Heroin & Krokodil

What is heroin? 

Heroin is a highly addictive opioid drug made from morphine, a natural substance extracted from the seed pod of the opium poppy plant. It can appear as a white or brown powder or as a sticky, black substance known as black tar heroin. 

Heroin acts quickly on the brain and central nervous system, producing intense euphoria and relaxation. However, it also slows breathing and heart rate, putting users at high risk for overdose and death. Heroin can be injected, smoked or snorted - and it is often mixed with other substances, which increases the risk of complications. 

Effects and risks of heroin use 

Heroin affects nearly every part of the body, especially the brain and lungs. 

Short-term effects may include: 

• Euphoria followed by drowsiness or confusion 
• Slow or shallow breathing 
• Nausea and vomiting 
• Constipation 
• Decreased heart rate and blood pressure 
• Itching or flushed skin 

Severe or long-term effects may include: 

• Respiratory depression and risk of coma 
• Collapsed veins and infections from injections 
• Heart lining or valve infections 
• Liver and kidney disease 
• Hypoxia (lack of oxygen to the brain), which can lead to seizures, coma or permanent brain damage 

Mixing heroin with alcohol, benzodiazepines or other opioids dramatically increases the risk of overdose. 

Heroin and fentanyl: a dangerous combination 

Many heroin overdoses in the United States now involve fentanyl, a synthetic opioid that is up to 100 times stronger than morphine.  

Fentanyl is often mixed with heroin or pressed into counterfeit pills without the user’s knowledge. 

Because even a few grains of fentanyl can be fatal, this combination has led to a dramatic rise in accidental overdoses. Fentanyl cannot be detected by sight, taste or smell. 

Signs of a fentanyl or heroin overdose include: 

• Slow or stopped breathing 
• Blue or gray lips or fingernails 
• Extreme drowsiness or unresponsiveness 
• Pinpoint pupils 

If you suspect an opioid overdose, call 911 immediately and administer naloxone (Narcan) if available. Naloxone can temporarily reverse the effects of an opioid overdose while waiting for emergency help. 

Withdrawal and long-term impact 

People who use heroin or fentanyl regularly may develop opioid use disorder (addiction) and experience painful withdrawal symptoms when they stop using. 

Withdrawal symptoms may include: 

• Strong cravings for the drug 
• Muscle and bone pain 
• Diarrhea or vomiting 
• Chills and goosebumps 
• Restlessness and insomnia 

Long-term effects can include chronic fatigue, mood disorders like depression or anxiety, and social, legal or financial problems. 

What is krokodil? 

Krokodil, also known as “Russian heroin,” is a homemade opioid called desomorphine made from codeine mixed with toxic chemicals such as gasoline or paint thinner. 

The drug’s nickname comes from the scaly, green-black skin it causes near injection sites, resembling a crocodile’s skin. 

Symptoms of krokodil use include: 

• Severe tissue damage and gangrene 
• Open sores or infections that may require amputation 
• Organ failure and death 

Krokodil is extremely toxic and often fatal within months of use. 

When to seek help 

If someone is showing signs of an overdose or is unresponsive, call 911 immediately. Do not wait. 

If you suspect heroin, fentanyl or krokodil exposure, call the Banner Poison & Drug Information Center at 602-253-3334 or your local poison center at 800-222-1222 for free, confidential help.