The addicts would come in with patches of flesh that looked dark and scaly, almost like a crocodile’s. Soon they discovered the cause of the unusual skin damage. It turned out to be from a new drug that went by the street name “krokodil” – which no surprise means crocodile in Russian.
What is krokodil
Krokodil (pronounced “crocodile”) is an opioid that is reportedly made from a drug called desomorphine, a derivative of codeine. It’s also mixed with other poisonous additives, such as paint thinner, lighter fluid, and gasoline.
Sometimes it goes by other names or spellings such as:
- Krocodil
- Krocodyl
- Krok
- Alligator Drug
- Russian Magic
- Zombie Drug
- Poor Man’s Heroin
The drug first surfaced in Russia in the early 2000s after heroin became scarce and expensive. Its popularity surged as it can be made from easily attainable substances and costs a fraction of the price of heroin.
Like heroin and other opioids, krokodil has sedative and pain-relieving effects, as well as gives users a euphoric feeling. It’s also highly addictive.
People who inject the drug can develop extreme skin sores, infections, and gangrene. These wounds often take on a discolored (green, grey, black) scale-like appearance that resembles the skin of a crocodile. It’s believed this is why the drug got the street name “krokodil”.
The drug has affected Russia and Ukraine the most, but there have been reports of its use in Western Europe, Australia, Canada, and the United States.
Krokodil drug
Krokodil contains desomorphine, synthetic morphine which is 10 times stronger than morphine.
However, krokodil also refers to chlorocodide, a codeine derivative in the synthetic path to desomorphine. The name “krokodil” is rumored to come from a step in the cooking process where codeine turns into a chemical called ɑ-Chlorocodide.
Another theory is that it got its name because it often causes ulcers and scaly skin that look like crocodile skin where it’s been injected.
It’s a cheap alternative to heroin and is made by boiling codeine tablets, a process known as “cooking” similar to how methamphetamine (meth) is made. Other organic solvents, like lighter fluid or gasoline, are often added in the illegal homemade versions.
Cooking causes a chemical reaction that makes an amber liquid. It also increases the strength of codeine. The drug has a strong acid-like smell and is usually injected into the vein.
Due to the additives in the drug, that aren’t always fully “cooked” out, it has been known to produce severe skin trauma near the injection site. For example, there are reports of necrotic ulcers, bone tissue infection, and bone tissue death, which can result in limb amputation.
Respiratory distress, organ failure, shortness of breath, elevated heart rate, and death have also been reported as side effects of krokodil use.
According to media reports, approximately 65 million doses of krokodil were seized in 2011 in Russia and 100,000 people were using krokodil.
It’s thought that krokodil became popular among people who injected drugs in Russia because codeine was available without a prescription and heroin was scarce.
Desomorphine
A German team working for the pharmaceutical company Knoll around 1920 first discovered and patented desomorphine. The U.S. synthesized the drug in 1930 and then patented it in 1934.
It’s a type of synthetic morphine which produces opiate-like effects with a rapid onset and brief action, lasting only about three hours.
Similar to other morphine derivatives, desomorphine is more potent than morphine. It is approximately 10 times more powerful.
There isn’t an accepted medical use for desomorphine in the United States. In fact, it’s been a controlled substance since 1936. Although, in Switzerland, it was used medically under the brand name Permonid to treat severe pain well into the 1950s.
For the rapid relief of severe pain, desomorphine is faster acting and more effective than morphine. But it was abandoned for medical purposes because its effects didn’t last as long and it had more negative side effects.
The drug was last reportedly used in 1981 for one person suffering from an unspecified disease that had specific pain relief needs in Switzerland. The drug hasn’t been manufactured or used clinically since the patient died.
Abuse of homemade desomorphine was first reported in Siberia in 2003 when Russia started a major crackdown on heroin production and trafficking. It is typically abused via the intravenous (IV) route but desomorphine can be taken in ampule and suppository forms.
In the U.S., desomorphine is a Schedule I substance.
Krokodil effects
The most common complications reported from krokodil injection are serious damage to the skin, blood vessels, bone, and muscles. The damage is sometimes bad enough that it requires limb amputation in long-term users.
One of the more reported skin effects noted by the media and researchers is the scaly, black, and green skin that resembles crocodile skin.
The localized tissue effects frequently occur at the drug injection site but can also appear in remote areas of the body, such as the skull and forehead.
These effects happen quite soon after the use of krokodil and experts suggest that it’s the added toxic solvents that cause the complications, not the desomorphine or codeine.
According to research, other reported health hazards include:
- Open ulcers and abscesses
- Blood poisoning
- Meningitis
- Bone infections (osteomyelitis) and bone death (osteonecrosis)
- Speech and motor skill impairment
- Rotting gums and tooth loss
- Blood-borne virus transmission (such as HIV and HCV due to needle sharing)
- Memory loss and impaired concentration
- Liver and kidney damage
- Pneumonia
- Respiratory problems (slowed or stopped breathing)
- Organ or central nervous system damage
- Death
Krokodil withdrawal effects include irritability, tremors, hypertension, nausea, vomiting, and hyperthermia.
Krokodil skin
The rough and scaly skin that appears around the injection site of krokodil drug users is known as krokodil skin. The characteristics of the skin discoloration and peeling look like the scales of a crocodile.
Depending on the level of severity, the skin can fall from the bone giving a “zombie-like” appearance. In the U.S., the drug became known as the “flesh-eating drug” due to the extreme skin peeling associated with its use.
Research suggests that the krokodil skin results from the toxic substances that are left in the substance after synthesis. For example, addicts often use readily available but poisonous and impure solvents like battery acid or paint thinner when cooking krokodil. The strong acids and bases can contribute to tissue damage and infection if the toxic solvents aren’t fully removed before injecting. However, it’s worth noting the exact mechanism behind its toxicity remains unknown.
Further, sometimes the user will miss the vein when injecting the drug. This can create an abscess, which can cause the flesh around the area to die off.
Other experts have suggested that the extreme pain-relieving effect of krokodil can contribute to users ignoring the severity of the skin consequences and delays them from seeking medical treatment.
Sources:
https://time.com/3398086/the-worlds-deadliest-drug-inside-a-krokodil-cookhouse/
https://www.bhpalmbeach.com/blog/authorities-wary-designer-drug-krokodil-appears-american-streets/
https://www.drugs.com/illicit/krokodil.html
https://www.deadiversion.usdoj.gov/drug_chem_info/desomorphine.pdf
https://www.healthline.com/health/krokodil-desomorphine#krokodil-ingredients
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4864092/
https://pubmed.ncbi.nlm.nih.gov/25710781/
https://jamanetwork.com/journals/jamadermatology/article-abstract/2089838
https://pubmed.ncbi.nlm.nih.gov/23726898/
https://pharmacy.hsc.wvu.edu/media/1315/krokodil-a-new-drug-of-abuse.pdf
https://www.youtube.com/watch?v=-xF1ejbShZ8
https://jamanetwork.com/journals/jamadermatology/fullarticle/2089838#
https://theconversation.com/krokodil-how-flesh-eating-zombie-drug-is-causing-a-global-crisis-106371
https://theconversation.com/the-rise-and-fall-of-russias-flesh-eating-drug-krokodil-31736
https://www.sciencedirect.com/science/article/abs/pii/S1010518214001619?via%3Dihub