[8] Desomorphine was used in Germany, Austria, and Switzerland under the brand name Permonid[9] and was described as having a fast onset and a short duration of action, with relatively little nausea compared to equivalent doses of morphine.

While medical usage of desomorphine was terminated in 1981, during the final years leading up to that it was being used to treat a single patient in Bern, Switzerland with a rare illness.

[14]: 408–409  While desomorphine was found to be faster acting and more effective than morphine for the rapid relief of severe pain, its shorter duration of action and the relatively more severe respiratory depression produced at equianalgesic doses, as well as a high incidence of other side effects such as hypotension and urinary retention, were felt to outweigh any potential advantages.

[14] The drug can be made from codeine and iodine derived from over-the-counter medications and red phosphorus from match strikers,[17] in a process similar to the manufacturing of methamphetamine from pseudoephedrine.

[14] Due to difficulties in procuring heroin, combined with easy and cheap access to over-the-counter pharmacy products containing codeine in Russia, use of krokodil increased until 2012.

[18][needs update] One death in Poland in December 2011 was also believed to have been caused by krokodil use, and its use has been confirmed among Russian expatriate communities in other European countries.

Injecting any such mixture can cause serious damage to the skin, blood vessels, bone, and muscles, sometimes requiring limb amputation in long-term users.

Desomorphine producers would use cheap, readily available but relatively toxic and impure solvents such as battery acid, gasoline or paint thinner during the reaction scheme, without adequately removing them afterwards before distribution.

[citation needed] Failure to remove insoluble fillers and binding aids from the codeine tablets used as starting material, as well as co-administration with pharmaceuticals such as tropicamide and tianeptine, are also cited as possible contributors to the high toxicity observed in users.

In monkeys, desomorphine had 10 times the depressant effect of morphine, developed tolerance less rapidly and less completely, and did not lead to the appearance of abstinence symptoms during withdrawal.

[25] Desomorphine has a molecular weight of 271.35 g/mol and three salts are known: hydrobromide (as in the original Permonid brand; free-base conversion ratio 0.770), hydrochloride (0.881) and sulfate (0.802).

The codeine is retrieved from over-the-counter medicine and is then mixed with ethanol, gasoline, red phosphorus, iodine, hydrochloric acid and paint thinner.