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Krokodil Drug Facts

Common or street names: Crocodil, Russian Magic, Poor Man's Heroin, Zombie drug

What is krokodil (desomorphine)?

Krokodil is reported to contain desomorphine, a semi-synthetic morphine analogue synthesized in the 1930s. Due to illicit, home-based manufacturing it may contain other unknown ingredients. It is typically abused via the intravenous (IV) route into a vein.

Krokodil also refers to chlorocodide, a codeine derivative in the synthetic path to desomorphine. Homemade versions of the drug start with codeine, and can be ‘cooked’ similar to illicit methamphetamine (“meth”) production. Organic solvents such as gasoline, paint thinner, or lighter fluid, iodine, hydrochloric acid, and red phosphorus (from matches) are used in homemade synthesis. These dangerous chemicals are not always fully “cooked” out of the concoction when used to make illicit krokodil.

According to the DEA, in 2004 the National Forensic Laboratory Information System (NFLIS) identified two samples of desomorphine. Since that time the DEA states no other exhibits have been identified as desomorphine (up to 2019). However, a case report from 2020 notes that usage is increasing in the US, but much less than heroin.

How is krokodil used?

What are the side effects of krokodil?

There have been multiple unconfirmed news reports of users in the U.S. and Canada who have had extreme skin ulcerations, infections and scale-like skin due to use of krokodil. The most common complications reported thus far from krokodil injection appears to be serious vein damage, soft tissue infections, necrosis and gangrene.

According to reports, the localized soft tissue effects occur relatively quickly after the use of krokodil. There have been news reports of amputations. It appears that ulcerations may occur locally at the 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 include:

Animal studies in rats have demonstrated cardiac (heart) congestion, necrosis (dead tissue) at the injection site, and kidney toxicity.

What is the extent of krokodil use?

Krokodil has been synthesized in Russia for over a decade. Reports have noted that over one million people in Russia use or have used 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. Krokodil has lead to thousands of deaths in Russia.

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 use 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% lower than the previous year. Therefore, in Europe and Asia, users turned to over-the-counter medications that contained codeine for pain or cough as an ingredient for krokodil.

Codeine is preferred instead of heroin because of lower costs and ease of availability. However, the effects and chemical reactions of the medications also in these codeine products (such as acetaminophen or terpin hydrate) are all unknown when mixed for illegal drug use. In some former Soviet Union regions, officials attribute at least half of all drug-related deaths due to krokodil abuse.

Desomorphine had previously been used medically in Switzerland under the brand name Permonid.

In the U.S., codeine is a controlled substance in various schedules and either requires a prescription or may be available over-the-counter in some states from the pharmacist. The extent of krokodil use in the U.S. is unknown but appears to be minimal.

Is krokodil in the U.S?

There were few reports of krokodil use in the U.S. until September 2013 when a poison control center in Phoenix, Arizona received inquiries about the product. Additional reports have surfaced from Illinois and Oklahoma. However, as of July 2019, the U.S. Drug Enforcement Agency (DEA) has stated that they are have not identified any krokodil since 2004 through their samples.

Is krokodil addictive?

Addiction is an obvious problem with krokodil use due to its high opioid 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. Variations in potency or "homemade" recipes can put users at increased risk of overdose.

According the the DEA, repeated administration of desomorphine with short intervals in cancer patients with severe pain showed that desomorphine produced a high degree of addiction liability.

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 finding treatment.

Related:

See also

Sources

  1. Ghazawi FM, Beecker J. Necrotic leg ulcers associated with krokodil injection in a 41-year-old man. CMAJ. 2019 Jun 24;191(25):E712. doi: 10.1503/cmaj.190027. PMID: 31235492; PMCID: PMC6592803.
  2. Alves EA, Brandao P, Neves JF, et al. Repeated subcutaneous administrations of krokodil causes skin necrosis and internal organs toxicity in Wistar rats: putative human implications. Hum Psychopharmacol. 2017 May;32(3). doi: 10.1002/hup.2572. Accessed 7/12/2022.
  3. Florez DH, Dos Santos Moreira AM, da Silva PR, et al. Desomorphine (Krokodil): An overview of its chemistry, pharmacology, metabolism, toxicology and analysis. Drug Alcohol Depend. 2017 Apr 1;173:59-68. doi: 10.1016/j.drugalcdep.2016.12.021. Epub 2017 Jan 31. 
  4. Facts about Krokodil (the “Zombie Drug”). DrugAbuse.com. Accessed 7/12/2022 at https://drugabuse.com/krokodil/
  5. Desomorphine. Drug Enforcement Agency (DEA). Accessed 7/12/2022 at  https://www.deadiversion.usdoj.gov/drug_chem_info/desomorphine.pdf
  6. Grunda JC, Latypovc A, Harris M. Breaking worse: The emergence of krokodil and excessive injuries among people who inject drugs in Eurasia. International Journal of Drug Policy 2013:24; 265–74. https://idhdp.com/mediaimport/41793/inj_damage_from_krokodil_in_eurasia.pdf

Further information

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