What You Should Know About Krokodil Addiction and Abuse

What Is Krokodil?

Krokodil, which is also called crocodile, krok or croc, is an opioid that has analgesic and sedative effects similar high to heroin that was first found in Siberia in 2002. Authorities believe that the drug was first manufactured in Russia because of a shortage of heroin caused by reductions in imports from Afghanistan. Krokodil gets its name as a reference to chlorocodide, a derivative of the codeine used to manufacture the substance, and from the Russian word for crocodile, due to the gangrenous inflammation that occurs in the skin at injection sites that looks similar to crocodile skin.

Medical providers use prescription opioids to treat pain. This class of drugs includes drugs made from poppy plants, such as morphine and heroin, and synthetic versions, such as fentanyl. Opioids attach to the opioid receptors in the brain which blocks pain signals and increases feelings of pleasure.

The main ingredient of krokodil is desomorphine, which is a synthetic derivative of morphine that was first manufactured in the United States in 1932. Manufacturers hoped to use the drug as a replacement for morphine with fewer side effects.

While the drug has the benefits of relieving pain faster and more effectively and causing fewer respiratory problems and less nausea, it has a higher risk of dependence than morphine. The drug wears off faster than morphine or heroin, which contributes to its higher addictive potential because the short duration of the high users get motivates them to inject the drug more frequently.

For a time, doctors in Switzerland used desomorphine to treat post-surgical pain under the brand name Permonid. It has been a controlled substance in the United States since 1936 and has no currently accepted medical use.

How Is Krokodil Made?

Much like methamphetamine, users and dealers can make the drug at home using cold medications, such as codeine, and other widely available ingredients. The drug is relatively easy to make by boiling codeine with a diluting agent, such as paint thinner, hydrochloric acid, gasoline, red phosphorous and iodine. The process takes about 10-45 minutes to complete.

What Are the Effects of Krokodil Use?

The use of this drug produces an intense euphoric effect and relaxation, similar to the high users experience when injecting heroin. However, the effect, which lasts for about two hours, is shorter.

Is Krokodil Addictive?

Desomorphine is an opiate in the same family as oxycodone, heroin and codeine. Opiates are particularly addictive because of the direct influence the drugs have on the reward center of the brain. This activation of the brain’s reward center creates a sense of euphoria that is difficult to match in any other way. People with addictions to other opiates, such as heroin, are particularly susceptible to krokodil addiction.

Repeated use can cause psychological and physical dependency. Users also experience increased tolerance, meaning they need more of the drug to get the same high. Withdrawal symptoms may occur when users stop using.

Is Krokodil Dangerous?

The drug made headlines as the “flesh-eating zombie drug” because of the devastating damage it does to muscles, vasculature and bones. Repeated use of the drug can lead to multiple organ failures. The physical effects of the drug are so severe that the average user lives only two to three years after first beginning to use the drug.

Krokodil is not purified after manufacture and its toxic byproducts can cause immediate tissue damage to bone, blood vessels and muscle. Short-term effects of the drug include shallow breathing and pain and swelling at the injection site. Users may experience one or more other physical effects:

• Flushing
• Miosis
• Constipation
• Nausea and vomiting
• Urinary retention

Long-term use of the substance can cause serious health effects due to the toxins present in the manufacturing process:

• Blood clots
• Severe tissue damage
• Swollen veins
• Muscle and skin infections
• Memory loss

Chronic users may also experience insomnia, exhaustion, speech problems, bone damage, gangrene, heavy metal poisoning and death. The iodine used to make the drug can cause thyroid dysfunction and the phosphorus can damage cartilage. Red phosphorus contamination can cause jaw osteonecrosis that resists medical treatment.

The toxic ingredients used to make krokodil lead to a higher rate of necrotic and gangrenous tissue damage than other intravenously injected drugs, such as heroin. As tissue damage at the injection site becomes severe, the user’s skin may slough off and expose bone.

These deep tissue wounds make users more vulnerable to serious infections that can lead to bone death. There is evidence that the drug does not completely dissolve in the blood and clumps of it can travel to other places in the body causing tissue damage, meningitis, pneumonia, sepsis, ulceration, neurologic injury, liver damage, kidney damage and death.

Users of this drug may also be at higher risk of contracting blood-borne viruses, such as hepatitis C and HIV. Because the drug wears off quickly and it doesn’t take users long to make another batch, some addicts fall into a cycle of making and injecting the drug to avoid the unpleasant withdrawal symptoms.

Binge patterns that last multiple days may lead to sleep deprivation, malnutrition and poor hygiene that can cause serious complications. Because the potency of the drug varies, users are at a high risk of overdosing.

Why Do People Use Krokodil?

You may find it difficult to understand why users would continue to use a drug that has such harmful effects. However, addicts are often not capable of acting rationally because the drug has such a powerful effect on the reward center of the brain.

Additionally, not using causes withdrawal symptoms. The powerful pain-relieving effect of the drug, which is 10 times as potent as morphine, makes it easier for users to ignore the painful physical conditions that develop as a consequence of their drug use.

Krokodil is less expensive to purchase and easier to make than other opioids. What often happens is that people become addicted to prescription pain killers, such as oxycodone, switch to less expensive heroin and then may try krokodil when they can no longer afford or obtain heroin. This pattern is why the drug has become such a problem in poor communities in Russia and Europe where heroin is difficult and expensive to buy.

Changing attitudes toward heroin use has also played a role. Heroin was once perceived as a drug that only the worst junkies used. Today, with many people smoking or snorting the drug instead of injecting it, heroin use is not viewed as negatively as it once was.

What Are the Signs of Krokodil Abuse?

Signs of addiction are similar to other opioid drugs:

• Withdrawal symptoms
• Inability to stop using
• Isolation from friends and family
• Continued use despite negative effects
• Lying about using the drug
• Loss of interest in hobbies and other activities

Additionally, addicts may spend an excessive amount of time focusing on how to get more of the drug, when they will use the drug and how good they will feel when using it.

Withdrawal Symptoms

Krokodil withdrawal symptoms resemble morphine withdrawal symptoms:

• Agitation
• Muscle aches
• Anxiety
• Insomnia
• Increased tear production

Other typical withdrawal symptoms include runny nose, yawning, sweating, diarrhea, abdominal cramps, goosebumps, dilated pupils, nausea and vomiting. While these symptoms are uncomfortable for people experiencing them, they are not life-threatening.

Physical Signs of Use

Because the toxic chemicals that contaminate krokodil vary depending on the ingredients used to make it, there isn’t a specific test to detect the drug, though tests can detect desomorphine in the blood within two hours of use and in urine samples within two to three days.

Because routine testing is usually not available, doctors typically diagnose krokodil abuse based on the history provided by the patient and the patient’s symptoms. Patients often have symptoms consistent with the use of other opioids and the tissue damage can resemble tissue infections that result from injecting heroin. This makes abuse of the drug difficult to diagnose if the patient doesn’t admit to using it.

How Is Krokodil Addiction Treated?

Drug users may need medical treatment for the serious physical effects of the drug. However, many users do not seek medical help until they have severe tissue injuries. These injuries usually require extensive wound care and intravenous antibiotics.

For many patients, amputation of the damaged tissue is the only available treatment. Doctors may use naloxone to treat respiratory depression and patients often need therapies for organ damage and infections as well.

Addiction Treatment

Medical providers can treat krokodil addiction, like other opiate addictions, by using prescription opiates, such as suboxone or methadone. However, the difficult withdrawal period makes opiate addiction challenging to treat and relapses common.

Detox programs followed by enrollment in a drug rehabilitation program may help prevent relapse. These programs focus on treating the underlying causes of addictive behaviors and on developing life skills that help recovering addicts remain sober by using treatment methods such as cognitive behavioral therapy, family therapy, education and peer support. The National Institute on Drug Abuse recommends long-term treatment that lasts at least 90 days.

Participation in a residential rehabilitation program may be most effective for people with long-term or severe krokodil addictions. Outpatient rehab can be effective for those with less complicated treatment needs and those who can not participate in residential programs because of work, school or family obligations.

Treatment After Rehab

Recovering addicts may benefit from continuing treatment after finishing a rehabilitation program. Options for treatment include sober living programs and aftercare programs that provide support and focus on preventing relapses.

Sober Living Programs

Many recovering addicts have difficulty adjusting to their new lives after completing rehab, particularly since they may be starting over with a new home, new relationships and a new job. Sober living programs help krokodil users transition from rehabilitation programs to an independent sober life.

Sober living homes provide a safe and supportive environment that promotes lasting lifestyle changes. These homes may also provide other support services:

• Tiered recovery programs
• Regular alcohol and drug testing
• Peer monitoring
• Employment assistance
• Educational planning
• Volunteer placement

Aftercare Programs

Aftercare programs provide extra support for people transitioning out of rehab programs. These programs usually include outpatient group therapy sessions for participants to discuss addiction recovery issues. People who participate in these programs may have the opportunity to build healthy relationships, share personal struggles, improve communication skills and support others in their efforts to stay sober.

How Much of a Problem Is Krokodil Abuse?

Though the use of this drug is illegal internationally and the United States Code Controlled Substance Act classifies it as a Schedule I drug, it spread rapidly from Russia to Europe because of its addictive nature and low cost. Russian authorities seized 65 million doses of desomorphine in 2011 and in the decade since the drug first appeared in Russia, an estimated 3 million people became addicts.

In an attempt to curb the spread of the drug, Russia restricted the availability of codeine-containing tablets to pharmacies in 2012. Russia and Ukraine are the countries with the most krokodil users; however, Germany, Georgia, Czech Republic, Kazakhstan, Belgium, France, Norway, Sweden and the United States have all reported cases.

Use in the United States

Drug overdoses are the leading cause of injury-related death in the United States and opioid abuse is a major contributor. The Centers for Disease Control and Prevention report that about 136 Americans die because of opioid overdoses every day and more than 70% of the drug overdose deaths in the U.S. involve an opioid.

While prescription and heroin-related drug deaths have been decreasing, deaths from synthetic opioids, such as fentanyl, were 18 times higher in 2020 than in 2013. However, there is little evidence to suggest krokodil has become a widespread problem in the U.S.

As of 2019, the Drug Enforcement Administration in the U.S. has received only two lab-confirmed reports of desomorphine use in the United States. There have been several other unconfirmed reports in Arizona, Oklahoma and Illinois, but due to many facilities not having tests for the substance and the high mortality rate among users, it is not widely known how popular the drug is in the U.S.

Additionally, some krokodil use may go unreported because users may purchase the drug thinking they are buying heroin. Most of the known users of the drug are 18-25-year-olds who say they are former heroin users who switched to the drug for economic reasons.

While there is a concern that drug users who can not afford heroin may turn to this less expensive option that they can manufacture at home, the prevalence of other relatively inexpensive drugs and the difficulty of obtaining codeine to manufacture it makes it less likely krokodil use will become widespread in the U.S.

What Can People Do To Combat Krokodil Addiction?

Because many people try krokodil after becoming addicted to other opiates, education about the dangers of opiates, particularly prescription opiates, may reduce the problem. Additionally, addiction recovery must focus on the underlying issues, such as poverty, mental illness and trauma, which lead many people to become addicts.

As part of its efforts to combat the ongoing opioid epidemic in the United States, the CDC implemented five key strategies:

• Research and surveillance
• Support for providers, payers and health systems
• Increase local, state and tribal capacity
• Public safety partnerships
• Consumer empowerment to make safe choices

The guiding principles of the CDC’s campaign to reduce opioid abuse are health equity, addressing underlying factors, broad partnerships, evidence-based action, scientific advancement and innovation.

The CDC’s efforts focus primarily on illicitly manufactured fentanyl and heroin, which along with cocaine and methamphetamine cause 85% of drug overdose deaths in about half of U.S. states. While the CDC does not specifically target krokodil, reducing opioid addictions can limit the potential for widespread use of the drug, due to the most common risk factor for use being a preexisting opioid addiction.

What Are the Krokodil Treatment Options at Clean Recovery Centers?

Clean Recovery Centers offers a unique three-phase program to people seeking recovery from addiction to drugs such as krokodil. Phase I is a 24/7 medically supported residential program that takes three to four weeks and includes medical detox and residential treatment.

Participants may complete phase II in either a residential or non-residential setting. This phase helps clients transition out of Phase I by addressing the underlying causes of their addictions. This phase usually takes two to three weeks to complete.

Phase III helps clients put what they learned in the first two phases into practice and transition out of full-time treatment. This phase usually lasts for six to eight weeks. We also offer an alumni program to help clients receive ongoing support and avoid relapse.

In addition to our treatment programs, we offer transitional living, life skills, family programs and wellness programs. Visit us online to learn more about how we can help you or your loved one recover from addiction.

Sources:

• https://www.cnn.com/2013/10/16/health/krokodil-zombie-drug/index.html
• https://calpoison.org/news/krokodil
• https://www.forbes.com/sites/daviddisalvo/2013/12/10/why-are-millions-addicted-to-a-drug-that-eats-the-flesh-off-their-bones/
• https://www.cbsnews.com/news/krokodil-use-reportedly-spreading-what-makes-dangerous-drug-so-addictive/
• https://www.deadiversion.usdoj.gov/drug_chem_info/desomorphine.pdf
• https://novarecoverycenter.com/drugs/krokodil/
• https://www.healthline.com/health/krokodil-desomorphine
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4864092/
• https://www.cdc.gov/drugoverdose/od2a/index.html
• https://www.cdc.gov/drugoverdose/prevention/index.html