Symptoms, Timeline, and Effects
Krokodil is the street name for desomorphine, a synthetic opioid that is about ten times more potent than morphine.1 Krokodil is a common name for this drug due to its toxic effects on the body, which can cause skin to turn green and scaly from chronic injection use.1,2
Desomorphine was synthesized in the early 1930s and was used in Switzerland for pain relief until 1952, when it became banned due to its high risk of addiction and respiratory depression.2 Krokodil belongs to the opioid class of drugs, and it is a DEA Schedule I drug, meaning that there is no accepted medical use and that it has a high risk of addiction or dependence.1,3,4 The opioid is often injected and is commonly abused as a cheap alternative to heroin, producing euphoria, sedation, and pain relief.1,2,4
Krokodil has been referred to as a “zombie drug” for several reasons.5 The most obvious reason is the skin lesions that appear from chronic use of krokodil, which can create massive damage to skin, muscles, and even bone, leading to gangrene or amputations.1,5 The other reason is that krokodil’s effects are relatively short-lived compared with some other commonly abused opioids.2,5 This means that krokodil users spend the majority of their time getting, making, and using it, creating the illusion of a zombie focused only on the drug.4,5 The internet has many videos available that depict the risks and distressing effects of krokodil, many of which are extremely graphic.
Effects of Krokodil Abuse
There are many harmful and potentially dangerous effects associated with the abuse of krokodil and other synthetic opioids, such as fentanyl. These short-term effects can include:2,4,6,7
- Constricted (or pinpoint) pupils.
- Depressed mood.
- Difficulty with memory and the ability to focus.
- Feelings of euphoria, followed by apathy.
- Flushed skin.
- Nausea and vomiting.
- Pain relief.
- Slowed breathing.
- Slurred speech.
Chronic use of synthetic opioids like krokodil can have severe and even life-threatening consequences in the long run. These can include:1-4,6,7
- Tolerance: This occurs when the body and brain become used to the presence of a drug, and larger amounts or more frequent use is required to achieve the desired results.
- Dependence: When someone has developed a dependence on a drug, they will experience withdrawal symptoms when they attempt to quit. Krokodil carries a risk of dependence that is higher than that of morphine.4
- Addiction: This is a chronic condition characterized by uncontrollable use. Also known as an opioid use disorder, addiction to krokodil or other opioids is a pattern of physical, mental, emotional, and social symptoms. As a potent, short-acting opioid, desomorphine lends itself to chronic, oft-repeated use, making the drug exquisitely addictive.
- Damage to skin, blood vessels, and soft tissue: Krokodil can create major issues with skin and soft tissue, causing severe ulcerations that can leave muscle and bone exposed. These lesions may become gangrenous, leading to the amputation of limbs, or even death. Abscesses, destruction of the jaw bone, rotting gums and ears, pale skin, and pain arealso reported to occur with chronic use of krokodil.
- Neurological effects: These can include difficulty speaking, concentrating, and remembering, along with impaired motorskills. Personality changes and hallucinations have also been observed due to krokodil use.
- Damage to major organs: Chronic krokodil use can harm the liver, kidneys, thyroid gland, heart, lungs, and brain, and these injuries can eventually cause death.
- Increased risk of communicable diseases: HIV and hepatitis C are spread through shared needles and are commonly found in krokodil users. Chronic intravenous use can also increase the likelihood of contracting tuberculosis.
- Death: Krokodil can kill users in various ways, including through seizures, respiratory depression, overdose, and complications from the physical damage due to use. The harmful effects shorten the lifespan of krokodil users immensely, with many users living only 1–2 years after krokodil use begins.4
Withdrawal Symptoms and Timeline
Krokodil use quickly leads to the development of physical dependence, similar to that of other opioids.7 This means that when krokodil use is stopped suddenly, or is cut down significantly, withdrawal symptoms emerge.7 This occurs as the body becomes accustomed to the constant presence of the drug and functions sub-optimally without krokodil or other opioids.8
Common symptoms of opioid withdrawal include:7,9
- Increased response to pain.
- Aching muscles or bone pain, especially in the back and legs.
- Alternating bouts of chills and sweating.
- Feeling restless, agitated, or irritable.
- Depressed mood.
- Difficulty sleeping.
- Excessive yawning.
- Dilated pupils.
- Runny nose.
- Excessive tearing of the eyes.
- Stomach cramps.
Opioid withdrawal has been well studied and follows a predictable timeline of symptoms.7,10 When abruptly stopping a relatively short-acting opioid, such as krokodil or heroin, withdrawal symptoms may begin within 6–12 hours.7 Symptoms typically continue to worsen until they peak about 1–3 days from last use, until they slowly resolve between 5–7 days.7
In general, detoxing from synthetic opioids is very uncomfortable and distressing, but is not usually life-threatening.9,10 However, it can be dangerous to detox on your own for several reasons. Some of the risks and complications of detoxing from krokodil or other synthetic opioids include:1-4,7,9,10
- Aspiration: This occurs when you vomit and gastric contents are inhaled into your lungs. Aspiration can lead to serious inflammation or infection in the lungs, or even death if it occurs while sleeping.
- Dehydration: The vomiting and diarrhea associated with opioid withdrawal can lead to rapid dehydration if not monitored appropriately. Fluid-depleted individuals may also experience disturbances in their electrolyte levels, which can lead to further physical complications.
- Relapse: Post-withdrawal relapse presents one of the more significant risks associated with opioid detox. After detoxing from opioids, tolerance is dramatically lowered, and overdose can more easily occur should someone attempt to use the same amount of drug they were accustomed to using before detoxing. The likelihood of a relapse occurring in the first place is also high during the detox/withdrawal period. Many find it difficult to get through the painful and sometimes prolonged withdrawal process and, without the proper care and supervision, may be more prone to relapse to alleviate withdrawal symptoms.
- Medical complications: Krokodil is especially likely to cause physical harm to the body due to various impurities during the production process, harmful chemicals used during synthesis, and the fact that it is frequently injected. If you or a loved one is trying to detox from krokodil or other synthetic opioids, it is especially important to seek formal medical treatment, since abscesses, infection, gangrene, and organ damage can cause additional health issues and lead to death if not treated. Any underlying medical conditions can worsen during detox and need to be monitored by medical professionals.10
Krokodil Detox Options
Professional detox occurs in various types of facilities, including hospitals, inpatient or outpatient facilities, or even your doctor’s office, and it is tailored to meet your needs.9,10 Detox involves treating the physical and psychological symptoms of withdrawal, providing education about addiction and recovery, and preparing patients to commit to further treatment.10
Detox services are not a substitute for addiction treatment but are a good start to recovery.10 The level of services needed are based on the severity and length of the addiction, if more than one type of substance is used, what outside supports are available, and if there are any co-occurring medical or mental health issues.10 Commonly utilized detox settings include:10
- Hospital: This setting is generally reserved for those who have experienced a medical emergency due to krokodil use, or if there are serious medical or psychiatric issues involved. Hospital-level care may be needed for those with long-term krokodil use as it provides adequate treatment interventions for severe health issues, such as infection or gangrene, along with the management of symptoms of withdrawal. Doctors and nurses are available for assessment, monitoring, and treatment around the clock, and hospitals are the setting best equipped to provide immediate care for complications and prevent negative outcomes.
- Inpatient: Inpatient or residential detox centers employ medical and counseling staff to monitor and care for patients around the clock. Doctors may not be on-site, but can be reached by phone at any time. Throughout the detoxification process, staff ensure that medications are available to ease withdrawal symptoms, while they also treat any other medical or mental health conditions or complications associated with detox.
- Outpatient: Patients following an outpatient detox protocol are required to attend regular detox sessions and see a medical doctor and trained nursing staff for ongoing monitoring throughout detox. Outpatient settings provide high-quality treatment with less of a time commitment than inpatient settings, while still providing regular monitoring of progress and administration of medications to ease the symptoms of withdrawal. This setting is ideal for people with a lot of support within the community and/or at home who cannot afford to neglect their obligations, such as at work, school, or home. Candidates for outpatient opioid detox, in general, have relatively less severe addictions and no significant co-occurring mental health issues.
- Doctor’s office: A physician trained in addiction medicine can prescribe medications and frequent monitoring to help a patient get through a detox period. As with other outpatient efforts, this type of detox treatment may be a good fit for someone with relatively mild addiction issues who has a very strong support system at home or in the community.
- Drug Enforcement Administration. (2013). Desomorphine.
- Alves, E.A., Grund, J.P.C., Afonso, C.M., Netto, A.D.P., Carvalho, F., & Dinis-Oliveira, R.J. (2015). The Harmful Chemistry Behind Krokodil (Desomorphine) Synthesis and Mechanisms of Toxicity. Forensic Science international, 249, 207–213.
- Drugs. (2020). Krokodil.
- Katselou, M., Papoutsis, I., Nikolaou, P., Spiliopoulou, C., * Athanaselis, S. (2014). A “Krokodil” Emerges From the Murky Waters of Addiction: Abuse Trends of an Old Drug. Life Sciences, 102(2014), 81–87.
- Jen, C. (2013). Flesh-Eating ‘Zombie’ Drug ‘Kills You From the Inside Out.’
- National Institute on Drug Abuse. (2017). Research on the Use and Misuse of Fentanyl and Other Synthetic Opioids.
- American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th). Arlington, VA: American Psychiatric Publishing.
- National Institute on Drug Abuse. (2007). The Neurobiology of Drug Addiction.
- U.S. National Library of Medicine. (2016). Opiate and Opioid Withdrawal.
- Center for Substance Abuse Treatment. (2006). Detoxification and Substance Abuse Treatment. Treatment Improvement Protocol (TIP) Series, No. 45, HHS Publication No. (SMA) 15–4131, Rockville, MD.