“Krokodil”—A Menace Slowly Spreading Across the Atlantic

Abstract

Krokodil (also known as crocodile, croc, krok, and poor man's heroin) is a suspension of desomorphine as the core substance with contaminants like iodide, phosphorous, and heavy metals, which are the byproducts of the manufacturing process. The name krokodil emerged due to the appearance of the skin lesions around the injection site, where it turns green and scaly like a crocodile skin due to desquamation. It is also known as the "drug that eats junkies" and "Russia's Designer drug." It is not available as a prescription anywhere in the world. It is a modern day man-made Frankenstein-like drug, which was manufactured due to the pursuit of drug addicts to make a cheap yet effective narcotic but ended up in creating havoc on its users. It has devastating effects on its users, including damage to skin, blood vessels, muscles, bones, and sometimes even multiorgan failure and eventually death. A systemic review was conducted to obtain any available data for the term krokodil to collect information for this article.

Lethal endomyocarditis caused by chronic “Krokodil” intoxication

“…The main feature of chronic injection of krokodil is the typical skin injury subsequent to long-term intravenous injections leading to sclerosis of the veins and thus to the practice of "skin popping", in which the drugs are introduced subdermally. A common complication of skin popping is the development of subcutaneous abscesses which may be used as injection sites and can lead to ulceration [5]. The subcutaneous space may host multiplying pathogenic organisms that are introduced by non-sterile injection of drugs, contaminants, and fillers, some of which may cause local tissue reactions (e.g., vasoconstriction) that predispose to the development of infections [15].…”

“…Desomorphine (C17H21NO2), the main active substance of "krokodil", is a semi-synthetic opioid derivative of morphine [3]. It is obtained by "cooking" codeine tablets or syrups, which may also contain paracetamol, acetyl salicylic acid and caffeine, with other substances such as alkali solutions, organic solvents, acidified water, iodine and red phosphorus [2,5]. The resulting mixture is a light brown liquid with a strong acidic pH [2].…”

DARK Classics in Chemical Neuroscience: Heroin and Desomorphine

“…This means (a) the drug has a high potential for abuse, (b) the drug has no currently accepted medical use in treatment in the US, and (c) there is a lack of accepted safety for its use under medical supervision . At the beginning of the 21st century, the drug reappeared in Russia (particularly in Siberia) in the context of the use of a homemade drug called krokodil, with the first confirmed report of its use in 2004, although there are unconfirmed earlier reports. ,− An epidemic increase of its use among Russian addicts has been observed since then. For example, in 2005, the Russian antinarcotics agency reported only isolated instances of the drug; but in 2011, the agency confiscated 65 million doses, a 23-fold increase from two years earlier .…”

Designer drugs: Review and implications for emergency management

“…Due to heavy metal exposure, multiple system organ failure and severe neurotoxicity are common side effects of Krokodil use. 36 Organ damage or failure must be treated symptomatically. However, reversal of long-term damage is often impossible.…”