“Krokodil”—Revival of an Old Drug with New Problems

Abstract

In order to summarize current knowledge about the drug “Krokodil” a systematic review including a literature search of the databases PubMed, Embase, Scopus, and Google was conducted in December 2011. According to information acquired, “Krokodil” is a mixture of several substances and was first reported to have been used in Russia in 2003. The core agent of “Krokodil” is desomorphine, an opioid-analogue that can be easily and cheaply manufactured by oneself. Self-production results in a contaminated suspension that is injected intravenously. Due to its pharmacologic features, desomorphine shows a high potential to cause dependence. Against the background of first possible cases of “Krokodil” use in Western Europe, it appears advisable to provide information regarding the fatal consequences of “Krokodil.”

RÉSUMÉ

“Krokodil” - la renaissance d'un ancien médicament à de nouveaux problèmes.

“Krokodil” est la renaissance d'un ancien médicament avec nouveaux problèmes. Pour résumer les connaissances actuelles sur la drogue “Krokodil” nous avons examiné systématiquement la littérature en Décembre 2011 qui comprenait une recherche par PubMed, Embase, Scopus et Google. D'après les informations recueillies “Krokodil” est un mélange de plusieurs substances. Le principal agent est desomorphine, un analogue opioide qui peut être fabriqué très facilement à un prix avantageux par soi-même. Le résultat est une suspension contamineuse contenant desomorphine. La suspension est appliqué par voie intraveineuse. A cause de ses caractéristiques pharmacologiques “Krokodil” a un potentiel élevé d'entraîner une dépendance. La drogue a été d'abord utilisé en Russie en 2003. A cause de premiers cas d'utilisation de “Krokodil” en Europe occidentale il faut donner des informations sur les conséquences fatales de la consommation de “Krokodil.”

MOTS CLÉS

Toxicomanie, héroïne, morphine, dépendance aux drogues, Russie

RESUMEN

“Krokodil” - renacimiento de una vieja droga con nuevos problemas.

Con el fin de resumir el conocimiento actual acerca de la droga “Krokodil” se llevó a cabo una revisión sistemática de la literatura en diciembre del 2011 que incluyó una búsqueda en las bases de datos PubMed, Embase, Scopus y Google. Según la información adquirida “Krokodil” es una mezcla de varias sustancias y fue utilizado por primera vez en Rusia en el 2003. El agente principal de “Krokodil” es desomorfina, un análogo de opiáceos y puede ser producido por uno mismo de forma sencilla y barata. El resultado de la fabricación casera es una suspensión que, además de desomorfina, contiene diferentes productos contaminantes. Se aplica por vía intravenosa y debido a sus características farmacológicas tiene un alto potencial para causar dependencia. En el contexto de los primeros posibles casos de uso de “Krokodil” en Europa Occidental nos parece aconsejable proporcionar información sobre las consecuencias fatales del consumo de “Krokodil.”

PALABRAS CLAVE

Adicción, desomorfina, heroina, morfina, dependencia de drogas, Rusia

Keywords :

• addiction
• desomorphine
• heroin
• morphine
• substance dependence
• Russia

THE AUTHORS

Maximilian Gahr, PhD, studied Medicine and Philosophy and currently works as a Resident Physician in Psychiatry at the Department of Psychiatry and Psychotherapy III, Ulm University. His main research interests are substance-associated mental disorders and psychopharmacology.

Roland W. Freudenmann, PhD, studied Medicine and currently holds positions as Senior Physician at the Department of Psychiatry and Psychotherapy III and as Assistant Professor of Psychiatry at the University of Ulm. His areas of interest include delusional disorders, clinical psychopharmacology, addiction, history of psychiatry, neuroimaging, and psychiatric emergencies.

Christoph Hiemke, PhD, studied Biology and currently holds positions as Head of Neurological Laboratory (Department of Psychiatry, University of Mainz), Head of the TDM-Group of the Arbeitsgemeinschaft für Neuropsychopharmakologie und

Pharmakopsychiatrie (AGNP), and Head of the Psiac Group for development and running of a web based Drug–Drug Interaction Program for Psychiatry (PsiacOnline: http://www.psiac.de). His research interests are clinical and experimental psychopharmacology, therapeutic monitoring of psychoactive drugs, metabolism of psychoactive drugs, drug–drug interactions, and drug transport.

Ingo M. Gunst, Dipl.-Psych., studied Psychology and currently works as a Clinical Psychologist and Psychotherapist at the Department of Psychiatry and Psychotherapy III, Ulm University. His main areas of interest are personality disorders, depression, and cognitive behavioral therapy.

Bernhard J. Connemann, PhD, studied Medicine and Mathematics and currently holds the position of Deputy Head of the Department of Psychiatry and Psychotherapy III at Ulm University. His main research interests are organic mental disorders, disorders of metabolism, clinical neurophysiology, and psychopharmacology.

Carlos Schönfeldt-Lecuona, PhD, studied Medicine and currently works as a Consultant at the Department of Psychiatry and Psychotherapy III, Ulm University. He is also senior investigator at the Neurostimulation Laboratory. His areas of interest are transcranial magnetic stimulation, electroconvulsive therapy, depression, and conversion disorder.