Krokodil Drug (The Russian Crocodile Drug): What Does Krokodil Drug Do To You?

The rebirth of the zombie drug.

In Russia, during the first decade of the new millennium, desomorphine made a comeback as the street drug krokodil. Some people called the krokodil drug the “zombie drug.” This is because street-made krokodil causes severe tissue damage and infection around the area it is injected.

When a person shoots up krokodil, the flesh around the injection site dies off and can fall off in chunks. The person may even lose toes or fingers. This flesh eating drug, filled with toxic substances, causes gangrene, limb amputation, and a leathery scaly skin.

Why would a person who uses heroin consider trying such a dangerous drug?

This street drug, which made headlines as the world’s deadliest drug, is essentially homemade desomorphine. It can be made with just a few ingredients available at any hardware store. Red phosphorus comes from the red substance on a pack of matches. A variety of other household chemicals are used as well, including iodine and hydrochloric acid.

One ingredient that is not quite so readily available is codeine, an opiate drug derived from the opium poppy. Yet, during the peak of krokodil use, around 2011, codeine was easily purchased over the counter in some countries, including Russia.

After a significant Russian crackdown on street heroin, krokodil use skyrocketed, because it fills the same need as heroin. There have been many news reports of desperate people injecting this toxic homemade drug.

Changes in drug policy can have significant effects on drug use on the streets. When Russian codeine tablets were restricted from OTC purchase, krokodil use plummeted. It is important to keep in mind that restricting one drug may lead people to seek out an alternate drug. Yet, krokodil is one of those toxic substances that must be taken off the streets. Has the krokodil epidemic reached the US?

Has Russian krokodil made its way from Ukraine to the United States?

As we have discussed, krokodil use was related to a perfect storm of circumstances that made it the fallback for people in Russia who could not obtain heroin. In the United States, we have other serious opioid issues, including super potent synthetic opioid drugs, such as fentanyl and carfentanil, known for causing deadly respiratory depression. However, around 2013 there were a handful of news reports of krokodil in the US, and the drug never established a supply here.

Fortunately, we are not seeing widespread use of krokodil here. With the dangers of severe tissue damage, amputation, soft tissue infections, and blood poisoning from krokodil injection, it would add more problems to our already difficult opioid epidemic.

In the US, crocodiles are not common. In fact, Everglades National Park in Florida is one of the few places where crocodiles can be found in this country. Because of the name of the drug and the appearance of krokodil skin, many people are confused about the krokodil drug, thinking there is a connection with actual crocodiles. Loved ones of people who use opioids are concerned about the crocodile skin drug as well as other unusual, exotic designer opioids on the streets.

What do home meth labs have in common with the crocodile street drug?

One reason why we should be concerned is the widespread prevalence in the US of homemade meth and low quality clandestine meth labs. For years, these home labs were able to function without limitation because they used over the counter Sudafed (pseudoephedrine) tablets and easily obtained chemicals.

While codeine is not so readily available, it is still easier to obtain than many other opioids. It may also be possible to use other opioids or opioid-like substances, such as tramadol, which was sold over the counter in Mexico until 2026, or loperamide, the active ingredient in Imodium.

Could a back alley drug lab use a common, over the counter anti-diarrheal drug to make the Russian crocodile drug? Hopefully not, but we must be vigilant, watching for new trends in dangerous street drugs.

Will the krokodil drug show up on any drug test?

If you have purchased a drug test from your local pharmacy with the intention of testing a loved one who might be using opioids, be careful how you interpret the results. Many people, even some experts, are under the impression that there is a general opioid panel on these screening tests that will show positive for any opioid. This is simply not true.

There is a morphine test that will show up positive for heroin and possibly some other related opioids. Otherwise, each drug, including individual opioids, must be tested separately.

Unfortunately, desomorphine is not tested for on typical urine drug screen tests. The best urine drug tests will test for drugs such as morphine, heroin, oxycodone, methadone, and other non-opioid drugs. If you are monitoring a loved one for krokodil use, do not count on a home drug test to come up positive.

What do I do if a loved one suddenly has crocodile skin on their arms or legs and they deny drug use?

Severe skin changes are definitely concerning and should be evaluated by a doctor immediately. Yet, a leathery appearing crocodile skin lesion could be due to another cause. In addition to the flesh eating drug, krokodil, there are also flesh eating infections.

However, if your loved one has a history of drug use, especially opioid use, you may have reason to believe that the skin problem is due to a krokodil injection. If they do admit to using street opioids, such as heroin, you should definitely be concerned. Heroin is often substituted with a less expensive opioid alternative, including fentanyl, and possibly krokodil.

Another tell-tale sign of krokodil or other opioid use is the presence of Kratom powder in your loved one’s environment. Often a greenish or yellowish powder, kratom is an opioid-like, plant-derived substance that people who are dependent on opioids sometimes use to get through withdrawal on their own.

Kratom tolerance builds quickly, so people who take it often have large amounts of powder residue everywhere, in their cars, work areas, and home. While kratom and krokodil have similar names and both act on opioid receptors, they are very different drugs.

Is “krokodil arm” a real diagnosis, and what should you do if you think you are looking at it?

“Krokodil arm” is not a diagnosis. It is the name the internet gave to photographs of an injection site after weeks of shooting up a drug cooked from codeine tablets, hardware-store chemicals, and a solvent such as gasoline or paint thinner, with the wound never looked at.

Why does the arm rot? Desomorphine itself is an ordinary opioid, so the likely culprit is everything left over from the cook, injected into a vein or left sitting in the flesh, where it burns whatever it touches. The vein clots into a hard, painful cord, the skin over it darkens and breaks open, and the sore grows instead of healing. From there, it is a short trip to abscess, gangrene, and the amputations in the photographs.

Yet, the name matters far less than what you do about the wound. A sore that is spreading, turning gray or black, giving off a foul smell, or coming with a fever needs a doctor today, and an emergency room if that is the fastest way to one. Wound care does not wait for the person to quit, and it does not require a confession about what was in the syringe.

In the US, a wound like this is far more likely to be an infected fentanyl injection site, or a missed shot that went into the flesh instead of the vein, than krokodil. Still, the first steps are the same either way. Fortunately, a doctor who sees the wound will know what to do with it.

There is one more piece of harm reduction, and it takes away the reason for the drug. Nobody chooses krokodil when anything else is available, so the person injecting it is in opioid withdrawal with no other way out. Physical dependence is not addiction, but it is what drives the next injection, and it is treatable.

Buprenorphine, the active medication in Suboxone, removes that desperation. Until the first dose, Narcan (naloxone) belongs within reach, because the drug that rots the arm is still an opioid that can stop the breathing. Treat the wound, and treat the withdrawal.

Can Suboxone help with krokodil addiction?

Suboxone is a prescription medication that is FDA approved to treat opioid dependence. The practice of prescribing Suboxone is called medication-assisted treatment, or MAT. Very few Suboxone doctors have experience with patients who have used krokodil.

The reason why Suboxone prescribing doctors do not see many krokodil patients is not because Suboxone will not work. It’s because krokodil use is essentially nonexistent in the US. American Suboxone doctors are more likely to see many patients who are addicted to fentanyl.

Additionally, the common reasons for krokodil use include the low cost compared to heroin. There is a desperation implied with shooting up krokodil. For a person to take the risk of serious infections, skin damage, and even amputations, they must be at the end of their rope, unable to obtain any other opioid to help stave off the inevitable and tortuous opioid withdrawal symptoms.

In fact, krokodil is a perfect indicator of how difficult it is to quit opioids, going through withdrawal and drug cravings. People are willing to risk their health with this toxic street concoction rather than give up opioids.

If someone uses krokodil, they most likely will need financial assistance in getting Suboxone therapy. There are a handful of government funded programs in the US. We need many more to provide better access for the people who need it.

How do you start Suboxone after quitting krokodil?

Suboxone will work very well for treating krokodil dependence. Because krokodil is desomorphine and desomorphine is an opioid that is very similar to morphine, Suboxone will work just as well as it does for morphine addiction. In fact, it may be easier to start Suboxone after quitting krokodil compared to other opioids.

Remember that desomorphine has a fast onset of action and a short half-life? The drugs that are the most difficult to quit and get on to Suboxone are the opioids that linger in your system. Methadone and street fentanyl are examples of long-lasting opioids that make the transition to Suboxone challenging.

To get started with Suboxone, you must first wait for a washout period to get enough opioid out of your system so that the buprenorphine in Suboxone does not cause precipitated withdrawal. Precipitated withdrawal is the very unpleasant reaction where buprenorphine interacts with remaining opioid molecules, causing the sudden onset of acute withdrawal symptoms.

Since krokodil wears off fast, a person coming off of it can usually start Suboxone sooner than someone coming off of methadone or fentanyl. Of course, the first dose is given only after clear signs of withdrawal have set in, and the timing of that dose is your doctor’s call at the induction visit.

Are there any krokodil rehabs?

Surprisingly, there are rehabs around the country that cater specifically to people addicted to a particular substance. There are, for example, kratom rehabs for people who have become addicted to the opioid-like, plant-based kratom. (delete the sentence)

With krokodil use still essentially nonexistent in the US, be suspicious of any rehab that advertises a krokodil program. The only question that would matter in such a program is whether it can treat the physical damage the drug causes.

In addition to wound care for the skin lesions caused by ongoing krokodil injections, a full physical workup, including a heart evaluation would be important. While all rehabs are affiliated with a medical director, a krokodil rehab would require more hands-on care from qualified physicians.

To handle krokodil, rehabs may have to upgrade their services.

There is a common practice with rehabs when it comes to marketing their services. Many programs advertise that they provide services specific to almost any addiction-related condition you can imagine. In fact, many promote on their websites and on the phone that they also treat most, if not all, mental illnesses as well.

When a facility tells the world that they can handle any problem that you throw at them, and they are not truly prepared to deliver that level of care, there exists a lack of integrity. Being able to trust a rehab and their ability to take care of a loved one who uses drugs is critically important.

While a residential rehab staffed by drug counselors and an off-site and minimally involved medical director may be able to skate by in many instances, treating patients with a drug addiction and mental health needs, it will not fly with krokodil patients.

A rehab offering krokodil treatment services should be prepared to address the specific medical needs of the patient. It may even be best for such rehabs to partner with a nearby hospital to coordinate care.

If krokodil care is so involved, can a doctor’s office handle treating patients who have used it?

While addiction treatment is currently being delivered successfully by independent, private doctors via telemedicine services, krokodil addiction may be best treated in person. It is important that a doctor provide a carefully performed physical examination of the patient.

Still, a private doctor, particularly a concierge medical office, would be an excellent option for the involved, hands-on care required for treating krokodil addiction. Patients who have been injured by this dangerous drug require more than just a prescription refill. They need close medical attention and mental health care.

While krokodil is a seriously dangerous drug with many potential complications, it is still essentially an opioid drug with all of the familiar effects of most opioids. It is closely related, chemically, to morphine and heroin.

Krokodil overdose can be treated with Narcan. Krokodil addiction will respond to treatment with Suboxone therapy. While this exotic drug was a scary newcomer on the streets of Eastern Europe, it is still just a short-acting opioid drug.

We can overcome krokodil addiction. It is important to be prepared, even if the drug never takes hold here.

This article is educational. It is not medical advice, and reading it does not create a doctor-patient relationship. Decisions about starting, continuing, or tapering any medication should be made with your own physician.