Krokodil: The Drug and Its Dangers
What krokodil is, why it is one of the most dangerous drugs, the horrific tissue damage it causes, its opioid effects, and how to get help.
Clinically reviewed by Dr. Ponlawat Pitsuwan, Physician and Addiction Medicine Specialist, Phuket Island Rehab.
Krokodil is the street name for a homemade injectable drug whose active ingredient is desomorphine, a powerful opioid. It is made cheaply and crudely, often from codeine combined with highly toxic and corrosive chemicals (such as industrial solvents, acids, and other caustic substances), which are not fully removed, so users inject a mixture of the opioid and these poisons. This is why krokodil is considered one of the most dangerous and destructive drugs. As an opioid, desomorphine produces effects similar to heroin (euphoria and sedation) but is very potent and short-acting, driving frequent injecting and rapid addiction. The most horrific and characteristic harm of krokodil is severe tissue damage at and around injection sites: the toxic chemicals damage blood vessels and tissue, causing the skin and flesh to become discoloured, scaly (which gives the drug its name, from the crocodile-like appearance), and to develop severe wounds, ulcers, infections, gangrene (dead tissue), and rotting flesh, sometimes exposing bone and requiring amputation. Krokodil also causes serious damage to internal organs and can be rapidly fatal, with a short life expectancy reported among users. It is extremely addictive and devastating. If you or someone you know is using krokodil, it is life-threatening, and urgent help is needed; opioid addiction is treatable.
What is krokodil?
Krokodil is the street name for a homemade injectable drug whose active ingredient is desomorphine, a powerful synthetic opioid. The name krokodil (Russian for crocodile) is thought to come from the scaly, discoloured, crocodile-like appearance of the skin that the drug causes, or from a chemical used in its production. Krokodil emerged notably in parts of Russia and Eastern Europe, where it was used as a cheap substitute for heroin. What makes krokodil so dangerous is not only the opioid itself but the way it is made: it is produced cheaply and crudely, often by cooking down codeine (an opioid available in some medicines) together with a range of highly toxic, corrosive, and poisonous chemicals, such as industrial solvents, acids, red phosphorus, and other caustic substances. These toxic chemicals are not properly removed in the crude home production, so when a person injects krokodil, they are injecting not only the opioid but also these poisons directly into their body. This is central to why krokodil is considered one of the most dangerous and destructive drugs in existence.
This article explains what krokodil is, why it is so dangerous, the horrific tissue damage it causes, its opioid effects, and how to get help. The central message is that krokodil is an extremely dangerous, homemade opioid drug that, because it is made with and injected alongside toxic, corrosive chemicals, causes devastating harm, most infamously severe destruction of the skin and flesh at and around injection sites, along with serious internal organ damage, and that it is highly addictive and can be rapidly fatal. It is important to understand just how destructive krokodil is, and that its dangers go far beyond those of typical opioids because of the poisons involved. It is also important to know that, as an opioid, krokodil is extremely addictive, and that if you or someone you know is using it, this is a life-threatening situation requiring urgent help. Understanding the horrific dangers of krokodil underlines why it must never be used and why anyone using it needs immediate help; opioid addiction, including to krokodil, is treatable, though krokodil’s specific harms make getting help urgent.
The opioid effects and why krokodil is so dangerous
As an opioid, the desomorphine in krokodil produces effects broadly similar to other opioids like heroin: euphoria, pain relief, sedation, and a sense of wellbeing, along with the typical opioid risks such as slowed breathing (respiratory depression) and overdose. Desomorphine is very potent, several times stronger than morphine, and it is short-acting, meaning its effects come on quickly but wear off quickly. This short duration drives users to inject frequently, often many times a day, to maintain the effect and stave off withdrawal, which increases exposure to the drug and its toxic contents and accelerates the harm and the development of a severe, rapidly-consuming addiction. Like other opioids, krokodil is extremely addictive, and users can become physically dependent, with a severe withdrawal on stopping. So on the opioid level alone, krokodil is dangerous and addictive.
However, what makes krokodil far more dangerous than typical opioids is the toxic, corrosive chemicals it is made with and injected alongside. Because krokodil is crudely home-produced and the poisonous chemicals (solvents, acids, phosphorus, and other caustic substances) are not removed, injecting krokodil means injecting these poisons directly into the bloodstream and tissues. These chemicals are highly toxic and corrosive, and they cause catastrophic damage to the body, particularly to blood vessels and tissue. This is why krokodil is associated with such extreme and horrific physical harm, far beyond the effects of the opioid itself. In effect, a krokodil user is repeatedly injecting a mixture of a powerful opioid and industrial poisons, which devastates the body from the inside and outside. Combined with the frequent injecting driven by the drug’s short action, and the often unsterile conditions of use, this leads to the rapid, severe, and characteristic damage described below. It is this combination, a potent, short-acting, addictive opioid delivered together with corrosive poisons, that makes krokodil one of the most dangerous and destructive drugs known, with devastating consequences for those who use it.
| Aspect | Detail |
|---|---|
| What it is | Homemade injectable drug; active ingredient desomorphine (opioid) |
| Made from | Codeine + toxic, corrosive chemicals (not removed) |
| Opioid effects | Euphoria, sedation, pain relief; potent, short-acting |
| Why so dangerous | Injected with industrial poisons; frequent injecting |
| Signature harm | Severe skin/flesh damage, ulcers, gangrene, rotting tissue |
| Outcome | Organ damage, often rapidly fatal; extremely addictive |
The horrific tissue damage and other harms
The most horrific and characteristic harm of krokodil is severe tissue damage at and around the injection sites. Because the corrosive, toxic chemicals are injected into the body, they damage the blood vessels and tissue, causing the skin and flesh to become discoloured, scaly, greenish-black, and hardened (the crocodile-like appearance that gives the drug its name), and to develop severe wounds, ulcers, abscesses, and infections. As the damage progresses, the tissue can begin to die (gangrene) and rot, leading to open sores and areas of dead, decaying flesh, sometimes so severe that muscle and even bone become exposed. This flesh-destroying damage can spread, and in severe cases it leads to the need for surgical removal of dead tissue or amputation of affected limbs, and it can cause life-threatening infections (such as blood poisoning). The images and reality of krokodil-related tissue damage are among the most disturbing of any drug, reflecting the catastrophic effect of injecting corrosive poisons.
Beyond the tissue and skin damage, krokodil causes serious harm throughout the body. The toxic chemicals can damage internal organs, including the liver, kidneys, and others, and can affect the brain and nervous system, blood vessels, and bones. Users are at risk of severe infections (both from the injecting and the tissue damage), blood clots, and the many complications of injecting drug use, including blood-borne infections. As an opioid, there is also the risk of overdose and death from respiratory depression. The combined effect of the opioid, the poisons, the tissue destruction, the infections, and the organ damage is devastating, and krokodil use is associated with severe illness and a very short life expectancy among users, with death often occurring rapidly after beginning to use it. Krokodil is also extremely addictive and consuming, trapping users in a rapidly destructive cycle. Given all this, if you or someone you know is using krokodil, it is a life-threatening emergency requiring urgent help. The reassuring point is that opioid addiction, including to krokodil, is treatable, with medically supported withdrawal, medications used in opioid use disorder treatment where appropriate, treatment of the physical damage and infections, counselling and behavioural therapies, and support for recovery; but because krokodil is so rapidly destructive, getting help urgently is critical. The key messages are that krokodil is an extremely dangerous homemade opioid made with toxic, corrosive chemicals, that it causes horrific tissue destruction, serious organ damage, and rapid, often fatal harm, that it is highly addictive, and that anyone using it needs urgent help. Krokodil use is a medical emergency, and reaching out for help is potentially life-saving.
Summary
Krokodil is the street name for a homemade injectable drug whose active ingredient is desomorphine, a powerful opioid. It is made cheaply and crudely, often from codeine combined with highly toxic and corrosive chemicals (such as industrial solvents, acids, and other caustic substances), which are not fully removed, so users inject a mixture of the opioid and these poisons. This is why krokodil is considered one of the most dangerous and destructive drugs. As an opioid, desomorphine produces effects similar to heroin (euphoria and sedation) but is very potent and short-acting, driving frequent injecting and rapid addiction. The most horrific and characteristic harm of krokodil is severe tissue damage at and around injection sites: the toxic chemicals damage blood vessels and tissue, causing the skin and flesh to become discoloured, scaly (which gives the drug its name), and to develop severe wounds, ulcers, infections, gangrene, and rotting flesh, sometimes exposing bone and requiring amputation. Krokodil also causes serious damage to internal organs and can be rapidly fatal, with a short life expectancy reported among users. It is extremely addictive and devastating. If you or someone you know is using krokodil, it is life-threatening, and urgent help is needed; opioid addiction is treatable.
As Dr. Ponlawat Pitsuwan, addiction medicine specialist at Phuket Island Rehab, puts it, “Krokodil is, without exaggeration, one of the most horrifying drugs I know of, and the reason is simple: people are not just injecting an opioid, they are injecting the acids, solvents, and industrial chemicals it is cooked with, straight into their veins. The opioid hooks them fast and hard, but the poisons rot them from the inside, blood vessels collapse, flesh dies and turns scaly and black, wounds open down to the bone, and limbs are lost. The life expectancy once someone is truly into krokodil is measured in a shockingly short time. So there is no cautious message here: if anyone is using krokodil, it is an emergency, full stop. Get help now. Opioid addiction is treatable, but with krokodil, every day matters.”
Frequently asked questions
What is krokodil made of?
Krokodil is a homemade injectable drug whose active ingredient is desomorphine, a powerful opioid, but what makes it so dangerous is what else it contains. It is produced cheaply and crudely, often by cooking down codeine (an opioid found in some medicines) together with a range of highly toxic, corrosive, and poisonous chemicals, such as industrial solvents, acids, red phosphorus, and other caustic substances. In the crude home production, these toxic chemicals are not properly removed, so the final product is a mixture of the opioid desomorphine and these poisons. This means that when a person injects krokodil, they are injecting not only the opioid but also these corrosive, toxic chemicals directly into their body. This is central to why krokodil causes such catastrophic harm, far beyond the effects of the opioid itself, because the poisons damage blood vessels, tissue, and organs. So krokodil is essentially a home-cooked opioid contaminated with industrial poisons, and it is this combination that makes it one of the most dangerous and destructive drugs. The exact chemicals used can vary, but they are consistently toxic and corrosive. Understanding what krokodil is made of helps explain its horrific effects and why it is so deadly. There is no safe way to use it.
Why does krokodil rot the skin and flesh?
Krokodil rots the skin and flesh because of the toxic, corrosive chemicals it is made with and injected alongside. Because krokodil is crudely home-produced and the poisonous chemicals (such as solvents, acids, and phosphorus) are not removed, injecting it means injecting these corrosive poisons directly into the bloodstream and tissues. These chemicals damage the blood vessels and tissue at and around the injection sites, cutting off blood supply and destroying the tissue. As a result, the skin and flesh become discoloured, scaly, greenish-black, and hardened (the crocodile-like appearance that gives the drug its name), and develop severe wounds, ulcers, abscesses, and infections. As the damage progresses, the tissue begins to die (gangrene) and rot, producing open sores and areas of dead, decaying flesh, sometimes so severe that muscle and even bone become exposed. This flesh-destroying damage can spread and, in severe cases, requires surgical removal of dead tissue or amputation of affected limbs, and it can cause life-threatening infections. So it is the corrosive poisons in krokodil, injected into the body, that cause this horrific rotting of the skin and flesh, one of the most disturbing effects of any drug. This is a direct consequence of injecting industrial chemicals, and it is a key reason krokodil is so devastating and why anyone using it needs urgent help.
How dangerous is krokodil?
Krokodil is extremely dangerous, considered one of the most dangerous and destructive drugs known. Its dangers come from both the opioid it contains and the toxic poisons it is made with. As a potent opioid, it carries the risks of addiction, overdose, and death from slowed breathing, and its short action drives frequent injecting and rapid, severe addiction. But its most devastating dangers come from the corrosive, toxic chemicals injected alongside the opioid: these cause horrific tissue damage at and around injection sites, with the skin and flesh becoming discoloured, scaly, and developing severe wounds, ulcers, infections, gangrene, and rotting flesh, sometimes exposing bone and requiring amputation, as well as serious damage to internal organs (such as the liver and kidneys), the brain, blood vessels, and bones. Users are also at high risk of severe infections, blood clots, and the complications of injecting drug use. The combined effect is devastating, and krokodil use is associated with severe illness and a very short life expectancy, with death often occurring rapidly. Krokodil is also extremely addictive. So krokodil is genuinely one of the most harmful drugs, with the potential to destroy the body rapidly and cause death within a short time of starting to use it. This extreme danger is why anyone using krokodil needs urgent help, and why it should never be used. There is no safe way to use krokodil; it is life-threatening.
Is krokodil an opioid like heroin?
Yes, krokodil is an opioid, and its active ingredient, desomorphine, produces effects broadly similar to heroin, but krokodil is far more dangerous because of the poisons it contains. As an opioid, desomorphine produces euphoria, pain relief, sedation, and a sense of wellbeing, along with the typical opioid risks such as slowed breathing and overdose, and it is addictive, causing physical dependence and withdrawal. Desomorphine is actually more potent than morphine and is short-acting, so its effects come on and wear off quickly, which drives users to inject frequently to maintain the effect and avoid withdrawal. In these opioid respects, krokodil is comparable to heroin, and it emerged as a cheap heroin substitute. However, krokodil differs from heroin in a crucial and terrible way: because it is crudely home-made from codeine and toxic, corrosive chemicals that are not removed, using krokodil means injecting industrial poisons along with the opioid, which causes the catastrophic tissue destruction, organ damage, and rapid, often fatal harm that heroin does not cause in the same way. So while krokodil is an opioid like heroin and shares the opioid effects and addictiveness, it is far more destructive and deadly because of the poisons involved. This makes krokodil one of the most dangerous drugs, and anyone using it needs urgent help. Opioid addiction, including to krokodil, is treatable, but krokodil’s specific harms make getting help urgent.
Can you recover from krokodil addiction?
Recovery from krokodil addiction is possible, as opioid addiction is treatable, but because krokodil is so rapidly and severely destructive, getting help urgently is critical, and the physical damage it causes can be severe and sometimes permanent. Treatment involves several elements. Because krokodil is an opioid, treatment includes medically supported withdrawal (as stopping opioids causes withdrawal) and, where appropriate, medications used in opioid use disorder treatment (such as buprenorphine or methadone) to reduce cravings and withdrawal and support recovery. Crucially, treatment also involves urgent medical care for the physical damage krokodil causes, such as treating severe wounds, infections, tissue damage, and organ damage, which may require intensive medical and surgical treatment. Counselling and behavioural therapies address the psychological aspects and any underlying issues, and support for recovery and treatment of any co-occurring mental health conditions are provided. The challenge with krokodil is that the physical harm can be advanced and life-threatening by the time a person seeks help, and some damage (such as lost tissue or limbs, or organ damage) may be permanent, which is why urgent help is so important, ideally before the damage becomes irreversible or fatal. So while recovery from krokodil addiction is possible with comprehensive treatment, and stopping can prevent further harm, the extreme and rapid dangers of krokodil mean that anyone using it should seek help as an emergency, without delay. If you or someone you know is using krokodil, urgent professional help is essential and potentially life-saving, and recovery, though challenging, is possible.
What should you do if someone is using krokodil?
If someone is using krokodil, treat it as a life-threatening emergency and act urgently to help them get professional care, because krokodil is so rapidly and severely destructive. In an immediate emergency, if the person shows signs of an opioid overdose (unresponsiveness, slowed or stopped breathing, blue lips, pinpoint pupils), call your local emergency number immediately and give naloxone if available, as krokodil is an opioid and naloxone can reverse opioid overdose. If the person has severe wounds, infections, or areas of dead or rotting tissue, these also need urgent medical care, as they can be life-threatening. Beyond the immediate danger, because krokodil causes such rapid and devastating harm, it is critical to help the person get urgent professional help for their drug use and physical condition, without delay, ideally before the damage becomes irreversible or fatal. Encourage and help them to access emergency and addiction services and medical care, approaching them with compassion and urgency. Do not wait or minimise the situation, given how deadly krokodil is. If it is safe and possible, help connect them with emergency services, a hospital, and addiction treatment. Look after your own safety and wellbeing too. The key message is that krokodil use is a medical emergency requiring urgent help, that every day matters given its rapid destructiveness, and that getting the person into emergency and addiction care as soon as possible is potentially life-saving. Opioid addiction is treatable, but with krokodil, urgency is everything.
Sources
National Institute on Drug Abuse (NIDA). Emerging and Dangerous Drugs. https://nida.nih.gov/
Drug Enforcement Administration (DEA). Desomorphine (Krokodil). https://www.dea.gov/
National Library of Medicine (MedlinePlus). Opioids and Injecting Drug Use. https://medlineplus.gov/
Substance Abuse and Mental Health Services Administration (SAMHSA). Opioid Use Disorder. https://www.samhsa.gov/
European Union Drugs Agency (EUDA). Desomorphine (Krokodil) Report. https://www.euda.europa.eu/
World Health Organization (WHO). Opioid Overdose. https://www.who.int/news-room/fact-sheets/detail/opioid-overdose
Krokodil — key entities and related terms
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