Krokodil (Desomorphine) Update

Background & Introduction

  • Krokodil is a mixture of several substances with the main ingredient being desomorphine – an opioid analog.
  • Media reports of krokodil use began surfacing in 2003 in Russia; the drug has been gaining popularity in the US since 2010.
  • In 2011, anecdotal reports from Russia suggest that 10 tablets of over-the-counter codeine with acetaminophen could be purchased for 120 Russian Rubles or $3.71 USD. This quantity was said to produce enough desomorphine to substitute for 500 Rubles or $15.46 USD worth of heroin.  There is no available data on price in the United States.
  • Originally synthesized with the intention to create an alternative to morphine with improved side effect profile, but it failed- and has showed an increased dependence on morphine – likely due to the quicker onset of action and shorter half-life.
  • Can be synthesized at home with codeine, iodine and red phosphorous: 5-10 codeine tablets are boiled with a diluting agent (paint thinner) and lighter fluid, hydrochloric acid, iodine and red phosphorous (scraped from striking pads of matchboxes), in this process desomorphine is generated from codeine via 2 intermediate steps.

Mechanism of action

  • The core ingredient is desomorphine (4,5-α-Epoxy-17-methymorphinan-3-ol) an opioid analog.
  • Mechanism of action: potent mu receptor agonist
  • 8-10 times higher analgesic potency compared to morphine and has a faster onset of action and shorter elimination half life
  • Effects are similar to other opioids. Positive effects often include euphoria, sedation, and analgesia. Common negative effects include constipation, nausea and vomiting, itching, urinary retention, decreased libido, and respiratory depression. Serious medical complications can include respiratory failure, allergic reactions, seizures, and physical and psychological dependency. When impure or acidic desomorphine is injected, it can cause pain, skin discoloration, and additional serious medical problems.

Dangers

  • Iodine used in the synthesis process can cause thyroid and muscle damage.
  • Phosphorus, also a contaminant, is known to damage cartilage.
  • The damaged tissue is susceptible to infection, which may lead to abscesses and thrombophlebitis; the constellation of related tissue damage has led to many media reports to refer to desomorphine as a “flesh eating” or “flesh rotting” drug.
  • Desomorphine itself does not have any innate corrosive effects, rather it is the contaminants it is mixed with that can cause damage and infection.
  • The use of a psychoactive substance with a high dependence potential accompanied by toxic byproducts leads to a mean survival time of 2 years after the first krokodil use according to reports from the media, but no scientific studies have been conducted that support this.

Bottom Line/Pearls & Pitfalls

  • Krokodil is desomorphine accompanied by various toxic agents that emerge during the self-production process.
  • The pharmacodynamics and pharmacokinetic properties of a shorter half-life and faster onset of action as well as the easy home manufacture from codeine (which is relatively cheap) make the drug highly addictive.
  • IV application of krokodil with contaminants is associated with high risk of local and systemic tissue damage regularly leading to death within the first few years of use.

Further Reading

  • Gahr M, Freudenmann RW, Hiemke C, Gunst IM, Connemann BJ, Schönfeldt-Lecuona C. “Krokodil” – Revival of an Old Drug with New Problems. Substance Use & Misuse. 2012; 47 (7): 861-863.
  • Eddy NB et al; Synthetic Substances with Morphine-like Effect: Clinical Experience: Potency, Side-Effects, Addiction Liability (Monographs on Individual Drugs: Desomorphine); Bull World Health Organization 17: 569-863 (1957)]
  • Gahr, M et al. Desomorphine goes “crocodile”. Journal of Addictive Disease, 31:4,407-412, PMID: 22468632
  • Grund JC, Latypov 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;24:265-274.
Edited by Adaira Landry

2 thoughts on “Krokodil (Desomorphine) Update”

  1. Krokodil @ TPR:

    “As TPR has argued before, the term can not refer to desomorphine itself, which is simply an opiate and is not, to my knowledge, available anywhere in pure form. To my mind, “krokodil” refers more to a process in which users attempt to home-brew desomorphine using codeine and various caustic ingredients such as lighter fluid, gasoline, hydrochloric acid, and red phosphorous.”

    This quote is referring to an article published in Am J Med which was subsequently retracted and then republished. Vibha’s paper above is spot-on in describing “krokodil” as a conglomeration of desomorphine plus additional agents used in the production process.

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