What is Krokodil (desomorphine)?
Desomorphine, known by the street name krokodil, is an opioid derivative of codeine. Like heroin and other opioids, it has a sedative and analgesic effect, is highly addictive, and potentially harmful. Krokodil is presumed to contain desomorphine, but due to illicit, home-based, manufacturing, it may contain other unknown ingredients, or in fact, no desomorphine at all.
Homemade versions of the drug start with codeine, and can be ‘cooked’ similar to meth production. Organic solvents such as gasoline, paint thinner, or lighter fluid, iodine, hydrochloric acid, and red phosphorus are used in homemade synthesis. These dangerous chemicals are not always fully “cooked” out of the concoction when used to make illicit krokodil.
People who inject these caustic agents into their veins can develop extreme skin ulcers, infections, and gangrene - a discolored (green, black) scale-like skin that resembles a crocodile, hence the street name “krokodil”. Krokodil also refers to chlorocodide, a codeine derivative in the synthetic path to desomorphine. Krokodil is also called “Russian Magic”, referring to its short duration of opioid intoxication (euphoria).
What Are Some Other Effects of Krokodil?
According to reports, the drug has been noted to be fast-acting and eight to ten times more potent than morphine. However, the half-life is short, and euphoric effects may last less than two hours. Due to the short “high”, many users find themselves in a rapid repetition of drug synthesis to avoid withdrawal symptoms that are typical of heroin. In fact, when the toxic chemicals are removed, quite often what is left is desomorphine, a compound very similar to heroin.
The analgesic effect of desomorphine is about ten times greater than morphine and three times more toxic. Due to the drug’s rapid onset but short duration of action and frequent administration, quick physical dependence may occur.
What is the Extent of Krokodil Use?
Krokodil has been synthesized in Russia for over a decade. About one million people in Russia use krokodil according to the New York State Office of Alcoholism and Substance Abuse Services. Krokodil goes by the names of “Cheornaya” in Russia and “Himiya” in Ukraine. According to the head of the Russian Federal Drug Control Service, the amount of krokodil seized in Russia increased 23-fold between 2009 and 2011. Krokodil has also been reported in other countries including the Ukraine, Georgia, Kazakhstan, Germany and Norway.
Previously in Russia and Ukraine, Afghan heroin was the drug of choice when making homemade injectables. Due to a possible Afghan opium crop fungal disease in 2010, the production of opium was 48 percent lower than the previous year. Therefore, in Eurasia, users turned to over-the-counter medications that contain codeine for pain or cough (e.g. Solpadeine, Codterpin or Codelac). Codeine is preferred instead of heroin because of lower costs and ease of availability. However, the medications combined with the codeine such as acetaminophen or terpin hydrate, their effect on the chemical reactions, and their ultimate contribution to the toxicity of krokodil are unknown.
In the U.S., codeine is a controlled substance and either requires a prescription or may be available over-the-counter from the pharmacist (as with some cough syrups) with restrictions in some states. There were few reports of krokodil use in the U.S. until September 2013 when a poison control center in Phoenix, Arizona, apparently received inquiries about the product. Additional reports have surfaced from Illinois and Oklahoma. However, as of October 2013, the U.S. Drug Enforcement Agency (DEA) has stated that they are skeptical that krokodil has crossed American borders. The DEA notes that they have not seen any cases of it, and nothing has been turned into their laboratories. To have official confirmation, the DEA would require a drug sample. Users in America may unknowingly buy krokodil off the streets under the assumption they are buying heroin.
What are the Health Hazards and Addiction Potential of Krokodil?
There have been multiple unconfirmed news reports of users in the U.S. who have had extreme skin ulcerations, infections and scale-like skin due to use of krokodil. Indeed, the most common complications reported thus far from krokodil injection appears to be the serious vein damage, soft tissue infections, necrosis and gangrene. There have been news reports of amputations. It appears that ulcerations may occur locally at drug injection site or also at remote areas of the body. There may be further organ or central nervous system damage.
Reported health hazards due to krokodil injection use:
- Blood vessel damage
- Open ulcers, gangrene, phlebitis
- Skin and soft tissue infections
- Skin grafts/surgery
- Limb amputations
- Blood poisoning
- Rotting gums/tooth loss
- Blood-borne virus transmission (HIV/HCV due to needle sharing)
- Bone infections (osteomyelitis)
- Speech and motor skills impairment
- Memory loss and impaired concentration
- Liver and kidney damage
According to reports, the localized soft tissue effects occur relatively quickly after the use of krokodil is started. In some former Soviet Union regions, officials attribute at least half of all drug-related deaths due to krokodil.
Addiction is an obvious problem with krokodil use due to its high potency and short duration of effect. Frequent administration may lead to binge patterns that can last for days. Users are at increased risk for exhaustion due to sleep deprivation, memory loss, and problems with speech. In areas where krokodil use is just beginning, variations in potency or recipes can put users at increased risk of overdose.
Another less obvious risk with krokodil use is that those who are afflicted with gangrene and other side effects may delay seeking much-needed medical treatment due to fear of legal action. In addition, the desire for continued krokodil administration to prevent withdrawal effects may prevent users from presenting for treatment