Krokodil—Morphine’s Deadly Derivative

Abstract

Graphically publicized in the media, the use of Krokodil, a heroin-like morphine derivative, has grown in Eastern Europe the last decade.  The popularity of the injectable drug has grown in part due to its inexpensive and simple manufacturing process through the use of codeine tablets.  Krokodil has a similar mechanism of action to morphine, although it is said to be as much as 10 times more potent and is notorious for plaguing its victims with rotting, scale-like skin lesions.  The drug was originally synthesized in hopes of creating a safer, less addictive alternative to morphine, however its impure manufacturing process, toxicity and addiction profile led to abuse and infection among its users.  The use of Krokodil is seen most commonly in the Ukraine and Russia, particularly in Siberia, however use has been recorded in Moscow and 27 other Russian cities, Kiev and 24 other Ukrainian cities, Kazakhstan, and other Kazakh regions bordering Russia.  Use has not yet been confirmed in the United States despite several reports due to the difficulty in isolating and discerning various metabolites in test samples.  Various attempts have been made in Eastern Europe in recent years to halt its production by restricting access to codeine, however without concrete legislation and increased public awareness, it is unclear if the growing Krokodil epidemic will be contained.