“Molly” has been recently popularized in songs by Miley Cyrus and Kanye West. With lyrics like, “We like to party / Dancing with Molly / Doing whatever we want” [We Can’t Stop] and “Let’s take it back to the first party / When you tried your first molly / And came out of your body” [Blood on the Leaves], the use of the drug “Molly” has been praised and glamorized.

But, what is Molly?

Molly is a pure form of MDMA, or 3,4-methylenedioxy-methamphetamine by its chemical name. MDMA is one of the ingredients of another popular drug, Ecstasy (which may be mixed with caffeine, LSD, speed, ketamine, talcum powder, and aspirin). Regardless of its composition, ingestion of MDMA can be dangerous and even fatal.

MDMA was first synthesized by the German pharmaceutical company Merck in 1912. It was used in the late 1970s, without the approval of the Food and Drug Administration (FDA), as an aid in psychotherapy and marital counseling. As of 1985, the Drug Enforcement Administration (DEA) has categorized MDMA as a Schedule I controlled substance due to its high potential for abuse and no accepted medical use in treatment.

MDMA is similar to the stimulant amphetamine and the hallucinogen mescaline. Taken orally in tablet or capsule form or snorted as a powder, MDMA produces an energy rush, elevated mood or euphoria, distorted perceptions, and heightened feelings of empathy. These “desired” effects are what drive people, mainly teenagers and young adults in the club and rave scene, to try and even abuse the drug, at times not fully aware of the dangers, both short- and long-term.

The number of emergency room visits related to MDMA use has more than doubled in the last 7 years. According to the Substance Abuse and Mental Health Services Administration’s Drug Abuse Warning Network report of 2011¹, there were an estimated 22,498 emergency room visits (compared to 10,227 in 2004). And the numbers keep rising…

MDMA causes a release of brain chemicals (neurotransmitters), including dopamine, serotonin and norepinephrine. The massive release of serotonin as well as its eventual depletion lead to the negative effects of the substance, as detailed below:

Central Nervous System Effects:

• Altered mental status (confusion)
  
• Hyperactivity, restlessness
  
• Seizures
  
• Anxiety
  
• Paranoia
  
• Depression
  
• Blurred vision
  
• Hallucinations
  
• Intracranial hemorrhage
  
• Stroke

Cardiovascular Effects:

• Tachycardia (increased heart rate)
  
• High or low blood pressure
  
• Chest pain
  
• Fatal arrhythmia
  
• Heart failure (risk increased in individuals with pre-existing cardiac disease)

Gastrointestinal Effects:

• Dry mouth
  
• Nausea
  
• Vomiting
  
• Abdominal cramping
  
• Loss of appetite

Respiratory Effects:

• Breathing difficulty
  
• Respiratory failure
  
• Aspiration (inhaling vomit)

Other Signs and Symptoms:

• Dehydration
  
• Excessive thirst
  
• Profuse sweating
  
• Teeth grinding
  
• Jaw clenching
  
• Muscle spasm

MDMA toxicity may also lead to the potentially fatal Serotonin Syndrome, causing:

• Hyperthermia (dangerously high fever)
  
• Altered mental status (confusion)
  
• Heart rate and blood pressure abnormalities
  
• Muscle rigidity (tightness)
  
• Death

Increased water intake (from heat and thirst) as well as the excessive sweating from physical exertion (dancing often in crowded and hot conditions) may lead to hyponatremia (low sodium levels). Severe hyponatremia may result in brain swelling, seizures, and death.

Most MDMA-related fatalities are attributed to symptoms of heat stroke and hyperthermia. Other causes include: dehydration, rhabdomyolysis (excessive muscle breakdown), acute kidney failure, electrolyte imbalance, cardiac arrhythmias, and stroke.

It is important to be aware of the effects of this potentially fatal drug. As if these effects were not of enough concern, MDMA may be used in the club/rave scene together with other drugs and/or alcohol, leading to a possibly fatal combination.

Beware of the several names used for MDMA, including: Molly, Mandy, Ecstasy, E, XTC, X, Adam, Clarity, Lover’s Speed, Roll, MD, Mad Dog, among others.

Remember…

Be Smart. Be Safe. Be Healthy. Be Strong.

Until next time!

Dr. Felix