Commentary: Molly – What You Need to Know
What’s in a (drug) name? The now-popular party drug named “Molly” sounds friendly and safe, and young people know that the name is supposed to refer to the pure crystalline powder form of 3,4-methylenedioxy-N-methylamphetamine or MDMA—what used to be taken in pill form as Ecstasy. But many are learning the hard way that, despite appearances, Molly is often not what it seems, and this version of MDMA is no more pure, safe, or innocent than its previous incarnation.
Whether called Molly or Ecstasy, MDMA produces a combination of energy and sociability that has made it popular at events like raves and concerts since it first burst on the recreational drug scene in the late 1980s. The euphoric effects of MDMA, like those of stimulants such as cocaine or amphetamines, come mainly from raising the level of the neurotransmitter dopamine in the brain’s reward pathways. Unlike those drugs, however, MDMA also raises serotonin, the brain chemical boosted by many antidepressants. Serotonin affects mood, sleep, memory, and appetite, and also triggers the release of oxytocin and vasopressin, hormones that promote social behavior and bonding, which are likely responsible for the empathic closeness to others that MDMA users also experience.
Like stimulants, MDMA can be hazardous for those with heart problems, because it raises heart rate and blood pressure. At high doses it can also interfere with the body’s ability to regulate temperature; this, especially in the high-energy context of a dance party, can cause the body to overheat, leading to liver, kidney, or heart failure. MDMA metabolites interfere with the body’s ability to further metabolize the drug, so unexpectedly high blood levels can accumulate in the body when users take additional doses, as they commonly do. MDMA can also seriously deplete serotonin levels in the brain, causing confusion, depression, and sleep problems after it is taken. There is some evidence that frequent users may permanently damage serotonin-containing neurons, causing lasting mood and memory impairments.
MDMA in its previous life as Ecstasy typically came in the form of a pill, and as happens with other drugs, doubts about adulterants or substitutes came to haunt it. Ecstasy tablets have been known to contain caffeine, methamphetamine, cocaine, ephedrine, and other harmful substances. MDMA’s recent reincarnation as a “pure” powder called Molly, short for “molecular,” follows a typical pattern in the marketplace: rebranding and repackaging a staid old product for a new generation, as well as giving it an aura of being “new and improved.” The word molecular suggests chemical purity. So does its powder form. But powders are readily mixed and substituted, and in the world of drugs purchased at concerts, names mean absolutely nothing.
Molly has simmered in the news the past few years because of pop stars singing its praises, but this summer Molly made the headlines when it was blamed for the deaths of two young adults who collapsed after overheating at a music festival in New York City. The New York City medical examiner later confirmed that pure MDMA was to blame for one of the deaths; the other person had taken Molly that actually consisted of a mixture of MDMA and methylone, one of a family of dangerous and unpredictable stimulant drugs called synthetic cathinones and often sold as “bath salts.”
NIDA’s Community Epidemiology Work Group reported that hundreds of Molly capsules tested in two South Florida crime labs in 2012 also contained methylone. And indeed, many people ending up in emergency rooms after taking what they think is Molly are testing positive for synthetic cathinones instead. Synthetic cathinones can be more energizing than MDMA, and have earned a reputation for inducing wild mood swings and hallucinations in users, as well as dangerous overstimulation of the heart.
Unfortunately, the new world of synthetic designer drugs is very hard to regulate. Labs are continuously churning out new molecules that evade legal restrictions and/or existing drug tests. The situation is so perilous that inexpensive drug purity testers are reportedly being sold at music festivals to help concertgoers tell whether the Molly they have purchased is actually MDMA.
Besides doing whatever we can to steer youth away from drug use altogether, it is crucial to impress on them the folly of purchasing or taking a drug that is so notoriously and frequently not what it seems that it needs to be periodically rebranded. Molly is not bright and shiny and new; it is an old drug being sold in a different form that is now even more subject to contamination and substitution. Young people should listen to their common sense, and stay well away.
Susan Weiss and Eric Wargo
National Institute on Drug Abuse
PHOTO CREDIT: Wikimedia Commons