Krokodil is an illegally homemade opioid drug that is widely used in parts of Eastern Europe, like Russia, Ukraine, and Georgia. Krokodil is made from codeine pills, which are cooked down with common household chemicals to create desomorphine, a powerful opioid. When injected, krokodil causes serious health issues, including necrosis of skin, tissue, and bone that can result in amputation, organ failure, and death. [1][2][3]Â
- Krokodil is a toxic, homemade, illicit synthetic opioid drug that users inject to get high.
- Krokodil use is more common in Eastern European countries like Russia and Ukraine.
- Krokodil use leads to severe and life-threatening health problems like necrotic skin and tissue, infections, addiction, and overdose.
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What is Krokodil?
Krokodil is an illicit drug that is made from codeine pills combined with common household chemicals like iodine and red phosphorus to create the synthetic opioid desomorphine. Desomorphine is a more potent, shorter-acting synthetic opioid that is 8-10 times stronger than morphine. The drug has been found to be more addictive than morphine, creating an intense but short-lived high. [2][3]Â
A growing number of people in Eastern Europe have become addicted to the drug Krokodil (aka croc or krok), which has severe, lasting, and alarming health effects. When Krokodil is injected (the primary method of abuse), it causes skin lesions and ulcerations, which eventually lead to a person’s skin and soft tissue rotting. [1][4]Â
This effect has been called Krokodil skin, which is named in part for the green and black scaly appearance the affected skin develops. Untreated, krokodil skin often leads to the underlying tissue and bone rotting and becoming necrotic, causing Gangrene. A number of people have had to have their limbs amputated, sometimes after only using the drug for a short time. [4]
What krokodil does to the body: Short high to rapid breakdown
Krokodil is abused because of its intense euphoric, analgesic, and sedative effects, which are said to be up to ten times stronger than morphine. The effects usually onset within minutes of injecting the drug, and last for two hours. The short half-life of krokodil leads some people to inject it more frequently, leading to serious health problems. [1][3]
Krokodil is highly toxic and can result in a number of severe and life-threatening health effects, sometimes after only short-term use. One of the most well-known health effects related to Krokodil use is Krokodil skin, which begins as swelling, discoloration, and lesions around the injection site. This often progresses into Gangrene, an infectious condition that involves the rotting of flesh, tissue, and bone, which may require amputation to treat. [3][4]
Krokodil’s effects on the skin, tissue, and bone are believed to be related to the primary ingredients of iodine, red phosphorus, and organic solvents that are highly acidic and caustic when injected. These and other contaminant byproducts (like heavy metals) may cause other problems like infections, renal and liver impairment, and neurological problems. [3][4]Â
How krokodil is produced
Krokodil is not manufactured or sold by any pharmaceutical company. Instead, it is cooked up in homemade batches using codeine pills combined with household chemicals that can be purchased at many retail stores. While the exact ingredients and methods can vary, most formulations include the ingredients iodine, red phosphorus, and chemical solvents like gasoline. The method of cooking krokodil is somewhat similar to methods for cooking methamphetamines, and results in an equally toxic result. [1][3][4]
Despite known serious health effects, krokodil has become popular because of its intense effects and also its relative affordability. Krokodil can be purchased for about one-fifth of the price of heroin, earning it the nickname ‘poor man’s heroin’. Krokodil abuse is mainly reported in Russia and Ukraine, where it first became a trend in the early 2000’s. Since then, the use of Krokodil has spread to other nations in Eastern Europe, as well as other countries. [1][3]
Health effects and visible damage
Krokodil is a synthetic opioid drug, but it has much more severe health effects than other opioid drugs. Because of how krokodil is produced, it is highly toxic to the body and brain, and causes rapid and severe health complications. One of the earliest krokodil health effects to develop is krokodil skin, a condition that involves infectious necrosis of skin, soft tissue, and eventually the underlying bone. [4]Â
One case study reported necrotic wounds in a user who had only admitted to injecting the drug one time. Untreated, these skin lesions can develop into a condition called Gangrene, which can be fatal. Researchers state that in severe, continued use, average survival is approximately 2 years due to complications and toxic effects on the body; however, outcomes vary, and cessation with medical care can improve prognosis. [2][4]
Besides skin lesions related to krokodil skin, other potential health effects include: [1][2][4]Â
- Vascular damage
- Respiratory depression
- Renal failure
- Liver failure
- Pneumonia
- Sepsis
- Meningitis
- Neurological impairments
- Addiction, tolerance, and withdrawal
- Fatal overdose and death
Desomorphine addiction, withdrawal, and overdose risk
Desomorphine, the psychoactive opioid responsible for krokodil’s intoxicating effects, is highly addictive. In fact, it was first developed in 1932 and years later brought to market in Europe for a brief time before being discontinued because it was found to be too addictive. Desomorphine is believed to be up to ten times more potent than morphine and has a shorter onset and effect window, which is also believed to make it more addictive in nature. [1][2]
Regular use of krokodil can result quickly in the development of tolerance, which some users overcome by increasing their use. This only accelerates the development of addiction, which will bear the hallmark symptoms of opioid use disorder like uncontrolled use, cravings, negative consequences related to use, and the experience of difficult and painful withdrawals. When a person has developed a dependence on an opioid like desomorphine, it can be very difficult for them to cut back or stop using without treatment. [3]
Sadly, most krokodil users will end up dying from their addiction, especially if left untreated. Researchers estimate that there is a 2-3 year life expectancy for heavy, untreated krokodil users due to the highly toxic and dangerous effects it has on the body. Some users may also die from a fatal overdose, which is unfortunately common in opioid users. Opioids are CNS depressants, and taking too high a dose can lead to respiratory depression and death, starving the body and brain of oxygen. There is a higher risk of accidental overdose in individuals who abuse illicit homemade opioids like krokodil because of variations in dose and purity. [1][2][3]Â
Overdose symptoms and emergency response
Opioid overdose can be fatal and requires immediate medical intervention to reverse. When caught early, an opioid overdose may be reversed with the use of the drug naloxone (or Narcan), which blocks the effects of the opioid.Â
Here are some of the signs of a potential opioid overdose: [5]
- Slowed, labored, or shallow breathing
- Blue tint to face, lips, or fingers
- Small ‘pinpoint’ pupils
- Being unresponsive or highly lethargic
- Loss of consciousness
- Impaired cognition and coordination
If you notice signs of opioid overdose, call 911 or get emergency medical treatment right away.
Evidence-based treatment for opioid use disorder
Opioid use disorder can be treated, often with a combination of medical, behavioral, and social support interventions. Current recommendations include medications like suboxone or methadone, which can prevent opioid withdrawals and make relapse less likely, in combination with behavioral therapies like motivational interviewing or Cognitive Behavioral Therapy (CBT). [5]Â
Individuals in recovery are also encouraged to participate in mutual help programs like Alcoholics Anonymous, SMART Recovery, or other addiction recovery groups. These programs can help people in recovery develop lasting supports and skills that will help them get and stay clean and sober. Recovery from opioid use disorder requires long-term treatment and support in developing healthier lifestyles, habits, and routines. [5]Â
Harm reduction (if not ready to stop)
Krokodil is much more toxic and dangerous to the body and brain than other opioids, making ‘safe use’ not applicable. One case study reported severe necrosis of the skin and tissue after just one reported incidence of use. While this is not normal, it is important to understand that due to the toxic effects of krokodil, it can be dangerous even if it is the first time taking it. Talking with a licensed addiction professional is recommended, as medications like suboxone or methadone may be the only safe option to stop using this drug. [1][2][5]
Medical care for krokodil-related damage
Krokodil abuse often results in severe health effects, which can even include necrosis, or rotting, of skin, tissue, and bone. This may require intensive wound care, including debridement, skin grafting, or, in some instances, limb amputation. Krokodil skin lesions are also often infectious, requiring antibiotics to effectively mitigate and treat. If you are experiencing negative health effects related to krokodil use, medical treatment and care may be an essential aspect of your treatment. Immediate medical attention may prevent the need for invasive treatments. [2][3][4]Â
