Desomorphine

Background

• Also called krokodil, krok, Russian magic
• First reported in Russia in 2003
• Injected SC or IV, or taken orally
• Mechanism of action is mu-opioid receptor agonism

Clinical Manifestations

Intoxication and Withdrawal

• Similar to other opioids

Skin and Soft Tissue Manifestations

• Can cause a green scaly appearance of the skin after injections, often with ulceration of skin, muscle, and cartilage
• Can cause gangrene down to bone, resulting in amputations
• The tissue damage is usually from contamination with paint thinner, lighter fluid, gasoline, lead, zinc, and hydrochloric acid used to prepare the drug