Krokodil, a “flesh-eating” narcotic from Russia, may finally be in America

Krokodil is a narcotic made from codeine that has gained popularity in Russia over the past several years.  Krokodil is named after the Russian word for crocodile, because of what it does to your skin before your skin rots and falls off entirely. Nonetheless, Krokodil is a popular drug, and may have finally come to American shores.

Krokodil is the name for “desomorphine,” a drug that was developed over fifty years ago. It’s reported to be about eight times more powerful than morphine, and two to three times more powerful than heroin. Estimates are that about 1,000,000 people in Russia have, or are, using it. Many may be using it on a regular basis.

Understandably, Russia is not very forthcoming about krokodil and its users. Some sources estimate that between three million to six million Russians use drugs on a fairly regular basis, with heroin and methamphetamine being the two most commonly used. Krokodil is fairly simple to make from codeine, which is easy to get in Russia and requires no prescription there. Reportedly Russian criminal elements are making it and selling it. It appears to be easier to obtain than heroin and, since it’s more potent, it’s sought after.

Krokodil users develop scaly, leathery skin at the injection point

Krokodil users develop scaly skin lesions and leather-like skin in the areas where the drug has been injected. The name “krokodil” is Russian for “crocodile,” presumably so named that because of the skin changes that are produced after it’s been used. Sometimes, these areas become large enough that they can deteriorate and lead to serious infections, like gangrene. The user’s limb(s) may then need to be amputated. Krokdil itself doesn’t produce these lesions. The chemicals used in the production of krokodil from codeine are the culprits. Red phosphorus, gasoline, iodine, paint thinner and lighter fluid are among the toxic compounds used in the synthetic process that results in desomorphine. What’s left of these chemicals is the cause the skin damage.

You can google images of krokodil-induced skin lesions for yourself.  They’re rather horrific.

Life expectancy on Krokodil is two to three years

Estimates are that regular krokodil users die about two to three years after first starting to inject the drug.

They continue to use krokodil (or heroin) because they may like the effects but also, to keep from going through withdrawal. Narcotic withdrawals are at best, unpleasant. Shaking, sweating, restlessness, anxiety, nausea, vomiting and other symptoms can last for some time after the addict begins to withdraw. And even when the acute withdrawal symptoms are gone, there are some residual symptoms that are still difficult to deal with: depression, sleeplessness and others. Helping the addict get through this process as painlessly as possible, is the goal of most drug rehabilitation sites. But some countries don’t do anything to help the addict get through withdrawal. Russia is one of those.

Russians try to “cure” Krokodil use by punishing users with forced, unaided, withdrawal

The Russian philosophy seems to be to make the withdrawal as miserable as possible so that the addict will remember the experience and never use again. In many other countries, other medications are substituted to help relieve symptoms. While they don’t make detoxification pleasant, they can make it less nightmarish.

In Russian “rehabilitation” centers, the detoxing addicts are sometimes handcuffed to beds and allowed to remain there as they withdraw. Minimal medical supervision and no other medications are used. After the worst of the detoxification is over, the addicts are then lectured about how they are useless degenerates with no self-control and are burdens on their friends and family. After a variable period of time, the “rehabilitation” center releases the addict and he is pretty much left on his own.

There are some Narcotics Anonymous groups in Russia. The addict who wants to stay clean may be able to find and use them. In other countries, in addition to Narcotics Anonymous and out patient therapy groups, there are options of using other drugs to stay off of heroin and krokodil – like methadone. Some addicts choose to use methadone or other prescription drugs given under medical supervision. But not in Russia. There, these pharmacologic options are not permitted. It is difficult enough for users to stay clean even when they have social supports, psychological counseling, Narcotics Anonymous and prescribed medications to help. In Russia, where those are limited or unavailable, chances of staying off of krokodil are remote.

Krokodil appears to have finally arrived in America

Until very recently, krokodil seemed limited to Russia and its environs. Then there were sporadic reports of it showing up in other areas of Europe. A few cases were reported in Germany and other countries. This past summer the first reported cases of krokodil in the US were reported.

Arizona has had at least two cases and there have been one or two cases reported in a few other states, as well. A few from Illinois, and possibly some from Montana and Colorado. The Drug Enforcement Agency is aware of these cases and is monitoring the situation.  (There was a Chicago Tribune article yesterday casting doubts on the Joliet case, but time will tell.)

Since some health care professionals may be unaware that krokodil even exists, much less is already showing its teeth in the US, there may be more users who just haven’t been diagnosed. Drug addicts usually only get medical attention when they’ve overdosed or have a major medical problem. Krokodil being less expensive than heroin would make it more attractive to users as well. So there may be more people using it in the US who just haven’t surfaced for medical care as yet.

Here’s a CNN broadcast about Krokodil from just a few weeks ago.  Again, very gruesome stuff.

Mark Thoma, MD, is a physician who did his residency in internal medicine. Mark has a long history of social activism, and was an early technogeek, and science junkie, after evolving through his nerd phase. Favorite quote: “The most exciting phrase to hear in science... is not 'Eureka!' (I found it!) but 'That's funny.'” - Isaac Asimov

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