The review in this issue of the International Journal of Drug Policy (Grund, Latypov, & Harris, 2013) highlights the disturbing harms caused by the increasing use of 'krokodil' by people who inject drugs (PWID) in Eurasia. The growing use of this home produced injectable opiate poses a number of challenges for harm reduction policy, particularly when situated in restrictive regulatory environments where initiatives such as Opioid Substitution Treatment (OST) are prohibited or limited. In such contexts where OST access is restricted, how can these harms be minimised, and what alternatives can be offered? This commentary addresses these questions, by offering the rarely researched case of home produced injectable opioid use in New Zealand as an example.