CVO - Addiction Research Centre, Utrecht, The Netherlands.
Int J Drug Policy. 2013 Jul;24(4):265-74. doi: 10.1016/j.drugpo.2013.04.007. Epub 2013 May 31.
Krokodil, a homemade injectable opioid, gained its moniker from the excessive harms associated with its use, such as ulcerations, amputations and discolored scale-like skin. While a relatively new phenomenon, krokodil use is prevalent in Russia and the Ukraine, with at least 100,000 and around 20,000 people respectively estimated to have injected the drug in 2011. In this paper we review the existing information on the production and use of krokodil, within the context of the region's recent social history.
We searched PubMed, Google Advanced Search, Google Scholar, YouTube and the media search engine www.Mool.com for peer reviewed or media reports, grey literature and video reports. Survey data from HIV prevention and treatment NGOs was consulted, as well as regional experts and NGO representatives.
Krokodil production emerged in an atypical homemade drug production and injecting risk environment that predates the fall of communism. Made from codeine, the active ingredient is reportedly desomorphine, but - given the rudimentary 'laboratory' conditions - the solution injected may include various opioid alkaloids as well as high concentrations of processing chemicals, responsible for the localized and systemic injuries reported here. Links between health care and law enforcement, stigma and maltreatment by medical providers are likely to thwart users seeking timely medical help.
A comprehensive response to the emergence of krokodil and associated harms should focus both on the substance itself and its rudimentary production methods, as well as on its micro and macro risk environments - that of the on-going syndemic of drug injecting, HIV, HCV, TB and STIs in the region and the recent upheaval in local and international heroin supply. The feasibility of harm reduction strategies for people who inject krokodil may depend more on political will than on the practical implementation of interventions. The legal status of opioid substitution treatment in Russia is a point in case.
卡痛叶，一种自制的可注射类阿片类药物，因其使用带来的严重危害而得名，例如溃疡、截肢和变色鳞片状皮肤。虽然卡痛叶是一种相对较新的现象，但在俄罗斯和乌克兰已经很普遍，据估计，2011 年分别有至少 10 万人和 2 万人注射过这种药物。本文将在该地区近期社会历史背景下，对卡痛叶的制作和使用的现有信息进行综述。
我们在 PubMed、Google 高级搜索、Google 学术、YouTube 和媒体搜索引擎 www.Mool.com 上搜索了同行评审文献或媒体报道、灰色文献和视频报告。还咨询了艾滋病预防和治疗非政府组织的调查数据，以及区域专家和非政府组织代表。
卡痛叶的制作是在共产主义崩溃之前出现的一种非典型的自制毒品制作和注射风险环境中产生的。它由可待因制成，据称其有效成分是去甲吗啡，但鉴于简陋的“实验室”条件，注射的溶液可能还包括各种阿片类生物碱以及高浓度的加工化学物质，这是导致这里报道的局部和全身损伤的原因。医疗保健和执法部门之间的联系、污名化以及医疗服务提供者的虐待，可能会阻碍使用者及时寻求医疗帮助。
对卡痛叶及其相关危害的全面应对措施应同时针对该物质本身及其简陋的制作方法，以及其微观和宏观风险环境，即该地区持续存在的药物注射、艾滋病毒、丙型肝炎、结核病和性传播感染的联合流行，以及当地和国际海洛因供应最近的动荡。减少卡痛叶使用者伤害的策略的可行性可能更多地取决于政治意愿，而不是干预措施的实际执行情况。俄罗斯阿片类药物替代疗法的法律地位就是一个例子。
