title: A "krokodil" emerges from the murky waters of addiction. Abuse trends of an old drug.
abstract: "Krokodil" is the street name for the semi-synthetic opioid derivative desomorphine. Although an old drug, it re-staged on "drug arena" during the last decade causing detrimental effects to its users. Despite the fact that Russia and other former Soviet Republics were the initial plagued countries, "krokodil" arrived in Europe and United States lately, as a substitute of the relative expensive, and in many cases unavailable, heroin. It can be easily manufactured in home-environment from codeine and causes significant health problems, even deaths worldwide. The aim of this review is to summarize the current knowledge about this drug, concerning its chemistry, synthesis, pharmacology and toxicology. Published or reported "krokodil" related cases, fatalities or intoxications, as well as self reports from drug users are reviewed. The existing analytical methodologies for the determination of desomorphine in biological samples as well as its legal status are also presented.
authors.affiliation: Department of Forensic Medicine and Toxicology, Faculty of Medicine, National and Kapodistrian University of Athens, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Katselou
authors.affiliation: Department of Forensic Medicine and Toxicology, Faculty of Medicine, National and Kapodistrian University of Athens, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Papoutsis
authors.affiliation: Department of Forensic Medicine and Toxicology, Faculty of Medicine, National and Kapodistrian University of Athens, Greece. Electronic address: pan_nik@hotmail.com.
authors.forename: Panagiota
authors.initials: P
authors.lastname: Nikolaou
authors.affiliation: Department of Forensic Medicine and Toxicology, Faculty of Medicine, National and Kapodistrian University of Athens, Greece.
authors.forename: Chara
authors.initials: C
authors.lastname: Spiliopoulou
authors.affiliation: Department of Forensic Medicine and Toxicology, Faculty of Medicine, National and Kapodistrian University of Athens, Greece.
authors.forename: Sotiris
authors.initials: S
authors.lastname: Athanaselis
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects / Q000138:chemical synthesis / Q000737:chemistry; D006801:Humans; D013287:Illicit Drugs / Q000009:adverse effects / Q000138:chemical synthesis / Q000737:chemistry*; D009022:Morphine Derivatives / Q000009:adverse effects / Q000138:chemical synthesis / Q000737:chemistry*; D009293:Opioid-Related Disorders / Q000175:diagnosis* / Q000453:epidemiology* / Q000401:mortality; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality
chemical_list: D000701:Analgesics, Opioid; D013287:Illicit Drugs; D009022:Morphine Derivatives
keywords: Crocodile; Desomorphine; Flesh-eating drug; Krokodil; Legislation