Pink cocaine is getting more attention after Liam Payne's death
Key Takeaways
One Direction singer Liam Payne's recently released toxicology report revealed he had pink cocaine in his system—a powdered drug cocktail growing in popularity, which may have contributed to his death.
Pink cocaine is a highly unpredictable drug due to its complex and varying composition, making it difficult to diagnose and treat overdose symptoms.
Physicians should be aware of the potential for pink cocaine to cause severe health risks, including increased heart rate, paranoia, psychosis, overdose, and death, especially when combined with other substances like alcohol or traditional cocaine.
An initial toxicology report revealed that Liam Payne, the former One Direction singer who fell from a balcony and died October 2024, had multiple drugs in his system, including “pink cocaine.”[]
Pink cocaine, also referred to as Tusi, has mind-altering hallucinogenic effects and, as the name suggests, comes in the form of a pink powder.[] It can contain a dangerous mixture of drugs, including MDMA, ketamine, caffeine, and a psychedelic drug called 2-CB, according to the DEA.
“Some samples of pink cocaine may only contain two of those drugs, while others may contain all of them,” says Antonia Nemanich, MD, a toxicologist and emergency medicine physician at RUSH University System for Health in Chicago.
About the powdered drug cocktail
While pink cocaine’s primary ingredients, such as MDMA, have been around for decades, the combination of these ingredients in a single product can make it feel novel and appealing, according to Jason Kellogg, MD, a psychiatrist and the medical director at Hotel California by the Sea, a substance use treatment center in Orange County.
Pink cocaine first appeared in Latin America and Europe before making its way to the US, research shows.[]
And it’s becoming more prevalent at nightclubs in LA, Miami, and New York. “It’s often marketed as a more exotic option compared to standard recreational drugs, and the colorful appearance and name contribute to its trendy appeal,” Dr. Kellogg tells MDLinx.
Every batch of pink cocaine is different, so it’s unclear how any given powder will affect someone, according to the DEA.[] “The primary effects would be dependent on the ingredients used in the specific batch of cocaine,” says Ryan Marino, MD, an associate professor at Case Western Reserve University School of Medicine.
As such, researchers call the drug a “mystery powder.”[] Oftentimes, the mixture does not even contain cocaine.[] The vast majority of batches confiscated and tested contain high levels of ketamine, and research shows pink cocaine is commonly taken with other substances, including alcohol, true cocaine, and ecstasy.[]
According to Poison Control, people who ingest pink cocaine report feelings of stronger social connections and euphoria.[] But the effects can shift rapidly and unexpectedly, says Dr. Kellogg. The drug can also cause anxiety, hallucinations, increased heart rate and blood pressure, nausea and vomiting, and elevated body temperature.
Additionally, it can trigger severe confusion, paranoia, or psychosis, says Olalekan Otulana, MBChB, DRCOG, MRCGP, DFSRH, a general practitioner and addiction physician at Ocean Recovery Centre in the UK. More seriously, the drug can lead to seizures, abnormal heart rhythms, and coma. Many people have also reported experiencing physical and sexual assault while taking the drug.
Combining uppers and downers can substantially increase the risk of an overdose.[] “Because pink cocaine is usually a combination of potent and unpredictable substances, the risks are often higher than [those associated] with traditional cocaine,” Dr. Otulana says.
Treating a pink cocaine overdose
Symptoms of a pink cocaine overdose include loss of consciousness, vomiting, paranoia, hallucinations, and severe agitation.[] Anyone who suspects an overdose should immediately call 911. CPR and naloxone (Narcan) should be administered to anyone who is unresponsive or not breathing.
"It’s especially risky because users often don’t know exactly what they’re ingesting."
— Jason Kellogg, MD
“In each case, overdose treatment depends on the symptoms of a specific patient,” says Dr. Nemanich. The patient’s heart rate, blood pressure, and breathing patterns should be monitored, and some patients may require IV fluids to clear the drugs from their system. Other medications can be given to help with seizures or hallucinations. “The most important thing is making sure that they are in a safe, monitored environment, as hallucinogens can cause people to behave erratically or in ways that are quite unsafe,” says Dr. Marino.
Because each batch of pink cocaine can be different, it can be difficult for emergency healthcare providers to know what exactly a patient has taken. “This unpredictability poses a significant challenge for medical staff, as the symptoms and treatment protocols can differ greatly depending on the specific substances involved,” says Dr. Otulana.
What this means for you
An initial toxicology report revealed that Liam Payne, the former One Direction singer who died after falling from a balcony in October 2024, had multiple drugs in his system, including a substance known as "pink cocaine," aka Tusi. This drug, a mixture typically consisting of MDMA, ketamine, caffeine, and a psychedelic, is unpredictable, with varying effects depending on the batch, and can lead to serious health issues such as hallucinations, seizures, and even overdose. As its popularity grows in nightclubs, the drug’s combination of stimulants and hallucinogens increases the risk of severe reactions, including addiction and death.
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