Krokodil

Krokodil (Крокодил) (krok, crocodile) is crudely made desomorphine, or an opioid drug used as a cheap and very nasty alternative to heroin. Its effects are similar to heroin, though several times more powerful, significantly shorter-lasting (1-2 hours, as opposed to about 8 with heroin) and, because of the impurities present from the sloppy synthesis, much more damaging.

How it is made
Krokodil is made by reduction of codeine (methylmorphine), which is easily available over-the-counter in Russia. The codeine is reduced using iodine and red phosphorus, with the red phosphorus reducing elemental iodine to hydrogen iodide, which with red phosphorus is an excellent reducing agent. The use of iodine and red phosphorus to reduce the codeine is also used to make methamphetamine from pseudoephedrine, which is known as a "red, white, and blue" cook.

This method of reducing codeine creates all kinds of nasty shit that isn't desomorphine. A cleaner, and traditional synthesis, is the chlorination of codeine with thionyl chloride followed by catalytic reduction and demethylation.

Krokodil ≠ desomorphine
Because of the crappy synthesis, the larger part of Krokodil is mainly toxic by-products, phosphorus, pill binders, unreacted codeine, methyldesorphine, some codeine analogues and a small amount of actual desomorphine. Pure desomorphine is about eight times as potent as morphine and about three times as potent as heroin. The large amount of problems such as gangrene seen with Krokodil use is the result of many junkies lacking the skill and inclination to purify and refine a drug and hence shooting up all the leftovers from their "cook". Unfortunately, popular harm-reduction sites make a 1:1 comparison to Desomorphine and Krokodil with uncertain consequences.

The phosphorus is of particular concern since phosphorus is known to cause necrotic diseases such as Phossy Jaw, which is a necrosis of the jaw. Although Phossy Jaw is usually seen with white phosphorus, it can be safely assumed that intravenous phosphorus is not exactly a healthy idea, and a number of Krokodil users end up needing surgery to remove large chunks of rotting bone from their jaws.

Deleterious effects of Krokodil
Used intravenously, Krokodil has a deleterious effect on soft tissues like skin, causing open sores and gangrene. The drug's name is believed to have come from the scaly crocodile-like appearance of skin around the injection site. Another theory is that the name comes from a twist from &alpha;-chlorocodide, an intermediary product. With prolonged use and no medical attention, limbs frequently rot and have to be amputated. The strong analgesic effect of Krokodil keeps addicts from noticing this while high. Users of Krokodil are highly likely to die as the result of their use, often within a year of starting (a few have made it as long as five, although this is very rare), and the few addicts who make it into rehab face around a month of severe withdrawal symptoms; the pain is so horrific that people frequently need to be put in an induced coma. While typical opioid withdrawal does not cause brain damage, the impurities in Krokodil and the typical polydrug patterns of Krokodil users makes it possible that brain damage will occur from Krokodil withdrawal.

Krokodil usage
Estimates of Krokodil usage vary widely, but it is perceived as a growing epidemic within Russia. It started in Siberian cities during the early 2000s, where heroin was and remains very difficult to get, and shortly thereafter spread throughout the country. The government has been slow to respond to the problem, and to calls for greater rehab provision and restrictions on the sale of codeine. Critics suggest that the stalling could be due to lobbying by pharmaceutical corporations who profit from the prescription-free sale of opiates.

Krokodil has since spread to former Soviet Socialist Republics, where heroin is similarly very expensive, then to Germany, Poland, and other European countries with Russian populations. Claims have been made of its arrival in the United States, but the closest thing to substantiation of these as of February 2014 is one alleged appearance in Mexico which confuses necropsy (examining dead stuff, equivalent to autopsy) and necrosis, unprogrammed cell death which is known from Russian reports to be associated with krokodil. The question of what market there would be in the United States for krokodil when Mexican black-tar heroin is already widely available (and when it's only even used in Russia because of the over-the-counter availability of codeine tablets, which is not the case in the United States) is an open one. As of January 2014 the Drug Enforcement Agency stated it had no knowledge of any forensic lab in the United States actually identifying krokodil. Claims to date of krokodil being identified in the United States have been disclaimed or debunked.