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Desomorphine

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Desomorphine

Desomorphine (or in some formulations known as Krokodil) is a semi-synthetic opioid commercialized by Roche, with powerful, fast-acting effects, such as sedation and analgesia. It was first discovered and patented in Germany by a German team working for Knoll in 1920 but was not generally recognized. It was later synthesized in 1932 by American chemist Lyndon Frederick Small. Small also successfully patented it in 1934 in the United States. Desomorphine was used in Germany, Austria, and Switzerland under the brand name Permonid and was described as having a fast onset and a short duration of action, with relatively little nausea compared to equivalent doses of morphine. Dose for dose it is roughly ten times more potent than morphine, with 1 mg desomorphine being equivalent 10 mg morphine, via the intravenous (IV) or intramuscular (IM) routes.

Desomorphine is a morphine analogue where the 6-hydroxyl group and the 7,8 double bond have been reduced. The traditional synthesis of desomorphine starts from α-chlorocodide, which is itself obtained by treating codeine with thionyl chloride. By catalytic reduction, α-chlorocodide gives dihydrodesoxycodeine, which yields desomorphine on demethylation.

A desomorphine product, usually based on codeine, has been developed as a recreational drug. The product in question is typically a highly impure variant of desomorphine. The scaly sores and necrosis that develop around the injection site has prompted the name krokodil (Russian for crocodile).

Desomorphine was previously used in Germany, Austria, and Switzerland for the treatment of severe pain. While medical usage of desomorphine was terminated in 1981, during the final years leading up to that it was being used to treat a single patient in Bern, Switzerland with a rare illness. While desomorphine was found to be faster acting and more effective than morphine for the rapid relief of severe pain, its shorter duration of action and the relatively more severe respiratory depression produced at equianalgesic doses, as well as a high incidence of other side effects such as hypotension and urinary retention, were felt to outweigh any potential advantages.

Desomorphine abuse in Russia attracted international attention in 2010 due to an increase in clandestine production, presumably due to its relatively simple synthesis from codeine available over the counter. Abuse of homemade desomorphine was first reported in Siberia in 2003 when Russia started a major crackdown on heroin production and trafficking, but has since spread throughout Russia and the neighboring former Soviet republics.

The drug can be made from codeine and iodine derived from over-the-counter medications and red phosphorus from match strikers, in a process similar to the manufacturing of methamphetamine from pseudoephedrine. Like methamphetamine, desomorphine made this way is often contaminated with various agents. The street name in Russia for homemade desomorphine is krokodil (Russian: крокодил, crocodile), possibly related to the chemical name of the precursor α-chlorocodide, or the resemblance of the skin damage caused by the drug to a crocodile's leather. Due to difficulties in procuring heroin, combined with easy and cheap access to over-the-counter pharmacy products containing codeine in Russia, use of krokodil increased until 2012. In 2012 the Russian federal government introduced new restrictions for the sale of codeine-containing medications. This policy change diminished but did not extinguish krokodil use in Russia. It has been estimated that around 100,000 people use krokodil in Russia and around 20,000 in Ukraine.[needs update] One death in Poland in December 2011 was also believed to have been caused by krokodil use, and its use has been confirmed among Russian expatriate communities in other European countries. In 2013 two cases of Krokodil use were reported in the United States. A single case of desomorphine use was reported in Spain in 2014, with the drug consumed orally rather than by injection. There are reports of krokodil use in the United Kingdom.

Animal studies comparing pure desomorphine to morphine showed it to have increased toxicity, more potent relief of pain, higher levels of sedation, decreased respiration, and increased digestive activity.

Illicitly produced desomorphine is typically far from pure and often contains large amounts of toxic substances and contaminants as a result of the drug producers neglecting to remove highly toxic reactants and solvents left over from synthesis. This neglect could be due to the producers having a limited understanding of chemistry or as a way to avoid the costs of extracting the toxic material. Injecting any such mixture can cause serious damage to the skin, blood vessels, bone, and muscles, sometimes requiring limb amputation in long-term users. This highly impure product may have received the name of krokodil due to the dire effects of the body which can readily be noticed.

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