In recent years, new forms of drug use have become increasingly common, posing significant challenges for public health. These include ‘tusi’ (also known as ‘pink cocaine’), nitrous oxide, and new cannabis products such as cannabinoid edibles, HHC, and mixtures of cannabis with prescription medicines.
According to the Clinical Toxicology Unit at Hospital Clínic Barcelona, these substances share three key risk factors: their composition is uncertain, their effects are difficult to predict, and they are frequently used alongside other drugs (polydrug use). This highlights the need for continuous toxicology monitoring and for healthcare services to adapt to new patterns of drug poisoning.
What are new psychoactive substances?
New psychoactive substances (NPS) are drugs or products that affect the nervous system and are introduced in new forms, combinations or chemical formulations.
The main risk is that these substances are often taken without knowing their composition, potency or potential effects. They may be marketed as "natural", "legal" or apparently harmless products, but these claims do not mean they are safe. This includes substances designed to mimic well-known drugs, mixtures of different substances, and chemically modified compounds created to evade drug control policies.
From a healthcare perspective, these substances present a double challenge: their effects can vary widely, and some may not be detected by standard rapid drug tests.
‘Tusi’ or ‘pink cocaine’: a misleading name
‘Tusi’, also known as ‘pink cocaine’ or ‘pink powder’, is a growing cause for concern because its name can be misleading. Despite what the name suggests, it is not cocaine.
Instead, it is usually a mixture of MDMA and ketamine, often combined with caffeine and other substances. It is typically sold as a pink-coloured powder and is most commonly snorted. Although its colour and street name may make it seem like a recognisable product, they provide no reliable information about its actual contents or the risks it may pose.
At Hospital Clínic, there has been a marked increase in emergency department visits related to ‘tusi’ between 2021 and 2025. Cases have risen from fewer than 1% of drug-related emergency attendances to almost 3%.
The main concern is its mixed composition. ‘Tusi’ combines substances that affect the nervous system in different ways. Some act as stimulants, while others can alter perception or cause dissociation. As a result, its effects are less predictable and can vary from person to person.
The presence of ketamine is of particular concern because it may increase the risk of dependence and can cause physical harm, which in some cases may be severe. In addition, urine tests carried out in the emergency department show that tusi is often used alongside other drugs, making the clinical management of these cases more complex.
