Desomorphine

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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