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Medically Reviewed By: Elena Hill, MD, MPH -

Desomorphine (Krokodil): Effects, Abuse & Warnings

Opioids Side Effects

Desomorphine is synthesized from codeine and manufactured with toxic additives. It is then called krokodil or crocodil. This cheaper alternative to heroin first showed up in the early 2000s in Russia. 

Krokodil is a synthetic opioid that is synthesized illegally, much in the same way that methamphetamine (meth) is created.[1] It gained popularity in Russia since it is commonly made from codeine. 

Because it is made illegally, it may contain chemicals including: 

  • Gasoline
  • Paint thinner
  • Iodine
  • Lighter fluid
  • Hydrochloric acid
  • Red phosphorus

Krokodil is extremely dangerous and classified as a Schedule I controlled substance in the United States, meaning that it has no accepted medical use and a high potential for misuse and dependence. 

It is called krokodil due to the scaly and greenish appearance it can cause near the injection site on the skin. It is highly toxic with a host of negative side effects.

Krokodil’s Popularity

Krokodil first appeared in Russia in the early 2000s, and it gained traction as the opioid epidemic grew and heroin became more expensive. Today, krokodil could be gaining in popularity in certain parts of the country. 

It is popular in both Russia and Ukraine, with around 100,000 Russians injecting the drug in 2011 and 20,000 people doing so in Ukraine.[2] It has reportedly made its way into the United States in recent years. As more than 9.5 million people misused an opioid drug in 2020 in the U.S., people are turning to newer options.[3] 

Opioids are highly addictive and often difficult to come by. Krokodil can be easily manufactured, even ordered over the internet, and can sometimes be cheaper than heroin which is part of the reason people use it. People may also turn to it if they are unable to obtain other opioids. 

Strength of Krokodil Compared to Other Opioids

Depending on the way it is synthesized, desomorphine can be up to 10 times more potent than morphine. It has a quick and short-acting onset of action.[4] To put this in perspective, heroin is around two to four times more potent than morphine, so desomorphine has the potential to be more potent than heroin. Because it is synthesized illegally, it is very hard to gauge how potent it will be, which makes it highly risky to cause overdose. 

Side Effects of Krokodil 

Krokodil is a deadly impure drug. With regular use, users have a mean survival time of two years after first using it.[5] 

It commonly causes damage to the skin near the injection site, leading to gangrenous inflammation that looks like crocodile scales. It is often called the “flesh eating” or “flesh rotting” drug. It is highly toxic. 

Desomorphine can have many of the same side effects of other opioid drugs, such as these:

  • Nausea
  • Vomiting
  • Sedation
  • Flushing
  • Breathing issues
  • Constipation
  • Drug tolerance and dependence
  • Overdose

Additional dangerous side effects of krokodil use can include the following:

  • Swelling and pain around the injection site
  • Greenish-black scaling of the skin
  • Necrosis, causing the skin and muscle to slough off down to the bone
  • Gangrene
  • Severe muscle and tissue damage
  • Damage to blood vessels and bones
  • Autoamputation
  • Sepsis
  • Pneumonia
  • Tooth loss
  • Increased risk for developing an infectious disease, such as HIV or hepatitis 
  • Meningitis
  • Memory impairment (neurological injury)
  • Renal impairment
  • Multiorgan failure
  • Death

Krokodil Use

Since its first appearance in 2002 internationally, krokodil use has increased in other countries including in the United States. [6] It is usually used via injection. 

Krokodil is an extremely poisonous, highly addictive, and dangerous drug. If someone is using krokodil, it is usually a sign of a severe substance use disorder that requires prompt treatment. If you know someone or are you yourself using this substance, please reach out to a substance use professional for assistance.

Medically Reviewed By: Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.
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  1. Desomorphine. National Center for Biotechnology Information. September 2022. Accessed September 2022.
  2. Breaking Worse: The Emergence of Krokodil and Excessive Injuries Among People Who Inject Drugs in Eurasia. The International Journal on Drug Policy. May 2013. Accessed September 2022.
  3. Key Substance Use and Mental Health Indicators in the United States: Results from the 2020 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration. October 2021. Accessed September 2022.
  4. A New Drug With a Nasty Bite: A Case of Krokodil-Induced Skin Necrosis in an Intravenous Drug User. JAAD Case Reports. April 2016. Accessed September 2022.
  5. Krokodil. California Poison Control System. September 2014. Accessed September 2022.
  6. Desomorphine. Drug Enforcement Administration. December 2019. Accessed September 2022.

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