We are hearing reports that the dangerous and hideous drug krokodil is here, in the US. Initial reports of possible krokodil use started 2 years ago, but this week we are facing what may turn out to be the first confirmed death from krokodil in Oklahoma, after several reports in Illinois.

In 2010 we first heard graphic reports of “Krokodil” abused by addicts in Russia. The horrific images and stories of addicts so lost to hope that they willingly inject themselves with visibly destructive chemicals, while drug dealers watch them die, drew media attention. To addiction treatment professionals, this was evidence of the severe end game of an addict abandoned by society, left to rot, and powerless under the forces of chemical addiction and commercial manipulation.

Krocodil has been observed since early reports such as this one from Russia in 2011, when the practice of deriving crude desomorphine from codeine using petro chemicals emerged from Siberia.
Krocodil has been observed since early reports such as this one from Russia in 2011, when the practice of deriving crude desomorphine from codeine using petro chemicals emerged from Siberia.

Krokodil, or desomorphine, is an opioid derived from morphine. It is also known as dihydrodesoxymorphine, once sold under the brand name Permonid. When codeine was deregulated in Russia a few years ago and sold over the counter, addicts seeking lower cost opioid highs experimented with codeine-containing medicines. They used any available chemical solvents to formulate desomorphine from codeine products, including gasoline, kerosene, paint thinner — or the cheapest of all: red phosphorous scraped off the heads of matches pulled from “free” matchbooks given away with cigarettes.

Krokodil is made from over the counter products containing codeine. The Russian government returned codeine to controlled status in 2012, reportedly due to the abuse of krokodil.

Drug users injecting krokodil are expected to live less than a year or two, due to the severe damage caused by injecting the drug. The horrific skin damage that leads these addicts quickly to disease and death, is caused by the solvents injected into the skin. The solvents cause blood vessels to burst, interrupting blood flow to the skin around injection sites on the arms and legs and wherever the addict injects, killing the skin.

While the media seems fascinated with the imagery of deformed and hideous addicts literally falling apart as they continue to inject, what is the real problem with krokodil? It comes down to two main issues: economics, and substance abuse treatment policy.

Krokodil is the cheapest high these addicts can find, by far. That economic fact… that these addicts cannot afford any other satisfaction from their addiction than an obviously suicidal injection of krokodil, tells the primary story behind the drug. The consequences of injecting krokodil are clear to all who witness it, which we can see from the Russian reports. Addicts surrounded by other addicts dying of the consequences, continuing to inject it. Krokodil is a high of last resort. And that fact highlights the second reason we must pay attention to krokodil: co-occurring mental disorders are behind many addictions, and must be treated.

The addicts we see with krokodil have abandoned all hope. They see no alternative to life under their addiction, except death, and choose death by krokodil over death by something else. This behavior reflects the mental state of the extreme addict left alone to die of addiction.They accept that since they have no hope, and no help, and are dying, they will die one way or another, which may include via the damage done by krokodil.

“While one can say the krokodil addict died of infection or another consequence of the skin damage caused by injecting desomorphine mixed with toxic petro chemicals, I can equally state they died of untreated mental illness, concurrent with terminal addiction”. — Ira Levy, Sunrise Detox in Florida

We eagerly await news from the scientific and policy agencies on these current reports of krokodil in the US. As the investigations get under way, we hope that everyone will look at the true root causes of the problem, which is untreated behavioral disorders associated with the disease of addiction, and the economics of drug abuse and treatment.

No addict in the US should ever be left alone to conclude there is no hope, and our society should not allow the criminal conditions of drug sale and encouragement witnessed in the early Russian video reports about krokodil.

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