The Dorsomorphin Risk

15 years ago, the Russian abuse of a potent (x10 morphine) semi-synthetic drug was reported by Pravda. Spreading
from remote locations in Siberia, when it reached cities, the drug became commonplace. Made from codeine and
using only cheap and simple household items and about 45 minutes of work, it was a cheap alternative to heroin.
The home-made nature meant that s mixture of chemicals, including several highly toxic allotropes of phosphorous
(white, black and violet) whose chronic damage is reminiscent of phossy jaw, the 19th century occupational disease.
But rather than being limited to the head, the limbs and trunk and indeed every injection site resulted in necrosis.

Krokodil () became a national disaster in Russia and all codeine containing medicines began to require a
prescription. While of some value, the black market has stepped in and while use has decreased, over 5 years later it
is still a problem. The move to fentanyl derivatives with a different pattern of production, distribution and usage
appears to have made people forget that Krokodil was never stopped. What is more, the ease of ordering mundane
photographic, home brewing and cleaning chemicals to the door makes it easy. The rest of the world considered that
since red phosphorous (vital for Krokodil synthesis) is almost impossible to obtain in most other 1st world countries.
The thing is, it turns out that like the fentanyl class, a LOT of possible combinations work.

The Russian route dissolves paracetamol/codeine tablets in water, adding a base (caustic soda) and then adding
petrol. The codeine freebase goes into the petrol. When the water is removed and replaced with hydrochloric acid
(brick cleaner). Then the codeine is back filtered into the water. With the concentrated codeine solution, iodine
(disinfectant) and red phosphorous (match-heads) are heated. The result is the formation of hydroiodic acid which
reduces the C-ring and de-protects the codeines methyl ether.

The problem is, mechanical losses from cleaning the product make it impossible on such a scale so hydrochloric acid,
hydroiodic acid, phosphorous allotropes and a mixture of 8 different opioids are injected. Missing a vein immediately
causes an abscess, tissue and bone necrosis appear rapidly and we have all seen the dreadful images of users with
flesh removed right to the bone, missing limbs, the dying and the dead.

From time to time, mainly Eastern Europeans have presented with this set of symptoms but too often, the cause is
not identified because to admit in Russia is to be deprived of medical aid. The long-term chronic effects are not
sufficiently understood by British medical practitioners, harm reduction workers or indeed the few British people
who have indulged in this DIY opioid.

The product is a mixture of chemicals but all of the available research data states that the drug responsible for the
positive effects is desomorphine. Desomorphine was first documented in the early 1930s and between 1957 and
1966 it was used in Swiss medicine under the name Permonid. With a potency of x8-x10 that of morphine and a fast
onset, the drug is reported to be more euphoric even than heroin. With a gram of heroin costing $50-$100/gram
(and few dealers sell sub-gram amounts), it wasnt long before someone worked out a route costing $4 per dose.
The short duration saw people on missions buying from every pharmacy they could in the day-time and at a
premium from street dealers whose profit derived from having a captive audience.

The Russian government has shown little support for HR efforts. No clean needles, no substitution therapy and only
a few expensive clinics providing support. Since 2003 there has been a thriving black market in methadone. Even
that is under pressure from people wanting dipipanone (1 precursor different from methadone) and the ongoing
fentanyl crisis.

It is our lack of market understanding that poses the greatest risk. It turns out that both iodine and red phosphorous
have multiple alternatives. As long as hydroiodic acid is in the mixture, it will always produce SOME desomorphine
and a small amount of research shows the wide number of precursors and the addition of a catalyst can produce
desomorphine in almost quantitative amounts.
In the place of red phosphorous:

Sodium metabisulfite, sodium dithionite, sodium bisulfite, sodium hypophosphite, sodium hypophosphite, sodium
hydrogen phosphite and disodium hydrogen phosphite, hydrogen sulphide.

In place of the iodine:

Sodium iodide, iodic acid, iodamine, diiodamine, N-iodosuccinamide, sodium iodide.

Catalyst for high yields

Boric acid (reduced to boric acid).

In essence, a chemical that can donate I[-] ions that can be reduced to hydroiodic acid HI that in turn reduces the
codeine to desocodine and removing the methyl ether producing desomorphine. As you can see, I have only covered
the sodium salts but the system will be all but identical if the lithium or potassium salts were used. I have only dealt
with sulphur and phosphorous based reducing agent. What the 2 have in common is that they demonstrate more
than 1 oxidation state. Sulphur may be 2,4 or 6 and phosphorous may be 3 or 5. It seems probable that selenium
salts will also work as will transition metals. I did not pursue every single candidate on the basis that the classes of
compounds I have named still covers many hundreds of different reduction/deprotection system. A chemist could
well keep themselves busy for a few months finding the best combination but the deprotection is also catalysed by a
number of transition metal salts. Put simply, codeine, dihydrocodeine & oxycodone are all candidates to produce a
high potency opioid.