Krokodil, Desomorphine

  • Background
  1. Morphine analog at 8-10x the potency (similar potency to Dilaudid)
  2. Injectable drug of abuse started in Russia
  3. Often self-produced by the user in small batches within homes (due to instability of the drug)
  4. Desomorphine is synthesized from Codeine with noxious chemicals
    1. Red Phosphorus
    2. Gasoline and other solvents
    3. Iodine
    4. Additional contaminants
  • Adverse effects
  1. Toxicity is associated with solvents, contaminants and variable pH
  2. Local tissue necrosis, infection or gangrene at injection site
  3. Diffuse involvement of the extremities may occur with Thrombophlebitis
  4. Potent Opioid effects
    1. Naloxone (up to 2 mg) may be effective for reversal
  • Labs
  1. Desomorphine level (red top tube)
    1. Send-out to toxicology lab for processing
  • References
  1. Nordt and Swadron in Majoewsky (2012) EM:Rap 12(11): 10
  2. Nordt and Swadron in Majoewsky (2014) EM:Rap 14(3): 10