Krokodil is an illegal narcotic that became popular as a replacement for heroin. It first appeared in Russia in 2002 and has since become a major problem there. Reports claim it is responsible for half of all drug-related deaths in that country. It is injected into a vein, like heroin, but it’s much more destructive to the person because it causes flesh to rot. Life expectancy of a heroin addict is five to seven years. For Krokodil, it’s two years. The fast-acting tissue damage results in large open wounds and infections that kill the user, if an overdose does not do it first.
The History of Krokodil
In pharmacological terms, the street drug krokodil is known as desomorphine. First synthesized from codeine in 1932, desomorphine was used to sedate patients and treat severe pain. It works quickly, but doesn’t last long, and physicians stopped using it in 1981 for a variety of reasons. These reasons included high toxicity when compared to morphine, a difficult side effect profile that includes depression, and a fast onset of addiction. Desomorphine is not legal in America, and the presence of the street drug krokodil is suspected.
Although desomorphine was in use for decades by the medical community, the street drug krokodil is new to the United States. Krokodil addiction is a huge problem in Russia and Eastern Europe, however. In Russia, where codeine was until recently sold without a prescription, it was easy for krokodil manufacturers to purchase this powerful opiate for use in krokodil. Manufacturers synthesize codeine and combine it with toxic substances such as gasoline, alcohol, paint thinner, iodine and red phosphorus to create krokodil. Users typically inject it, and the presence of these impure substances creates ghastly infections that resemble a flesh-eating virus.
Krokodil became a problem in Russia because of the governmental crackdown on heroin. Heroin is an opiate that produces similar effects to krokodil. Like all opiates, krokodil and heroin come from psychoactive substance made by the opium poppy. Krokodil is the only opium-based drug that contains both an opiate and hazardous toxins.
Why Is It Called Krokodil?
The drug is called krokodil because it causes a person to develop dark green, scaly skin — similar to the skin of a crocodile — over different parts of the body. The dark green color results from gangrene, which is when flesh rots because it does not receive enough blood. The scaly skin is due to crusting and peeling of dead tissue. Another reason why this drug is called krokodil is because it comes from a chemical called alpha-chlorocodide, which is a derivative of the codeine that is used to make krokodil.
How Does Krokodil Work?
Krokodil is an effective analgesic, or painkiller, because it activates the opioid receptors on nerve cells. Opioid receptors are proteins on the surface of nerve cells that reduce the amount of pain we experience. Our body naturally produces chemicals that reduce the amount of pain we feel. Examples are endorphins, which are released when we exercise. Endorphins not only reduce the pain we feel due to rigorous exercise, but they also make us feel better. Like morphine, krokodil binds to nerve cells and makes them less excitable. Sluggish nerve cells don’t send signals as fast as normal nerve cells, so feelings of pain don’t get to the spinal cord and brain as fast or at all.
What Is This Drug Usually Prescribed For?
Desomorphine, the active analgesic ingredient in krokodil, is prescribed as a painkiller that is 10 times stronger than morphine. It was invented in 1932 in the United States an alternative to morphine. Though it acts faster than morphine, its pain-relieving effects do not last as long. Since the pain-relieving effects of desomorphine do not last as long, desomorphine has a higher risk of addiction and thus its use in the United States has waned.
How Common Is Krokodil Addiction?
According to the Russian Federal Drug Control Service, the amount of krokodil confiscated in Russia jumped 23-fold between 2009 and 2011. The New York State Office of Alcoholism and Substance Abuse Services reports that about one million people in Russia use krokodil.
So far, only three accounts of people using krokodil have been documented in the United States, all of which occurred in 2013. The first case was reported by Banner’s Poison Control Center in Phoenix, AZ, which treated two people.
The second case was announced in the American Journal of Medicine, which reported krokodil use in a young man in Missouri. He was hospitalized multiple times in a five-month period due to quickly rotting flesh on his legs that appeared after injections of home-made heroin. He was previously hospitalized because of a finger that just fell off, after a time of injecting krokodil in his arm.
In the third case, two sisters, Amber and Angie Neitzel of Illinois, were hospitalized for tissue damage due to krokodil use. They had no idea they were taking krokodil. Amber reported that her boyfriend also used krokodil and that she had seen maggots crawl out of his rotting leg. Other than these cases, no other accounts of krokodil use in the United States have been reported.
The physicians who treated the krokodil user in Missouri wrote a report in the American Journal of Medicine to warn other physicians to be prepared to recognize and treat the side effects of the drug. 12 Keys Rehab’s experienced medical and psychiatric staff are fully aware of what is needed to help the special case of someone suffering from krokodil addiction. Time is of the essence when it comes to helping someone survive and overcome krokodil addiction, especially since the goal is to minimize permanent physical and cognitive damage.
What Are Signs & Symptoms of Krokodil Addiction?
If someone has started or is thinking of starting krokodil, getting professional help is urgent. Without help, intense withdrawal symptoms that include unpleasant physical issues and long-lasting psychological problems will develop.
Typical Signs of Drug Withdrawal
Some of the typical signs of withdrawal from krokodil include:
- Intense flu-like symptoms that can last for several days, including vomiting, diarrhea, tremors, fever and profuse sweating
- Stomach cramps
- Muscle pain and twitching
- Chills and goosebumps
Signs of addiction that are specific to krokodil are:
- Green, scaly skin
- Patches of rotting skin that peels off
- Open blisters
- Ulcers on the skin
- Multiple areas of skin infection
- Fingers and toes that rot and fall off
- Rotting flesh that falls off the bone
Symptoms of Krokodil Addiction
There are also other symptoms of a krokodil addiction, such as:
- Severe anxiety
- Cravings to use krokodil
What Types of Co-Occurring Disorders Exist With Krokodil?
Since krokodil is an opioid like heroin, but stronger, similar co-occurring disorders will accompany addiction to krokodil as they do heroin. It is likely that four major disorders co-occur with krokodil addiction: depression, post-traumatic stress disorder, attention deficit hyperactivity disorder, and schizophrenia. 12 Keys Rehab has years of experience helping people deal with both their addiction and co-occurring mental health disorders. A successful recovery program requires attentiveness to both issues.
Brain scan studies show that similar things happen in the brain in people with major depression and those with substance abuse addiction. Symptoms include irritability, insomnia, anxiety and difficulty focusing. Research shows that people who have major depression are at high risk for substance abuse, and those who have substance abuse addiction have a high risk of major depression. 32-54% of people with major depression also abuse illicit drugs.
Post-Traumatic Stress Disorder (PTSD)
40-44% of veterans who have PTSD also have a lifetime substance use disorder. Among civilians with PTSD, 22-43% have substance use disorders. The more someone is under the influence of a drug, the more likely they will find themselves in a traumatic situation. Furthermore, since chronic substance abuse and withdrawal states can increase anxiety, users have a higher chance of developing PTSD after a traumatic experience. Substance abuse can make PTSD worse by making it hard for the user to adjust to traumatic memories.
Attention Deficit Hyperactivity Disorder (ADHD)
Children who have both a substance abuse disorder and ADHD are more prone to severe drug abuse. 30-50% of adolescents who have ADHD, conduct disorder or oppositional defiant disorder also have substance abuse disorder. Data suggests that having to cope with high levels of relational stress with parents or within the family is associated with higher chances of having substance abuse disorder. In a measure of electrical activity in the brain called the “P3 amplitude,” 17-year-olds who showed low activity had a higher chance of developing a substance use disorder three years later.
It is believed that the high prevalence of substance abuse in people with schizophrenia is because patients attempt to self-medicate themselves with illicit drugs in hopes of easing the side effects of antipsychotic medications. Up to 50% of people with schizophrenia abuse either alcohol or illicit drugs. Schizophrenia involves the dysfunction of the part of the brain that controls the motivation & reward system. This makes people with schizophrenia more vulnerable to substance abuse addiction.
How Addictive Is Krokodil?
Krokodil is 10 times more powerful than morphine. In a study of cancer patients who received either desomorphine, the active ingredient in krokodil, or morphine, only one-tenth the dose of desomorphine was able to produce the same effect as a full dose of morphine. After just three weeks of desomorphine, though, the patients experienced withdrawal symptoms as soon as four hours after the last dose. Because desomorphine works within one to two minutes after injection, but lasts only one to two hours, the person is left with a craving for another dose every few hours. This can lead to several consecutive days of binging.
How Do People Become Addicted to This Drug?
Since krokodil can be purchased for several dollars, it is only one-tenth the price of heroin on the streets. The high krokodil provides while only costing a fraction of the price makes it a tempting solution to a heroin habit. Some people don’t realize they are buying krokodil when they buy heroin off the streets. Since the potency of krokodil is 10 times that of heroin, users find themselves going back for more of the same product. By the time tissue damage and the resulting pain is obvious, it’s too late — the person is addicted.
Does This Addiction Cause Any Permanent Damage?
Krokodil can quickly cause severe damage that is permanent. The damage happens fast because tissues that receive the toxic injection die and rot. Long-term use of krokodil results in nerve damage and organ damage.
Those who overcome krokodil addiction can have permanent nerve damage. They may have problems with speech, uncontrolled erratic movements and a lack of control of eye movements that results in what is called vacant gazing.
Krokodil is an opioid, like morphine, so high doses over time can alter a person’s pain sensation. Though opioids are effective as painkillers, it is known that sometimes opioids can make pain worse. Researchers are currently working to understand and reverse this effect when it happens. People who use morphine before surgery report more pain after surgery than people who did not use morphine before surgery.
One reason could be because opioids cause nerve cells called microglia to become over-reactive. Microglia are nerve cells that protect other nerve cells called neurons. Neurons are nerve cells that relay signals from your body to your brain. Microglia guard the neurons by fighting off infection. However, opioids can make microglia hyperactive, so they send stronger signals to pain neurons than they should, which causes nerve damage.
External Bodily Damage
The side effects of krokodil’s mixture of toxic chemicals kills human flesh. This can result in fingers and toes auto-amputating, meaning they just fall off after rotting. Large chucks of muscle tissue can rot and literally detach, exposing bare bone. Large amounts of tissue death require amputating arms and legs to prevent infection. Such procedures will permanently limit the mobility and physical activity of the patient. Skin ulcers can develop into eschars, which are deep patches of dead, rough, black skin.
Internal Bodily Damage
The toxic chemicals in krokodil can damage internal organs, such as the liver and kidneys. The liver’s function is to detoxify harmful chemicals in the body. However, when toxins are present in high amounts, the liver is overwhelmed and is itself damaged. The liver can regenerate itself, but the prolonged use of toxic chemicals leads to permanent damage. The kidneys’ function is to filter out toxic chemicals so they are excreted in urine. However, prolonged high amounts of toxic chemicals can damage the filtration units inside of kidneys, preventing them from getting rid of the normal harmful chemicals in the body, not just the toxic ones in krokodil.
How Is Krokodil Addiction Treated?
Because krokodil contains many toxic chemicals that cause immediate damage to large parts of the body, both inside and out, treating krokodil addiction requires intensive medical attention in addition to addiction treatment. Not only does the person need medications to prevent the physiological complications of abusing the drug, but they also need strong antibiotics to fight off infection, along with surgery and routine wound care.
Since the pain of withdrawal is more severe than in the case of heroin addiction, physicians need to give the highest doses of pain medication so users don’t pass out. In some cases, powerful tranquilizers are used to help the user calm down and rest. For instance, a person may receive the sleep drug Propofol so they can sleep through the pain. Treatment using these powerful medications requires the attention of trained health professionals, since some medications are given intravenously. The patient’s vital signs must be monitored during treatment so heart rate and breathing do not slow to dangerous levels.
How Do You Safely Detox From Krokodil?
People who come in for addiction treatment are assessed by physicians and therapists. The clinical staff at 12 Keys Rehab is highly experienced in helping the patient and family figure out the person’s history of drug abuse. It’s important to know what other drugs have been used along with krokodil, so adverse drug reactions are avoided in the treatment plan. Analyzing a urine sample is helpful in determining what chemicals are in a person’s body.
The active ingredient in krokodil is desomorphine, which is an opioid. Opioids help people relax by dulling their senses and slowing their heart rate & breathing. One reason overdose of opioids is lethal is because the person’s heart rate and breathing become too low to sustain consciousness and life. Opioids have this effect because they make nerve cells less excitable and slower, which is how pain sensation is reduced.
However, opioids also block an important enzyme called cholinesterase. This enzyme deactivates a neurotransmitter called acetylcholine. Acetylcholine is a signal that one nerve cell uses to activate another nerve cell, thus passing forward a message of “go.” However, because the desomorphine in krokodil blocks the enzyme that breaks down acetylcholine, a lot of this “go” signal builds up. This can lead to excessive activation of nerve cells out of their turn, which causes organs to malfunction. To give you an idea of how dangerous an overdose of desomorphine can be, consider that the chemical weapon called Sarin gas also attacks cholinesterase, causing convulsions and organ failure.
Safe detoxification from krokodil will require not just preventing the patient from relapsing into using krokodil again, but also managing the sometimes unbearable pain of withdrawal. Additionally, depending on how much krokodil the person had been using prior to receiving treatment, the patient may need to take an opioid antagonist. Opioid antagonists are medications that do the opposite of what opioids do.
Since krokodil suppresses the central and peripheral nervous system by dulling the nerves that control heart rate and breathing rate, opioid antagonists bind to nerve cells and make them more active. One such antagonist is called Naloxone, and it’s given in the case of opioid addiction treatment to prevent the heart and lungs from slowing down too much.
What Are the Stages of Krokodil Withdrawal?
Withdrawal from opiates occurs in three general stages that vary depending on the opiate used: early stage, peak stage and long-term stage. How long does it take to withdraw from this drug? Krokodil is 10 times more powerful than morphine, so the withdrawal symptoms are more severe, and more time is required for the complete withdrawal process. Overcoming the symptoms of heroin withdrawal takes one week, but overcoming krokodil takes up to a month. Here are some details about each of the stages:
- Early Stage. The first stage includes headaches, goose bumps, fevers, chills and irritability. With morphine, this early stage lasts about 12-24 hours, but since krokodil is 10 times more potent, the early stage may end sooner. Studies of the effect of desomorphine on cancer patients showed that middle stage symptoms occurred just several hours after the last dose.
- Peak Stage. During the peak stage, the withdrawal symptoms are the worst. They include nausea, vomiting, major headaches, stomach cramps, intense cravings and an overall feeling of sickness. For morphine, the peak stage lasts for several days. For krokodil, it can last for several weeks.
- Long-Term Stage. The long-term stage can last for months to years. Long-term withdrawal symptoms include insomnia, nervousness, weakness and muscle aches. Due to its length, this is the stage a person needs the social support necessary to keep from relapsing. Early on in this stage, it's important to learn methods of dealing with the desire to relapse and how to establish a social support system to stay on track for the long run.
How Can I Help My Loved One Recover From a Krokodil Addiction?
Krokodil addiction brings with it an additional social shame in that the damaging effects of the drug are externally obvious through patches of rotting flesh. However, many of the staff at 12 Keys Rehab are recovering addicts who understand what it’s like to be unable to make the right life decisions while under the oppression of mental health disorders and chemical addiction.
Everyone is accepted at 12 Keys Rehab. We specialize in providing the personal attention you need to be on the path to recovery. The comfortable facilities and beautiful location will help you relax and feel at home, and our experienced staff will guide you each step of the way during recovery.
If you or a loved one are suffering from krokodil addiction, please contact us today. There is hope.
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