Abstract
BackgroundKrokodil is an informal term for a cheap injectable illicit drug domestically prepared from codeine-containing medication (CCM). The method of krokodil preparation may produce desomorphine as well as toxic reactants that cause extensive tissue necrosis. The first confirmed report of krokodil use in Russia took place in 2004. In 2012, reports of krokodil-related injection injuries began to appear beyond Russia in Western Europe and the United States.ObjectiveThis exploratory study had two main objectives: (1) to determine if Internet search patterns could detect regularities in behavioral responses to Russian CCM policy at the population level, and (2) to determine if complementary data sources could explain the regularities we observed.MethodsFirst, we obtained krokodil-related search pattern data for each Russia subregion (oblast) between 2011 and 2012. Second, we analyzed several complementary data sources included krokodil-related court cases, and related search terms on both Google and Yandex to evaluate the characteristics of terms accompanying krokodil-related search queries.ResultsIn the 6 months preceding CCM sales restrictions, 21 of Russia's 83 oblasts had search rates higher than the national average (mean) of 16.67 searches per 100,000 population for terms associated with krokodil. In the 6 months following restrictions, mean national searches dropped to 9.65 per 100,000. Further, the number of oblasts recording a higher than average search rate dropped from 30 to 16. Second, we found krokodil-related court appearances were moderately positively correlated (Spearman correlation=.506, P≤.001) with behaviors consistent with an interest in the production and use of krokodil across Russia. Finally, Google Trends and Google and Yandex related terms suggested consistent public interest in the production and use of krokodil as well as for CCM as analgesic medication during the date range covered by this study.ConclusionsIllicit drug use data are generally regarded as difficult to obtain through traditional survey methods. Our analysis suggests it is plausible that Yandex search behavior served as a proxy for patterns of krokodil production and use during the date range we investigated. More generally, this study demonstrates the application of novel methods recently used by policy makers to both monitor illicit drug use and influence drug policy decision making.
Highlights
OverviewKrokodil, otherwise known as desomorphine, is a cheap injectable drug synthesized in household kitchens from codeine-containing medication (CCM)
In the 6 months preceding CCM sales restrictions, 21 of Russia's 83 oblasts had search rates higher than the national average of 16.67 searches per 100,000 population for terms associated with krokodil
Google Trends and Google and Yandex related terms suggested consistent public interest in the production and use of krokodil as well as for CCM as analgesic medication during the date range covered by this study
Summary
OverviewKrokodil, otherwise known as desomorphine, is a cheap injectable drug synthesized in household kitchens from codeine-containing medication (CCM). In 2012, reports of horrific krokodil-related injection injuries began to appear beyond Russia in Western Europe [1] and the United States [2]. We conducted this exploratory study to determine if several complementary data sources may provide insight into the relative scale and spatial patterns of behaviors consistent with an interest in the production and use of krokodil before and after the imposition of Russian federal restrictions on CCM sales in 2012. In 2012, reports of krokodil-related injection injuries began to appear beyond Russia in Western Europe and the United States
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