Although law and drug enforcement agencies in the United States are skeptical about the spread of krokodil in America, in Russia, the threat of the potent, heroin-like drug is very real.
Italian photographer Emanuele Satolli spent the last year in Russia documenting the lives of krokodil addicts in Yekaterinburg, and captured chilling footage from inside a krokodil cookhouse.
The three-and-a-half-minute video produced for Time, which has been covering the spread of krokodil since 2011, tells the story of "Zhanna," a krokodil addict who has survived by learning to prepare the drug without using the impurities that give the drug its deadly reputation.
"I can survive and am able to maintain my habit because I am a good cook and people call me to cook," Zhanna says in the video. "Those who cooked when I first started using [krokodil], they've all died. After all the friends I have buried... nothing scares me anymore. You keep shooting up."
Krokodil is made from crushed codeine pills cooked with household chemicals. The impurities in the chemicals damage a user's veins when injected, causing green, scaly sores to develop. The flesh ultimately mortifies and rots off the bone.
Krokodil reached its peak in Russia in 2011, before new laws made over-the-counter codeine harder to get. Yet, the availability of codeine and the relative scarcity of heroin in that country makes krokodil a much cheaper alternative.
Many drug enforcement and medical experts think that the clandestine drug economy in the United States is stacked against krokodil.
"Relatively accessible and inexpensive alternatives, such as heroin, make krokodil production and use in the United States highly unlikely," Dr. Michael Lynch, medical director of the Pittsburgh Poison Center, told The Huffington Post in an email Thursday. "Krokodil use in Russia is likely related to the availability of non-prescription codeine in conjunction with the relative inaccessibility and cost of heroin and alternative opioids in that country."
Although data from the Drug Enforcement Administration shows two cases of desomorphine, the drug known by the street name "krokodil," in 2004, no other reports of the substance have been confirmed in the United States since then, despite numerous purported cases.
Krokodil skeptics think the telltale gangrenous sores on drug users who claim to have injected krokodil could be the result of dirty needles.
"We see IV drug users with horrible infections on a daily basis," Oklahoma Bureau of Narcotics spokesman Mark Woodward told The Huffington Post in October. "Infections from bacteria and dirty needles -- that doesn't mean it's [krokodil]."