Suyash Tiwari
An opioid is a medicine to treat persistent or severe pain. It attaches
itself to opioid receptors on nerve cells in the brain and spinal cord. It acts
as a blocker and restricts pain signals from travelling through the spinal cord
to reach the brain. Often used to curb surgery discomfort or injury due to
sports, its impact on the human body is not restricted to the reduction of
pain. It has been found to induce addictive behavior, specifically when used to
manage chronic pain over a longer duration. The most common illegal opioid is
heroin. However, the strongest opioid available in the market is Desomorphine,
popularly called krokodil. Through this blog post, I shall elucidate upon
krokodil’s history, method of preparation, addictive behaviour and side effects.
Krokodil was originally created in Russia. Around 2002, it reached
Siberia and has since spread throughout Ukraine, Georgia, and Kazakistan. While
several drugs are harshly addictive and physically damaging, krokodil sets a
new standard for the immediate destruction of mind, spirit and body. Its name
possibly originates from its precursor, α-chlorocodide. It may also be a
reference to the skin lesions around the injection site, which appear green and
scaly like crocodile skin due to desquamation (Oliver, Gheevarghese, Gandhi,
Bhat, & Pillai, 2015). In 2012, the difficulty in procuring heroin fuelled
the manufacturing of krokodil. This drug was cheaper than heroin and had a much
harder kick.
Krokodil is also known as “Russian Magic,” denoting its brief duration
of intoxication. The intravenous route is utilized for drug abuse. A
home-cooked drug, its ingredients are easily procurable and its main component
- codeine - is present in several over-the-counter medications. Codeine is then
mixed with ethanol, gasoline, red phosphorus, iodine, hydrochloric acid and
paint thinner (Alvis et al., 2015). Since Krokodil is not meticulously
prepared, addicts often abuse a half-prepared drug, thereby damaging their body
even further.
Krokodil is fast-acting and hits within 2-3 minutes. It is 10 times more
potent than morphine and three times as toxic (Anderson, 2018). The rapid onset
only persists for a short while. Within 2 hours, the high starts to wear off,
forcing the abuser to take another short. To avoid withdrawal, addicts tend to
repeatedly abuse the drug. Due to this short cycle and frequent administration,
quick physical dependence may occur (Anderson, 2018). Variations in potency or
"homemade" recipes can expose users to an increased risk of overdose.
Excluding physical dependence, krokodil usage leads to extreme skin
ulcerations and infections. The most widespread complications reported due to
krokodil injection are serious vein damage, soft tissue infections, necrosis
and gangrene (Anderson, 2018). Ulcerations may occur locally at the drug
injection site accompanied by further organ or CNS damage. Memory loss,
pneumonia, blood poisoning, osteonecrosis, HIV and HCV infections due to needle
sharing are a few known consequences. Certain cases of death have also been
noted.
The time for clinicians to intervene is now. The therapist-client
relationship is not enough to eradicate krokodil addiction. Health policies and
administrative measures must work together to minimize the availability of
substances in order to reduce the initial cases of addiction. Additionally,
cases of mental illness due to drug abuse is another area of concern. Doctors
struggling with drug abusers claim that krokodil abuse is the strongest level
of addiction and hardest to cure, damaging the patient both physically and
mentally. Precautions must be taken to reduce the number of future abusers, and
more importantly, to provide a krokodil free country for the upcoming
generation.
References
Alves, E. A., Grund, J.
C., Afonso, C. M., Netto, A. D., Carvalho, F., & Dinis-Oliveira, R. J.
(2015). The harmful chemistry behind krokodil (desomorphine) synthesis and
mechanisms of toxicity. Forensic Science International,249, 207-213. doi:
10.1016/j.forsciint.2015.02.001
Anderson, L. A.
(2018, August 21). Krokodil Drug Facts: Effects, Abuse & Warnings.
Retrieved April 28, 2019, from https://www.drugs.com/illicit/krokodil.html
Florez, D. H.,
Moreira, A. M., Silva, P. R., Brandão, R., Borges, M. M., Santana, F. J., &
Borges, K. B. (2017). Desomorphine (Krokodil): An overview of its chemistry,
pharmacology, metabolism, toxicology and analysis. Drug and Alcohol
Dependence,173, 59-68. doi: 10.1016/j.drugalcdep.2016.12.021
Gahr, M.,
Freudenmann, R. W., Hiemke, C., Gunst, I. M., Connemann, B. J., &
Schönfeldt-Lecuona, C. (2012). Desomorphine Goes “Crocodile”. Journal of
Addictive Diseases,31(4), 407-412. doi:10.1080/10550887.2012.735570
Krokodil Information.
(n.d.). Retrieved from https://www.narconon.org/drug-information/krokodil.html
Oliver, T.,
Gheevarghese, S. J., Gandhi, U., Bhat, Z. Y., & Pillai, U. (2015).
“Krokodil”—A Menace Slowly Spreading Across the Atlantic. American Journal of
Therapeutics,22(3), 231-233. doi:10.1097/mjt.0000000000000085
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