The following photographs were taken in Yekaterinburg, Russia in 2013.Alexei, age 33, injects a dose of krokodil. Because of his dependence on krokodil, Alexei has injuries and swelling around his feet and is forced to walk with a cane.
The following photographs were taken in Yekaterinburg, Russia in 2013. Alexei, age 33, injects a dose of krokodil. Because of his dependence on krokodil, Alexei has injuries and swelling around his feet and is forced to walk with a cane.Emanuele Satolli
The following photographs were taken in Yekaterinburg, Russia in 2013.Alexei, age 33, injects a dose of krokodil. Because of his dependence on krokodil, Alexei has injuries and swelling around his feet and is forced to walk with a cane.
A stage of krokodil preparation. Pills of codeine are crushed and mixed with iodine, hydrochloric acid and other chemicals.
Olya, 35 years old, injects krokodil.
Pavel, 31 years old, shows the effects of the krokodil on his skin. The chemicals used to prepare krokodil cause deep wounds and sores.
A view from the top of Yekaterinburg. The city, the regional capital, has about 1.5 million inhabitants and was the first Russian city in Asia. About 80 percent of the population of the region lives in Yekaterinburg. Registered drug addicts number about 40,000.
Zhanna, 34 years old, is out in the Uralmash district about thirty minutes after she has taken krokodil.
A stage of krokodil's preparation.
Andrey, 43 years old, injects Zhanna with krokodil in his apartment in the Uralmash district.
Zhanna, under the influence of krokodil, tries to relax.
Andrey scratches out the desomorphine left on the pot.
Andrey prepares the pills containing codeine. The main ingredient of krokodil is desomorphine, an opiate that is obtained through the synthesis of codeine.
Zhanna checks the krokodil while it cooks.
Zhanna, under the influence of krokodil, tries to get up while Andrey drains the water from a pot to obtain dry sulfur.
Andrey injects krokodil, with Zhanna in the background already under the influence of the drug.
Zhanna, under the influence of krokodil, lies down on the couch.
A woman walks at night on a street in Yekaterinburg during a snow storm.
Oxana, 33 years old, cooks krokodil.
Oxana injects krokodil.
The codeine is boiled in a closed bottle for a few minutes as part of the preparation of krokodil.
Alexey, 30 years old, blows air in a bottle to push the liquid through a filter and use it to prepare the krokodil.
From the left, Alexey, Natalya, 34 years old, and her husband Ilya, 34 years old, prepare krokodil in a kitchen.
A dose of krokodil is ready to be injected.
Alexey injects krokodil. The effect of the drug lasts about 40 minutes.
Alexey lies in bed soon after haven taken the krokodil.
Elman, 40 years old, displays the injuries on his legs which hes says were caused by the use of krokodil and methadone.
The following photographs were taken in Yekaterinburg, Russia in 2013. Alexei, age 33, injects a dose of krokodil. Beca
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Emanuele Satolli
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The World’s Deadliest Drug: Inside a Krokodil Cookhouse

Dec 05, 2013

About a decade ago, Russian doctors began to notice strange wounds on the bodies of some drug addicts—patches of flesh turning dark and scaly, like a crocodile's—in the hospitals of Siberia and the Russian Far East. It didn't take them long to discover the cause: the patients had begun injecting a new drug they called, predictably, "krokodil." (Some accounts suggest the name was derived from one of the drug's precursor chemicals, alpha-chlorocodide.) Videos showing the effects of the "flesh-eating" drug—christened desomorphine when it was invented for medical use in 1932—quickly went viral online. There are now alarming stories that the monster could be at large in the U.S.

American drug-enforcement officials say fears of an imminent krokodil epidemic are overblown. But it's hard not to be frightened of a drug that leaves a reptilian mark on its victims. Especially when it is so easy to make: an addict can cook up krokodil using ingredients and tools bought from the local pharmacy and hardware store. The active ingredient, codeine, is a mild opiate sold over the counter in many countries. Users mix codeine with a brew of poisons such as paint thinner, hydrochloric acid and red phosphorus scraped from the strike pads on matchboxes. The result—a murky yellow liquid with an acrid stink—mimics the effect of heroin at a fraction of the cost. In Europe, for example, a dose of krokodil costs just a few dollars, compared with about $20 for a hit of heroin.

But addicts pay dearly for krokodil's cheap high. Wherever on the body a user injects the drug, blood vessels burst and surrounding tissue dies, sometimes falling off the bone in chunks. That side effect has earned krokodil its other nickname: the zombie drug. The typical life span of an addict is just two or three years.

The drug quickly became popular among Russian addicts. In 2005, the country's counternarcotics agency reported catching only "one-off" instances of the drug; six years later, in the first three months of 2011, the agency confiscated 65 million doses, up 23-fold from two years earlier. At its peak that year, krokodil use had spread to as many as a million addicts in Russia.

A ban on over-the-counter codeine sales that was introduced on June 1, 2012, has brought numbers down sharply, but Emanuele Satolli, an Italian photographer who has been chronicling a group of Russian addicts, says many now score that key ingredient on the black market. For the past year, Satolli has focused on the industrial city of Yekaterinburg in the Ural Mountains, a place notorious in Russia for drug abuse, photographing about a dozen krokodil addicts.

The krokodil epidemic may have peaked in Russia, but the drug's use has already been reported elsewhere. In October, a report published online in the American Journal of Medicine confirmed the case of a 30-year-old addict in Richmond Heights, Mo., whose finger "fell off" and whose skin began to rot after he began injecting krokodil. The monster has crossed the ocean.

Emanuele Satolli is an Italian photojournalist based in Milan.

Simon Shuster is TIME's Moscow correspondent. Follow him on Twitter @shustry.

Translation by Eugene Reznik.

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