How do u make krokodil

Krokodil causes serious damage to the veins and soft tissue infections, rapidly followed by gangrene and necrosis, according to a study PDF. The soft tissue damage happens around the injection site. The drug also seems to clump in the veins as it fails to dissolve completely in the blood.

The clumps make their way to distant places in the body and start to damage tissue, said Dr. Robert Geller, medical director of the Georgia Poison Center. Geller said he hopes the drug "doesn't show its ugly face" in Georgia but said doctors across the country are aware of the drug.

So far there are no officially confirmed American cases of krokodil abuse. To have official confirmation, the Drug Enforcement Administration would need to have a sample of the drug that caused the problem. A DEA fact sheet about the drug released this month said the National Forensic Laboratory Information System, the DEA database that collects scientifically verified data on drug items and cases, identified two exhibits submitted to these labs as desomorphine in but none since then. Skin sloughs off at the injection site, often exposing the bone below.

The ill effects of Krokodil are not limited to localized injuries and include pneumonia, sepsis, meningitis, osteomyelitis and osteonecrosis, neurologic injury such motor and memory impairment , ulceration and tissue damage at sites distant from the injection site, liver injury, renal impairment and death.

These complications occur shortly after Krokodil is injected. Present accounts often involve young individuals presenting to Emergency Departments with severe complications. Additionally, practices common to homemade drug production are known to potentiate blood-borne virus transmission such as HIV and hepatitis C. The short duration of action about 1. High concentrations of iodine in the injected solution disrupt the endocrine system, causing thyroid disorders, while high concentrations of heavy metals cause central nervous system effects such as speech and motor impairment, poor memory and concentration.

Jaw osteonecrosis, which is resistant to medical treatment, can develop in the maxillofacial region in users due to red phosphorus contamination.

Because of the high degree of contamination with different toxic chemicals, which vary among users, scientific analysis of the chemical composition is not available. Desomorphine can be detected in blood samples within a couple of hours and in urine samples within days after Krokodil administration. Routine testing in the acute clinical setting is not typically available. Diagnosis is therefore based on the history provided by the patient as well as the clinical presentation.

Although extensive tissue damage is typically described, this can also be seen in patients who develop skin and soft tissue infections from heroin use. In chronic Krokodil users, it may be worthwhile screening for heavy metal poisoning given the contamination during the manufacture process.

In regions where Krokodil use is problematic, poor access to proper health care may exacerbate the described complications. Medical help is reportedly only sought after during the late stages of tissue injury and may end with severe mutilation, amputation and death.

If someone seeks care, extensive wound care and IV antibiotics is typically indicated. In many cases, amputation is the only solution. Existing reports have emphasized the high potency of desomorphine and the need for frequent redosing, resulting in binge patterns that can last over days. During these binges, sleep deprivation, poor hygiene, and malnutrition places users at risk for further complications. Variations in potency of desomorphine places users at increased risk of overdose. Treatment must consider not only the local tissue destruction that occurs, but also the distant tissue injury and multi-system organ damage that can occur.

In the setting of respiratory depression, naloxone 0. In this work, we reviewed several aspects of krokodil use, including its epidemiology, pharmacology and the chemical properties of the main active ingredient desomorphine. To enhance our understanding of the clinical and toxic effects and to support the implementation of harm reduction measures, we also describe the "bathtub chemistry" of krokodil and the content of the final solution.

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