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“Molly” – An innocuous nickname hides potential danger

Have you seen Molly?  Do you know who she is? Do you know what she is?  

“Molly,” if you are to believe your neighborhood drug dealer or the person selling it at a music festival, is a pure and more potent form of MDMA (3, 4-methylenedioxy-N-methylamphetamine) or “Ecstasy.” Where Ecstasy tends to be manufactured and sold in a pill form, Molly is generally available as a powdered or crystalline substance in capsule form. Molly is classified as a Schedule I drug, a description reserved for substances with no recognized medical use.

http://louderthanwar.com/us-up-in-arms-over-new-mdma-product-molly-ltw-take-a-closer-look/

Since last spring, seven people attending dance concerts died with symptoms matching overdoses of MDMA. The Electric Zoo Festival on Randall’s Island New York closed early after two deaths of patrons. The House of Blues in Boston was temporarily closed after three overdoses, one resulting in death, and a University of Virginia student died after taking MDMA and attending a dance concert in the District of Columbia.  (NBC September 6, 2013; Sisario & McKinley, September 9, 2013; Seldon, August 31, 2013).

Molly is reputed to provide a more intense, longer lasting, and yet safer experience than Ecstasy. However, “Molly” you purchase may not be pure “MDMA,” but may contain MDA or “Adam,” (3, 4-methylenedioxyamphetamine , PMA (paramethoxyamphetamine), cocaine or PCP. The drug may be “stepped on” or adulterated with other substances.  Marketing the drug in a capsule doesn’t assure purchase of 100 percent MDMA.  Molly may be taken in conjunction with prescribed drugs for depression, anxiety, or attention deficit disorder, these drugs may exacerbate the effects of the MDMA and cause serotonin syndrome (Dobry, Rice, & Sher 2013).

MDMA use can create feelings of emotional warmth, sociability, and empathy toward others, in part due to increasing plasma oxytocin levels. Molly can also give the user perceptive distortions, such as failing to recognize dangerous social situations (Bedi, Hyman & de Wit, 2010).  It can release 80 percent of available serotonin in the brain (Parrot 2013) and this flood of serotonin makes the user’s experience (dance, sensual, sexual) feel heightened to a degree they have never achieved.  The depletion of serotonin after a weekend of partying with Molly may lead to a crashing mood a few days later that has been termed “Suicide Tuesday.”

Users of Molly should know that effects of the drug will change depending upon the size of the dose, the actual chemical composition of the dose and what other drugs they mix with it.  Alcohol, caffeine, methamphetamine, or cocaine may be combined with high doses or multiple doses.  User expectations can also affect their reaction to the drug.  Users have a high probability of misreading social cues and not having cognitive competency in risky situations (Bedi et al, 2010).

Popular Culture

Molly has become known to the public through its appearance in the lyrics of songs and depiction of use (or effects of use) in music videos. Attendees at music festivals, house music parties, and electronic dance music concerts use it. Ecstasy was prevalent at “raves” ten and twenty years ago, but early raves were small, privately held parties rather than large, organized festivals with thousands of attendees. As with MDMA, the prevalent water bottles, light sticks, or LED lights, languorous hair stroking, and sweating can imply Molly use.

Molly is featured as a drug of choice in numerous rap and pop songs, including:

“Do you know where I can find Molly?  She makes my life happier, more exciting. She makes me want to dance, dance, dance, dance, dance… Please help me find Molly,” a blonde actress intones in a synthesized voice to Cedric Gervais.
At the Ultra Music Festival in Miami, Madonna asked her audience  "How many people in this crowd have seen molly?" and received criticism from “deadmau5,” a house music producer who has been attempting to disassociate the view of the electronic dance music  community as a drug culture.  She replied. “…I don't support drug use and I never have. I was referring to the song called 'Have You Seen Molly' written by my friend Cedric Gervais…” (Makarechi, 2012).   Madonna’s next album however, was titled MDNA and contains tracks like “I’m Addicted,” “Girl Gone Wild,” and “Gang Bang.”

Miley Cyrus became more obvious to non-teen viewers at the recent VMA awards program for her performance of “We Can’t Stop,” which includes:

So la-da-di-da-di we like to party
Dancing with Molly
…
And everyone in line in the bathroom
Trying to get a line in the bathroom
Trinidad James “One More Molly”
Chorus:
I just popped a super molly
I just popped a super molly
She just popped a super molly
She just popped a super molly
She just won’t stop looking at me
She just won’t stop looking at me
We about to have a party
We about to have a party
Jay-Z “Empire State of Mind:
Came here for school, graduated to the high life
Ball players, rap stars, addicted to the limelight
MDMA got you feelin' like a champion
The city never sleeps, better slip you an Ambien.
Music videos depict users combining Molly with alcohol.  Rick Ross in Rocko’s U.O.E.N.O. supplies a verse recommending use of Molly as a date rape drug and lost his sponsorship by Reebok (Aleksander, 2013).
Put Molly all in her champagne, she ain’t even know it
I took her home and I enjoyed that, she ain't even know it
Other performers Tony Yayo and Soulja Boy suggest combining Molly with “Purple Drank” or “Lean,” (promethazine and codeine cough syrup mixed with alcohol or soft drinks,  Jolly Rancher™ candy or powdered drink mix) for added effects:

Tony Yayo “Lean Molly”
We got that lean and Molly’s
That lean and Molly’s
That lean and Molly’s
That lean and Molly’s
That lean and Molly’s
…
Soulja Boy “Molly With That Lean”
…
Molly with that lean, rolling through the streets
…
Take her to the crib, molly roll, molly roll
With that lean, with that lean, with that smoke, with that smoke
…
Molly with the lean, molly with the lean
Molly with the lean, molly with the lean

Molly as a trope in rap and pop music may be on the way out.  Kendrick Lamar in an interview with MTV said that, “When everybody consciously now uses this term or this phrase and putting it in lyrics, it waters the culture down.”  “It’s really about keeping hip-hop original and pushing away the corniness in it.”  When former Disney stars start singing about “Molly,” it may indeed be passé.

Health Risks

Users believe that Molly is safe and pure, and less dangerous than other street drugs.  The user may purchase what she or he believes is “pure” MDMA and take unknown and possibly more dangerous substances. Molly’s name, “3, 4-methylenedioxy-N-methylamphetamine” indicates that it is an amphetamine, and use can lead to many of the health problems encountered with other amphetamines. 

Serotonin syndrome may occur to those taking SSRI drugs for depression or anxiety (Selective Serotonin Reuptake Inhibitors) (Dobry, Rice & Sher 2013).  Commonly prescribed SSRIs include fluoxetine (Prozac), citoprolam (Celexa), and sertraline (Zoloft).  Mild serotonin syndrome symptoms may be the same as that from use of MDMA—agitation, confusion, sweating, headache, shivering. Severe serotonin syndrome can be much more serious with a high and irregular heartbeat, seizures, high fever (over 106?F) and loss of consciousness.  Temperatures over 106.7?F were correlated with mortality (Gowing, Henry-Edwards, Irvine & Ali, 2002).

An epidemiological study of what seemed to only be 6 overdoses and one death from a Los Angeles New Year’s Eve rave attended by 45,000 people found that there were, in fact, over 30 more emergency room visits by these dance patrons.  The patients started to arrive shortly after the party began, and most arrived during the rave.  One patient who died at home had also taken cocaine, heroin, and Ecstasy.  The patients were found to be suffering from agitation, hypertension (high blood pressure), mydriasis (excessive dilation of the pupil), and tachychardia (faster than normal heart rate which can disrupt heart function) (CDC, 2010).

Those ED patients were relatively unscathed as overdoses of Molly may lead to hyperthermia and that may manifest seizures, rhabdomyolosis (breakdown of muscle fibers and releasing their contents into the bloodstream), renal (kidney) or hepatic (liver) failure, metabolic disturbances, hemorrhagic stroke or cerebral edema.  Some of the patients had consumed other drugs or alcohol with MDMA (CDC, 2010; Parrot 2013).

MDMA/Molly as well as other amphetamines can cause tooth grinding or “bruxism.” This would seem minor until one needed to have broken teeth or dental appliances repaired. Less common are drug-induced valvular heart disease and chronic hepatitis. 

Deaths due to MDMA alone are relatively rare when compared to deaths due to some other causes, but are completely preventable.  In 2009, Australian researchers found that a total of 82 deaths over a five year period with MDMA as a contributing cause.  Of these deaths, 23 per cent were entirely attributable to Ecstasy as a sole substance (Kaye, Darke, & Duflou, 2009). In Taiwan between 2001 and 2008, 59 fatalities were found to test positive for MDMA (Lin, Liu & Liu, 2009).

While recovering from a period of use of Molly may cause depressed moods, “Suicide Tuesday” has not been a given. A few cases of suicide can be directly linked to MDMA. Data from the 2000 National Household Survey on Drug Abuse found that suicide attempts among adolescents who used Ecstasy were almost double that of adolescents who used other drugs, and nine times that of adolescents with no drug use (Kim, Fan, Liu, Kerner & Wu 2011).

Use in Therapy

Supporters of recreational use of MDMA/Molly claim it to be safe because it is “used in therapy,” laboring under the misperception that MDMA is a commonly prescribed psychiatric drug. While there are clinical trials with small numbers of patients taking MDMA in conjunction with psychotherapy, MDMA is not an FDA approved drug for general use.

One recent Posttraumatic Stress Syndrome (PTSD) treatment study added three MDMA or active placebo (low dose of MDMA in addition to weekly psychotherapy sessions.  The twelve patients only received the drug for three weeks, and were given follow-up assessment at two month and one year post-treatment. Clinicians did not detect any improvement in symptoms, but patients self-reported improvement in PTSD symptoms (Oehen, Traber, Widmer, & Schnyder 2013).

Prevalence

It is difficult to estimate the prevalence of Molly use.  National and local surveys may not inquire directly about the use of “Molly,” but may ask about MDMA or Ecstasy instead.  Some users may not recognize that “Molly” is in fact, the same drug as MDMA.  There may also be questions about stimulants or hallucinogens—and someone who is using Molly may not recognize their drug of choice as either a stimulant or hallucinogen.  Online polls and classroom queries indicate higher amounts of use and familiarity than do many published drug use surveys.

In Indiana 6-12th grade students, 5.3 percent of 12th graders claimed to have tried MDMA in their lifetime (Gassman et al, 2013), compared with 7.2 percent of students in a national sample (Monitoring the Future) (Johnston, et al, 2013).  Indiana 12th graders reported monthly use of Ecstasy at 1.7 percent versus the MTF national report of 0.9 percent.

The Substance Abuse and Mental Health Administration (SAMHSA’s) Drug Abuse Warning Network  (DAWN) is a public health surveillance system that monitors drug-related hospital emergency departments  (ED) and drug-related deaths investigated by medical examiners and coroners. DAWN’s reports are published with a two-year lag (2013 is 2011 data), so it isn’t a drug “early warning network,” but helps provide information specific to drug overdoses and deaths. 

DAWN reported that ED visits between 2009 and 2011 involving drug abuse or misuse increased 10 percent overall, or 200,000 visits per year for two years (SAMHSA, 2013). In 2011 data, MDMA reported as a single substance used was only found in 1.7 percent of Emergency Department visits. However, since 2011, over 50% of all ED visits included illicit drugs. Of that 50 percent, 56.3 percent involved multiple drugs, and 27.9 percent of all visits involving illicit drugs involved alcohol. (SAMHSA, 2013)

ADAM II (ONDCP, 2012), a sampling of male arrestees in five counties and the District of Columbia found varying use of MDMA as a secondary drug.  The study conducted 1,938 interviews and tested 1,736 urine arrestees within 48 hours of their arrest. New York and Chicago arrestees reported 5 to 6 percent use of MDMA or Ecstasy while Atlanta arrestees reported only 0.8 percent use.

Molly is not differentiated from other amphetamines or from hallucinogen-type street drugs, but it is one of the top 25 substances reported to one of the nation’s 57 poison control centers. All street drugs and stimulants (66,540 instances) were 2.42 percent of those reported (Bronstein et al, 2012).

The drug has been used for recreational purposes since the 1980s and is well known particularly in relationship to the dance club or rave scene. It became very popular in the Far East and Australia, and the United Kingdom.  A survey taken of dance magazine readers found that 96 percent had used Ecstasy and 41 per cent had used it for over five years (Winstock, Griffiths & Stewart, 2001).

Manufacturers and Distribution

Molly/MDMA is produced domestically, but also imported.  In 2012, a Federal Jury convicted two New York residents of importing Molly from Shanghai, China.  The DEA had been investigating a drug ring distributing Molly since 2009.  The drug trafficking organization had distributed over 100 kilograms over three years.  The drug was manufactured in China, shipped to distributors in the Syracuse area, and then distributed to others in New York, Florida, California, Texas, Virginia and elsewhere.  (US DEA, 2012).

Social media sites and the New York Times report Molly selling for $20-$50 a dose (about 100 milligrams) (Aleksander 2013).  Molly or similar substances are sold on the internet.

Molly-related merchandise can be purchased online (whatismolly.com), and test kits can be acquired to be sure one is taking the “real thing,” and not adulterated illicit product (www.dancesafe.org).  DanceSafe.org advocates for responsible use and harm-reduction of substances associated with dance events.

References

Aleksander, Irina. (June 21, 2013).  Molly: Pure but Not So Simple.  New York Times. http://www.nytimes.com/2013/06/23/fashion/molly-pure-but-not-so-simple.html?pagewanted=all&_r=0

Bedi, G., Hyman, D., & de Wit, H. (2010). Is Ecstasy an “Empathogen”? Effects of ±3, 4-Methylenedioxymethamphetamine on Prosocial Feelings and Identification of Emotional States in Others. Biological Psychiatry, 68(12) 1134-1140. http://dx.doi.org/10.1016/j.biopsych.2010.08.003.

Bronstein, A. C., Spyker, D. A., Cantilena, L .R., Rumack, B. H., & Dart, R. C. (2012). 2011 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 29th Annual Report. Clinical Toxicology, 50,911–1164. https://aapcc.s3.amazonaws.com/pdfs/annual_reports/2011_NPDS_Annual_Report.pdf

Centers for Disease Control and Prevention. (June 11, 2010). Ecstasy overdoses at New Year’s Eve rave – Los Angeles, California, 2010. Morbidity and Mortality Weekly Report. 2010, 59 (22): 677-681. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5922a1.htm

Centers for Disease Control and Prevention. ( June 8, 2012) Youth Risk Behavior Surveillance — United States, 2011. MMWR. 2012,61(No. SS-4): 21-22. http://www.cdc.gov/mmwr/pdf/ss/ss6104.pdf

Dance Safe (2013). http://www.dancesafe.org/

Dobry, Y., Rice, T. & Sher, L. (2013). Ecstasy use and serotonin syndrome: a neglected danger to adolescents and young adults prescribed selective serotonin reuptake inhibitors.  International Journal of Adolescent Medicine and Health, 25(3):193-199.

Hogan, Marc.  (2013). Kendrick Lamar Comes not to Praise Molly Rap But to Bury it.  http://www.spin.com/articles/kendrick-lamar-death-to-molly-rap-video-interview/

Kaye, S., Darke, S., & Duflou, J. (2009). Methylenedioxymethamphetamine (MDMA) related fatalities in Australia: demographics, circumstances, toxicology and major organ pathology. Drug and Alcohol Dependence, 104(3):254-261.

Kim, J., Fan, B., Liu, X., Kerner, N. and Wu, P. (2011), Ecstasy Use and Suicidal Behavior among Adolescents: Findings from a National Survey. Suicide and Life-Threatening Behavior. 41(4): 435–444. doi: 10.1111/j.1943-278X.2011.00043.x

King, R. A., & Jun, M. K. (2012). Results of the Indiana College Substance Use Survey – 2012. Bloomington, IN: Indiana Prevention Resource Center, Indiana University.

Gassman R., Jun, M. C., Samuel, S., Agley, J. D., Lee, J., Crane, M. K., Boyken, J., Oi, S. E., Pardue, S. E., Smith, J. N., Stigger, C.K. (2013). Alcohol, Tobacco, and Other Drug Use by Indiana Children and Adolescents. Bloomington, IN: Indiana Prevention Resource Center. 70-71.

Gowing, L. R., Henry-Edwards, S. M., Irvine, R. J., & Ali, R. L. (2002). The health effects of ecstasy: a literature review. Drug and Alcohol Review, 21(1):53-63.

Johnston, O’Malley, Bachman, & Schulenberg (2013). Monitoring the Future: Overview of Key Findings. http://www.monitoringthefuture.org//pubs/monographs/mtf-overview2012.pdf

Lin, D. L., Liu, H. C., & Liu, R. H. (2009). Methylenedioxymethamphetamine-Related Deaths in Taiwan: 2001–2008. J Analitical Toxicology, 33(7): 366-371 doi:10.1093/jat/33.7.366

Makarechi, Kia. (2012). Deadmau5 Slams Madonna Over 'Molly,' Ecstasy Reference at Ultra Music Festival. Http://www.huffingtonpost.com/2012/03/26/deadmau5--madonna-molly-ultra-_n_1379437.html

National Institute of Drug Abuse. (2013). DrugFacts: MDMA (Ecstasy or Molly). http://www.drugabuse.gov/publications/drugfacts/mdma-ecstasy-or-molly

Parrott, A. C. (2013), Human psychobiology of MDMA or ‘Ecstasy’: an overview of 25?years of empirical research. Human Psychopharmacol Clin Exp, 28: 289–307. doi: 10.1002/hup.2318

ONDCP (2012). ADAM II:  Arrestee Drug Annual Monitoring Report, p. 73. http://www.whitehouse.gov/sites/default/files/ondcp/policy-and-research/adam_ii_2012_annual_rpt_final_final.pdf

NBC Washington. (September 6, 2013). Police Investigate "Molly" Use in U.Va. Student's Death (September 6, 2013). http://www.nbcwashington.com/news/local/Police-Investigating-Molly-Use-in-UVa-Students-Death-Mary-Shelley-Goldsmith-222397561.html

Seldon, D. (August 31, 2013). Molly drug death closes House of Blues (Video).  Examiner.com. http://www.examiner.com/article/molly-drug-death-closes-house-of-blues-boston

Sisario, Ben and McKinley, James C.  (September 9, 2013). Drug Deaths Threaten Rising Business of Electronic Music Fests. New York Times. http://www.nytimes.com/2013/09/10/arts/music/drugs-at-music-festivals-are-threat-to-investors-as-well-as-fans.html?pagewanted=all

Substance Abuse and Mental Health Administration (2013). Drug Abuse Warning Network (DAWN): National Estimates of Drug-Related Emergency Department Visits. HHS Publication No. (SMA) 13-4760, DAWN Series D-39. Rockville, MD: Substance Abuse and Mental Health Services Administration. Pp 22, 25-26. http://www.samhsa.gov/data/DAWN.aspx  http://www.samhsa.gov/data/2k13/DAWN2k11ED/DAWN2k11ED.htm

U.S. Drug Enforcement Agency. (2012). Federal Jury Convicts Two Syracuse Men for Conspiracy to Import and Distribute Synthetic Drug “Molly.” http://www.justice.gov/dea/divisions/nyc/2013/nyc051613.shtml

Whatismolly.com (2013). Molly Test Kit and Molly Merchandise.   http://whatismolly.com/test-your-drugs/  http://whatismolly.spreadshirt.com/

Winstock,  A. R. , Griffiths,  P., & Stewart, D.  (2001). Drugs and the dance music scene: a survey of current drug use patterns among a sample of dance music enthusiasts in the UK. Drug and Alcohol Dependence, 64(1):9-17.

By Carole Nowicke, 9/12/2013