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What is the Krokodil Drug?

by Landmark Recovery

December 11, 2018
A crocodile sticking its head out of the water. The Krokodil drug name comes from this creature

Since the early 2000’s, opioids, specifically synthetic opioids, have had detrimental effects in the United States. There are a number of specific opioids that have been especially harmful to the country, such as codeine, oxycodone, and fentanyl. Fentanyl in particular has come into prominence over the past few years and today is present in about 30,000 of the 72,000 annual drug deaths in the country.

As synthetic opioids such as fentanyl continue to leave their mark on the U.S., other deadly opioids are wreaking havoc across the pond. One drug in particular has had a major impact on countries like Russia, Serbia, and other European countries like Germany. The drug, known by its street name krokodil, is an opioid derivative of codeine and, like other opioids, it is highly addictive.

The drug causes a number of horrible effects including major skin problems including festering skin and blood poisoning. These effects can eventually progress and many cases lead to amputations and even death. While there have been reported cases of krokodil in the United States, many believe that it is unlikely to become a prominent drug due to the number of cheap alternatives available in the country.


Brief History of the Krokodil Drug

Desomorphine, known more commonly by the street name krokodil, is a synthetic opiate analogue that was invented in 1932. It is a derivative of morphine but is considered to be five or 10 times more potent. Like many other opioids, krokodil has sedative and analgesic effects when it is used.

Despite being first synthesized in the United States, there is no accepted medical use for desomorphine in the country and it has been a controlled substance since 1936. However, it has been used medically in Switzerland under the brand name Permonid. It was found to have a faster onset and shorter duration than morphine, with less nausea and respiratory depression.

There have been pharmacology studies on laboratory animals with desomorphine. During these studies it was found that in comparison to morphine, desomorphine is at least 15 times more effective as a general depressant, more than 10 times as effective as an analgesic, and three times more toxic. It also showed that the drug can produce a high degree of addiction liability.

Desomorphine abuse first started showing up in 2002 in Russia and Siberia. It started gaining steam as an illicit drug in Russia, especially when heroin became too scarce or expensive.

It first gained attention in Russia due to its simple illicit production, utilizing cheap and easy-to-obtain items like paint thinner, gasoline, lighter fluid, and more. The drug is a derivative of codeine, which at one point was available without a prescription in Russia. However, the laws have since changed after Krokodil started gaining popularity.

At one point, use in Russia was estimated as high as one million, however more recent estimates put that number closer to 100,000. The drug also spread through many European countries including Ukraine and Germany.

While Krokodil has been able to survive and thrive in Eastern Europe and Russia, some believe that it is unlikely that the drug will have the same impact on the United States.

One article notes that the drug only became prevalent in Russia due to the fact that heroin was expensive and hard to find in the country, meanwhile in the United States heroin is more easily available and is a relatively cheap drug.

Krokodil made its first appearance in the United States in 2013 when it was first reported in Arizona. Since then, there have only been minor incidents with the drug, meanwhile heroin has seen much higher usage rates in the country.

While it is unlikely that krokodil will become a major problem in the United States, being aware of what the drug does to its users can still be beneficial when learning about opioids.


Effects of Krokodil

Krokodil is inexpensive and is a highly addictive substitute for heroin. Krokodil is produced by synthesizing desomorphine from codeine and combining it with other low-cost additives.

The other additives, like the ones mentioned before paint thinner, gasoline and others, are believed to contribute to the drug’s severe systemic effects. The toxic byproducts of the additives associated with the production of the drug have also been linked to neurologic, liver, and kidney impairments.

Krokodil gets its name because of the deteriorative effects it has on the body. When the drug is injected, the mixture destroys the user’s skin tissue, causing the skin to become green and scaly similar to a crocodile. Krokodil is the Russian word for crocodile. Festering sores and blood poisoning are also common among users.

These skin problems can eventually progress to severe muscle and cartilaginous tissue damage. The tissue injuries tend to manifest shortly after the injection of the drug. Gangrene and amputations are common among krokodil users and the toxic mix can even dissolve jawbones and teeth.

Because of the highly visible effects that the drug has on its users, addicts may delay seeking needed medical treatment due to the fear of legal percussions. Similarly, the withdrawal effects that occur from the drug may also delay seeking medical attention.

Due to the high potency and short duration effect, it can lead to binge patterns that can last for days. Users are at increased risk for sleep deprivation, memory loss, and speech impediments. Also, differences in homemade recipes can lead to users being at increased risk of overdose.

Other major health hazards that occur from krokodil injection include:

  • Blood vessel damage
  • Pneumonia
  • Meningitis
  • Rotting gums or tooth loss
  • Speech and motor skills impairment
  • Liver kidney damage
  • Powerful respiratory depressant effect

And, obviously, death can occur from using Krokodil. According to USA Today, the average life expectancy among krokodil addicts in Russia is two to three years.


Case Studies

One case study published in Journal of the American Academy of Dermatology followed a 23-year-old women with a history of intravenous drug abuse. After the woman began using krokodil, she developed skin ulcers on her hands and forearms that were present for approximately 12 months. The ulcers eventually lead to necrosis in the skin.

Similarly, a photographer from Russia documented the manufacture and use of krokodil among ten addicts. A follow up with some of the users found that only three of the previous subjects were still alive and one had to receive amputations on her leg and was bedridden.



Other Deadly Opioids

Krokodil uses the opioid codeine along with a number of other ingredients to give users the euphoric feeling. Obviously, there are a number of other deadly side effects that occur from using krokodil.

These effects are similar to other opioids that have become popular over the past decade in the United States.

According to recent data from the Center for Disease Control, opioids, and synthetic opioids in particular, have been been contributing to drug deaths at an alarming rate. The number has been climbing since 1999 but saw huge spikes from 2013 and on.

From 1999 to 2017, drug overdose death rates involving synthetic opioids such as fentanyl increased from 0.3 deaths per 100,000 people to 9.0 per 100,000.

“The rate increased on average by 8% per year from 1999 through 2013 and by 71% per year from 2013 through 2017,” the report said.



As mentioned earlier in the article, krokodil is a derivative of codeine but uses other additives as well. Codeine is a medication that is used to relieve mild to moderate pain and has commonly been used in many cough and cold medications.

Codeine use can lead to withdrawal symptoms, including:

  • Irritability
  • Fast breathing and heartbeat
  • Vomiting
  • Stomach cramps

It is possible to overdose and excessive codeine use can also lead to coma, seizures, and death.



Over the past few years, fentanyl has become one of the most deadly and well-known synthetic opioids on the market. It is 50 to 100 times more powerful than morphine and has lead to tens of thousands of deaths over the past decade.

Fentanyl was first developed in 1959 and is legally manufactured and distributed in the United States as a pain medication. When fentanyl first started being abused in the early 2000’s, it was leading to just over 1000 fatal overdoses annually, however those number have shot up in recent years to about 30,000.

Some of the effects that occur from fentanyl include:

  • Nausea
  • Fainting
  • Seizures
  • Slowed respiration and reduced blood pressure
  • Death



Morphine is a non-synthetic opioid with high potential for abuse. The drug is derived from opium and is used to treat pain, generally in a medical care setting. Morphine is used almost exclusively by injection and offers patients a sense of euphoria and pain relief. However, due to these effects, morphine has become a drug that is being abused more commonly.

Some side effects of morphine include:

  • Low blood pressure
  • Sleepiness
  • Slowed pulse rate and breathing
  • Coma
  • Possible death



Oxycodone, generally marketed as OxyContin, is a semi-synthetic narcotic that has become more popular among drug abusers with the rise of prescription painkillers. Oxycodone tablets are sold by 10, 20, 40, and 80 mg and are either extended release or immediate release. It can be abused orally or intravenously if the tablets are crushed, dissolved in water, and injected

Some effects of oxycodone include:

  • Respiratory depression
  • Extreme drowsiness
  • Muscle weakness
  • Slow heart rate
  • Come
  • Possible death



Methadone is used to relieve severe pain in people who cannot be treated with other medications. It is also used to prevent withdrawal symptoms from patients who were addicted to opiate drugs. Some treatment programs use methadone in order to stop taking or continue not taking drugs.

While it is used to help wean addicts off of drugs, it can still be abused and patients can even overdose on the drug. Methadone deaths peaked in the mid 2000’s but are still deadly. In 2017, methadone lead to almost 3,200 deaths in the United States.

Some effects that occur from Methadone include:

  • Stomach pain
  • Headaches
  • Seizures
  • Nausea
  • Vomiting
  • Difficulty breathing
  • Death



Many people may not think of heroin as an opioid as opioids are more commonly prescription medications or drugs that are administered by health care professionals. However, heroin is considered an opioid, a powerful one at that. More recently, it has seen a resurgence in the United States and usage and deaths due to heroin have risen over the past decade.

From 2010 to 2016, heroin-related overdose deaths increased five-fold and in 2016 almost 15,500 people died from drug overdoses involving heroin.

Heroin is highly addictive and with regular use, tolerance beings to develop which, in turn, leads to higher doses and can lead to overdoses.

Some effects of heroin include:

  • Drowsiness
  • Respiratory depression
  • Nausea
  • Convulsions
  • Coma
  • Death

Along with these opioids, there are synthetic opioids that are constantly being reviewed and sometimes approved by the Food and Drug Administration. In fact, in early November the FDA approved a powerful new painkiller called Dsuvia. The drug is 10 times more powerful than fentanyl. It is a highly potent opioid that is administered intravenously and is known to be lethal even in small doses.


In Conclusion

Opioids have had a disastrous effects in the United States as fentanyl, heroin and others have contributed to the 72,000 annual drug deaths we see in the country. While there are a number of opioids that are harming our citizens, some opioids that the country hasn’t been exposed to are ravaging other countries. Krokodil is one of these types of opioids that has affected millions of Russian citizens. Even though the U.S. hasn’t been impacted too harshly from this drug, understanding it can still be beneficial when learning about opioid abuse. If you believe that you or a loved one is suffering from some type of opioid abuse problem, Landmark Recovery is here to help. Reach out to our admissions staff to learn more about treatment options.

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About the Author

Landmark Recovery

Landmark Recovery

Landmark Recovery was founded with a determination to make addiction treatment accessible for all. Through our integrated treatment programs, we've helped thousands of people choose recovery over addiction and get back to life on their own terms. We're on a mission to save one million lives over the next century. We encourage all those struggling with substance use to seek professional help.