"Krokodil" is the street name for the homemade injectable mixture that has been used as a cheap substitute for heroin. Its use begun in Russia and Ukraine and nowadays is being spread over several other countries. Desomorphine is the semi-synthetic opioid claimed to be the main component of krokodil and considered to be responsible for its psychoactive characteristics. The starting materials for desomorphine synthesis are codeine tablets, alkali solutions, organic solvent, acidified water, iodine and red phosphorus, all of which are easily available in retail outlets, such as supermarkets, drugstores, etc. The resulting product is a light brown liquid that is called krokodil. People who inject krokodil present a great variety of serious signs and symptoms, including thrombophlebitis, ulcerations, gangrene, and necrosis, quickly evolving to limb amputation and death. These effects are thought to result from the toxic components produced as byproducts during the homemade drug synthesis. 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.

Center of Medical Chemistry Porto Portugal

Department of Analytical Chemistry Chemistry Institute Fluminense Federal University Niterói Brazil

Department of Legal Medicine and Forensic Sciences Faculty of Medicine University of Porto Porto Portugal; REQUIMTE Laboratory of Toxicology Department of Biological Sciences Faculty of Pharmacy University of Porto Porto Portugal; EPSJV Polythecnical School of Health Joaquim Venâncio Oswaldo Cruz Foundation Rio de Janeiro Brazil

Department of Legal Medicine and Forensic Sciences Faculty of Medicine University of Porto Porto Portugal; REQUIMTE Laboratory of Toxicology Department of Biological Sciences Faculty of Pharmacy University of Porto Porto Portugal; IINFACTS Institute of Research and Advanced Training in Health Sciences and Technologies Department of Sciences Advanced Institute of Health Sciences North CESPU CRL Gandra Portugal

DoA CUNI Addiction Research Centre Utrecht The Netherlands; Department of Addictology 1st Faculty of Medicine Charles University Prague and General University Hospital Prague Prague Czech Republic

REQUIMTE Laboratory of Toxicology Department of Biological Sciences Faculty of Pharmacy University of Porto Porto Portugal

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