Breaking Worse: The Emergence of Krokodil and Excessive Injuries among People who Inject Drugs in Eurasia

Breaking Worse: The Emergence of Krokodil and Excessive Injuries among People who Inject Drugs in Eurasia

Addiction Research Centre, Utrecht, NL;
Department of Addictology, Charles University, Prague, CZ;
Global Health Research Center of Central Asia, Columbia University, New York, USA;
Centre for Research on Drugs and Health Behaviour, London School of Hygiene & Tropical Medicine, UK.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

ABSTRACT

Full report: CLICK HERE >>>

 Background

Krokodil, a homemade injectable opioid, gained its moniker from the excessive harms associated with its use, such as ulcerations, amputations and discolored scale-like skin. While a relatively new phenomenon, krokodil use is prevalent in Russia and the Ukraine, with at least 100,000 and around 20,000 people respectively estimated to have injected the drug in 2011. In this paper we review the existing information on the production and use of krokodil, within the context of the region's recent social history.

Methods

We searched PubMed, Google Advanced Search, Google Scholar, YouTube and the media search engine www.Mool.com for peer reviewed or media reports, grey literature and video reports. Survey data from HIV prevention and treatment NGOs was consulted, as well as regional experts and NGO representatives.

Findings

Krokodil production emerged in an atypical homemade drug production and injecting risk environment that predates the fall of communism. Made from codeine, the active ingredient is reportedly desomorphine, but – given the rudimentary ‘laboratory’ conditions – the solution injected may include various opioid alkaloids as well as high concentrations of processing chemicals, responsible for the localized and systemic injuries reported here. Links between health care and law enforcement, stigma and maltreatment by medical providers are likely to thwart users seeking timely medical help.

Conclusion

A comprehensive response to the emergence of krokodil and associated harms should focus both on the substance itself and its rudimentary production methods, as well as on its micro and macro risk environments – that of the on-going syndemic of drug injecting, HIV, HCV, TB and STIs in the region and the recent upheaval in local and international heroin supply. The feasibility of harm reduction strategies for people who inject krokodil may depend more on political will than on the practical implementation of interventions. The legal status of opioid substitution treatment in Russia is a point in case.

File Name: Dit is een leeg document.pdf

Related documents

What lessons from the Dutch Experience can be applied.
What lessons from the Dutch Experience can be applied.

van de Wijngaart, G. (1989). What lessons from the Dutch Experience can be applied. British Journal of Addiction, 84, 990-992.

Netherlands cannabis policy
Netherlands cannabis policy

Ossebaard, H. C.

The Lancet, 347, 1996

De weg naar een internationaal drugbeleid.
De weg naar een internationaal drugbeleid.

van de Wijngaart, G. (1987). De weg naar een internationaal drugbeleid. Maandblad Geestelijke volksgezondheid, 42, 1383-1388.

The Netherlands
The Netherlands

van de Wijngaart, G. F., S. Barber. (1992). The Netherlands. In S. B. MacDonald, B. Zagaris (Ed.), International handbook on drug control. Westport/London: Greenwood Press.

A fault confessed is half redressed - the disease model of addiction.
A fault confessed is half redressed - the disease model of addiction.

van de Wijngaart, G. F., B.K. Alexander, H.C. Ossebaard, C. Lewis. (1993c). A fault confessed is half redressed - the disease model of addiction. Paper presented at the 4th International Conference on the reduction of drug related harm, Rotterdam.

A social history of drug use in the Netherlands: Policy outcomes and implications.
A social history of drug use in the Netherlands: Policy outcomes and implications.

van de Wijngaart, G. (1988f). A social history of drug use in the Netherlands: Policy outcomes and implications. Journal of Drug Issues, 18(481-495).

Zoek naar rapporten

Please publish modules in offcanvas position.

Free Joomla! template by L.THEME | Documentation