“Krokodil” paper reappears on American Journal of Medicine website
January 2, 2014, 4:02 pm
‘Krokodil’ — A Designer Drug from Across the Atlantic, with Serious Consequences. Thekkemuriyi DV et al. Am J Med 2013 Oct 15 [Epub ahead of print]
This paper, which was posted in manuscript form and then temporarily withdrawn from the American Journal of Medicine website, has reappeared as a “Clinical Communication to the Editor” prior to publication. As @ForensicToxGuy points out in a thorough analysis on his blog, the journal, the new version of the case report has been edited to eliminate some of the horrendous grammar and sentence structure in the original manuscript, and some details have for some reason been changed.
I agree with the criticism that the extremely rapid acceptance and posting of the original manuscript was unusual, perhaps unprecedented. I also agree that the use of the term “flesh eating” is inappropriate for a scientific publication, and that the claim that use of “krokodil” is spreading rapidly across Europe is unsupported by any evidence.
However, I believe that @ForensicToxGuy, like many toxicologists who have written about “krokodil” since the manuscript of this communication was first posted by the journal, is remiss in not positing a clear definition specifying exactly what is meant by the term “krokodil.” As TPR has argued before, the term can not refer to desomorphine itself, which is simply an opiate and is not, to my knowledge, available anywhere in pure form. To my mind, “krokodil” refers more to a process in which users attempt to home-brew desomorphine using codeine and various caustic ingredients such as lighter fluid, gasoline, hydrochloric acid, and red phosphorous. There is not laboratory test that can confirm this process — the diagnosis depends on consistent soft-tissue injury and a history of using the home-brewed product. It laboratory tests fail to find desomorphine, this might just mean that the user was unsuccessful in manufacturing it, or that so much time has passed since last use that — although the soft tissue injury remains — the drug has been eliminated from the body.