Desperation Breeds Disaster: The Ugly Truth About Krokodil

It's easy to focus on the sensational aspects of the emerging krokodil "flesh-rotting drug" story, but that ignores the most troubling issues around its origins, its popularity and its continued use.
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It's easy to focus on the sensational aspects of the emerging krokodil "flesh-rotting drug" story, but that ignores the most troubling issues around its origins, its popularity and its continued use. Krokodil is the street term for a home-made injectable opioid called desomorphine, a drug with effects similar to, but not as long lasting, as heroin. Desomorphine was first patented in the U.S. in 1932, but the homemade version has risen in popularity in Russia in recent years. Desperation often breeds tragedy and disaster, and Russia's shoddy methods of treating their sick and addicted created the desperation that led to the disastrous popularity of krokodil.

In Russia, there is no methadone, drug treatment is totally inadequate, the street price of heroin can be very high and drug users are left to struggle with their addictions with no real therapeutic assistance. In that awful climate krokodil emerged and spread. Lacking any real alternatives, drug users attempt to manage their addictions themselves by creating a substitute for heroin. According to the World Health Organization, the Russian Federation has one of the highest rates of opiate use in the world. Millions of drug users throughout Russia urgently need access to evidence-based treatment and medication for their drug use, but are refused it, largely due to stigma and ignorance.

Earlier this year, the Pulitizer Center reported on the dire situation in Russia, describing it as "Death by Indifference." But this is hardly breaking news. We've known about these failures a long time. Back in 2008, the New York Times reported on it, shining an important light on the urgent need for methadone access.

People who use drugs urgently need, at minimum, access to evidence-based treatment and the full range of therapeutic interventions and medications that can help them. We take this for granted in the U.S., because we do a pretty good job at helping people access substance abuse treatment. But when drug users are pushed to the margins of society and denied access to lifesaving interventions, including rehabilitation and treatment services, we see the failures of the drug war in stark relief: underground drug markets explode and flourish; HIV is transmitted via shared syringes; serious medical consequences are exacerbated due to neglect; human beings are pushed in corners, forgotten about and essentially left for dead.

For decades we have engaged in an increasingly futile, increasingly costly war on drugs. Prohibition creates an environment for new drugs to emerge; new methods of making drugs contribute to an ever more clandestine 'make it yourself' drug market (see the rise of 'shake and bake' at-home meth manufacturing in soda bottles).

Very few details about the emergence of krokodil in Arizona are yet available. What we don't know about this story far outweighs what little we do know. We don't yet know anything about the patients treated; other substances they may have been using; the extent of krokodil use in their communities; if their use of krokodil was experimental or daily; if they were using it as a substitute for another opioid; or really anything . Much of the reporting thus far has been little more than a few gory pictures of "flesh rot" and fear mongering about the drug.

The media is highlighting some of the horrific consequences of homemade drug production -- but we can't stop there. Because beyond the eye-popping pictures of necrosis associated with krokodil, there is a question begging to be asked: why aren't we doing more to help these people? Why are we tolerating a world in which people are driven to extreme and serious medical consequences instead of simply having access to the treatments that can save their lives?

Meghan Ralston is the harm reduction manager for the Drug Policy Alliance.

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