Thursday, October 17, 2013

Fear the Heroin, not the Krokodil

I know it is jazzier, “sexier” to put Krokodil front and center in the news these days. However, for a news outlet (CBS2) to step on a report about a community forum discussing the scourge of heroin sweeping the suburbs, seemingly to grab attention and not give useful information, is reprehensible in my way of thinking. 

Yes, talking about a drug whose name translates to crocodile as “flesh-eating” (all news outlets) and/or as a drug that turns people “into zombie-like creatures” (CNN) gets folks to tune in and buy your newspaper. But how about a little truth in reporting. Krokodil is a drug made from codeine and various “household” chemicals, including gasoline. When injected it has a high potential of destroying blood vessels in various parts of the users body, dead blood vessels equal dead skin/tissue. It does not “eat” flesh. It no more makes the user “zombie-like” than any number of other illicit and licit drugs. Krokodil use has grown in some countries where codeine is cheap and readily available, while heroin is expensive and difficult to come by. That is not the case in the US and especially not true in the Chicago area.

Krokodil may or may not be in our area. Keep in mind that having “dirty” works for injection preparation or poor injection technique can lead to blood vessel “death” just as certainly as Krokodil.

In our area heroin is cheap ($5-10 a dose), potent, and readily available. I have spoken of that many times in this blog over the years, e.g. 2008 Illicit Drug Prices and 2009 Coroner riffs on heroin deaths. Heroin deaths have shown no signs of abating and they are definitely increasing in many areas around Chicago. The heroin, available in most any neighborhood any more, is so pure you don’t have to inject it, making it oh so much easier to use. It’s purity makes it profoundly addicting as well. It is so cheap that it crowds out competing drugs.

Heroin use and abuse must be our focus, as it was yesterday, is today, and needs to be in the forseeable future. Heroin is the drug scourge locally, not some drug that makes it easier to write catchy headlines and subject teasers. Heroin is what we must fear (and work to get control of), not Krokodil.


anna said...

Thank you for posting this. I know it was a bit ago but wow did it need to be said! Also I must tell you how much I appreciate your answering questions for those that remain.

Anonymous said...

Dr Keller, I know this blog is old but I am hoping you may still be able to answer a couple of questions. My brother passed away from a heroin overdose. He was found about 18 hours after he was deceased. His morphine level in the toxicology report was 1,000 ng/ml he also had a mm6 (heroin) metabolite of 24ng/ml. Is this a extremely high level? Another question is my brother used heroin via iv injection, the last few months of his life I noticed a couple of his fingernails on his left hand (he was right handed so he would shoot into his left hand and or arm) were rotting. Could this have been an effect of the iv use in that hand/arm?

Dr. Richard Keller said...

First, my condolences.

Yes, those levels are quite high and definitely go with the opinion that your brother died of an overdose.

Regarding his fingers: It is not all that unusual for IV drug users to develop small blood clots downstream from their injection sites that will cause death to the skin and other tissues supplied by the now clogged blood vessel. The clots arise from the drugs they are injecting and the impurities in the drugs that they are injecting. They can also be caused by infection related to injecting. That would be a likely explanation for what you observed with his fingers.