What is the krokodil drug and why is it so deadly?
It is interesting to note that a crocodile has a life span of 70 to 100 years. Yet, someone addicted to the drug, krokokil, only has a lifespan of two to three years. How did a street drug get the name krokodil, and why would anyone use it?
It is possible that the name came from the chemical precursor of the drug, chlorocodide. Or, it could have come from the scaly skin lesions caused by the drug that resemble the leathery skin of a crocodile. Another possibility is that the user is literally eaten alive by the drug, as if a crocodile is chewing bits and pieces of flesh from the bone.
Krokodil is a street name for the drug desomorphine. Desomorphine, a controlled substance alternative to morphine, was discovered a hundred years ago. It is a potent opioid that showed promise for medical treatment because it worked quickly and wore off quickly. Unfortunately, it had enough downsides, including excessive respiratory depression, to make it of little use in hospitals.
The rebirth of the zombie drug.
In Russia, during the first decade of the new millenia, 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 krokodil addict shoots up, the surrounding flesh around the injection site dies off and can fall off in chunks. The krokodil user 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 heroin addict consider trying such a dangerous drug?
This recreational drug, also known 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 abuse skyrocketed, because the high is very similar to that of heroin. There have been many news reports of desperate addicts 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 users to seek out an alternate drug. Yet, krokodil is one of those toxic substances that must be taken off the streets. Has the krokodi epidemic reached the US?
Russian krokodil makes its way from the Ukraine to the United States.
As we have discussed, krokodil use was related to a perfect storm of circumstances that made it ideal for Russian addicts 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, there has been some use of krokodil noted in the US.
Fortunately, we are not seeing widespread use of the zombie drug 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 conection with actual crocodiles. Loved ones of opioid users are concerned about the use of the crocodile skin drug as well as other unusual, exotic designer opioids on the streets, such as black death.
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 pseudofed 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 tramodol, which is over the counter in Mexico, 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 abuse, 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, sometimes used by opioid addicts to detox on the streets.
Kratom tolerance builds quickly, so users 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.
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 being addicted to krokodil.
The reason why Suboxone prescribing doctors do not see many krokodil addicts is not because Suboxone will not work. It’s because krokodil use is limited 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, the krokodil addict should be able to start their Suboxone within 12-24 hours after quitting the drug. Of course, the Suboxone induction must be performed under the supervision of a doctor.
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. In a way, this makes sense, since some drugs present unique challenges and it might help to have rehab residents with similar experiences, particularly for group sessions.
While krokodil use is still limited in the US, there may be rehabs out there that specialize in the unique issues related to krokodil use. An important focus of a krokodil rehab would be to address physical problems caused by the severe toxicity of the drug.
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 is a drug user 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, handling complications of homemade desomorphine, possibly the world’s deadliest drug, can a doctor’s office handle treating krokodil addicted patients?
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 krokodil victim.
Still, a private doctor, particularly a concierge medical office, would be an excellent option for the involved and personalized care required for treating krokodil addiction. Patients who are victims of 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 is a scary newcomer on the streets of Eastern Europe, and now in the US, it is still just a short-acting opioid drug.
We can overcome krokodil addiction. It is important to be prepared so that we may prevent a krokodil epidemic.