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The Legacy of Krokodil: World’s Deadliest Drug

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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