No drugs tested as suspected Krokodil have contained desomorphine, the intoxicating agent in the mixture. Krokodil is not believed to have left Russia, where it is used only by poor people and in rural areas where heroin is not available.  Most users have self-manufactured the drug from codeine.  It is the impurities from the manufacture that cause the distinctive flesh deterioration.

According to the DEA and its sister agencies in Canada and the UK, there are no known cases in the West involving skin, blood or bone infections that can be attributed to anything but the usual sources: poor sanitation on the part of injection drug users.

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