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In some drug markets where heroin is relatively difficult to obtain, people have turned to alternatives such as krokodil as a heroin substitute. Krokodil is attractive to those seeking a euphoric high because it is cheap, relatively easy to make or obtain, produces a high similar to that of heroin, and delivers potent sedative and pain-relieving effects in the user. Krokodil has a very fast onset of about minutes and lasts for approximately 2 hours. The drug, while cheap, produces a relatively short high, and various media sources have covered stories about addicted individuals who need to frequently administer the drug to maintain their high and avoid withdrawal.

Users are said to be able to make krokodil in roughly 45 minutes with codeine and minimal equipment. Users attempting to create desomorphine often do so by combining several toxic ingredients like hydrochloric acid, household cleaners, and gasoline with codeine.

They may also sometimes add cigarette ash to balance the pH. Skin infections. Soft tissue infections.

Der Heroin Schuster German Edition -

Thrombophlebitis inflammation of the veins. Skin ulceration. Necrosis death of living tissue. When the drug is injected, it can damage veins and lead to localized infections. These infections may ultimately spread to other areas and cause organ damage.

If parts of the body, such as the limbs, are badly infected, doctors may need to amputate or perform surgery on the individual. Because krokodil is a homemade opioid, the conditions in which it is prepared can introduce a number of potential health risks. Users making the drug often share preparation equipment and syringes for injection.

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Because krokodil is a drug administered frequently throughout the day, this can significantly increase the likelihood of unsafe, non-sterile needle use. Even short-term use of krokodil can lead to severe health complications and death. Fatalities for chronic users are common within years of the first dose but even the first use can be fatal in some instances Skowronek, Celi?

Most reports of drug use by the media have shown addicted individuals who have gangrene or eschars dead patches of skin on their body. There have been numerous sensational reports about the appearance of krokodil in the United States based on a small number of suspected cases; however, the National Institute on Drug Abuse NIDA had not confirmed any cases of krokodil use in the country as of Lauren holds a B.

For those seeking addiction treatment for themselves or a loved one, the DrugAbuse. Our helpline is offered at no cost to you and with no obligation to enter into treatment. Neither DrugAbuse. Browse Featured Rehabs. Additionally, the Internet hosts a number of drug discussion fora, wherein users publicly and anonymously exchange knowledge. Several Darknet drug markets have discussion fora as well, where, for example, the quality of the drugs and vendors are rated and discussed. These drug fora offer users practical tools prior to purchase and use of substances and indigenous harm reduction.

Numerous studies have emphasised the importance of harm reduction occurring amongst these online communities [ 92 — 96 ]. Between and , Russian policy makers highlighted the negative effect the Internet had in the dissemination of information related to krokodil production and use. A marked rise in online searches for krokodil preparation and methods to purchase was noted [ 16 ]. However, a major reduction in Internet searches for krokodil related information was noted after the ban on pharmaceutical sales of codeine, June 1, [ 22 ].

These homemade drugs are rife in marginalised strata of society such as amongst people with lower socioeconomic status or homeless individuals, due to their low costs and widespread availability of OTC or diverted pharmaceuticals and easy access to recipes [ 16 , 23 , 97 ]. In Russia, the process for producing krokodil only comprises of a small amount of precursor pharmaceuticals, e.

Although other home-produced substances are not without harms, krokodil seems to be associated with particularly severe complications and ghastly health outcomes [ 10 ]. The severe morbidity associated with injecting krokodil is likely a function of the short half-life of the drug, dictating frequent injection, missing or inapt reactants, and incomplete synthesis, leaving large fractions of reactants and resulting in an extremely corrosive drug cocktail [ 14 , 65 ].

The transmission of BBVs is a major health concern associated with any form of injecting drug use [ 16 , 22 ]. The primary causes of BBV transmission are the collective use of injecting equipment needle sharing and sharing of liquefied drugs [ 98 — ]. It has been documented that there is a high risk of BBV transmission amongst PWID, through the sharing not only of needles but also of other equipment used in the process. These first two countries are reported as the most affected by krokodil use [ 23 ].

Grund et al. Reportedly, limb amputations or jaw removals are often the only lifesaving intervention [ 20 , 57 , ]. Reportedly, people who inject krokodil often present at medical services in the later stages of disease because they fear medical stigma and close ties between medical providers and law enforcement or other systems of social control, such as child protection agencies [ 14 , — ].

Krokodil is not the only homemade substance to have severe physical complications. During the reaction, Manganese Mn is released and toxic levels of remnants remain in the liquid drug. The rapid progression of Manganism amongst boltushka consumers [ , ] points at short term, continuous exposure to perhaps extremely high concentrations of manganese. Although data are missing, we suggests that manganese concentrations in people who inject homemade meth cathinone may exceed levels amongst people affected by industrial pollution and perhaps even those of workers in the battery manufacturing and manganese processing industries, who, reportedly, are most at risk [ ].

This is a serious concern for PWID, treatment providers, healthcare workers, and policy makers alike as the resulting Parkinsonism syndrome is not reversible [ 44 ]. Studies suggest Manganism related to meth cathinone injection amongst immigrants in Western Europe and in Canada [ ].

Individuals have reported experiencing manganese toxicity from using MCAT 4-methylmethcathinone [ ] in online drug community forums [ ]. Countries outside of Eastern Europe should be well-informed about these grave public health concerns. A variety of opioid and stimulant syntheses are described in detail on the Internet, and the precursors and reactants are readily available.

This may lead to such harmful substances emerging in unexpected settings. Indeed, traditional drug diffusion theory [ , ] accounts poorly for the way in which new drug trends spread geographically, from one locality to another, and culturally, between different social groups or communities, and also how information about their risks is being shared. Emerging drug trends no longer necessarily commence in cultural capitals, harbour cities or along physical drug trading routes. Indeed, in the glocalised and Vernetzte twenty first century, iDrugs and new drug trends may emerge in any municipality, large or small, urban, or rural.

Digitalisation of drug markets, immigration, and global travel may also be of significant influence [ 16 ]. Due to the adverse health issues associated with these homemade substances, governmental reaction is necessary so as to increase the regulation of over the counter and prescribed medications, and also to provide coordinated services such as counselling services, medical supports, wound and infection management, testing and support for HIV, outreach, and rehabilitation services for users of the substances [ 16 , 20 , 58 , 65 , — ].

Facts about Krokodil (the “Zombie Drug”)

Development of harm reduction tactics such as hygiene education, needle exchanges, bleach distribution, provision of filters, foil packs to try encourage users to reverse route of administration, provision of safer recipes for home-produced substances, treatment such as opiate substitution and antiretroviral therapy, and prevention programmes are vital [ 16 , 44 , — ].

Continued surveillance and monitoring at harm reduction programmes using internal data systems to monitor new trends is warranted. Home-produced substances that replace illicit ones, such as heroin and amphetamines, are associated with many complex health issues and high levels of morbidity. This scoping review has presented extant literature on the topic and highlights how this issue is a growing and concerning public health imperative warranting drug user and online surveillance, targeted harm reduction and clinical responses.

Stimulant use in Central and Eastern Europe: how recent social history shaped current drug consumption patterns. In: Pates R, Riley D, editors. Interventions for amphetamine misuse. Oxford: Wiley-Blackwell; Grund JPC. In: McElrath K, editor. Westport, CT: Greenwood Press; HIV and drug use in Eurasia.

In: Twigg JL, editor. Volume 2. Orlova AV. Probl Post Communism. J Drug Issues. HIV infection associated with drug injecting in the Newly Independent States, Eastern Europe: the social and economic context of epidemics. Soc Sci Med. Int J Drug Policy. Risk and protective factors in the initiation of injecting drug use: report of a respondent driven sampling study and strategy paper on preventing the initiation of injecting drug use among vulnerable adolescents and young people. Accessed 18 Mar Individual and network interventions with injection drug users in 5 Ukraine cities. Am J Public Health.

Latypov AB. Harm Reduct J. Cone EJ. Ephemeral profiles of prescription drug and formulation tampering: evolving pseudoscience on the Internet. Drug Alcohol Depend. Breaking worse: the emergence of krokodil and excessive injuries among people who inject drugs in Eurasia. The new drug phenomenon. Drug Test Anal.

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Van Hout MC. Kitchen chemistry: a scoping review of the diversionary use of pharmaceuticals for non-medicinal use and home production of drug solutions. World drug report Vienna: United Nations; Subst Use Misuse. J Addict Dis. Am J Med. Internet search and krokodil in the Russian federation: an infoveillance study. J Med Internet Res. The harmful chemistry behind krokodil desomorphine synthesis and mechanisms of toxicity. Forensic Sci Int. Methamphetamine: history, pathophysiology, adverse health effects, current trends, and hazards associated with the clandestine manufacture of methamphetamine.