Desomorphine (dihydrodesoxymorphine or dihydrodesoxymorphine-D), commonly referred to its street name “krokodil”, is a synthetic morphine analogue synthesized in the 1930s in the U.S. It is about ten times more potent than morphine and possesses a fast onset and brief duration of action due to its short half-life. 

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The production of krokodil requires  codeine, iodine, strong alkali (eg, Mr. Muscle) organic solvents (eg, gasoline, paint thinner), HCl acid, and red phosphorus from matches. Due to the little or no further purification, krokodil has been known to cause severe tissue damage when administered intravenously. Long-term abusers may present as greenish and scaly due to damaged blood vessels, thrombosis, and damaged tissue surrounding the injection sites. These injuries can develop into thrombophlebitis and gangrene, and ultimately result in limb amputation or death.  Other consequences include severe withdrawal and spread of HIV through contaminated needles.

Desomorphine was used medically in Switzerland, under the brand name Permonid. Desomorphine abuse first appeared internationally in 2002. Since then, it has become quite extensively used in Russia and Ukraine. According to a study published in the International Journal of Drug Policy, about 100,000 people in Russia and about 20,000 people in Ukraine are estimated to have injected krokodil in 2011.

Five hospitalizations were recently reported in a Chicago suburb, with symptoms similar to cases reported in Utah, Arizona, and Oklahoma.

So far there are no officially confirmed cases of krokodil abuse in the U.S. The DEA released a fact sheet on desomorphine earlier this month. Desomorphine is a as a Schedule I substance and has been controlled in the U.S. since 1936.

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