Advertisement
AJM online Clinical communication to the editor| Volume 127, ISSUE 3, e1-e2, March 2014

Download started.

Ok

‘Krokodil’—A Designer Drug from Across the Atlantic, with Serious Consequences

Published:November 25, 2013DOI:https://doi.org/10.1016/j.amjmed.2013.09.030
‘Krokodil’—A Designer Drug from Across the Atlantic, with Serious Consequences
Previous ArticleLevothyroxine Dosage Is Associated with Stability of Thyroid-stimulating Hormone Values
Next ArticlePrimary Pulmonary Lymphoma: A Case of ‘Unresolving Pneumonia’
      To the Editor:
      Use of “Krokodil,” a deadly Russian designer drug, has been spreading rapidly across Europe.

      Jean-Paul C. Grund, http://www.ijdp.org/article/S0955-3959(13)00051-0/abstract Alisher Latypov, http://www.ijdp.org/article/S0955-3959(13)00051-0/abstract Magdalena Harris) Breaking worse: The emergence of krokodil and excessive injuries among people who inject drugs in Eurasia, International Journal of Drug Policy http://www.ijdp.org/issues?issue_key=S0955-3959(13)X0004-0 Volume 24, Issue 4, Pages 265-274, July 2013.

      , 

      Thomas Roche, Deadly Russian Drug “Krokodil” Hits Germany's Streets http://techyum.com/2011/10/deadly-russian-drug-krokodil-hits-germanys-streets/ October 21, 2011.

      It can turn an addict’s skin dark, scaly, and necrotic and cause it to wither away. “Krokodil” use was first reported in Siberia in 2002 and so far has been reported only in European countries.
      • Gahr M.
      • Freudenmann R.W.
      • Hiemke C.
      • et al.
      Desomorphine goes “crocodile”.
      J Addict Dis. 2012; 31 (Review. Erratum in: J Addict Dis. 2013;32:118): 407-412
      Our case aims to shed light on the alarming fact that this deadly mixture has made its way into the United States. We report a case of a young man who has been admitted multiple times in a 5-month period, with rapidly progressing necrotic leg ulcers, after intravenous abuse of homemade heroin.

      Case Report

      Our patient is a 30-year-old man who presented to the hospital with pain, swelling, and ulceration of his left thigh. The patient mentioned that he had been injecting a homemade drug called “Krokodil” into his affected area for the past 6-7 months. He initially noticed blisters at the skin popping sites, which rapidly turned black along with painful swelling of the legs. Within 1 month, the black necrotic area peeled off, leaving a painful necrotic ulcer (Figure). Two months before this admission, he noticed rapidly progressing swelling of his left little finger with blisters, which later turned black and auto-amputated. The patient had been injecting heroin into his arms and thighs for the past 7-8 years. The patient was a daily heroin user, which cost him approximately $300 per day, forcing him to obtain cheaper homemade heroin substitutes prepared from codeine. While in the hospital, he was treated with intravenous antibiotics and intensive wound care along with precautions for opiates and benzodiazepine withdrawals. As soon as he felt some relief from his pain, he left the hospital against medical advice. The patient was lost to follow-up despite multiple attempts.
      Figure thumbnail gr1
      FigurePatient’s lower extremity showing injection site ulcers with necrotic scar tissue.

      Discussion

      “Krokodil” is a mixture of several chemicals; the root agent is desomorphine, a synthetic derivative of morphine. It can be manufactured at home from codeine, along with easily available additives, and is significantly cheaper than heroin. Desomorphine has 8 to 10 times higher analgesic potency, faster onset of action, and shorter half-life compared with morphine, which accounts for its increased addictive potential.
      • Bognar R.
      • Makleit S.
      Neue Methode fürdie vorbereitung von dihydro-6-desoxymorphine.
      Arzneimittelforschung. 1958; 6: 323-325
      , 
      • Janssen P.
      A review of the chemical features associated with strong morphine-like activity.
      Br J Anaesthesia. 1962; 34: 260-268
      The simple and cheap domestic production process involves boiling codeine with a diluting agent (mostly paint thinner), gasoline, hydrochloric acid, iodine, and red phosphorous (which are scraped from the striking surfaces on matchboxes), resulting in the production of desomorphine and various toxic byproducts.
      • Gahr M.
      • Freudenmann R.W.
      • Hiemke C.
      • et al.
      Desomorphine goes “crocodile”.
      J Addict Dis. 2012; 31 (Review. Erratum in: J Addict Dis. 2013;32:118): 407-412
      Because of the high degree of contamination with different toxic chemicals, which vary among users, scientific analysis of the chemical composition is not available. Its regular use results in severe damage to the vasculature, muscles, and bones, and in multiorgan failure with a mean survival time of 2 years since its first use.
      • Gahr M.
      • Freudenmann R.W.
      • Hiemke C.
      • et al.
      Desomorphine goes “crocodile”.
      J Addict Dis. 2012; 31 (Review. Erratum in: J Addict Dis. 2013;32:118): 407-412
      , 

      Shuster S. The curse of the crocodile: Russia’s deadly designer drug. Time [Internet]. June 20, 2011 [cited August 20, 2013]. Available at: http://www.time.com/time/world/article/0,8599,2078355,00.html. Accessed April 10, 2013.

      Use of this novel flesh-eating drug has been spreading rapidly across Europe

      Jean-Paul C. Grund, http://www.ijdp.org/article/S0955-3959(13)00051-0/abstract Alisher Latypov, http://www.ijdp.org/article/S0955-3959(13)00051-0/abstract Magdalena Harris) Breaking worse: The emergence of krokodil and excessive injuries among people who inject drugs in Eurasia, International Journal of Drug Policy http://www.ijdp.org/issues?issue_key=S0955-3959(13)X0004-0 Volume 24, Issue 4, Pages 265-274, July 2013.

      , 

      Thomas Roche, Deadly Russian Drug “Krokodil” Hits Germany's Streets http://techyum.com/2011/10/deadly-russian-drug-krokodil-hits-germanys-streets/ October 21, 2011.

      because of its low cost and higher addictive potential. With a significant number of prescription opiate drug abusers in the United States, “Krokodil” could find a fertile breeding ground here.

      Conclusions

      Our case highlights the need for physicians to be cognizant of this deadly flesh-eating drug. Because of “Krokodil's” ease of manufacture, low cost, and potency, there is a good chance that it could become popular in the US.

      References

      1. Jean-Paul C. Grund, http://www.ijdp.org/article/S0955-3959(13)00051-0/abstract Alisher Latypov, http://www.ijdp.org/article/S0955-3959(13)00051-0/abstract Magdalena Harris) Breaking worse: The emergence of krokodil and excessive injuries among people who inject drugs in Eurasia, International Journal of Drug Policy http://www.ijdp.org/issues?issue_key=S0955-3959(13)X0004-0 Volume 24, Issue 4, Pages 265-274, July 2013.

        View in Article

      2. Thomas Roche, Deadly Russian Drug “Krokodil” Hits Germany's Streets http://techyum.com/2011/10/deadly-russian-drug-krokodil-hits-germanys-streets/ October 21, 2011.

        View in Article
        • Gahr M.
        • Freudenmann R.W.
        • Hiemke C.
        • et al.
        Desomorphine goes “crocodile”.
        J Addict Dis. 2012; 31 (Review. Erratum in: J Addict Dis. 2013;32:118): 407-412
        View in Article
        • Bognar R.
        • Makleit S.
        Neue Methode fürdie vorbereitung von dihydro-6-desoxymorphine.
        Arzneimittelforschung. 1958; 6: 323-325
        View in Article
        • Janssen P.
        A review of the chemical features associated with strong morphine-like activity.
        Br J Anaesthesia. 1962; 34: 260-268
        View in Article

      6. Shuster S. The curse of the crocodile: Russia’s deadly designer drug. Time [Internet]. June 20, 2011 [cited August 20, 2013]. Available at: http://www.time.com/time/world/article/0,8599,2078355,00.html. Accessed April 10, 2013.

        View in Article

      Article info

      Publication history

      Published online: November 25, 2013

      Footnotes

      Funding: None.

      Conflict of Interest: None.

      Authorship: DVT and UP had access to the data and played a role in writing this manuscript. SGJ participated in the literature review only and did not have access to patient data.

      Identification

      DOI: https://doi.org/10.1016/j.amjmed.2013.09.030

      Copyright

      © 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.

      ScienceDirect

      Access this article on ScienceDirect

      Linked Article

      The content on this site is intended for healthcare professionals.


      We use cookies to help provide and enhance our service and tailor content. To update your cookie settings, please visit the Cookie Preference Center for this site.
      Copyright © 2023 Elsevier Inc. except certain content provided by third parties.


      RELX