Krokodil has Shown Up in Australia

A few years ago, certain Australian media outlets started publishing ominous reports of a “flesh-eating drug” that had “ravaged” Russia and “left a trail of ‘zombies’ in its wake”. Such descriptions were predictably overblown, but not by much. The flesh-eating substance was krokodil—an impure form of desomorphine that commonly causes severe tissue damage and gangrenous infection after use—and it was warned that it would soon be coming to Australia.

Now, three years later, the first instance of an Australian patient presenting with the symptoms of krokodil use has been reported in rural New South Wales, according to the ABC. A young man turned up at a drug and alcohol service centre with an infection in his arm, claiming he’d injected krokodil. Notwithstanding the scare-mongering reports from several years ago, actual use of the substance had not previously been reported in Australia. So, have we encountered patient zero of a flesh-eating zombie drug that’s set to ravage the nation? Or is this more likely an isolated case?

It’s probably worth getting the lay of the land here, and taking a look at what krokodil actually is. In its pure form, desomorphine is a synthetic opioid which induces a small range of powerful, fast-acting effects such as sedation and analgesia. It’s a “morphine analogue” that’s been found to be faster-acting and more effective than morphine for the quick relief of pain—albeit with a shorter duration—and has previously been used in a clinical setting in Switzerland and Russia. The substance also comes with a higher risk of undesirable side effects than morphine, however, including hypotension (low blood pressure) and urinary retention.

Krokodil is the street name often assigned to illicitly produced, homemade equivalents of desomorphine. Type that word into Google Images and you’ll see why the reptilian reference is fitting: when injected, the impure substances that typically constitute krokodil can cause serious damage to the skin, blood vessels, bone, and muscles. This damage often resembles black or green scales, scabs, or just straight-up rotten flesh—hence, in part, the zombie associations—and occasionally long-term users need to get their limbs amputated.

The causes of this damage can often be traced back to the ingredients used when cooking krokodil. Usually, codeine or another opioid is mixed and heated with readily available solvents such as battery acid, gasoline, or paint thinner. In the not uncommon event that the user fails to remove the toxic substances after cooking, these solvents can cause big problems upon ingestion. There have been reports of the user missing the vein when injecting the mixture, creating an abscess and killing off the flesh around the entry-point. Other common effects of use include gangrene, inflamed veins, blood clots, blood infection, bone infection, and brain damage.

The drug’s known as being big in Russia in recent years, presumably due to its relatively simple synthesis from over-the-counter codeine, which until 2012 could be obtained without a prescription in a country where heroin was relatively scarce. The first instance of krokodil abuse was reported in Siberia in 2003, and spread throughout Russia shortly thereafter. Between 2013 and 2015, media reports started emerging of krokodil use in the United States and the United Kingdom. Now, we have what appears to be our first Australian krokodil moment.

So should we be worried about the possibility of an impending zombie drug epidemic? Julaine Allan, senior research fellow at Charles Sturt University, doesn’t seem to think so. Writing for the ABC’s The Conversation, Julaine suggests that the case of the young man in rural NSW is likely the result of a single drug dealer who’s been faced with an opioid shortage and so cooked up a batch of krokodil as a substitute. Less likely, she says, is the prospect that the substance is being manufactured and used on a large scale.

If nothing else, then, this story represents just one extreme case of a much broader problem: namely, the chronic issue of dealers cutting or cooking their products with unwanted additives. Whether it’s ecstasy laced with fentanyl, cocaine cut with speed, or opioids mixed with paint thinner, the practice of adulterating drugs is widespread and persistent. The fear, it seems, should not be that krokodil might “hit Aussie shores”, as The Daily Telegraph warned in 2016; it’s that all the building blocks for krokodil are already here—and it only takes the will of what Julaine Allan calls an “entrepreneurial dealer” for the flesh-eating drug to rear its ugly head.

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