From “Pink Cocaine” and “Rhino Tranq” to “Gas Station Heroin” and “Fake Xanax”: The Epidemiology of Tusi, Medetomidine, Tianeptine, and Bromazolam

Session Description: The drug landscape in the United States continues to evolve at a rapid pace, with the introduction of many new drugs and drug concoctions. The NIDA-funded National Drug Early Warning System (NDEWS) has been monitoring trends in novel drugs and alerting the scientific and lay community to new trends of concern. This presentation focuses on the recent epidemiology of tusi (“pink cocaine”), “rhino tranq” (medetomidine), “gas station heroin” (tianeptine), and “fake Xanax” (bromazolam). Tusi, now more commonly referred to as “pink cocaine”, is a pink-colored powder concoction which almost always contains ketamine and other drugs such as MDMA, cocaine, methamphetamine, and synthetic cathinones (“bath salts”). Tusi has become an increasingly prevalent party drug although the name “pink cocaine” is a misnomer because the concoction rarely contains cocaine. Medetomidine is a potent animal tranquilizer which has begun to appear in overdose cases involving the ingestion of illicitly manufactured fentanyl. Medetomidine is mixed with fentanyl as an adulterant, typically along with xylazine and has been leading to overdoses that are increasingly complicated to reverse. Tianeptine is an antidepressant which was recently an ingredient in various ‘dietary supplements’ sold at gas stations and convenience stores and has been associated with recent clusters of poisonings. Finally, bromazolam is a potent novel benzodiazepine which is commonly mixed with fentanyl and pressed into counterfeit tablets resembling alprazolam. Bromazolam has been linked to over 1,400 deaths in 2023 alone.

This presentation will cover what is known about these drugs and drug concoctions with a focus on known prevalence of use, nonfatal poisonings, and deaths. These drugs are commonly associated with unintentional exposure so prevention, treatment, and harm reduction will also be discussed.