Emerging Trends

New drugs and drug use trends often burst on the scene rapidly. NIDA’s Community Epidemiology Work Group (CEWG) is a network of researchers in major metropolitan areas and some states across the United States that reports data on emerging trends and patterns in drug use. On this page we will provide periodic updates based on CEWG reports and other reliable information, as well as links for where to go for more information.

“Krokodil”

“Krokodil” is a homemade synthetic form of a heroin-like drug called desomorphine that is made by combining codeine tablets with various toxic chemicals including lighter fluid and industrial cleaners. This extremely dangerous mixture gets its name from the scaly, gray-green dead skin that forms at the site of an injection. The flesh destroyed by krokodil becomes gangrenous, and, in some cases, limb amputation has been necessary to save a user’s life.

Desomorphine has a similar effect to heroin in the brain, although it is more powerful and has a shorter duration. For the past decade, homemade desomorphine has been used as a cheap heroin substitute in poor rural areas of Russia, and its use has also been reported in Germany. More recently, it has been reported in a few U.S. states.

“N-bomb”

“N-bomb” refers to any of three closely related synthetic hallucinogens (25I-NBOMe, 25C-NBOMe, and 25B-NBOMe) that are being sold as legal substitutes for LSD or mescaline. Also called “legal acid,” “smiles,” or “25I,” they are generally found as powders, liquids, soaked into blotter paper (like LSD) or laced on something edible.

These chemicals act on serotonin receptors in the brain, like other hallucinogens, but they are considerably more powerful even than LSD. Extremely small amounts can cause seizures, heart attack or arrested breathing, and death. At least 14 young people are reported to have died after taking 25I- 25C- or 25B-NBOMe between March 2012 and April 2013.  For more information, see http://www.deadiversion.usdoj.gov/drug_chem_info/nbome.pdf (PDF, 217KB)
 

“Syrup,” “Purple Drank,” “Sizzurp,” “Lean”

Drinking prescription-strength cough syrup containing codeine and promethazine mixed with soda was referenced frequently in rap music beginning in the late 90s and has now become increasingly popular among youth in several areas of the country, according to recent CEWG data. Codeine is an opioid that can produce relaxation and euphoria when consumed in sufficient quantities. Promethazine is an antihistamine that also acts as a sedative. Users may also flavor the mixture with the addition of hard candies.

Codeine and other opioids present a high risk of fatal overdose due to their effect of depressing the central nervous system, which can slow or stop the heart and lungs. Mixing with alcohol greatly increases this risk. Deaths from prescription opioid medications now outnumber overdose deaths from all other drugs (including cocaine and heroin), and codeine-promethazine cough syrup has been linked to the overdose deaths of some prominent rap musicians.

Links:

• Drug Facts: Prescription and Over-the-Counter Medications
• Leaning on syrup - The misuse of opioid cough syrup in Houston (PDF, 276KB)
• The Partnership at Drugfree.org articles on cough syrup

Updated 4-1-2013

“Molly”

Molly—slang for “molecular”—refers to the pure crystalline powder form of the club drug MDMA (3-4 methylenedioxymethamphetamine), which in pill form is known as ecstasy. Molly, which is usually purchased in capsules, has seen a surge in interest in the past few years, being celebrated frequently by popular music artists. MDMA in any form produces energy and euphoria in users but also may dangerously affect body temperature and cause confusion, depression, and sleep problems.

Users may be seeking out Molly to avoid the adulterants or substitutes known to be commonly found in pills sold as ecstasy, such as caffeine, methamphetamine, and other harmful drugs. But those who purchase what they think is pure MDMA as Molly may actually be exposing themselves to the same risks. Hundreds of “Molly” capsules tested in two South Florida crime labs in 2012, for example, contained methylone, a dangerous stimulant commonly found in “bath salts” (see video below). News reports elsewhere have reported “Molly” capsules containing cocaine, heroin, and other substances.

Links:

• Drug Facts: MDMA
• Drug Facts: Synthetic Cathinones

Updated 4-1-2013