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Krokodil: The New Killer


“Krokodil” is a new and terrifying addition to the chronic drug epidemic in the United States. Its effects are sudden, horrific, and deadly. Information from the United States is currently limited because of the drug’s recent appearance in the American drug culture. We intend to bring some clarity to the confusion regarding Krokodil. Misinformation is rampant, with devastating effects among so many who are unaware of the immediate consequences of using this drug. While the international community has some experience with Krokodil, the United States and its drug prevention communities must make itself aware of how to recognize and treat these addictions.

Krokodil was apparently developed initially in Russia near the turn of the 21st century. The name comes from the green and scaly skin that develops on the user’s skin, resembling that of a crocodile. Health officials in Arizona have confirmed multiple cases of the drug’s use within that state. It quickly became known among its users for its flesh-eating property. The drug is a combination of codeine and such substances as rubbing alcohol or turpentine. When cooked together and injected, Krokodil can cause flesh to rot and expose bone and muscle tissue. Its addictive power is similar to that of heroin, but it appears to be much cheaper to produce. This substance is so new within the borders of the United States that the U.S. Drug Enforcement Agency has not yet listed Krokodil among its drugs of abuse. Currently this list includes cocaine, marijuana, heroin, and methamphetamines.

The international history of this drug has shown that it can be found in areas where heroin did not become prevalent. Krokodil is connected with a pattern of increased injectable-drug use that was observed in Russia and surrounding countries over the last 20 years. The refinement and development of Krokodil has been shown to be comparable to the home production increase of methamphetamines. Researchers have shown that the analgesic effect of Krokodil can be upwards of 10 times greater than that of morphine and significantly stronger than that of heroin. Not enough research has been conducted to distinguish the characteristics of different production methods of Krokodil in relation to their potency and outward characteristics of use. The effects of the drug immediately after use are intense but apparently short-lived. This pattern is consistent with its repeated use being due to financial availability. Further, the devastating physical effects are compounded and spread throughout the entire body. Some reports by NGOs have shown that some of these users of Krokodil do not have a history of drug use. Therefore, the prediction of use is currently unclear (Grund et al., 2013).

Although forensic medical reports on the effects of Krokodil are currently limited in medical journals, one case study shows some of the haunting effects of the drug on an individual. A 2013 case study of a 29-year-old has given the medical community an example of the brain damage that can result from the use of Krokodil. In the hours before the subject’s death, a CT scan showed massive brain swelling. While the patient had no prior medical history, his friends and associates believed he was addicted to Krokodil. The autopsy showed what was described as an encapsulated mass lesion in the frontal right lobe. These types of lesions are noted to be somewhat rare in modern forensic science. While no conclusive evidence can currently be shown, the combination of a rarely tested substance and a rare cranial abnormality is cause for concern in the medical community (Hayashi et al., 2013).

New Zealand has had its own battles with Krokodil. Much like the United States, this island nation is struggling to understand how best to combat this homemade drug. As in Russia, the rise of Krokodil was a result of heroin becoming scarce in New Zealand. The rates of codeine abuse are connected with the inevitable move to make the drug injectable. In order to combat the rise of Krokodil within their borders, police and other national authorities focused on making the main ingredient of Krokodil, codeine, scarce as well. Unfortunately, the characteristics of Krokodil capture its victims suddenly and completely. The achieved high is very intense, but short-lived. Often, the codeine is mixed with a variety of chemicals, such as industrial cleaning oil, lighter fluid, or even iodine. When heroin prices skyrocket, those in need of a high then focus on the availability and potency of Krokodil. Further, those in New Zealand have attempted to connect the increase of Krokodil use to the seasonal output of opium and the inconsistency of that drug’s potency (Harris, 2012).

The consequences within the borders of the United States cannot yet be understood. The Drug Enforcement Agency, or DEA, has attempted to track Krokodil’s movement across the globe in order to anticipate, and prevent, its arrival in the United States. Since that goal seems to have failed, Americans must understand the severity of this drug. Doctors are describing it as a drug that eats its user from the inside out. The complications attributed to the drug include gangrene, abscesses, and thrombophlebitis. The results do not seem out of hand, since users often mix codeine with substances as extreme as hydrochloric acid, paint-thinner, red phosphorus, or even gasoline. Luckily, doctors have been briefed on the possibility of this drug entering the United States. The injection sites are often deteriorated to such an extent that bone and tissue are outwardly exposed. Infection is often the leading cause of death among Krokodil users (Gahr et al., 2013).

The introduction of Krokodil into the borders of the United States was something everyone in law enforcement and health care hoped to prevent. Now that cases are confirmed in Arizona, we must go forward with educating members of the healthcare community, and especially drug treatment communities, so that our cities and towns may understand the horrific potential of Krokodil. Have doctors in your area seen cases that might be connected to Krokodil? Our staff can help connect you to the resources you need to combat this new threat today.



Gahr, Maximilian, Roland W. Freudenmann, Christoph Hiemke, Ingo M. Gunst, Bernhard J. Connemann, and Carlos Schönfeldt-Lecuona. "“Krokodil”-revival of an old drug with new problems." Substance Use & Misuse 47, no. 7 (2012): 861-863.


Grund, Jean-Paul C., Alisher Latypov, and Magdalena Harris. "Breaking worse: The emergence of krokodil and excessive injuries among people who inject drugs in Eurasia." International Journal of Drug Policy (2013).

Harris, Magdalena. "The ‘do-it-yourself’New Zealand injecting scene: Implications for harm reduction." International Journal of Drug Policy (2012).

Hayashi, Takahito, Claas Buschmann, Dejana Matejic, Benno Riesselmann, and Michael Tsokos. "Brain abscess complicating drug abuse." Forensic Science, Medicine, and Pathology (2013): 1-4.

Reuters. (2013)

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