title: Internet search and krokodil in the Russian Federation: an infoveillance study.
abstract: BACKGROUND
  Krokodil is an informal term for a cheap injectable illicit drug domestically prepared from codeine-containing medication (CCM). The method of krokodil preparation may produce desomorphine as well as toxic reactants that cause extensive tissue necrosis. The first confirmed report of krokodil use in Russia took place in 2004. In 2012, reports of krokodil-related injection injuries began to appear beyond Russia in Western Europe and the United States.
  
  
  OBJECTIVE
  This exploratory study had two main objectives: (1) to determine if Internet search patterns could detect regularities in behavioral responses to Russian CCM policy at the population level, and (2) to determine if complementary data sources could explain the regularities we observed.
  
  
  METHODS
  First, we obtained krokodil-related search pattern data for each Russia subregion (oblast) between 2011 and 2012. Second, we analyzed several complementary data sources included krokodil-related court cases, and related search terms on both Google and Yandex to evaluate the characteristics of terms accompanying krokodil-related search queries.
  
  
  RESULTS
  In the 6 months preceding CCM sales restrictions, 21 of Russia's 83 oblasts had search rates higher than the national average (mean) of 16.67 searches per 100,000 population for terms associated with krokodil. In the 6 months following restrictions, mean national searches dropped to 9.65 per 100,000. Further, the number of oblasts recording a higher than average search rate dropped from 30 to 16. Second, we found krokodil-related court appearances were moderately positively correlated (Spearman correlation=.506, P≤.001) with behaviors consistent with an interest in the production and use of krokodil across Russia. Finally, Google Trends and Google and Yandex related terms suggested consistent public interest in the production and use of krokodil as well as for CCM as analgesic medication during the date range covered by this study.
  
  
  CONCLUSIONS
  Illicit drug use data are generally regarded as difficult to obtain through traditional survey methods. Our analysis suggests it is plausible that Yandex search behavior served as a proxy for patterns of krokodil production and use during the date range we investigated. More generally, this study demonstrates the application of novel methods recently used by policy makers to both monitor illicit drug use and influence drug policy decision making.
authors.affiliation: Menzies Centre for Health Policy, University of Sydney, University of Sydney, Australia. andreyzheluk@gmail.com.
authors.forename: Andrey
authors.identifier: http://orcid.org/0000-0001-8769-1243
authors.initials: A
authors.lastname: Zheluk
authors.forename: Casey
authors.identifier: http://orcid.org/0000-0002-4329-7882
authors.initials: C
authors.lastname: Quinn
authors.forename: Peter
authors.identifier: http://orcid.org/0000-0002-3029-9918
authors.initials: P
authors.lastname: Meylakhs
mesh_terms: D000328:Adult; D003061:Codeine / Q000031:analogs & derivatives*; D062665:Epidemiological Monitoring; D006291:Health Policy; D006801:Humans; D013287:Illicit Drugs; D020407:Internet; D008297:Male; D009022:Morphine Derivatives; D009293:Opioid-Related Disorders / Q000453:epidemiology; D062486:Public Health Surveillance / Q000379:methods*; D012426:Russia / Q000453:epidemiology; D015813:Substance Abuse Detection / Q000379:methods* / Q000639:trends; D014481:United States
chemical_list: D013287:Illicit Drugs; D009022:Morphine Derivatives; C000599494:desomorphine; D003061:Codeine
keywords: Russia; controlled substances; designer drugs; search engine; street drugs; surveillance