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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
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In addition to ABC News' "World News Tonight" anchor and "20/20" co-anchor David Muir's special report, "Breaking Point: Heroin in America," our ABC affiliates and ABC-owned stations across the country have also been reporting on the heroin epidemic. We’ve pulled together the best of their coverage to show how addiction has affected cities and towns in so many states. We hope this effort will help add to the national discussion.
More than 47,000 people died from drug overdoses in 2014, and that tragic number has consistently grown from 23,518 deaths in 2002, according to the Centers for Disease Control. The CDC also found there was an average of 15 deaths per 100,000 Americans related to drug overdose in 2014, up from roughly eight per 100,000 in 2002.
Click here to see the CDC's breaks down the number of deaths by state and county:
Drug Poisoning Morailty
Below are just some of the reports our ABC affiliates and ABC-owned stations have done on heroin. Scroll through to find your home state:
ALASKA: Anchorage, KYUR - Even far flung Alaska isn’t immune to the heroin epidemic. Click here to watch the report.
ARIZONA: Phoenix, KNXV – Heroin epidemic hits Arizona hard. Click here to watch the report.
CALIFORNIA: Los Angeles, KABC – Support group has helped thousands of families in crisis. Click here to watch the report.
CONNECTICUT: New Haven, WTNH – Addicts must take a 100 mile trek to reach lifesaving medical rehab treatment. Click here to watch the report.
FLORIDA: Orlando, WFTV - Addicts across the state turned to heroin when Florida authorities cracked down on prescription pain pills. Click here to watch the report.
GEORGIA: Macon, WGXA – Heroin use crosses all demographics in rural Georgia. Click here to watch the report.
HAWAII: Honolulu, KITV - As heroin use increases, users in Hawaii are getting younger and younger. Click here to watch the report.
IDAHO: Idaho Falls, KIFI – As crime soars, police say heroin and other drugs are to blame. Click here to watch the report.
IOWA: Cedar Rapids, KCRG – As drug deaths continue to soar in Iowa, officials hope a new treatment program will help turn that around. Click here to watch the report.
MAINE: Portland, WMTW – Drug deaths worsen as dealers add the illicit painkiller Fentanyl to pills and heroin. Click here to watch the report.
MARYLAND: Salisbury, WMDT - The quiet Delmarva area struggles with the question of punishment vs. treatment for addicts. Click here to watch the report.
MASSACHUSETTS: Boston, WCVB – A radical new tactic catches on as one police chief tries helping addicts instead of arresting them. Click here to watch the report.
MASSACHUSETTS: Western Mass., WGGB - A mother’s fight to save her daughter from heroin’s grip. Click here to watch the report.
MISSISSIPPI: Biloxi, WLOX – A Mississippi mother has to drive her son 20 hours away, all the way to Massachusetts, to the nearest rehab center she can find for him. Click here to watch the report.
MISSOURI: Springfield, KSPR – Opioid addiction treatment centers are overwhelmed with patients. Click here to watch the report.
MISSOURI: St. Louis, KDNL – Heroin antidote Naloxone saves three lives every day in St. Louis. Click here to watch the report.
NEVADA: Reno, KOLO: A local drug prevention program handles calls from distraught parents who have just made an increasingly common discovery. Click here to watch the report.
NEW HAMPSHIRE: Manchester, WMUR – New poll finds that opioid abuse is considered the state’s top problem. Click here to watch the report.
NEW HAMPSHIRE: Hanover, WVNY - High school now carries the heroin antidote Naloxone on campus. Click here to watch the report.
NEW YORK: Rochester, WHAM – Is saving the lives of overdose victims more important than arresting their fellow drug users? Click here for more.
NEW YORK: Albany, WTEN – Small towns to suburban malls, heroin and death are everywhere. Click here to watch the report.
NEW YORK: Syracuse, WSYR - Police say 80 to 90 percent of all burglary arrests have been heroin related. Click here to watch the report.
NEW YORK: Buffalo, WKBW – Naloxone saves lives of overdose victims….but may also allow those addicts to push the limits. Click here to watch the report.
NORTH CAROLINA: Charlotte, WSOC – An undercover police sting nets a young women selling drugs with her 5 year old son in tow. Click here to watch the report.
NORTH CAROLINA: Raleigh-Durham, WTVD – Tip leads to a huge heroin bust. Click here to watch the report.
OHIO: Columbus, WSYX – Helping heroin addicted moms maintain contact with their children, as they work their way through rehab. Click here to watch the report.
PENNSYLVANIA: Easton, WPVI – Caught on camera; After a man overdoses on a bus, police revive him with the antidote drug Nalaxone. Click here to watch the report.
TENNESSEE: Nashville, WKRN – A lifesaving heroin anti-overdose drug is now being offered without a prescription. Click here to watch the report.
TENNESSEE: Memphis, WATN - Families stunned by unexpected overdose of teen friends. Click here to watch the report.
VIRGINIA: Hampton Roads, WVEC – Hooked on heroin, Virginia’s growing killer. Click here to watch the report.
VIRGINIA: Richmond, WRIC - A baby boy born to a heroin addict spends 22 days detoxing off the drugs. Click here to watch the report.
WASHINGTON: Spokane, KXLY - A desperate dad tries to get his teenage daughter arrested, to stop her from using heroin and force her into rehab. Click here to watch the report.
WASHINGTON: Seattle, KOMO - A grandmother’s body is dumped after she overdoses on heroin. Click here to watch the report.
WASHINGTON D.C.: WJLA – Heroin Highway: Tracing heroin’s spread from city to suburb. Click here to watch the report.
WISCONSIN: Madison, WKOW – Wisconsin struggles to destroy thousands of pounds of prescription pain pills considered the source of the heroin epidemic. Click here to watch the report.
WISCONSIN: Wausau, WAOW – A Wisconsin woman talks about her sister’s losing battle with heroin. Click here to watch the report.
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