Tech + Health

11.07.13

Behind the Krokodil Panic

Relax! The home-brewed Russian drug isn’t invading America. Here’s how the media got duped into mistaking an old existing epidemic for a new outbreak.

“Zombie Apocalypse Drug Reaches U.S.,” read one headline. “Flesh-Eating 'Zombie' Drug 'Kills You from the Inside Out,” blared another.“The Most Horrifying Drug in the World Comes to the U.S.,” warned a third.

They sound more like quotes from a horror movie trailer than headlines from Mother Jones, CNN, and Time, respectively, but the panic was real. Over the past several weeks, a wave of apparent users of Krokodil—a highly addictive morphine derivative brewed in rural Russia—appeared to herald a chilling new age in America’s drug wars. Cases popped up in at least six states. The media went wild.

But here’s the catch: not one of the dozens of suspected cases tested positive for desomorphine, the drug's official name. In fact, according to public-health experts and federal officials, the great Krokodil scare of 2013 is really just the latest symptom of a true epidemic long in the making: American’s growing dependence on heroin and prescription painkillers.

The hysteria can be traced back to September 23, when two patients were sent from an Arizona emergency room to the Phoenix Banner Poison Control Center, a private clinic. There, the patients told Dr. Frank LeVecchio, the center’s co-medical director, that they had developed open sores after trying a drug called Krokodil. LeVecchio, already familiar with the Russian drug from a 2011 feature in Time called The Curse of the Krokodil, quickly connected the dots. “Their wounds were not inconsistent with it, so we pursued the diagnoses,” LeVecchio recently old The Daily Beast. Lab tests would take several days to provide proof, but LeVicchio didn’t wait to send out his preliminary diagnosis to a listserv of fellow toxicologists. He also spoke to the media. "As far as I know, these are the first cases [of Krokodil] in the United States that are reported. So we're extremely frightened," he told CBS5 in Phoenix the following day. "Where there is smoke there is fire, and we're afraid there are going to be more and more cases," he continued.  

Grisly news travels fast.  

In a matter of days, LeVecchio’s words had not only captivated the attention of the nation, but the world.

In bordering Utah, local DEA agents warned drug users about the “flesh-eating drug” that could soon be roaming the state’s streets. Sure enough, less than two weeks later, local news stations ran a story claiming that the Utah Poison Control Center had confirmed two cases of Krokodil. Next came two Illinois sisters confessing that they’d tried it. Then a few cases in Ohio, and elsewhere—all of which led to the same conclusions by police: unconfirmed.

To be fair, the symptoms in each case did resemble the aftereffects of Krokodil, a true public-health scourge in rural Russia. The drug, a morphine analogue that acts similarly to heroin but with a shorter high, is made by combining codeine, paint thinner, and lighter fluid (among other things) in small batches. An April 2013 article from the International Journal of Drug Policy titled Breaking Worse explains the dangers of the homemade drug. “Desomorphine may be the opioid that the cooks intend to produce, but it is not what they necessarily end up with,” the article reads. The “bootleg chemistry” results in a drug that is notoriously impure and often contains a lethal mix of toxins.

For Russians who find themselves addicted to heroin with no way to get it, Krokodil is the next best thing. “I don’t care, I’m gonna f--king die in a week” says one young boy about to shoot up Krokodil in a Vice documentary on the topic released in 2011.

But for American’s who can buy heroin much more easily than they can codeine, Krokodil use just doesn’t make sense.

“We don’t have a Krokodil epidemic, we have a heroin and painkiller epidemic.”

The facts bear this out. “To date none of our forensic labs have analyzed an exhibit that contain desomorphine [Krokodil],” Rusty Payne, a spokesperson for the federal Drug Enforcement Administration told The Daily Beast this week. “We have nothing to indicate that it’s out there.” Payne called the Krokodil fiasco the “story of the month,” blaming it both on misinformation and myths propagated by the media. “What happens is people jump the gun,” Payne explains. “Poison controls, emergency rooms, cops—folks that aren’t trained in narcotics,” he says. “We [the DEA] are knee deep in local synthetic drugs. This is what we do.”

 “I saw it on the news,” says a spokeswoman for the DEA in Utah. “We ran it down, but there was nothing to run down. I’ve yet to see a confirmed case.” Meanwhile Marty Malheiro, a spokeswoman for the Utah Poison Control Center, told The Daily Beast that the entire thing “got totally misconstrued.” Malheiro says she was there when two TV stations interviewed Barbara Insley Crouch, the center’s executive director. “We never said we had a case. She made it clear that we had a suspicious case with similar symptoms.” Malheiro says that whoever claimed Crouch confirmed the cases of Krokodil “got her statements wrong.”

Henry Spiller, Director of Central Ohio Poison Center, where the most recent suspected case of Krokodil made headlines, agreed, telling The Daily Beast that he considers the Krokodil incident “more smoke than fire.”

The less glamorous but more likely culprit in the Krokodil scare—the one that didn’t make headlines—is a drug that Americans have been snorting, sniffing, and injecting for decades: heroin. The sores are nothing new, either. As widely documented on drug policy sites across the web, intravenous drug users are susceptible to a wide range of deadly infections, including HIV, Hepatitis, B/C, and MRSA—many of which can result in gangrenous skin, deep abscesses, and loss of limbs.  

“We don’t have a Krokodil epidemic, we have a heroin and painkiller epidemic,” Dr. Andrew Kolodny, chief medical officer at Phoenix House, a non-profit alcohol and drug rehab center, tells The Daily Beast. A nationally recognized psychiatrist, Kolodny has spent close to 20 years studying substance abuse and addiction. The graphic images flooding the Internet with “Krokodil” tags didn’t shock him. “This is not a new problem. Drug users are prone to skin infections and blood infections. There are serious medical infections that come from injecting drugs,” he says. While the infections are not new, Kolodny says increased heroin dependence means it won’t be the last time we see pictures like these.   

“We’ve got a very serious problem with opiods,” Kolody says, using the term for drugs that resemble morphine or other opiates. Synthesized from opium, heroin entered the U.S. in the late 1800s, marketed as a non-addictive morphine substitute and cough suppressant. When it turned out to be more addictive than morphine (which doctors initially hoped it would replace), it was quickly taken off the shelves. In 1924, Congress banned the sale, manufacture, and importation of the drug. After a heroin epidemic swept the nation in the 1970s, the numbers plateaued.

But with a surge in prescription painkillers—opioids that produces a similar high as heroin—the numbers are steadily rising once again. “People are addicted to painkillers, but the pills are very expensive,” Kolodny explains. “Sometimes they transition to heroin.” 

Heroin’s nexus to prescription pain pills has put them both at record highs. According to the 2012 National Survey on Drug Use and Health, the number of people with heroin dependency in 2012 (467,000) was nearly double the number in 2002 (214,000). The use of painkillers has seen an even higher jump. In the same survey, the number of people seeking treatment for nonmedical use of pain relievers in 2012 (973,000) was almost triple the same number in 2002 (360,000). Another CDC report from July 2013 shows a staggering 400-percent increase in female overdoses from prescription painkillers since 1999, compared to a 265-percent jump among men. A Centers for Disease Control survey from shows a 45 percent increase in heroin overdoses from 2006-2010.

Kolodny says that in order to bring the epidemic under control, a few things need to happen immediately. “The medical community needs to prescribe narcotic painkillers more carefully,” he says. “Instead of giving a kid who just got his wisdom teeth out 40 vicodin, give him three.” Beyond that, Kolodny says it’s “access to effective treatment” that’s vital.  

Rafael Lamaitre, a spokesperson for The White House’s Office of National Drug Control Policy, confirmed to The Daily Beast that his team is “continuously monitoring all available data and reporting on emerging drug threats.” “The abuse of heroin and prescription painkillers have a devastating impact on public health and safety,” Lamaitre said.

New cases of suspected Krokodil use are likely to emerge in the weeks to come. Perhaps this time, the graphic images will serve as proof that there's a drug epidemic we’re already fighting—not one that we haven't begun.