Tussi—commonly referred to as “pink cocaine”—is an unregulated synthetic drug mixture that has begun appearing with increasing frequency in New York nightlife and party settings. Despite its name, Tussi rarely contains cocaine and instead consists of variable combinations of stimulants, dissociatives, and other psychoactive substances. The absence of a standardized composition, combined with the growing risk of opioid contamination, presents significant challenges for public health, overdose prevention, and treatment response. This article provides an evidence-informed overview of Tussi, its associated risks, and the implications for harm reduction and treatment in New York.