On the challenges of studying suicide

Nature has an important article on why virtually no-one is trying to develop treatments to prevent suicide because research with such high-risk patients is almost impossible to get approved.

Most psychiatric drug trials today—the majority of which are industry sponsored—exclude anyone expressing thoughts of suicide. This is for ethical as well as practical reasons: physicians consider it taboo to give people on the brink of suicide an experimental drug, let alone a placebo, if other options are available, and many additional safety precautions are required to run trials in this vulnerable population. To complicate matters, few mental health experts are trained in how to conduct suicide research, and those who do are often afraid of lawsuits.

As a result, institutional review boards aren’t always so amenable to this kind of high-risk research. “It takes forever to get anything approved to do suicide prevention research, and it’s incredibly frustrating,” says Marjan Holloway, a clinical psychologist who is running clinical trials with suicidal military personnel at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. Kate Comtois, a psychologist at the University of Washington in Seattle who has run psychotherapy trials in people with borderline personality disorder (BPD), expresses a similar concern. “I hear many stories from other institutions where people have basically given up recruiting high-risk patients because their institutional review boards are so cautious that they throw up roadblocks,” she says.

Suicide research also suffers from a practical problem related to the development of risk-assessments.

Normally, if I want to develop a way of predicting who will develop depression or not, I can assess a group of people and I can return later and see whether my predictions were right or not.

If I do the same with a suicide assessment and it suggests that several people are at high-risk of suicide, I have a moral duty to intervene and help them.

What complicates the issue is that this often applies regardless of the quality of my assessment. In other words, imagine that my suicide assessment is useless but I don’t know it – I will still intervene.

This means it’s often hard to get the assessment ‘off the ground’ in terms of its testing and development and this is why most scales are based on research looking at less serious outcomes, like having suicidal thoughts, that aren’t a very good predictor of whether someone will actually try to kill themselves or not.

This is also one reason why ethical review boards, and indeed researchers, are reluctant to get involved in this research.

Who wants to be known as someone who had several patients kill themselves during a trial to test an experimental form of suicide prediction? Despite the fact that, actually, virtually all the established scales are equally as ‘experimental’ due to lack of data.

The Nature article does a fantastic job of tackling these delicate issues and highlighting the need for better research on a crucial issue.

Link to Nature article ‘The Ultimate Endpoint’ (via @Neuro_Skeptic)

Inside The Ailing Brain

The Ailing Brain is a fantastic documentary series on the brain and its disorders that’s freely available online. It has been produced in Spanish but the first part is now on YouTube with English subtitles.

The series is among the best neuroscience documentary series I have even seen (along with Susan Greenfield’s Brain Story – made before she lost the plot) with the first part tackling the science and effects of neural implants.

If you see nothing else, go to 6:10 to watch what happens when a patient with an implanted deep brain stimulation device to treat Parkinson’s Disease switches off the machine. It’s an amazing sight.

But if you’ve got 20 minutes, you’d be very well advised to take some time to watch the whole episode as it’s both wonderfully produced and utterly compelling.

There are three programmes so far although the second and third haven’t been subtitled yet. But if you understandeas español, you can check out the whole series here. The second part is on memory disorders and the third is on mental illness.

I’ll post more on Mind Hacks when the other parts with English subtitles appear. Wonderful stuff.

Link to ‘Refurbished Brains’ episode with English subtitles.
Link to whole series in Spanish.

A bipolar expedition

In 2008, The Lancet published an amazing article on the ‘psychological effects of polar expeditions’ that contains a potted history of artic madness.

Unfortunately, the paper is locked, or shall we say, frozen, behind a paywall, although this snippet on the history of mental health problems on artic expeditions makes for quite surprising reading.

Accounts of expeditions throughout the 19th and early 20th centuries rarely mentioned episodes of psychiatric disturbance or interpersonal conflict, as such was not in keeping with the image of polar explorers, who were expected to have specific qualities and characteristics, such as strength and resilience. Nevertheless, equally rare was the polar expedition that did not have at least one member who was debilitated by depression, anxiety, paranoia, alcoholism, or sleep disorders. During Sir Douglas Mawson’s second Antarctic expedition (1910–14), that person was Sydney Jeffryes, the radio operator, whom Mawson believed “surely must be going off his base. During the day he sleeps badly, gets up for dinner looking bad, husky; mutters sitting on his bunk in the dark afterward.”

Frequently, the entire crew of a polar expedition would experience melancholy and depression, as was the case of the Belgica expedition to Antarctica in 1898–99. As described by the great polar explorer and expedition physician, Frederick A Cook, “The curtain of blackness which has fallen over the outer world of icy desolation has descended upon the inner world of our souls. Around the tables, in the laboratory, and in the forecastle, men are sitting about sad and dejected, lost in dreams of melancholy from which, now and then, one arouses with an empty attempt at enthusiasm.”

Cook tried to treat these symptoms by having crew members sit in front of large blazing fires. This baking treatment, as he called it, could be the first recorded attempt to use light therapy to treat symptoms of winter depression or seasonal affective disorder. Other expeditions, such as the Greely expedition of 1881–84, met a far worse fate than the Belgica exploration. In their attempt to establish a scientific base on Ellsmere Island in the Arctic, the crew of the Greely expedition was driven to mutiny, madness, suicide, and cannibalism, leaving six survivors of a crew of 25 men.


Link to frozen Lancet article.

Bring the love

The world of art, neuroscience and, er… competitive affection, collide in a delightful film about a love competition held in an fMRI scanner.

The piece is by film-maker Brent Hoff who seems to be making a series of films based on the idea of emotion competitions.

In this film, competitors are asked to ‘love someone as hard as they can’ while being brain scanned with the prize going to the person with the greatest amount of brain activity.

I was a bit thrown by the piece as I couldn’t work out whether it was a mis-representation of an actual study – the scanning is run by genuine Stanford researchers Melina Uncapher and Bob Dougherty – or an offbeat competition that brought some neuroscientists on board.

So I contacted Melina and got the back story to the unusual piece:

I should say at the outset that it was not intended to be a study, nor was it intended to discover anything new about the brain. It was intended to be a public outreach piece, to help raise awareness that science can be beautiful (in the hopes of advancing interest in science). The finding was simply this: when a group of participants were instructed to ruminate on the person or concept they associate with love, BOLD signal in the nucleus accumbens showed individual differences.

The filmmaker Brent has a thing for emotional competitions, beginning with a previous film entitled The Crying Competition. In that case, as in the Love Competition case, people were explicitly instructed that it was a competition among the other participants in the room, and the person with the highest/fastest respective metric wins.

Here, the person with the highest signal in nucleus accumbens was considered the winner. Contestants were instructed to this prior to entering in the scanner. They all met each other during the interviewing stage, so there was a bit of competitiveness in the air, but it was tempered by the fact that they were considering those they love.

Melina also explained that scans in the film not only show nucleus accumbens activity. They also included a functional connnectivity analysis – essentially seeing which other brain areas change their activity in unison with the nucleus accumbens, which is why you can also see activity across the brain.

Link to film The Love Competition (thanks Sally!)

The seers and oracles

An evocative passage from the 1976 book Hallucinogens and Shamanism about the use of the hallucinogenic Psilocybe mexicana mushroom by the Mazatec people of Mexico.

The Mazatecs say that the mushrooms speak. If you ask a shaman where his imagery comes from, he is likely to reply: I didn’t say it, the mushrooms did. The shamans who eat them; their function is to speak, they are the speakers who chant and sing the truth, they are the oral poets of their people, the doctors of the word, they who tell what is wrong and how to remedy it, the seers and oracles, the ones possessed by the voice.


Link to details of book.

The hidden history of lobotomy’s non-inventor

A fascinating snippet on the notorious supposed inventor of the frontal lobotomy, Egas Moniz, from an article in the Polish Journal of Neurology and Neurosurgery:

Egas Moniz: a genius, unlucky looser or a Nobel Committee error?

Neurol Neurochir Pol. 2012;46(1):96-103.

Lass P, Sławek J, Sitek E.

Portuguese neurologist António Egas Moniz is one of the most intriguing figures in the history of medicine. While an invention of angiography in 1927 is his acknowledged merit, lobotomy, invented in 1935 became a black legend of psychiatry, although sporadically it is performed also today. There are even postulates to withdraw the Nobel Prize, which Moniz received in 1949 for inventing the lobotomy. Moniz in fact re-invented lobotomy, primarily introduced in 1888 by a Swiss psychiatrist Gottlieb Burckhardt and later forgotten. Its popularisation, including its abuses was chiefly done by American neurologists Walter Freeman and James Watts.

Aside the science, Moniz was an exceptionally colourful person, a merited politician, Portuguese minister of foreign affairs, the head of its delegation at Versailles in 1918, in 1951 he was even proposed a position of a Presidentof Portugal. He was a versatile humanist and a writer, even a gambling expert. His person is hard for black and white evaluation, definitely deserving a re-evaluation from today’s historical perspective.


Link to abstract of article on PubMed.

Wishful resilience

The New York Times has an extended article that uncritically dicusses a $125 million US Military programme currently designed to increase resilience against mental illness.

If you’re interested in the effects and treatment of psychological trauma, it’s always worth keeping tabs on what the military are doing. The concept of trauma has largely been driven by the military and they are usually pioneers in developing treatments and interventions.

The Comprehensive Soldier Fitness programme is a US Army programme based on positive psychology and was developed with the help of the field’s guru Martin Seligman.

Rather than aim to treat mental health problems, it aims to prevent them by improving the psychological strength of individual soldiers. Owing to the fact that the US Military has surprisingly high levels of PTSD, it is clearly designed with this in mind.

It involves completing a 110 item questionnaire called the ‘Global Assessment Tool’ that gives scores based on the four domains of programme: emotional fitness, social fitness, family fitness and spiritual fitness (it would be interesting to see how atheists score on this last part).

The idea is that the programme can then be tailored to the GAT profile of each soldier to strengthen vulnerabilities and build on existing strengths.

If you were going to base your programme on a psychometric assessment, most importantly, you would want to know that your assessment predicted problems or coping in particular soldiers.

For example, if a particular soldier had a low score on, let’s say, the emotional fitness part of the scale, it would be important to know that tells us about what sort of problems the soldier is likely to have in real life and during his or her service.

You would also want to know that the assessment told us about the likelihood of the solider getting mental illness. It makes sense, right? If you’ve designed a programme intended to prevent mental illness based on an assessment, the assessment should tell us which soldiers are at higher risk for psychiatric difficulties so we can help with skills and abilities that mitigate the risk.

In psychological jargon, this is known as predictive validity and it can be tested statistically.

It is not known whether the Global Assessment Tool does actually predicts anything useful about US soldiers’ problems because this was never tested.

We know this because the GAT and the other aspects of the Comprehensive Soldier Fitness Programme were the subject of the special issue of American Psychologist that had numerous articles on the development and evidence for the programme by the programme’s creators, including an article on the GAT.

As a whole, it seems the Army implemented the programme wholesale and has since been evaluating it in retrospect, which seems a little bit of an odd way of going about it.

By the way, the New York Times article is really focused on ‘posttraumatic growth’ – the psychological benefits that surviving trauma can bring. In places it seems to imply a sort of split view of the phenomenon where you either are traumatised or experience growth – when in reality, it’s possible to be both disabled in some aspects of life while growing in others.

One of the best things I read on this recently was Stephen Joseph’s book What Doesn’t Kill Us: The Psychology of Post-Traumatic Growth (note: I’m blurbed on the back but I don’t make any money from it) that, as a level-headed look at the concept, comes highly recommended.

Link to NYT article on post-traumatic growth.

Goodbye Colombia, for now

A few days ago I moved back to the UK after spending three years working in beautiful Colombia.

I had the pleasure of learning from some fantastic colleagues and managed to find myself working across the country from the Amazon to the Andes.

As a small and inevitably inadequate token of my appreciation I’d like to thank my colleagues in Médecins Sans Frontières from across Colombia, colleagues from the Hospital Universitario San Vicente de Paúl and the Universidad de Antioquia in Medellín, as well as the many other fantastic mental health professionals who helped me along the way and tolerated my enthusiastic but ‘freestyle’ Spanish.

I arrived in Bogotá to find Alonso, a particle physicist, had organised ‘neurobeers’ which were both enormously good fun and full of fantastic folks. Much appreciated.

And finally, thank you to Shakira (who can now contact me at my British address).

Neurotoxic e-waste recycling

The Lancet has an extensive news piece on how the recycling of old electronics in developing countries may be a serious neurological risk owing to the high levels of neurotoxic chemicals in modern electronics.

“The recycling of e-waste is big business in developing countries”, explains Javier Carod-Artal (Virgen de la Luz Hospital, Cuenca, Spain). “But many people are working without any kind of protection—most aren’t even aware of the potential risks. It’s a serious health threat.”

Carod-Artal explains that in its destination countries, e-waste is traded to individuals who recycle it in small workshops and sometimes even in their houses, locations in which ventilation is poor and little thought is given to the control of environmental contamination.

These individuals are exposed to many neurotoxicants during the extraction process. Lead, for example, has a low melting point, meaning that it evaporates quickly and can be inhaled quite easily when burning e-waste.

Many studies have shown that exposure to lead can adversely affect brain development, but electronic devices contain many more potential toxicants. For example, among as many as 40 different elements, a mobile phone can contain known neurotoxicants such as arsenic, cadmium, and chromium.

As many modern electronics also rely on conflict minerals, that is, essential elements minded from areas controlled by illegal armed groups, we can safely say that electronics manufacture is not the most person friendly practice in the world.

If you want more details you can read the entire Lancet article for free online although, annoyingly, you have to create an account with their website first.

Link to Lancet piece on neurotoxic e-waste.

Buried words

I’ve just found a fantastic video that explains the speech-impairing disorder aphasia to children of all ages.

Its called ‘The Treasure Hunt’ and was created by speech pathologist Shiree Heath and it went on to win first place in the Society for Neuroscience’s video competition.

The video combines a cartoon treasure hunt with recordings of a real-life aphasia patient who seems to be affected by a type of anomic aphasia where affected people have trouble with saying names of objects or items.

It’s worth noting that this is only one of many types of speech-affecting aphasias that are possible after brain damage, although this is perhaps the one that has been most delightfully described so far.

Link to The Treasure Hunt video (via @mocost)

A thread of hope from a shooting

No-one knows why Steven Kazmierczak snapped. When he kicked his way into a packed lecture hall in Northern Illinois University, shooting dead five students and injuring 21 more, those who knew him expressed surprise that he was capable of such brutal violence.

He killed himself at the end of the spree, meaning his motives remain unknown, but the legacy of this tragic event may be more than just the actions of a lone unfathomable killer.

Because when Kazmierczak attacked, a team of psychologists and neuroscientists had already assessed a large group of students who had been recruited as non-affected participants for a study on the effects of victimisation, giving the researchers an unwanted opportunity to better understand how sudden trauma affects the innocent.

Since the 1980s we have recognised a trauma-specific mental disorder. Its name, ‘post-traumatic stress disorder,’ seems to suggest that trauma alone causes the condition but we have known for years that genetics play a large part in determining who does and who doesn’t develop PTSD.

Not everyone who experiences a violent attack, disaster or sexual assault will develop PTSD. In fact, the single most common outcome after tragedy is not mental illness, but recovery. That’s not to say that we wouldn’t feel shaken up or distressed after such events but most people can return to their everyday lives, perhaps changed, but unimpaired.

What we still don’t know is how people who recover are different. Why is it that some individuals develop the disorder following trauma while others appear to be relatively resilient?

We’ve known since studies on Vietnam veterans that genetics accounts for up to 30% of the difference in PTSD symptoms but researchers have been keen to find to specific genes that confer the biggest vulnerability.

Normally these types of studies look at people with and without PTSD and compare the presence of specific genes known to be linked to brain function, to see if they appear more in one group than another. Although helpful, one problem with these sorts of studies is that it is difficult to say whether the genes might directly contribute to the condition or to a general difficulty with mood or behaviour.

In scientific terms, the reason this can be a problem is because people who are already, for example, low in mood or impulsive, are on average more likely to be victimised, attacked or abused. This means it’s difficult to know exactly which genes are most important for explaining the reaction to trauma, rather than the chance of being victimised.

Psychologist Kristina Mercer was leading a study on trauma before the shooting occurred. She had been interviewing female students about their life histories and experience of trauma at Northern Illinois University, originally planning to re-interview the students over time to see which characteristics made them more likely to experience sexual assault.

Clearly motivated to make sure that something more than grief and pain would come from the event, she switched focus to better understand what made some people more likely to develop PTSD after the shooting.

The team re-interviewed the participants in the weeks following the tragedy, assessing their exposure to the violence, any PTSD symptoms present and their level of support from friends and family. A similar interview was conducted 8 to 12 months later and at the end of the study, the researchers took saliva samples to look at the DNA of each participant.

As PTSD is largely a disorder of anxiety accompanied by an intrusive reexperiencing of the event that doesn’t fade with time, the team focused on genes for the serotonin transporter system or SERT.

Serotonin is one of the brain’s neurotransmitters that provide chemical signalling between brain cells. The serotonin transporter system is responsible for removing the used serotonin from the synaptic cleft, the signalling space between the neurons, and putting it back in place, ready to be used again.

This is important because if not removed from the synaptic cleft, the serotonin will keep on signalling. In other words, the efficiency of the serotonin transport system in cleaning-up stray neurotransmitter determines the strength of the signal as much as the original message.

We know that many of the key circuits involved in anxiety are reliant on the serotonin neurotransmitter, so the research team suspected that people with genes differing in how they control transport system could be differently susceptible to anxiety and, perhaps, trauma.

In line with their thinking, the results showed a similar picture. A transport gene called rs25531 was identified as directly linked to the chance of developing PTSD after the shooting. Interestingly, a commonly mentioned serotonin gene, 5-HTTLPR, was only linked to PTSD risk when it was also present with rs25531, suggesting the importance of looking at genetic interactions and not just single genes.

Because of nature of the shootings – a lone gunman who randomly attacked anyone in range – the results are more directly tied to reaction to trauma, rather than a possible vulnerability to being victimised, meaning this is one of the few studies that gives us an unambiguous insight into the post-trauma process.

Now it’s common at this point to say that a discovery of specific genes raising the risk of mental illness should lead to a better treatment for trauma, but this is usually nothing more than a hopeful twist on the scientific details, and this case is no different.

The results suggest no direct treatment and no immediate cure because mind, brain and trauma are too complex for simple solutions.

But the study is no less important. It’s still an essential part of our understanding and provides an essential thread in a tapestry of knowledge.

And fittingly, it shows that even from the shadow of tragedy, light emerges.

Link to locked scientific article.
pdf of full text.

Post-sex psychology

Slate has an article covering the growing research on post-sex behaviour – what we do after we’ve got it on and what it might mean.

To be honest, I had no idea that anyone was studying what people do after sex but it sounds like the science is well underway.

Counter to popular opinion, a dated study, and the great wisdom of many lady mags, researchers have not found that men fall asleep faster than women after sex. In fact, according to a recent study [pdf] of heterosexual pairings by Kruger and Hughes, a woman is just as likely as a man to be out first. But — and here’s the interesting part — regardless of gender, the partner who stayed awake longer reported that they weren’t getting enough post-sex hugging, kissing or talking – what evolutionary psychologists call “pair bonding” activities…

And what about the other activities people move on to after sex, like hanging out in bed, ordering Chinese food, or smoking a cigarette? Earlier in 2011 Kruger and Hughes published a report in the Journal of Sex Research, considering a wider range of after-sex impulses. In that case they found that our post-coital behaviors – again considering only heterosexual sex – tend to split along gender lines. Eating, fixing yourself a drink, smoking and asking your partner for favors – all activities that sound pretty good to me – were more likely to be taken on by the men. The women, in this case, placed greater importance on behaviors related to intimacy, like cuddling and “professing their love.”

From reading the article though it’s clearly a fascinating area, even if the research seems only to have looked at heterosexual sex so far.

Apparently though, my preferred behaviour, apologising, seems barely to feature at all.

Link to ‘After the Climax’ from Salon (via @QMUPsychology)

A mental space filled with flowers

An entire psychiatric hospital has been filled with flowers before demolition as part of a beautiful art installation to remember a place “rich with a history of both hope and sadness.”

Art website Colossal has amazing pictures of the sublime artwork.

In 2003 a building housing the Massachusetts Mental Health Center (MMHC) was slated for demolition to make way for updated facilities. The closure was a time for reflection and remembrance as the MMHC had been in operation for over 9 decades and had touched countless thousands of patients and employees alike, and the pending demolition presented a unique problem. How does one memorialize a building impossibly rich with a history of both hope and sadness, and do it in a way that reflects not only the past but also the future? And could this memorial be open to the public, not as a speech, or series of informational plaques, but as an experience worthy of they building’s unique story?

To answer that question artist Anna Schuleit was commissioned to do the impossible. After an initial tour of the facility she was struck not with what she saw but with what she didn’t see: the presence of life and color. While historically a place of healing, the drab interior, worn hallways, and dull paint needed a respectful infusion of hope. With a limited budget and only three months of planning Schuleit and an enormous team of volunteers executed a massive public art installation called Bloom. The concept was simple but absolutely immense in scale. Nearly 28,000 potted flowers would fill almost every square foot of the MMHC including corridors, stairwells, offices and even a swimming pool, all of it brought to life with a sea of blooms.

A beautiful and touching piece.

Link to photos from Colossal (via @sarcastic_f)
Link to artist’s pages on the project.

Reminder: revelatory experiences conference

A final reminder about the revelatory experience conference where the psychology, neuroscience and anthropology of visionary experiences will be discussed in London on March 23rd.

Rather than debating whether such experiences are ‘true’ or not, it’s more aimed at discussing how well our current tools of science, medicine and interpretation help us make sense of the wide variety of revelatory experiences in the world.

Link to conference details.

Attractive people less shallow

I’ve just found a disappointing study from the European Journal of Psychology that found that physically attractive people are more likely to be psychologically balanced and accepting than the rest of us.

The study asked 119 participants to complete the Personal Orientation Inventory, a measure of psychological characteristics such as self-acceptance, spontaneity and self-actualisation, while a photo of each was also rated on physical attractiveness by a six person panel.

The study revealed that participants in the high attractiveness group scored significantly higher on 7 of the 12 POI scales in comparison to the participants in the low attractiveness group: Inner-Directed, Self-Actualising Value, Feeling Reactivity, Spontaneity, Self-Regard, Self-Acceptance, and Capacity for Intimate Contact.

The researchers debate why more attractive people might, on average, end up being more psychologically accepting of themselves and others.

They suggest that it could be due to a self-fulfilling prophecy effect. Previous research has shown that good looking people are stereotyped as being more confident, warm, dominant, stable and socially skilled, among other things, and being treated this way could enourage exactly these sorts of behaviours and attitudes.

Personally, I have been trying to cultivate a shallow and empty persona in the hope that it would make me seem more physically attractive but I now realise I should have been saving to enhance my rack as a form of personal development.

Link to study.

Catching the krokodil

Over the last few months somewhat sensational media reports have appeared discussing a cheap Russian heroin-like drug nicknamed ‘krokodil’ due to it causing scaly lesions at the site of injection.

It has been variously headlined as a ‘designer drug’ or ‘the drug that eats junkies’ but until now it has not been discussed in the scientific literature.

For the first time, however, a short article has appeared with more details, and has just been published in Clinical Toxicology by three Russian resesarchers.

The main part of the article is reproduced below edited to remove the references.

“Crocodile” is a street name of drug containing mainly desomorphine (Dihydrodesoxymorphine-D), produced in home conditions by simple synthesis from codeine, most often on the basis of codeine-containing medicines, in Russia available over-the-counter so far. Desomorphine presents sedative and analgesic effects; it is 8–15 times more potent than morphine, and has weaker toxic, convulsant, emetic and respiratory depression action.

The drug is administered intravenously or intramuscularly. It has very fast onset of action (2–3 min) and a short duration of action (2 h). First symptoms of addiction usually appear after 5–10 days. From intake of the first dose, death comes maximally after 2–3 years, but even single dose may be lethal for predisposed person. High toxicity is caused by the presence of impurities. Skin in the places of injections becomes grey and green, scabrous, flakes off, so it resembles the skin of crocodile. Postproduction impurities (residues of acids and alkalis, petroleum derivatives, industrial oils, organic solvents, red phosphorus, iodine, heavy metals) act irritant on vessels which become damaged and afterwards obliterated.

It causes peripheral limb ischemia with following necrosis, often secondarily infected, which require surgical intervention and even limb amputations. So this drug “bites” the limbs, as a real crocodile. Addicted people may be recognized by the smell of iodine, used during drug production. “Crocodile” generally is similar to so-called “Polish heroin” (“compote”)— drug produced also in home conditions from poppy straw, popular in Poland till the late 1990s.

The “crocodile” is cheap (costs less than one can of bear), so it is very popular and is used mainly by poor opiate drug addicts in Russia. Its production developed at the time of restriction of heroin trafficking from Afghanistan. According to current estimates, in Russia there are 100—250 thousands of people addicted to “crocodile.” About 30 thousands of people die per year.

The presence of this drug was confirmed in Germany (among immigrants from Russia), Czech Republic, Ukraine, France, Belgium, Sweden and Norway. Unofficially, one fatal poisoning of 23-year-old man from Warsaw in Poland, in December 2011, is suspected, but we don’t know details yet, because of lasting investigation. With people migration, we should expect single cases of “crocodile” use in countries, where it is not present at this moment.

Oddly the article has translated the Russian ‘krokodil’ into ‘crocodile’ for the article, despite the fact it is more widely known by its original spelling.

Interestingly though, it seems that the drug is another in the line of nasty highs that can be synthesised by anyone with household ingredients and a single container (the other being the single bottle methamphetamine synthesis).

Link to locked short Clinical Toxicology article.
Link to Wikipedia on krokodil and desomorphine.