Getty Images Gasoline is one of the ingredients in a flesh-eating drug, Krokodil

A flesh-eating drug called Krokodil, because it makes user’s skin scaly and green before it rots away, has arrived on American soil. The Banner Poison Control center in Arizona has reported the first two users of the drug — which has been available in Russia for more than a decade — here in the U.S.

Krokodil most closely resembles morphine or heroin and is injected into the veins. It is made of codeine, a painkiller often used in cough syrup, and a mix of other materials including gasoline, paint thinner, and alcohol. It has become popular in Russia, where it was first reported in 2002, because it is cheap–it can cost 20 times less than heroin according to Gawker–and can be made easily at home.

“As far as I know, these are the first cases in the United States that are reported,” Dr. Frank LoVechhio, co-medical director at Banner Good Samaritan Poison and Drug Information Center in Arizona, told CBS 5. “So we’re extremely frightened.” The average life span of a Krokodil user is two to three years, according to a 2011 TIME investigation of the drug’s prevalence in Russia.

When it is injected, the drug rots the skin by rupturing blood vessels, causing the tissue to die. As a result, the skin hardens and rots, sometimes even falling off to expose the bone. “These people are the ultimate in self-destructive drug addiction,” Dr. Ellen Marmur, chief of dermatological and cosmetic surgery at Mount Sinai Medical Center in New York City told Fox News, “Once you are an addict at this level, any rational thinking doesn’t apply.”