There is no good medical explanation for why Pavlova survived her addiction. The average user of krokodil , a dirty cousin of morphine that is spreading like a virus among Russian youth, does not live longer than two or three years, and the few who manage to quit usually come away disfigured. But Pavlova says she injected the drug nearly every day for six years, having learned to cook it in her brother's kitchen. "God must have protected me," she says. But the addiction still left some of its trademark scars. She developed a speech impediment, and her pale blue eyes have something of a lobotomy patient's vacant gaze. "Her motor skills are shot from the brain damage," says Andrei Yatsenko, the house manager, who was addicted to heroin for seven years. "She'll try to walk forward and instead jolts back into something. So we try to be gentle with her." (See why Russia raids Afghanistan for drugs.)
As typically happens in Russia, Pavlova began her drug use as a teenager shooting a substance called khanka , a tarlike opiate cooked from poppy bulbs, then graduated to heroin and finally, at the age of 27, switched to krokodil , because it has roughly the same effect as heroin but is at least three times cheaper and extremely easy to make. The active component is codeine, a widely sold over-the-counter painkiller that is not toxic on its own. But to produce krokodil , whose medical name is desomorphine, addicts mix it with ingredients including gasoline, paint thinner, hydrochloric acid, iodine and red phosphorous, which they scrape from the striking pads on matchboxes. In 2010, between a few hundred thousand and a million people, according to various official estimates, were injecting the resulting substance into their veins in Russia, so far the only country in the world to see the drug grow into an epidemic.
It seems to have first appeared in Siberia and the Russian Far East around 2002, but only in the past three years has it spread throughout the country. Since 2009, the amount of krokodil seized in Russia has increased 23-fold, according to the head of the Federal Drug Control Service, Viktor Ivanov. In the first three months of this year alone, the service says, it confiscated 65 million doses. "As recently as five years ago, there were only one-off instances of catching this drug," Ivanov told a meeting on April 18 attended by President Dmitri Medvedev and other top officials. Medvedev then turned to his tablet computer and searched the Internet for krokodil . The search engine gave him a list of recipes and instructions on how to cook it. "What does this mean?" he demanded. "Most people are not just looking for what desomorphine is, but how they can use it." Two of the governors at the meeting then informed him that krokodil accounts for about half of all addictions and drug-related deaths in their regions. In some provinces, Ivanov chimed in, it "has practically pushed out traditional opiates." (See "To Prevent AIDS in Russia, Drug Addicts Need Care.")
Predictably, it has spread the fastest in the poorest and most remote parts of the country, like Vorkuta, Pavlova's hometown, a former Gulag prison camp about 100 miles (161 km) north of the Arctic Circle. The winters there last eight months of the year, and as Pavlova recalls, the young people are in a constant state of boredom. Most of them drink and few of them work, the same as in hundreds of towns and villages across Russia's frozen north. Besides her, Pavlova says there were about a dozen krokodil addicts she hung around with, including her brother. "Practically all of them are dead now," she says. "For some it led to pneumonia, some got blood poisoning, some had an artery burst in their heart, some got meningitis, others simply rot."
The "rotting" explains the drug's nickname. At the injection site, which can be anywhere from the feet to the forehead, the addict's skin becomes greenish and scaly, like a crocodile's, as blood vessels burst and the surrounding tissue dies. Gangrene and amputations are a common result, while porous bone tissue, especially in the lower jaw, often starts to dissipate, eaten up by the drug's acidity. For Pavlova, the breaking point came in 2008, when she holed herself up in her brother's apartment for two weeks and did almost nothing but cook the drug and inject it into the femoral artery in her groin. "The high lasts about an hour and a half, and it takes about an hour to cook it. So I was basically cooking and shooting 24 hours a day," she says. By the end of the binge, gangrene had begun to develop around her groin and blood poisoning was setting in. She was rushed to the emergency room, then transferred to the detox ward, where a pair of Pentecostals were inviting addicts to rehab. Pavlova agreed. (See pictures of drug-smuggling submarines.)
A sad peculiarity of the rehab system in Russia is that the government does little to help. Medvedev's meeting in April has led to a meandering public debate about the need to ban codeine or impose mandatory drug testing in schools, and a plan is in the works to create the state's first network of rehabilitation clinics over the next few years. But so far the Health Ministry runs only a handful of live-in rehab centers for an estimated 2.5 million drug addicts, most of whom still use heroin. The Russian union of Evangelical Christians, which is dominated by the Pentecostals, runs more than 500 centers with no assistance from the state, making them the largest provider of rehab in Russia.
To get Pavlova away from potential relapse triggers — such as the pharmacies where she once bought codeine or the stairways where she used to shoot up — the Evangelicals transferred her to the Chichevo center in the suburbs of Moscow, a three-story cottage that seems like a throwback to the 19th century, with a wood-burning stove in the kitchen and a traditional bathhouse, or banya , that the residents built for themselves in the yard. Vast fields and forests of pine and birch separate Chichevo from the nearest town. But in 2009, when the cravings became unendurable near the end of her first stint in rehab, Pavlova managed to hitchhike her way to Moscow and catch a train back to Vorkuta to get high. She is now a week away from finishing her second course of rehabilitation. The cravings, she says, have finally passed. "I can't go back to that. I was beautiful when I started out, but what happened ..." The thought dangles for a moment. "It was like living in a horrible swamp."
SOURCE: http://www.time.com/time/world/article/0,8599,2078355,00.html#ixzz1QBnw4erl
