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Addiction Medicine FYI

"Krokodil"

Desomorphine (Dihydrodesoxymorphine) is an opiate analogue invented in 1932 in the United States that is a derivative of morphine, though more potent. Like the opioid class in general, it has sedative and analgesic effects when used. It was used in Switzerland under the brand name Permonid, where it was found to have a faster onset and shorter duration than morphine, with less nausea and respiratory depression. It appears to be used quite extensively in Russia, especially when heroin becomes scarce or too expensive. (Russia has a significant opiate addiction problem partially due to its close proximity to Afghanistan.

Desomorphine has attracted attention in Russia due to its simple production, utilizing codeine, iodine, gasoline, paint thinner, hydrochloric acid, lighter fluid and red phosphorus. The clandestine manufacturing process is similar to that of methamphetamine. "Homemade" desomorphine made this way is highly impure and contaminated with various toxic and corrosive byproducts. The street name in Russia for home-made Desomorphine made in this way is "krokodil" (crocodile), reportedly due to the scale-like appearance of skin of its users, and it is used as a cheaper alternative to heroin, as codeine tablets are available without a prescription in Russia.

Since the mix is routinely injected immediately with little or no further purification, "Krokodil" has become notorious for producing severe tissue damage including injury to the veins (phlebitis) and gangrene. Other consequences of use have included severe withdrawal, spread of HIV through the use of contaminated needles and death.

Use in Russia is estimated as high as 1 million and use has spread to other European countries including Germany. The Russian government has considered some steps to curb this epidemic, including banning websites that explain how to make the opiate, placing codeine back into the prescription only category and increasing enforcement with escalated confiscation.

The DEA reports that they are looking at the drug overseas but have not as yet seen it in the US.

Medical Consequences

 photo showing a pair of legs tht are badly scarred, ulcerated, and covered with sores  photo of a foot with red raw lesions  photo of a hand with large black lesions

2/2012