknowingly consumed. As tusi acquires more popularity as a mystery powder, more people may create their own drug amalgamations to sell under its name, and similar to the current cocaine situation in the US (23), fentanyls may begin to appear in tusi, which will increase potential for overdose and death. A task force in California has already seized 4.4 lbs. of pink powder containing ketamine and despropionyl fentanyl (24), but this is a fentanyl precursor, which is thought to be relatively inactive (25).

"The tusi phenomenon also has the potential to complicate drug research. While toxicology studies tend to be more focused on testing which substances people have been exposed to, clinical, epidemiological, and social science studies that rely primarily on self-report can be affected. Most drug surveys do not query the use of actual 2C series drugs, so it is unlikely that such surveys will begin to ask specifically about tusi. Those who add questions about this concoction may assume tusi and 2C are the same product and collect unreliable data. It is also important to differentiate between what a product is called and what drug or drugs are present in the product. In this case, currently, ketamine appears to be the most common and most abundant drug present in tusi. While the two leading national drug surveys in the US do query ketamine use, “correct” responses to questions about use would depend on the participant knowing they were exposed to ketamine in tusi. As such, use of drugs such as ketamine or MDMA that was present in tusi will likely be underreported. Similarly, the use of synthetic cathinones (“bath salts”) is commonly underreported among people who use ecstasy because they are unaware that the ecstasy they used contained these compounds (26,27). Prevalence of ketamine use already appears to be increasing in the US (28), and increasing use of tusi will further drive increases, but estimated increases would likely depend on people knowing that they actually used ketamine."