By Tristan Reed and Rebecca Keller
Recent months have seen a surge in U.S. media coverage of a highly dangerous and addictive illicit synthetic drug known as Krokodil. Since U.S. media outlets first began reporting on domestic cases of Krokodil use in September 2013, coverage has focused on the particularly damaging effects of the drug on the human body and its rapid spread in Russia since its introduction in 2002. The drug's damaging side effects can include decaying flesh, which at times can appear green and scaly, giving it its name. ("Krokodil" is Russian for "crocodile.")
Use of the intravenously administered drug grew rapidly in Russia over the past decade as a cheaper alternative to heroin, leading to lurid coverage of its shocking effects. Such coverage has provoked fears North America will also see widespread use of the drug. While we do expect to see isolated cases of Krokodil abuse in the United States, the economics of the illegal drug trade in the Western Hemisphere are not the same as they were in Russia a decade ago. Ultimately, market conditions in the United States will likely prevent Krokodil from endangering public health on the same scale as cocaine, methamphetamine, heroin or the nonmedical use of prescription drugs.
Krokodil and Desomorphine
Krokodil's desired active ingredient, desomorphine, is synthesized from codeine. Desomorphine, a potent opioid first patented as a painkiller in the 1930s, can be produced in a laboratory environment via a chlorinated codeine derivative (alpha-chlorocodide) followed by a catalytic reduction and demethylation. On the streets, producers employ a technique requiring less technical know-how to extract codeine (using ingredients like gasoline and hydrochloric acid) from readily available pharmaceuticals, then combine the isolated codeine with iodine and red phosphorus to produce a mixture that contains a variable amount of desomorphine. Several other compounds emerge as byproducts during the latter process; incomplete purification means many toxic reactants often remain in the final product mixture. Krokodil refers to the final product mixture from the crude synthesis, not to laboratory-grade desomorphine.
As an alternative to heroin for drug addicts, Krokodil was well-positioned for the Russian market, where demand for heroin is particularly high. According to the 2010 World Drug Report by the U.N. Office on Drugs and Crime, an estimated 70 metric tons of heroin were consumed in Russia in 2008 compared to 22 metric tons in the United States and Canada combined. Until June 2012, codeine was easily obtainable in Russia in over-the-counter medications. Given its widely available precursors and relatively easy production, Krokodil costs substantially less than heroin in Russia. According to a 2012 report in the International Journal of Drug Policy, 120 rubles ($3.62) worth of over-the-counter codeine yields enough desomorphine to substitute 500 rubles worth of heroin in Russia, meaning heroin addicts could feed their habit for approximately a quarter of the cost.
Krokodil has several significant differences from heroin for drug addicts besides a potentially quicker high and more intense withdrawal. Many of the contaminants from the illegal synthesis can quickly destroy the tissue of the user; it is this combined with shared and used hypodermic needles (a danger present in all IV drug abuse) that produce its characteristic visually frightening health effects. Internally, Krokodil's precursors can damage vital systems and organs, further increasing vulnerability to infection. Solvents such as gasoline or paint thinner used to isolate codeine from the initial step can be corrosive to human tissue if still present in the final mixture. Finally, the Krokodil mixture is often acidic, increasing the likelihood of tissue damage.
Despite these reported health effects, Krokodil use in Russia has grown since its first appearance. According to some estimates, Russia had one million users by 2010. This rapid growth has given rise to fears the drug could similarly spread in North America.
Limitations on Krokodil in North America
Reports of Krokodil use first emerged in the United States and Mexico within the past few months, generating increased media coverage in both nations. Sonoran officials in Nogales reported Jan. 9 that a man had checked himself into a hospital for addiction to the drug. A week earlier, a woman sought admission to a hospital in Puerto Vallarta, Jalisco state, for genital lesions that reportedly occurred after she injected Krokodil. According to a Mexican medical official specializing in drug abuse, the woman stated she had been using Krokodil in Houston prior to her trip to Mexico. A third incident of Krokodil abuse in Mexico was previously reported in Baja California state.
As with the recent example in Puerto Vallarta, reports of Krokodil use in the United States all originated after users sought admission to drug rehabilitation clinics or hospitals. Besides these anecdotal accounts, there is little data confirming the presence of Krokodil in North America. This limited number of reported cases indicates the drug is not widely used in North America at this time.
U.S. media outlets frequently portray Krokodil as a cheaper, more easily obtained replacement for heroin capable of taking root North America. Though true in Russia, this is not the case in North America. Krokodil is attractive primarily to those already addicted to opioids with limited available options, whether due to cost or supply issues, to appease their intense addictions. Increased Western media coverage of Krokodil including images of decaying flesh and limbs has spread awareness of the drug's potential physical effects in the United States, making drugs with less visually disturbing effects such as heroin or prescription painkillers more attractive to potential drug users.
More important, unlike in the United States, in Russia codeine was previously available over the counter (and is still available through black market pharmacies), heroin addiction was particularly rampant, and the intravenous use of illicit drugs was fairly common. The conditions permitting and promoting increased demand for Krokodil that existed in Russia simply don't exist in the United States, nor do the conditions permitting its widespread production. And while Krokodil may be the poor man's heroin in Russia, black tar heroin already fills that role in the United States thanks to Mexican cartels, which would be the likely large-scale suppliers to the United States were there a market for Krokodil.
Supply, Demand and Mexican Drug Traffickers
As with any commodity, supply and demand dictate the price and availability of illegal drugs. And given that the United States has the highest demand for many illicit drugs in the Western Hemisphere, the illicit drug market in the United States plays a critical role in shaping the behavior and business strategy of drug-trafficking organizations in the region. According to the U.S. Department of Health and Human Service's 2012 National Survey on Drug Use and Health, 335,000 U.S. citizens reported they had used heroin during 2012 and more than 2.1 million reported nonmedical use of prescription pain relievers. To a drug trafficker, these figures justify the risk of supplying the United States with illicit opioid drugs, particularly heroin.
Mexico's transnational criminal organizations, commonly referred to as cartels, are intimately aware of the demand for illicit drugs in the United States. Geography gives them control over the ability of criminal organizations in other countries to supply the U.S. market. Mexican organized criminal groups have continued to expand their operations up and down the supply chain of illicit drugs. They have increased their share of the drug market by continually increasing the production of illicit drugs, such as methamphetamine and heroin, while expanding into South America for a share of the cocaine supply chain.
The adaptation of drug traffickers — particularly those based in Mexico — to supply and demand forces governing the methamphetamine trade in the United States provides an interesting case study. Recreational use of methamphetamine surged in the United States during the 1990s thanks to the relative ease of production using a method similar to how Krokodil is made in Russia. But ever-tightening regulations of methamphetamine precursors (specifically pseudoephedrine and ephedrine) by national governments around the world and law enforcement pressure have increased the cost and difficulty of domestic production in the United States. Mexican criminal organizations soon found a competitive advantage in profiting off U.S. demand for methamphetamine by moving greater resources to manufacturing, expanding their access to more precursor markets and enjoying much less pressure from law enforcement. Furthermore, the criminal organizations are capable of mass production via more advanced chemical synthesis, sidestepping the need for some precursors once widely used in domestic production in the United States.
Were there demand for Krokodil in the United States, cartels would likely initiate the mass production of the illicit drug along the lines that they expanded methamphetamine production. Mexican cartels have access to opium poppies cultivated in Mexico and to pharmaceutical and industrial chemicals. Indeed, Mexican cartels could synthesize desomorphine from the opium poppies already cultivated for heroin and opium or from pharmaceutical ingredients using the traditional, cleaner laboratory synthesis — limiting the contaminants that gave Krokodil its name and cause its undesirable effects. (Codeine occurs in opium poppies, but represents 3 percent on average of the opium mixture compared to 8-19 percent for morphine. Because of this, commonly produced synthetic codeine would likely be the starting material for any large-scale desomorphine synthesis.)
But to want to do this, the cartels would need an economic incentive. Thus, the potential market value of Krokodil would have to outweigh the costs. Demand in the United States will continue to favor alternatives, and the opportunity cost of producing Krokodil would direct the cartels to cheaper, more profitable alternatives like black tar heroin. With black tar heroin and other drugs widespread and relatively inexpensive in the United States, current economic conditions dictate that Krokodil use in the United States will remain sporadic.
