Krokodil Tears: Toxic Mix of Codeine, Solvents, Used in Lieu of Heroin
More possible cases of the use of krokodil, the flesh-eating drug
popular in Russia and Eastern Europe as a cheaper alternative to
heroin, have surfaced in the U.S., this time in a Chicago suburb,
health officials said.
Dr. Abhin Singla, director of addiction services at Chicago’s Presence St. Joseph Hospital, last week reported treating five people with signs of addiction to krokodil, an injected drug that provides a heroin-like high but leaves gangrenous wounds and scaly, green flesh.
“It is a horrific way to get sick. The smell of rotten flesh permeates the room,” he said in a news release issued by the hospital. ”Intensive treatment and skin grafts are required, but they often are not enough to save limbs or lives.”
Singla said in a telephone interview Friday that three women in their 20s arrived in the emergency room last weekend with rotting flesh.
He said the patients told him they’d been injecting krokodil, the word for crocodile in Russia, where the drug’s use first became common. He said two more men reported using the drug later in the week. Two of the women left the hospital against medical advice, and one underwent surgery to remove large amounts of gangrenous skin, Singla said.
“It’s pretty frightening,” said Dr. Syed Bokhari, a surgeon who said he treated the woman.
“When she came in, she had the destruction that occurred because of this drug over about 70% of her lower body,” Singla said in an interview with CBS2 in Chicago.
The drug first became popular internationally as a cheap alternative to heroin, accomplishing a similar “high” for about 10% of the price, Singla said. In Russia, up to 1 million people are estimated to use krokodil, according to New York’s Office of Alcoholism and Substance Abuse Services.
Singla worried that the area’s “burgeoning heroin epidemic may have created a tolerance level to the point where users are now looking for cheaper and better highs.”
The emergence of possible krokodil abuse in Illinois follows reports last month of Arizona physicians treating patients who claimed to have used krokodil. For now, the cases in Arizona, Illinois and elsewhere in the U.S. remain unconfirmed.
Photographs of addicts with gruesome wounds from krokodil use are easy to find on the Internet, accompanied by stories about widespread use in Russia and the Ukraine, as well as unconfirmed cases of krokodil use in Arizona, Utah and Nevada.
The recipe for the drug, a homemade form of desomorphine, is gag-inducing: codeine tablets are mixed with solvents like lighter fluid or cleaning products and cooked on a stove top.
The drug reportedly cropped up in Russia and in the Ukraine, where codeine is available over the counter and heroin is difficult to get. But Chicago-area public health officials and experts who deal almost daily with heroin addicts voiced skepticism that krokodil has arrived in the region, or that it is likely to become widespread.
Some addiction experts questioned Singla’s reports. The wounds associated with krokodil use — infected abscesses that have become gangrenous — also are common among users of other injectable drugs, a symptom of using dirty needles and sloppy injection technique, said Dan Bigg, director of the Chicago Recovery Alliance, which serves thousands of drug users at needle exchange clinics.
“In 24 years of almost daily contact with opiate users, I have never seen it, nor have I heard of anyone who has used it,” Bigg said. ”There would be no reason to use it here. Codeine is not readily available. Heroin is easily available, and costs $5 or $10 (per dose). Why would someone want to mix gasoline with their drugs if they didn’t have to?”
Horror stories about krokodil will serve little good, said Kathleen Kane-Willis, director of the Illinois Consortium on Drug Policy, and may harm long-term
efforts to address a burgeoning problem of heroin and
prescription painkiller addiction.
“This might have been people who got a hold of (impure) heroin, or haven’t used clean needles, but those are problems that don’t depend on using krokodil,” she said. ”If you’re out there scaring people about something that isn’t really happening, it’s not useful when you have a real problem that is happening.”
The horrific images of “krok” addicts, their skin peeling like zombies, also makes the addicts seem subhuman, Kane-Willis said.
“It doesn’t help to demonize these people,” she said. “It’s like they’re not people anymore. You’ve turned them into crocodiles, even.”
Dr. Singla, an addiction specialist for 16 years, said krokodil is often cheaper and the high is three times stronger than alternatives. He added that the wounds are markedly different from those that come from infected needles.
“This is going to get worse, much worse,” Singla said.
“In most cases, users die in two years.”
Cook County hospitals have yet to report any cases of krokodil-related illness, or users seeking treatment for krokodil addiction, said Dr. Steven Aks. “We haven’t seen it,” said Aks, an ER doctor and toxicologist at Stroger Hospital. ”I don’t really get why someone would use it here. Heroin isn’t hard to get.”
Frank LoVecchio, co-medical director of Phoenix-based Banner Poison Control and Drug Information Center, which first received reports of krokodil use in Arizona, said confirming the drug’s use requires the original injected substance and not merely positive identifications of codeine or morphine metabolites in a suspected user’s urine.
“The DEA and our legal department have said that to confirm the cases, they would like the original substance,” said LoVecchio, which they have been unable to provide.
“It’s difficult,” LoVecchio said. “You’re asking someone who is a drug user if they still have what they injected and is willing to give it to the authorities to have it checked.”
One of the reasons that federal officials want the original substance tested before confirming the use of krokodil is that the same kind of symptoms could be caused by other forms of drug abuse. For instance, heroin contaminated with acids, gasoline or paint thinners could destroy a user’s flesh and internal organs, LoVecchio said.
Intravenous drug abusers could develop abscesses and lesions from repeated infections by the bacteria Methicillin resistant Staphylococcus aureus, or MRSA. And those who use krokodil would also likely test positive for MRSA infections, LoVecchio said, because the drug abuse compromises the immune system.
Nevertheless, LoVecchio said his “gut feeling” is that some of the reported cases were credible.
* * * * * * * *
Move over, meth.
We viewed over a hundred images of krokodil use and they were all insidiously ugly on a scale we haven’t seen before. We chose not to use them here. They’re that horribly wicked and stomach-churning.
(Sourced from LA Times, ChicagoLand, Chicago CBS2, and Vice.com)
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