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Krokodil: A Dangerous Opioid With Irreversible Consequences

Elena Hill, MD, MPH profile image
Medically Reviewed By Elena Hill, MD, MPH • Updated Aug 14, 2023 • 5 cited sources

Krokodil is one of the most dangerous drugs people still intentionally misuse. It is significantly stronger than morphine, and it comes with a variety of additional dangerous effects associated with it. 

What Is Krokodil?

Krokodil is the street name for the drug desomorphine, a particularly dangerous illicit drug with an opioid-like mechanism of action that is 10 times more potent than morphine.[1] While it would be dangerous enough for its opioid-like effects, it can also cause quite serious health effects not typical of opioids, including severe tissue damage and necrosis that can result in the need for amputation or even death.

Krokodil is particularly dangerous even when compared to other kinds of drug misuse. A person should never engage in krokodil use. If you are currently using the drug, seek addiction treatment immediately. 

What Is Desomorphine Used For?

Desomorphine has no accepted medical use in the United States, and it has been considered a controlled substance since 1936. It is not used commonly in the US, but if it is used, it might be used by people with opioid use disorder as a cheap alternative to heroin or as an attempt to stave off withdrawal symptoms from other opioids.  Using Desomorphine illicitly is never safe. If you are using Desomorphine alone or in combination with other opioids, treatment can help. 

Some Key Facts About Krokodil

Krokodil is dominantly used in Russia and Eastern Europe, where people often view it as a cheaper and/or more accessible alternative to heroin.[2] It isn’t as heavily used in the United States, at least in part due to the ease of access to heroin and other opioids, which may be part of the reason it is generally understudied and most US clinicians are not familiar with it.

Importantly, very little krokodil available on the street is true, pure desomorphine. While desomorphine is usually a component of illicitly bought krokodil, it is often cheaply made from a variety of easily accessible store-bought chemicals mixed by individuals who may or may not have any real experience with chemistry or access to good equipment. 

This is in part what contributes to just how dangerous krokodil use can be. It tends to be “dirtier” than other drugs of a similar type.

The Origin of Its Name

Krokodil’s name is generally attributed to the fact it is associated with causing a dried, scaly texture on a user’s skin, like a crocodile, due to an injection site reaction. Krokodil is Russian for crocodile. In fact, some people simply call the drug crocodile.

What Is Krokodil Made Of? 

Krokodil is synthesized from codeine tablets, alkali solutions, organic solvent, acidified water, iodine, and red phosphorus.[3] The resulting mixture, assuming it was synthesized correctly, is a light brown liquid, which users generally will inject. 

As previously mentioned, it is often manufactured impurely and may contain many toxic byproducts. The exact nature of these toxic components isn’t fully understood and can also vary depending on exactly what was used to make the drug. Thus, very little “krokodil” that you purchase illicit on the street is pure, and may contain substances other than what the dealer is claiming. 

How Does It Make Users Feel?

Desomorphine is a powerful narcotic. It will produce a strong sense of euphoria and pain relief in users, acting very chemically similar to opioids. Its effects will vary depending on how it was made and whether or not it is pure or impure. As explained above, many people purchase largely impure Krokidil without knowing how it was made or what they are really getting. 

Dangerous Side Effects of Krokodil

Krokodil carries most of the same dangerous side effects associated with opioids. Krokodil is especially dangerous if a person engages in polydrug use, mixing it with other drugs that may amplify its effects. 

Desomorphine causes respiratory depression, affecting a person’s breathing and potentially causing oxygen deprivation, brain damage and even overdose and death. 

Repeated krokodil use is associated with significant addiction risk just like other opioids. 

Krokodil can cause serious damage to a person’s skin. It is associated with causing greenish, scaly skin due to damaged blood vessels, thrombosis, and damaged soft tissue at injection sites. Severe enough tissue damage can cause thrombophlebitis and gangrene, essentially causing a person’s skin to rot due to the caustic nature of the chemical as it enters the bloodstream through the skin. [4] 

Its use can also have devastating oral health consequences if taken by mouth, causing the death of bone cells in the jaw, skin and soft tissue infections of the face, dental abscess, esophageal perforation and sepsis. 

Krokodil is not known to be any safer than other opioids. In fact, one can argue that it could potentially be more dangerous as it may be manufactured impurely as explained above. 

Addiction Treatment Options

While research into krokodil addiction specifically is limited in the US, it is still and opioid which suggests that a standard opioid addiction treatment program is likely to help an individual manage their addiction to this drug. 

The backbone of opioid addiction treatment is both psychotherapy and pharmacotherapy in conjunction. In therapy sessions, individuals will work with a therapist to identify toxic and otherwise harmful thought patterns that lead to drug use and redirect those thoughts to better avoid drug use.[5] With pharmacotherapy, there are three FDA approved medications to reduce opioid (including Krokodil) use” Methadone, Suboxone and Naltrexone. 

If you are using Krokodil and want to pursue addiction treatment that is safe and evidence based, reach out to your doctor or to Bicycle Health.

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 ... Read More

Sources
  1. Desomorphine. Drug Enforcement Administration. https://www.deadiversion.usdoj.gov/drug_chem_info/desomorphine.pdf. December 2019. Accessed October 2022.
  2. Effects of Krokodil (Desomorphine) Use on Oral Health - A Systematic Review. British Dental Journal. https://www.nature.com/articles/s41415-019-0854-x. November 2019. Accessed October 2022.
  3. The Harmful Chemistry Behind Krokodil (Desomorphine) Synthesis and Mechanisms of Toxicity. Forensic Science International. https://pubmed.ncbi.nlm.nih.gov/25710781/. February 2015. Accessed October 2022.
  4. Eaten Alive by Krokodil: A Disastrous New Drug of Abuse. EMN. https://cme.lww.com/ovidfiles/00132981-201401000-00005.pdf. January 2014. Accessed October 2022.
  5. Cognitive-Behavioral Therapy for Substance Use Disorders. Psychiatric Clinics of North America. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2897895/. September 2011. Accessed October 2022.

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