From Our 2013 Archives
'Krokodil' Drug FAQ
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Deadly Drug May Have Entered the U.S.
By Kathleen Doheny
Reviewed by Arefa Cassoobhoy, MD, MPH
Sept. 30, 2013 -- A deadly, homemade drug known as krokodil may have made its way from Russia to the U.S.
Two people in Arizona are suspected of using the heroin-like drug, which rots the skin from the inside out, says Frank LoVecchio, DO, MPH. He is the co-medical director at the Banner Good Samaritan Poison & Drug Information Center in Phoenix, Ariz.
In the last week, he and his team have consulted with doctors about the patients, but he can't confirm the injections were krokodil because the drugs have not been tested.
LoVecchio says at least two other U.S. cities have unconfirmed reports of krokodil use. It's named for the crocodile-like look it gives users' rotting skin.
So far, there are no confirmed U.S. cases, says Barbara Carreno, a spokeswoman for the Drug Enforcement Administration. "We've been following this drug overseas for several years," she says. "We are very concerned about the possibility of this drug coming to the U.S."
Here, the two address other questions about the drug.
What is krokodil?
Krokodil is a homemade drug. It combines codeine, lighter fluids, gasoline, paint thinner, alcohol, and other ingredients, Carreno and LoVecchio say.
When and where did it become popular?
Krokodil was first used in Russia in 2003, according to the Journal of Addictive Diseases.
LoVecchio suspects krokodil took off in Russia because it was difficult to smuggle in heroin. Its use spread quickly across the country.
How is it used?
Users inject the drug because it delivers a faster high than in tablet form, LoVecchio says. "If the onset [of effects] was an hour or 2 for pill form, it could be within 5 to 10 minutes if you shoot it IV."
What are the effects and side effects?
The drug may be 10 times cheaper than heroin, LoVecchio says. For less money, it is said to give a heroin-like effect of euphoria -- but at a price.
It eats the user from the inside out, he says, rotting the flesh and leaving bone and muscle tissue exposed. The skin takes on a scaly, green appearance, earning its name of krokodil, Russian for "crocodile."
"A common reason for death is the loss of skin," LoVecchio says. He says that users can die of infection and gangrene. The drug also destroys the blood vessels it's injected into, causing blockages.
Regular users in Russia often die within 2 years of starting krokodil, he says.
How did it get to the U.S.?
LoVecchio says drug users here may have heard of it and looked for information on web sites. "Another explanation would be that addiction, whether opiates or alcohol, is a very terrible disease. People get desperate. Taking a pill wouldn't be enough. They might look for ways to make them higher."
How are side effects treated?
Medications to reverse effects are one way, LoVecchio says. Wound care, skin grafts, and surgery may be needed if the user survives the injections.
SOURCES: Frank LoVecchio, DO, MPH, co-medical director, Banner-Good Samaritan Poison & Drug Information Center, Phoenix. Barbara Carreno, spokeswoman, Drug Enforcement Administration. Journal of Addictive Diseases, October 2012.