Key questions about the Arizona krokodil cases

September 28, 2013, 2:01 pm

Very few details have been released so far concerning the two cases of possible exposure to krokodil exposure in Arizona that we posted about yesterday. My understanding is that the cases are being investigated by the public health department, and that they are awaiting laboratory confirmation.

I am not quite sure what “laboratory confirmation” would mean in these cases. The major damage done by krokodil is not caused by desomorphine itself,  but by the various caustic ingredients used to make that opiate from codeine — gasoline, hydrochloric acid, red phosphorous, iodine, etc. Even if no desomorphine turned up on laboratory tests, if might just indicate an error in the manufacturing process. I’m not sure one could test for the various reagents. If the patient came in with his arm eaten away and gave a history of trying to make desomorphine at home from codeine, I’d consider that a krokodil exposure even if toxicology tests were negative.

Here are some important questions I’d be interested in having answered about the Arizona cases:

  1. Did the patients give a history of attempting to make desomorphine out of codeine?
  2. If so, what reagents did they use?
  3. If not, did the patients buy a product sold on the street as a designer drug?
  4. If so, how was it labelled and represented?
  5. What were the presenting signs and symptoms?
  6. Did these result from a one-time exposure, or multiple uses?
  7. What lab tests were done? What did these show?

We will no doubt be hearing much more about these cases in the future.

For those with strong stomachs, here is a Vice media documentary on krokodil in Russia (WARNING: graphic images):


  1. Adam Glass Says:

  2. Leon Says:


    There not much detail on these 3 potential cases in Joliet as yet. Not clear if the CDC or FDA are investigating. (Or, if not, it’s because of the government shutdown.)