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With the drug krokodil making its way from Russia to the Southwest and allegedly into the Chicago area, the flesh-eating bastardized heroin substitute could be injecting itself into the arteries of the midwest.

Columbus, Ohio officials tell WBNS-TV that a homelesss man was discovered recently with evidence on his skin of krokodil use. “The patient had a large, open wound and it is consistent with what we’ve been seeing, or the trend when people use this type of medicine,” Columbus Division of Fire Deputy Chief Jim Davis said.

(MORE: Chicago Area Krokodil Victims Describe Drug’s Horrifying Effects)

The man was the first suspected case of krokodil use in the Central Ohio region, but Davis said he is warning his entire department to watch for the drug. Ohio Poison Center authorities say only two other possible cases have shown up in the state, but neither were in Columbus.

Davis believes that the drug, a concoction which contains a mix of codeine, gasoline, paint thinner, and alcohol, that can cause abscesses and gangrene on the skin, will bring risk of other dangerous ailments that typically come with intravenous drug use.

“Our biggest issue with this is the fact that anybody who uses needles in some type of drug situation, is highly suspected of other highly contagious diseases, such as hepatitis and HIV,” Davis said.

Meanwhile, authorities are trying to confirm cases throughout the United States. Officials in Arizona reported the first cases in the country, but Drug Enforcement Agency officials in the Chicago area say they have not confirmed actual use of krokodil and are skeptical that the drug has hit America in the way that was initially feared.

“We have run quite a few buys in the city and suburbs,” Jack Riley, DEA special agent told the Chicago Tribune. “What the lab tells us is it’s just heroin.”

MORE: The World’s Most Horrifying Drug Spreading Rapidly Across the U.S.