The deadly flesh-eating drug krokodil, which recently surfaced in the US, has now spread to Canada, with two cases reported in Niagara.
Rhonda Thompson, an outreach worker in Niagara, described the current drug scene as the "wild west" saying staff are "on their toes" in preparation for more cases, reports CHCH.
Krokodil is a drug whose effect is similar to but shorter-lived than heroin. However, it is much cheaper as it is made from household items including lighter fluid, gasoline and codeine.
The drug first surfaced in Russia about 10 years ago and is believed to have now made its way to North America, with the first US cases reported in Arizona in September.
It rots users from the inside out, destroying blood vessels and causing gangrene, as graphic photos of users show. The average life expectancy of a person using the drug is just two years.
Brenda Horton, from the Drug Treatment Centre in St Catharines in the Niagara area, said two men were recently hospitalised with sores on their bodies from using the drug.
"The one gentleman described it he felt like there was a burning coming from the inside out. And it left holes all over his arms," she said.
New to the region
"Street workers may have only been aware of krokodil in the past two weeks but they believe it's been on the streets of Niagara for months. And they fear more victims will soon be showing up at hospital emergency rooms. The life expectancy is about two years once you start using. So it's deadly."
Rich Gadreau, from the Niagara Regional Police, said they have no evidence that krokodil is being produced or sold. "But that just shows how new it is in the region," he said.
The US Drugs Enforcement Agency is yet to confirm its presence in the US despite reports from several states, including Arizona, Illinois and Missouri.
Some experts have also said the cases reported are likely a result of heroin and painkiller abuse, not through injecting krokodil.
Andrew Kolodny, chief medical officer at rehab centre Phoenix House, told The Daily Beast: "We don't have a Krokodil epidemic, we have a heroin and painkiller epidemic. This is not a new problem. Drug users are prone to skin infections and blood infections. There are serious medical infections that come from injecting drugs."