Krokodil, the Russian flesh-eating drug

Desomorphine was used in Russia and Switzerland to treat strong pain until 1981 under the brand name Permonid but disappeared from use as other drugs delivered fewer side effects and more effective pain relief.

The first use of desomorphine as Krokodil was in Russia in 2003. Krokodil was thought to be popular among people who injected drugs in Russia because codeine was available without a prescription and heroin was scarce.

The name Krokodil is thought to come from a step in the cooking process where codeine turns into a chemical called a-Chlorocodide, and also because it often causes ulcers and scaly skin. In 2012 over-the-counter codeine was banned in Russia and reports of Krokodil use declined. But between 2013 and 2015, media reports of Krokodil use in the United States and the United Kingdom gave the impression its use remained widespread. The skin infections and examples of gangrene said to be related to the drug. Krokodil was referred to as a flesh-eating drug and suggested users became zombies. Desomorphine was largely forgotten for years until situations conspired to bring it back into prominence.

When the Russian government restricted the movement of heroin from Afghanistan into Russia around 2003, there was a sharp increase in the price of heroin on the street. Russian addicts started looking for cheaper substitutes like desomorphine. Krokodil use first became prevalent in Russia, leading to a lethal epidemic there, it has now spread to Colombia, the US, and Europe, and the UK. Poor injecting practices and poisons cause skin and vein problems, including infections, in people injecting any type of drug. But injuries from Krokodil can be more serious. Medical case reports have identified infections and rotting skin down to the bone at injection sites. This can include jaw osteonecrosis (jawbone exposure in the mouth) where ulcers and skin infections have affected a person’s gums.