Editors’ choiceBreaking worse: The emergence of krokodil and excessive injuries among people who inject drugs in Eurasia
Section snippets
Introduction: the wheel of history
Russia, Ukraine and all other former Soviet countries share a long history of injection of home produced opioid and stimulant drugs that dates back to before the demise of the Soviet Union. Researchers have documented a lively and regionally varied pattern of small scale production and injection of home-made heroin (called Cheornaya in Russia and Himiya in Ukraine), methamphetamine (Vint) and methcathinone (Jeff) (e.g. Booth et al., 2008, Grund, 2002, Heimer et al., 2007a, Platt et al., 2008).
Methods
Our research strategy comprised: 1. Literature searches (search terms “krokodil,” “crocodile”, “desomorphine”,“desoxymorphine”) of PubMed, Google Scholar, Google, and the media search engine Mool.com (krokodil, desomorphine) for grey, media and academic literature pertaining to krokodil use, production and effects; 2. Consultations with relevant researchers and NGO representatives in the region to ascertain a variety of perspectives and gain access to grey and unpublished literature; 3. A video
Krokodil production
In considering the drug krokodil, two aspects are of importance, its pharmacology and its chemistry. The short half-life, limited high after the impact effect and, in particular the need for frequent administration may narrow the attention of users on the (circular) process of acquiring, preparing and administering the drug, leaving little time for matters other than avoiding withdrawal and chasing high, as reported in several popular magazines (e.g. Shuster, 2011, Walker, 2011). However, when
Discussion
A number of factors appear to have precipitated and exacerbated the use of krokodil in Russia and the Ukraine. These include changes to heroin availability, purity and price due to heroin ‘droughts’ and increased police interdiction; legislative changes targeting poppy straw and rising poverty levels in Russia since the start of the 2008 global economic crisis (Rapoza, 2012). In 2010 the total opium production in Afghanistan (the source of most of the heroin used in the Eurasian region) was 48%
Conclusion
As detailed, krokodil use is situated within a multifaceted high risk environment. This environment is comprised of a multitude of macro and micro risk factors, such as the poor chemical synthesis of the drug itself and the resulting contaminants in the drug solution injected; the home-based production environment; drug manufacture and distribution practices; the frequency of production and injection; the poverty, social marginalization and stigma experienced by many PWID; rising heroin prices;
Acknowledgements
We thank Dasha Ocheret (Eurasian Harm Reduction Network, Vilnius); Anya Sarang (Andrey Rylkov Foundation, Moscow, Russia); Natalia Dvinskykh, Liudmyla Shulga, Inna Shvab & Oksana Matiyash (ICF “International HIV/AIDS Alliance in Ukraine,” Kiev, Ukraine); David Otiashvili (Alternative Georgia, Tbilisi, Georgia); and Jana Javakhishvili (Global Initiative on Psychiatry, Tbilisi, Georgia) for their input, valuable comments and providing data on the extent and geographic spread of krokodil use in
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