“How did it get so late so soon? It's night before it's afternoon.” - Dr. Seuss
by Gina Luna
- The Capitol Hill Times -
Russia is the world’s leading consumer of heroine, and balances on the line of epidemic regarding its population’s drug use. Krokodil, a homemade knockoff of heroin that is known for rotting its users from the inside out is growing in popularity, and is showing up in other parts of the world. Weeks ago, krokodil surfaced in the United States.
Krokodil – named for its codeine base, plus the green-black color and scaly texture that it leaves users’ skin – first surfaced in Russia and Siberia 10 years ago. The homemade desomorphine answered to a market of low-income heroine addicts in a time of strict prohibition. By securing codeine (sold over-the-counter in Russia), then cooking it with iodine and organic solvents like paint thinner or gasoline, a liquid drug is produced, but with many accompanying health risks and the likelihood of death. Someone using krokodil rarely survives two years.
With a high similar to that of heroin, korkodil is felt quickly, within seconds of injecting. Unlike the pure version, however, which produces a trip that is felt up to eight hours, the sensation of krokodil fades in about 60 minutes, encouraging users to inject often. Regular injection of this combination of poisons cause localized injury as well as other damages throughout the body. While serious venous damage as well as skin and soft tissue infections are common among users who inject homemade drugs, necrosis and gangrene are specific to krokodil users. Skin breaks down quickly and is then open to infection, beginning rapid decay. Add with that the possibility of tooth loss, speech impediments, plus neurological, endocrine and organ.
Dr. Frank Lovecchio, Co-Medical Director at Banner Health in Arizona, told The Capitol Hill Times that a krokodil user’s cause of death is usually overwhelming infection, after the skin breaks down, first from the chemicals, than bacteria. Among krokodil users who don’t die from it, most are left mutilated after needed skin grafts or amputation.
Today, the street drug is most prevalent in Russia and Ukraine, but as information spreads, krokodil is moving across the globe, and has been seen in Poland, Germany, Norway and, most recently, the United States. Dr. Lovecchi, based in Arizona, is one of the first medical professionals in the States to treat self-proclaimed users of krokodil, but he’s not alone; cases are also being reported in Utah, Tennessee, Massachusetts, Washington D.C., Mississippi and Oklahoma, where deaths have already been recorded.
In these instances, patients that have been seen and treated disclosed that they were using krokodil (most finding the recipe online), but until the United States Drug Enforcement Administration (DEA) is able to analyze and verify an exact compound, these cases are limited to being called “unconfirmed.” Verifying a drug of this variety, though, isn’t easy.
“The burden of proof is difficult for us, and for a number of reasons,” Dr. Lovecchio said. “Codeine goes in and out of your system; it’s gone within a day. Not all labs can check for it. Also, many drug users don’t have a batch of drugs that are leftover; many don’t share it, or at least not with their health care providers.”
In Seattle, so far, no cases have been reported. Dr. Robin Smith of the Washington State Recovery Hotline’s crisis clinic thinks that krokodil won’t surface in Seattle until sometime next year.
“If it’s going to hit here, I just wouldn’t expect it until sometime next year. That could be early or middle, I don’t know, but I don’t expect to see it pop up before Christmas. It takes a while for whatever is trending in the East Coast and Midwest to migrate this way,” Dr. Smith said.
The hope is that krokodil won’t hit Seattle at all. The city, state and county, however, should prepare if future cases arise, as well as make a preemptive plan to discourage potential users.
With codeine requiring a prescription in the United States, krokodil is already an inch more difficult to replicate. It’s always a good idea to throw out the expired drugs in your medicine cabinet and know what your teenagers are up to, but locking away all drugs might not be the answer. Krokodil, in fact, was created because clean drugs were hard to acquire in Russia, and so users looked to what was available, inventing an unsafe, dangerous alternative.
Even without codeine easily available in the States, Dr. Smith warns that recipes for methamphetamine change constantly, depending on how accessible ingredients are, and this wouldn’t be so different.
But what about people who are already using and addicted? Having accessible, affordable, non-judgmental and quality care available to users with encourage them to seek early treatment, potentially saving limbs and lives. The International Journal of Drug Policy’s article “Breaking Worse: The emergence of krokodil and excessive injuries among people who inject drugs in Eurasia” says of users, “in their personal ‘hierarchy of risk,’ seeking help for significant health problems is subordinate by the need to stay under the radar of the authorities.” Equally important is outreach and outpatient counseling and programs.
Without favoring all drugs, it’s difficult to imagine that an epidemic like krokodil could arise in a country like the Netherlands, where many drugs are legal. When clean, pure versions are accessible at an affordable price, there is no need to tamper with dangerous homemade adaptations.
As Washington State and Colorado blaze a trail in the United States for legalizing marijuana, are there other recreational drugs that government should consider decriminalizing?