Billed as a flesh-eating superdrug and gaining the attention of U.S. media and drug officials, "krokodil" is certainly some nasty stuff. But there's no guarantee that it's here.
Reports in recent weeks have obliquely mentioned "cases in Utah," and on Thursday local TV news outlets reported that Murray's Intermountain Medical Center saw two patients who seemed to display the synthetic opiate's trademark side effects. But IMC spokesman Jess Gomez could only say that those cases it is unknown when they occurred "fit some of the clinical criteria." If they were the result of krokodil, they were minor reactions, and there is no sure test.
Even though there's no smoking gun, Salt Lake Drug Enforcement Agency spokeswoman Susan Thomas told The Tribune on Friday that "sometimes you just have to use your common sense."
Krokodil, or desomorphine, is roughly 10 times stronger and three times more toxic than morphine. Not only is it especially potent, but the high is fleeting and users require frequent injections to stay high.
Although it was first synthesized in the United States in the 1930s, it first became widely abused overseas in 2002. The DEA has only forensically identified krokodil twice in the U.S., both times in 2004. In Russian it means "crocodile" named for scaly gangrenous skin caused by damaged blood vessels and tissues at injection sites.
What makes it especially dangerous are the chemicals used to synthesize the compound. Chemicals such as gasoline and hydrochloric acid are used to extract codeine from tablets that contain other active ingredients, such as acetaminophen. Then the resulting isolated codeine is reduced into desomorphine using ingredients such as iodine and red phosphorus. The characteristic skin problems aren't caused by the opiate but by impurities from the chemicals used in synthesis.
"Directly injecting those things into human tissue is going to be catastrophic," Thomas said.
For the DEA, the mission is to identify who is creating the drug. Is it super labs across international borders, or is it "mom and pop" operations here in Salt Lake City?
Synthetic drugs are on the rise in recent years, Thomas said, from MDMA to methamphetamine to Spice and bath salts. Although the key ingredient in krokodil codeine is not as readily available in the United States as it is in other countries, where it can be obtained over the counter, Thomas worries that it is "widely prescribed." The Russian Federation passed a law last year that limited the purchase of codeine drugs.
"My hope is that just the shock factor is going to keep drug users from seeking it," Thomas said. "I don't think it would ever be widely abused because the consequences are too grave."