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Tusi but not 2C: A Miami-Dade medical examiner case series highlighting the variable drug composition in colored powder paraphernalia.

Diane M Moore, Alexander D Giachetti, M Elizabeth Zaney, Rocio B Potoukian, Kenneth D Hutchins

Journal of Forensic Sciences May 1, 2025 DOI: 10.1111/1556-4029.70012 (opens in new tab)

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Study at a glance

AI-extracted from the abstract
Characteristics Case series Case report Peer reviewed
Sample size 8
Population Decedents in Miami-Dade County who ingested "tusi" powder
Duration September 2020 to July 2024
Topics Ketamine MDMA
Keywords Drug_safety Designer_drugs 2c-b Pink cocaine Forensic_analysis forensic toxicology Postmortem toxicology Illicit_substances MDMA 2c‐b Tucibi Tusi
Citations 3
Key findings All "tusi" powders contained ketamine and most contained MDMA, but none contained fentanyl or 2C-B, and all eight deaths involved multiple drugs in the decedent's blood.

Abstract

Eight fatalities between September 2020 and July 2024 in Miami-Dade County involving the ingestion of colored powders, referred to as "tusi," "tucibi," or "pink cocaine," are reported. For each case, a description of the terminal event, the postmortem toxicology findings, the cause and manner of death, and the chemical composition of the "tusi" powder(s) found on or near the decedent are summarized. Fourteen powders, mostly pink with a sweet or fruity aroma, were submitted for analysis. Ketamine was identified in all submissions, with the majority also containing methylenedioxymethamphetamine (MDMA). Other substances identified in the powders include stimulants (cocaine, methylenedioxyamphetamine [MDA], and methamphetamine), opioids (oxycodone), benzodiazepines (alprazolam), synthetic cathinones (eutylone), and over-the-counter medications (diphenhydramine and loratadine). Five of the powders contained cocaine; however, none contained fentanyl or 4-bromo-2,5-dimethoxyphenethylamine (2C-B). Five deaths were ruled as accidents, with four attributed to a drug overdose and one attributed to a fall from height. The remaining cases were classified as suicides (one fall from height, one hanging, and one self-inflicted gunshot wound). All cases reported multiple drugs in the decedent's postmortem blood in addition to ketamine and MDMA. The peripheral blood concentrations of ketamine and its metabolite, norketamine, ranged from 0.38-8.8 and 0.16-3.0 mg/L, respectively, and the concentration of MDMA and its metabolite, MDA, ranged from 0.10-3.0 and <0.01-0.27 mg/L, respectively. The medical examiner cases reported are the first to illustrate, through analytical testing, the variable drug composition of "tusi" powders and the impact its use may have in medicolegal death investigation.

Comparable studies

Other case reports and case series on MDMA, most cited first.

Study Year Design Participants
'Eve' and 'Ecstasy'. A report of five deaths associated with the use of MDEA and MDMA Individuals whose deaths were associated with MDMA or MDEA use 1987 Case series n = 5
Pathology of deaths associated with "ecstasy" and "eve" misuse. Young white men aged 20 to 25 who died after using ring-substituted amphetamines (MDMA... 1996 Case series n = 7
'Eve' and 'Ecstasy' Individuals who died after using MDMA or MDEA 1987 Case series n = 5
A Method of Conducting Therapeutic Sessions with MDMA Clients with clear therapeutic purpose, excluding those with serious functional... 1998 Case study n = 2
Diversity of Psychopathology Associated with use of 3,4-Methylenedioxymethamphetamine (‘Ecstasy’) Psychiatric patients presenting between 1990 and 1992 whose symptoms developed in the... 1994 Case series n = 13

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