Krokodil...not so fast, my friends!

The Infamous Krokodil

Well, look at this…

http://www.amjmed.com/article/S0002-9343(13)00879-6/abstract

The krokodil paper that was published online in the American Journal of Medicine has been withdrawn “temporarily” online.  It is definitely an interesting turn of events. Many scientists, including me, had questions when this paper was originally published online.  Let’s go through a very brief list of observations and questions that other scientists (and I)had after review of the originally accepted manuscript:

1.       The manuscript consisted of terrible grammar, punctuation, and sentence structure. Was this manuscript not proofread during review?

2.       The manuscript was received on September 19^th, revised on September 24^th, and accepted for publication on the very same day (September 24^th).  If you consult the calendar, that is 3 business days from receipt of manuscript to revision to acceptance.  Highly unusual! Did the quick turnaround on the manuscript lead to errors during the review process? Was the review process really even effective?

3.       The drug is described as “flesh eating”. This is not accurate and I would expect highly trained physicians to accurately describe a drug and its effects in scientific literature. The drug, desomorphine or its derivatives, does not cause the necrotic effects.  The usage of this sensationalism is merely perpetuating the media hysteria around this drug.

4.       The manuscript states that the drug is spreading rapidly around Europe. There is no scientific evidence to this claim.  And actually, there is no evidence for the drug outside of some Russian countries.

5.       A TIME article is cited as a scientific reference. Since when did an online magazine article become a scientific resource on the emergence of drugs in society?  Is it peer-reviewed? No, I don't think so.

6.       No toxicology, not even a routine urine drug screen, is discussed in the manuscript.  Major flaw!  Was there even an opiate detected in this patient's biological specimens?

7.       The authors conclude that because opiates are prevalent in the USA, krokodil will find its place among drug users.  This is a baseless claim. Krokodil use in the USA is illogical for many reasons, including  the prevalence of cheap heroin, the prescription controls on codeine, the prevalence of other prescription opioids, harm reduction programs such as clean needle programs, as well as the prevalence of treatment programs using methadone and buprenorphine.  That's not to say that some drug user would try to home-brew some krokodil - never say never when it comes to drug users, but it is simply illogical.  And to say anything else is absurd.

I’m sure there will be more to report on this paper withdrawal.

Until then, there is still NO (zero, nil, zilch, nada, none) evidence that supports krokodil is here in the United States.

I'll followup when there is more information available.

Cheers,

ForensicToxGuy