On November 11, St. Louis’s KTVI reported that krokodil, a nasty opioid concoction with roots in Russia, had arrived in their town. They based that report on a case study published in the American Journal of Medicine, “Krokodil’—A Designer Drug From Across the Atlantic, with Serious Consequences,” and interviewed two of the paper’s authors, Dany Thekkemuriyil and Unnikrishnan Pillai.
The case study involved a 30-year-old man the Thekkemuriyil and Pillai said they had seen at St. Mary’s Health Center in Richmond Heights, Missouri. As the St. Louis Post-Dispatch reported a few days later:
The homemade drug nicknamed krokodil (the Russian word for crocodile) can turn users’ skin into a green and scaly texture when injected. With continued use, the drug can cause rotting skin, tissue and bone.
Desomorphine, the drug’s official name, is made by cooking prescription painkillers with contaminants such as gasoline, alcohol, paint thinner or lighter fluid. The drug produces a high similar to heroin but is much cheaper to make and more addictive.
But that American Journal of Medicine article has now disappeared.
Elsevier has added “TEMPORARY REMOVAL” in front of the paper’s title, and a notice that reads:
The publisher regrets that this article has been temporarily removed. A replacement will appear as soon as possible in which the reason for the removal of the article will be specified, or the article will be reinstated.
Elsevier tells us:
The article has been temporarily removed because of a permission problem that the originating institution is working to resolve.
“Permission problem” could mean a number of things, from a violation of patient confidentiality to whether someone else wanted to report this case study himself or herself. We’ll update with anything we learn.
In the meantime, you can read ForensicToxGuy’s demolition of the original paper here. Some of Guy’s complaints: “terrible grammar, punctuation, and sentence structure,” apparent acceptance within five days of submission, and that “No toxicology, not even a routine urine drug screen, is discussed in the manuscript.”
And note that even if the St. Louis case holds up, it’s not the first in the U.S. [Update, 7 a.m. Eastern, 12/4/13: A few commenters have noted that the Drug Enforcement Administration (DEA) also doubts those cases, which were not published in the scientific literature.]
Hat tip: David Juurlink
You can still find the manuscript:
https://docs.google.com/file/d/0B5q8aqy9Ct5-TWtxaHdqRUZPeFk/edit
No longer; I’ve unshared the file now that it’s been retracted. Apologies.
Krokodil was also the name of a Soviet-era Russian satirical magazine — think of a Soviet version of the Onion. I hope this wasn’t somebody’s idea of a joke.
According to the DEA, it is not confirmed that it has actually been seen in the US. I think by now there have been enough extraordinary drug hoaxes to require extraordinary evidence.
http://reason.com/blog/2013/11/22/dea-debunks-krokodil-sightings
Thanks, have added an update.
The last sentence of this post (re: STL not being first confirmed case and the link) is not correct. The other “case reports” have not provided confirmation and a few of them have already been proven false… there’s not been a “first” confirmed case in the US yet.
Chris is absolutely correct. There have been zero confirmed cases of Krokodil in the US, as well as the UK or Canada. This goes for biological and nonbiological substances.
Several medical toxicologists who also are involved with poison control centers throughout the countryand a research scientist in drug abuse submitted a letter to the editor disputing the article’s claim. that letter was rejected. the Editor in Chief then added his comment: Thanks for submitting this letter. The article you refer to is currently being held back because of concerns that you expressed as well as an IRB issue. If we do indeed publish this article, please resubmit your letter and I will accept it. Sincerely, Joseph Alpert. Thus they seem to still be considering its publication, despite no evidence to support the authors contentions.
Interesting, thanks for the background information Steven.
Do you know if this sort of practice is “normal” for this journal?