Krokodil Drug Guide

Krokodil is a mixture of several different chemicals that are typically combined with codeine. It’s believed that the drug first appeared in Russia in the early 2000s. The mixture became popular in Eastern Europe but its actual use in the United States at the time of this writing still appears to be relatively rare. Speculation by media in 2013 that the drug was becoming popular in the United States was effectively countered by professional sources, such as the American Journal of Medicine in 2014 and the United States Drug Enforcement Administration (DEA) in 2013. However, suspected cases of Krokodil use have turned up in the United States recently.

What Exactly Is Krokodil?

Krokodil is typically manufactured using codeine and a number of other additives that can include paint thinner, gasoline, iodine, hydrochloric acid, phosphorous from matchboxes, and other potentially toxic substances. The chemicals are mixed and boiled, resulting in the production of the drug desomorphine and a number of potentially toxic substances, depending on the chemicals used.

Desomorphine is a Schedule I controlled substance, according to the DEA, indicating that the substance has no identified medicinal uses and is a significant drug of abuse that has a high potential to develop physical dependence in individuals who use it. Desomorphine is 8-10 times more potent than the drug morphine. It has a significantly faster onset of action and a significantly shorter half-life than morphine, making it a very addictive drug. Because of the high number of potentially toxic substances used to make krokodil, its use can result in severe tissue damage, including severely damaged and greenish scaly skin (hence the name krokodil for crocodile). Krokodil can also refer to chlorocodide, a codeine derivative that occurs as a result of making desomorphine from codeine.

Reports indicate that the various mixtures of krokodil can be extremely toxic, and chronic use can result in severe health effects, including tissue damage, ulcers, and the development of gangrene in untreated cases. As a result of these overt effects, the drug has often been referred to as “the flesh eating drug” or “the zombie drug” by the media.

The Effects of Using Krokodil

Krokodil’s primary method of administration is injection, but it can be taken by other means. In addition to the effects mentioned above, desomorphine is an extremely potent narcotic drug. Due to its quick onset of action and short half-life, its effects wear off relatively rapidly, and individuals will tend to repeat use more often than they may for drugs like heroin and other opiate drugs. This can result in the rapid development of tolerance and physical dependence.
Typical effects of desomorphine include:

• A feeling of euphoria and wellbeing
• Reduction in the perception of pain
• Reduction in anxiety
• Sedation
• Decreased motor reflexes
• Appetite loss and constipation

Other effects associated with krokodil’s use include:

• A number of potential infections to the skin and organs
• Blood vessel damage
• Blood poisoning
• Low blood pressure
• The transmission of blood-borne viruses due to needle sharing
• Infections of the bone
• Damage to the liver and kidneys
• Respiratory issues due to suppression of breathing
• Impairment of coordination and motor skills
• Speech impairments
• Neurological damage that can lead to issues with attention, memory, and problem-solving
• Meningitis
• An increased potential for overdose
• The development of a comatose state
• Severe neurological damage due to overdose

The development of an opioid use disorder may be enhanced with chronic abuse of desomorphine. Chronic abusers may go on patterns of bingeing that last for significant periods of time, leading to issues with exhaustion and neglect of personal hygiene. This is particularly problematic due to the large number of issues with tissue damage associated with use of the drug. In addition, individuals with significant substance use disorders may neglect treatment for severe physical injuries, such as gangrene, due to a fear of legal action or other reprisals from authorities.

Signs of Abuse

A number of potential symptoms and signs may signal that an individual is abusing desomorphine or krokodil. These include:

• Finding empty containers of codeine and/or containers of other ingredients, associated with the process of manufacturing the drug, such as lighter fluid, gasoline matches, etc.
• Finding other drug paraphernalia, such as needles and syringes
• Displaying a number of skin issues, such as lesions, ulcers, and other sores that do not heal and rapidly worsen
• Appearing lethargic and drowsy
• Slurred speech and pinpoint pupils along with some of the other symptoms above
• Issues with motor coordination
• Injection marks on the individual’s arms, legs, or other areas of the body
• Becoming isolated or missing for days at a time due to drug binges
• Displaying intermittent periods of flulike symptoms, such as nausea, fever, vomiting, etc., as a result of not being able to manufacture or get the drug

The formal diagnostic criteria of an opiate use disorder can only be made by a licensed clinician. Individuals who are abusing krokodil are obviously at risk for a number of serious health issues, including potential fatalities due to infections or overdose. These individuals should seek treatment as soon as possible.

Treatment Issues

Because desomorphine has a relatively short half-life, withdrawal symptoms appear rather rapidly once the drug is discontinued. In addition, many individuals may have a number of serious health concerns, such as issues with their skin, ulcers, and infections. These individuals require close medical supervision throughout all stages of recovery.

The first stage of recovery should include a thorough physical and mental health assessment to identify any co-occurring issues that are present. Following the assessment, the following should take place:

• The client will receive immediate medical attention for any infections or other physical issues.
• The client will be placed in an inpatient physician-assisted withdrawal management program, also known as medical detox.
• The withdrawal management program will address the symptoms of withdrawal that will almost inevitably occur in chronic users of desomorphine by administering opioid replacement medications. The drugs will be administered on a tapering basis; the dosage will be tapered down slowly over time to allow the person’s system to adjust. In this manner, the withdrawal process can be controlled.
• The individual should begin intensive inpatient counseling for their substance use disorder. The primary component of this counseling should be substance use disorder therapy.
• Therapy can be delivered in the form of individual therapy, group therapy, or a combination of group and individual therapy. The therapy will be delivered according to the general principles of treatment for substance use disorders, but will also be personalized for the specific case.
• In addition to therapy, participation in support groups, such as 12-Step groups (e.g., Narcotics Anonymous), is highly recommended. Solid participation in a 12-Step program can continue for years and be an important part of the individual’s long-term recovery.
• Family support should be encouraged, and if necessary, family therapy should be instituted.
• Many individuals with opiate use disorders need special interventions, such as specialized training or other forms of therapy that can include vocational rehabilitation, occupational therapy, speech therapy, physical therapy, etc.
• Continued management of co-occurring conditions should be a priority throughout the recovery process and beyond.
• Treatment should not end once the inpatient portion of the treatment program has been completed. The individual should be encouraged to continue with therapy and support group participation as well as other interventions.
• While treatment is often focused on relapse prevention, relapses do occur. If the individual suffers any type of relapse, it should be used as an opportunity to learn and improve their recovery program.

One of the keys to recovery is to maintain adherence to treatment for a sufficient length of time. Contrary to many popular beliefs, this adherence should continue for years following discontinuation of any drug of abuse. There is no hard and fast rule regarding how long treatment should continue; however, research indicates that active involvement in treatment and remaining abstinent for a minimum period of 5-7 years is often necessary to be ensured of long-term success in recovery. Despite these findings, many individuals find that they receive benefits from remaining in activities associated with recovery, such as support group participation, indefinitely.