Drug Expert Explains Facts on Krokodil

As the flesh-rotting drug Krokodil grabs media headlines around the U.S., drug expert and EMS World Expo speaker Lynn Riemer says the cause for concern is real.

“There’s huge concern because you make it just like you make meth, but instead of pseudoephedrine you use codeine… It’s something you can make at home. It’s an opiate in the heroin family.”

The drug has been reported in Arizona, Utah and Illinois, and Riemer is hearing about cases local to her in Colorado, where a colleague reports two users recently visiting the ER for skin problems. A report from TIME says the drug is being investigated in the deaths of two Oklahoma men. Meanwhile, the DEA has reported that no U.S. cases have actually been confirmed.

The drug draws its name and prompts morbid fascination from the symptoms it creates in users: scale-like skin texture and flesh-eating sores. A person literally rots alive, according to Riemer.

“The skin gets scaly, infected, and everything goes south from there,” she says.

Meth and heroin can also leave users with sores, but they don’t become flesh-eating, Riemer explains. Media reports suggest that users take krokodil due to desperation or because they get tricked and think it's heroin.

As for how EMS personnel should handle potential cases -- “It is so new here I think it may be a little while before we get any real information on what to look for,” she says. Her latest handout on “New Trends in Substance Abuse” includes the following details on Krokodil.

Desomorphine (“Krokodil”) -- from Lynn Riemer, ACT on Drugs             

Desomorphine is an opiate analog invented in 1932 in the United States. It has sedative and analgesic effects, and is around 8-10 times more potent than morphine. It has a fast onset and a short duration of action, with relatively little nausea or respiratory depression compared to equivalent doses of morphine. Desomorphine attracted attention as a popular street drug in 2010 in Russia.

The drug is easily made from codeine, iodine, and red phosphorus in a process similar to the manufacture of methamphetamine from pseudoephedrine. However, desomorphine is highly impure and contaminated with various toxic and corrosive byproducts including iodine, phosphorous and heavy metals that may cause very serious side effects. High concentrations of iodine disrupt the endocrine system and causes muscular disorders; high concentrations of phosphorus, weakens bones; and dangerous mixtures of heavy metals such as iron, zinc, lead and antimony cause disorders of the nervous system and inflammation of the liver and kidneys.

The street name in Russia for homemade desomorphine is "krokodil" (crocodile), reportedly because of the scale-like appearance of skin of its users. It is used as a cheaper alternative to heroin. Drug addiction often follows the first dose.

Desomorphine users suffer from an acute deterioration in their general health, including a weakened immune system and failing liver. Their circulation is so affected that their limbs gradually wither and die. Non-healing ulcers appear on the body and a person literally rots alive. Veins located near the injection sites “burn up.”

"Krokodil" has become notorious for producing severe tissue damage, and gangrene sometimes requiring limb amputation in long-term users. The amount of tissue damage is so high that addicts' life expectancies are said to be as low as two to three years. The use of this drug is spreading worldwide.