Krokodil withdrawal and detox is a complicated process but is manageable with professional care.
The terms withdrawal and detox are often used interchangeably, but in addiction treatment, they have subtle differences in meaning.
- Krokodil withdrawal refers to the psychological and physiological process that the body experiences as it re-adjusts to not having a constant supply of krokodil. Withdrawal can refer to physical symptoms like nausea, vomiting or tremors. Withdrawal also refers to psychological symptoms like cravings, depression, and anxiety that accompany the cessation of substance use.
- Krokodil detoxification, or detox, refers to the removal of krokodil from the body. Removing krokodil is accomplished by first stopping usage, and second by organs like the liver, kidney or skin (via sweat).
Withdrawal usually begins after the initial detox phase, but for a person with chronic krokodil abuse, withdrawal can begin before as krokodil cravings occur before they complete detox.
Krokodil withdrawal can be divided into two phases, initial and chronic.
- The initial withdrawal phase lasts about 12 hours, and usually includes temperature instability, nausea, vomiting, anxiety, and agitation. These symptoms are typically intense and contribute to cravings and drug-seeking behaviors.
- Chronic withdrawal begins after the acute phase and can last anywhere from days to months, depending on the level of krokodil abuse.
Krokodil Withdrawal Symptoms
Krokodil withdrawal has many of the same symptoms as opiate withdrawal, including:
- Hot and cold sweats
- Muscle cramping
- Drug cravings
How Long Krokodil Withdrawal Lasts
The half-life of krokodil is short, but since krokodil (or desomorphine) is not well studied, data about how long it stays in the body is scarce. Half-life is a measure of how much time it takes for half of a drug to clear from your body. Krokodil has a half-life of about 60-120 minutes. For comparison, the half-life of heroin (diamorphine) is about three to five minutes.
When thinking like a pharmacist, the rule of thumb for how long it takes a drug to leave the body completely is about five half-lives. So, while heroin clears from the body in about 15-30 minutes, krokodil sticks around for five to 10 hours, which probably delays the effects of acute withdrawal, compared to heroin. A krokodil withdrawal timeline probably begins between 12-24 hours after the last dose and may continue for weeks to months, depending on the level of abuse.
Krokodil Withdrawal Medications
The approach to treatment for krokodil withdrawal is multi-faceted and can either involve treatment of the symptoms or delay of withdrawal. The latter is an important treatment for pregnant women, as abrupt withdrawal can lead to miscarriage, and it is healthier for the mother and baby to participate in medically assisted withdrawal.
Krokodil withdrawal symptoms and their respective remedies may include:
- Ondansetron and promethazine for nausea: Ondansetron and promethazine are commonly prescribed for nausea and vomiting. The former is preferred for delayed nausea and vomiting, while the latter better treats acute symptoms.
- Selective serotonin reuptake inhibitors (SSRIs) for anxiety: These are topically first-line remedies but may take several weeks to work, so are only useful for chronic withdrawal symptoms. It is unlikely that benzodiazepines would be prescribed for withdrawal symptoms since they have abuse potential.
- Loperamide for diarrhea: One of the most common withdrawal symptoms and it is treated with loperamide (Imodium). Loperamide is an opiate that does not absorb into the body, so it is useful for opiate-related diarrhea.
- Clonidine for drug cravings: Clonidine can be used to help suppress cravings during acute withdrawal.
Krokodil Withdrawal Deaths
Withdrawal from krokodil can (and has) lead to death from both withdrawal symptoms and from the serious skin infections that result from the use of krokodil. Since it is made with toxic chemicals, like acetone (paint thinner) and gasoline that are not removed prior to sale, injecting krokodil often leads to dry and scaly patches of dead skin. These skin patches are called necrosis, which is where krokodil gets its name.
When patches of skin die and fall off muscle and bone, they become infected and can lead to amputation or death. Krokodil is unique among other opiates because its use creates more dangerous withdrawal symptoms than those involved in typical opiate withdrawal.
Note, however, that skin infections can also occur after only one or two uses of krokodil and may happen before withdrawal even begins.
Krokodil Withdrawal Cold Turkey
Attempting to detox cold turkey (or stop using it suddenly) from krokodil is dangerous and can lead to serious illness or death. In addition to the skin infections associated with krokodil withdrawal, opiate withdrawal, in general, is often accompanied by severe vomiting and diarrhea. These withdrawal symptoms can lead to severe dehydration if left untreated.
For these reasons, it is not recommended to detox from krokodil cold turkey. Seek medical attention immediately for krokodil withdrawal symptoms.
Krokodil Withdrawal Tips
There are several important considerations with krokodil withdrawal.
- See a medical professional: Krokodil withdrawal is not something to be attempted alone. A medical professional can help mitigate withdrawal symptoms and provide much-needed monitoring support.
- Stay hydrated: If a person remembers only one tip, staying hydrated should be it. Dehydration has deadly consequences, and opiate withdrawal involves severe vomiting and diarrhea that robs the body of hydration.
- Get good rest, eat well and exercise: It is important to maintain as many healthy habits as possible to help the body readjust and normalize itself.
Krokodil detox happens on its own via the body’s natural metabolic mechanisms. The liver will do most of the work clearing krokodil, but the kidneys, intestines, and skin help clear the drug as well.
The detox process is not one that a person can speed up or slow down. Coffee will not speed up the process, and nor will taking other drugs help. Detox must happen with time, and based on the half-life of krokodil, it should clear from the body within five to 10 hours, but can take longer, depending on how much krokodil was in the body.
Krokodil is highly lipophilic, which means absorbs well into fat tissue, and can store in fat for long periods of time. It can slowly release into the bloodstream, prolonging the detox process. Therefore, the actual period of detox is unpredictable and may last much longer than a day or two.
While the body naturally cleanses itself of krokodil, the safest way to detox from krokodil is with the help of doctors and clinicians in a medical detox program at a rehab center like The Recovery Village.
Krokodil Detox at Home
Since krokodil often causes severe skin infections, it is not a good idea to attempt detox at home.
Krokodil detox comes with intense cravings and when the drug begins to leave the system, the pain from a skin infection may be intense, amplifying cravings. Untreated skin infections can lead to amputation, sepsis, and death. Otherwise, just stopping krokodil will trigger the detox process as the body begins to clear it over the next several days.
Detoxing from krokodil at home is not safe and not recommended. Seeking help at a rehab center like The Recovery Village can help anyone avoid potentially life-threatening withdrawal symptoms and heal in a safe, supportive environment.
Helping Someone Who Is Detoxing From Krokodil
Someone detoxing from krokodil will need both medical and psychiatric support. For this reason, it’s important to not detox from krokodil alone or at home and to seek rehab care instead.
It is important to also identify any open wounds or sores and encourage the person to seek medical care. To facilitate this healing, remind the person that you are concerned for their health and safety, and that you are there to support them in any way you can.
To help the person, you can also:
- Offer to call a rehab center for them
- Offer to drive them to the doctor or a treatment facility
- Remind them that addiction is a disease that deserves professional care
- Help them monitor their withdrawal symptoms
- Offer to stay with them during withdrawal, if they are at home
- Be ready to call 911 if symptoms worsen
Finding a Krokodil Withdrawal and Detox Center
If you or someone you know would like to detox from krokodil safely, seek medical help if you can. Information and treatment can be found from your primary care provider, urgent care clinic, local emergency departments, or addiction treatment centers like The Recovery Village. It is important to get help with this process.
To find treatment options for krokodil addiction, you can:
- Search recovery resources by zip code
- Use the treatment locator map from the Substance Abuse and Mental Health Services Administration
- Call The Recovery Village
If you or someone you know needs treatment for krokodil abuse or addiction, The Recovery Village can help. We have facilities located across the country and offer comprehensive treatment programming tailored to each client’s unique needs. To take the first step toward recovery, call The Recovery Village today.
Minns, Alicia. “Krokodil.” California Poison Control System, September 2014. Accessed 19 April 2019.
M, Leesa. “Acute Opioid Withdrawal: Identificati[…]tment Strategies.” U.S. Pharmacist, November 2016. Accessed 19 April 2019.
National Center for Biotechnology Information. “Withdrawal Management.” Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings, 2009. Accessed 19 April 2019.
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