Krokodil: Highly Addictive Flesh-Eating 'Zombie Drug' Wreaks Havoc Desomorphine (dihydrodesoxymorphine, Permonid, street name krokodil) is a derivative from morphine (an opioid) with powerful, fast-acting sedative and analgesic effects. Patented in 1932, it is around 8--10 times more potent than morphine. It was used in Switzerland under the brand name Permonid and was described as having a fast onset and a short duration of action, with relatively little nausea or respiratory depression compared to equivalent doses of morphine. Desomorphine attracted international attention in 2010 in Russia due to an increase in clandestine production, presumably due to its relatively simple synthesis from codeine which has been relatively easily available over the counter. Reports of its use there date back to 2003 when Russia started a major crackdown on heroin production and trafficking. The drug is easily made from codeine which can be derived from cough syrup, iodine from OTC medications and red phosphorus from match strikers, in a process similar to the manufacture of methamphetamine from pseudoephedrine. Like methamphetamine, desomorphine made this way is often highly impure and is contaminated with various toxic and corrosive byproducts. Various other common products like gasoline may be substituted as part of the production. The street name in Russia for homemade desomorphine is krokodil (Russian: крокодил, crocodile).The name derives from the notoriously severe tissue damage incurred by chronic users and the precursor α-chlorocodide. Due to difficulties in procuring heroin, combined with easy and cheap access to over-the-counter pharmacy products containing codeine in Russia, use of krokodil has increased. It has been estimated that around 100,000 people use krokodil in Russia and around 20,000 in Ukraine. Cases in the US have been reported with a few stating they learned how to craft the drug themselves, and most of the cases the users stating they thought they had procured heroin. The Drug Enforcement Administration has been looking into the cases but has not confirmed any; although, they expect that some will soon be registered The high associated with krokodil is akin to that of heroin, but lasts for a much shorter period. While the effects of heroin use can last four to eight hours, the effects of krokodil do not usually extend past one and a half hours, with the symptoms of withdrawal setting in soon after. Krokodil takes roughly 30 minutes to an hour to prepare with over-the-counter ingredients in a kitchen Since the homemade mix is routinely injected immediately with little or no further purification, krokodil has become notorious for producing severe tissue damage, phlebitis and gangrene, sometimes requiring limb amputation in long-term users. Although there are not many addicts, their life expectancies are said to be as low as two years due to injecting drug users' high susceptibility to infections and gangrene. The start of the skin-eroding krokodil side effects occur with the injection of the drug via a needle. The injection site of the drug produces scarring and begins to kill the veins near it, essentially causing them to burst. The toxic chemicals used to make the drug are also highly acidic, and result in the decay, and essentially burning of the skin and fat in that area. This is the cause of the green and scaly "crocodile" looking skin following use of the drug. In addition to the decomposing effect this drug has on the surrounding tissue and vessels, the chemical combination of krokodil impairs the immune system's ability to protect itself from the infections that result from the sores and scarring left at the injection site. Abuse of homemade desomorphine was first reported in middle and eastern Siberia in 2002, but has since spread throughout Russia and the neighboring former Soviet republics. One death in Poland in December 2011 was also believed to be caused by krokodil use, and its use has been confirmed among Russian expatriate communities in a number of other European countries. Possibly the first discovery of use of the drug in the United States was reported by the Banner Poison Control Center in Phoenix, Arizona, in September 2013. In October 2013, numerous cases of krokodil-related hospitalizations were reported in Joliet, Illinois. The drug was reported to have "flesh-eating" properties, causing open wounds around the injection site. In November 2013, doctors published a paper in the American Journal of Medicine, giving details of how they treated a drug addict in December 2012 who had been using krokodil in St Louis, Missouri for eight months. This publication has since been removed from the American Journal of Medicine.

• published: 27 Dec 2013
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