RT Book, Section A1 Williams, Saralyn R. A1 Thurman, R. Jason A2 Knoop, Kevin J. A2 Stack, Lawrence B. A2 Storrow, Alan B. A2 Thurman, R. Jason SR Print(0) ID 1181056733 T1 Desomorphine (Krokodil) T2 The Atlas of Emergency Medicine, 5e YR 2021 FD 2021 PB McGraw-Hill PP New York, NY SN 9781260134940 LK accessemergencymedicine.mhmedical.com/content.aspx?aid=1181056733 RD 2024/03/29 AB Desomorphine, also known by its street name krokodil, is a powerful highly addictive synthetic opioid commonly made from codeine. The drug features a very rapid onset of action and is about 10 times as powerful as morphine. The medical use of this drug was terminated in 1981 due to its short duration and significant respiratory depression compared to other opioids, but recreational use has surged in the past decade. Due to the over-the-counter availability of codeine products in Eastern Europe and Russia, desomorphine may be easily manufactured through “krokodil labs” in a similar fashion to methamphetamine production. The drug is heated and usually intravenously injected by the user. Severe skin necrosis is caused by many contaminants, such as iodine and phosphorus from matchstick heads used in the production process. These contaminants are caustic, causing skin and soft-tissue breakdown as well as damage to blood vessels, muscles, bones, and organs. Lesions may become severe, causing deep space infections and gangrene, and may even result in the need for amputations. Desomorphine’s street name “krokodil” is thought to be derived from the similarity of damaged skin to crocodile leather.