Doubts About Reported Krokodil Cases Within US

Suspected krokodil a false alarm
Negative tests lead to further skepticism
October 27, 2013|By Andy Grimm, Chicago Tribune reporter

The hunt for krokodil continues as tests conducted in recent days on a suspected sample of the so-called flesh-eating drug came back negative, federal officials said.

An announcement two weeks ago by a Joliet doctor who said he treated three patients who showed the telltale rotting flesh associated with the toxic, home-brewed opiate — made from mixing codeine tablets with solvents like gasoline or acids — has sparked media coverage. A week later, a Crystal Lake hospital reported treating a krokodil user, and reports have cropped up across the country.

In a sweep modeled after the agency's successful search for the source of deadly fentanyl-tainted heroin some six years ago, 200 DEA agents across five states have made finding krokodil a top priority, Riley said.

"We have run quite a few buys in the city and suburbs," Riley said "What the lab tells us is it's just heroin."

Some experts in law enforcement and public health say it's unlikely the drug will be widely used beyond the remote areas of Russia and eastern Europe where it became popular a decade ago.

The Tribune contacted health officials in nine states where reports of krokodil have surfaced in the media, but no agency, yet, has found conclusive proof that the drug is in use. The number of unverified cases recorded by poison control centers in states where krokodil has been reported in the media is barely into double digits.

 [...]
 Most of the reported cases of krokodil use have come from people who thought they were buying heroin, public health officials said.

"For krokodil ... people think they are getting heroin, and they say, 'I was using heroin and I got these sores.'"

In the Joliet case at least, suspected krokodil victims reportedly were heroin users who began to develop sores where they injected the drugs.

And even the symptoms associated with krokodil use are not that unique, said Jane Maxwell, a researcher at the University of Texas who has studied drug trends and sits on a National Institute on Drug Abuse panel that has identified new drug variants.

Long-term users of injectable drugs like heroin can develop infections from reusing needles and exposing themselves to all sorts of bacteria, leading to staph infections or those that are resistant to methicillin, known as MRSA infections.

Maxwell said there have been outbreaks of infections among heroin users that point out a peril facing users of illegal drugs that is well known, and less insidious than a new concoction: quality control.

"In California once, there were these outbreaks of sores," she said. "It was because the heroin was coming across the border stuck up the rear ends of cows."

Desomorphine, questionably the main component of Krokodil

     I had my own doubts about the appearance of krokodil within the US. One reason krokodil is a thing in Russia is because codeine is available OTC. Combined with a high rate of opiate use and crushing poverty it's not surprising some people desperate to relieve their pain turn to this toxic, home-baked and short-acting opioid. I doubt there are very many recreational krokodil users, though I may be wrong.
     Codeine is not exactly rare in the US, but given how short-acting desomorphine is (duration around 90 minutes), it just does not seem economical. Most codeine pills are 15, 30 and 60 mg. No synthesis is 100% efficient and there is every reason to believe the amateurish attempts at synthesizing desomorphine from codeine would result in low yields. I personally have not done much in depth research on the specifics of the "krokodil" method, there are some on the opiophile forums that question whether the Russians are truly producing desomorphine. Anyway codeine is sold in Russia OTC and cheap, but that is not the case here in the US.
      So it's possible the recent krokodil-like effects seen in some heroin users may in fact be due to contaminated heroin. We have seen this before, in anthrax outbreaks in UK heroin users (caused by smuggling heroin in the stomachs of animals). You know what might stop people from sticking heroin up the rear end of cows and causing infections in users? Legalization. Drug users have rights, among them the right to the highest possible standard of health. Any regime which violates fundamental human rights is illegitimate and should be discarded. 


A Note about Krokodil Synthesis:

The Russian makers only get a low yield or an impure product BUT codeine phosphate capsules are about $1.50/50x25mg so the start material is cheap. The exact route varies from maker to maker but they all seem to do more or less this:

1-Codeine + SOCl2 ---> α-Chlorocodide + HCl + SO2

2-α-Chlorocodide + I2 ---> 7,8 diiodo α-Chlorocodide

3-7,8 diiodo α-Chlorocodide + HI ----> desomorphine

Basically steps 2 & 3 are done in 1 pot. The iodine adds across the 7,8 double-bond in the same way Br adds across a double bond. The chemist then adds P to make HI which is a reducing agent. It removes the Is. The HI also demethylates the 3-methoxy. Looking at a list of the stuff formed, 6 or 7 impurities are found in varying amounts. Yield of product is about 30% at best. Of course, the stuff is x10 morphine so about 4x heroin (the BNF directs doctors that diamorphine is x2.5 morphine in medical uses).
Now, the product has a bare phenol on it so it cannot be smoked. One can readily esterify this compound (acetyl ester, nicotinic ester and so on) so it's BP becomes sufficiently low.
I will do a full test including pictures if enough people ask me to. It's about £300 of stuff I will use and I have no interest in taking the product... or selling... or giving away.

-Borohydride on the Opiophile Forum

Afterword

    It appears Russia has made codeine prescription-only. Apparently krokodil has become less common, a good thing. For people who used codeine medically, or for junkies trying to take the edge off the withdrawals, life is bound to get more difficult.
     Opiophilia was mentioned in Jacob Sullum's article on krokodil, Another Way Prohibition Makes People's Flesh Rot. I'm a huge fan of Sullum's work, he and Maia Szalavitz are two of the best writers in the mainstream press covering drugs and drug policy.