Pubdate: Tue, 28 Jul 2015
Source: Washington Post (DC)
Copyright: 2015 The Washington Post Company
Contact:  http://www.washingtonpost.com/
Details: http://www.mapinc.org/media/491
Author: Susan Berger
Bookmark: http://www.mapinc.org/mdma.htm (Ecstasy)

A STREET DRUG WIDELY CONSIDERED SAFE, MOLLY ACTUALLY POSES MAJOR RISKS

In high school, Shelley Goldsmith was a student council president and 
tennis team captain. She'd won an academic scholarship to the 
University of Virginia, had raised money for the American Heart 
Association and baked cupcakes for cancer patients when her dad was 
going through chemotherapy.

The Abington, Va., teen also loved music. In August 2013, Goldsmith, 
then 19, attended a rave concert at a club in Washington where she 
took some Molly, a popular recreational drug. After a few hours of 
hard dancing, she collapsed. She died several hours later at a hospital.

A purified version of ecstasy, or MDMA, Molly is commonly thought to 
be a safe drug, and it has been popularized by such singers as Miley 
Cyrus, Kanye West and Rihanna. It produces a high that users say 
allows them to dance tirelessly, be more open and uninhibited 
emotionally, and experience euphoria and heightened sensory 
awareness. The Drug Enforcement Administration says no other drug is 
quite like MDMA, creating amphetamine-like energized feelings and 
mild mescaline-like hallucinations.

In the 1970s, MDMA was prescribed as an aid to psychotherapy to 
improve patients' insights about their problems and enhance their 
ability to communicate with their therapists. In 1985, as the drug 
began showing up in clubs and other nontherapeutic settings, the DEA 
grew worried about abuse and banned it.

Recently, though, clinical trials of MDMA have been approved for 
treating post-traumatic stress disorder, anxiety in terminal cancer 
patients and social anxiety in adults with autism. Some have shown 
promising results.

The Molly sold on the street often is laced with other substances - 
such as acetaminophen, amphetamines and ketamine, a compound used in 
anesthesia - that can be deadly in large enough doses, according to 
an NYU Langone Online Journal of Medicine article.

Molly typically works in about an hour, and its effects last a little 
more than seven hours. In addition to causing users to feel good, it 
can cause paranoia, anxiety, depression, loss of appetite, dry mouth, 
hot and cold flushes and teeth grinding. (See sidebar aboutMolly's effects.)

In February, 10 Wesleyan University students and one guest at the 
Connecticut college were hospitalized, some in critical condition, 
according to Mark Neavyn, director of toxicology at Hartford 
Hospital, who was in the emergency room when some of the young people 
came in. Although they had taken what they thought was Molly, Neavyn 
said, blood and urine tests suggested they had actually ingested 
other chemicals and drugs.

All of the hospitalized students eventually were released. Two 
Wesleyan students, Zachary Kramer, 21, of Bethesda, and Eric 
Longeran, 22, of Rio de Janeiro, face federal charges, including for 
distributing synthetic drugs.

With its friendly-girl-nextdoor name and its embrace by music 
culture, Molly began to grow in popularity beginning in about 2004, 
according to figures from the Office of National Drug Control Policy. 
A 2013 report from the Substance Abuse and Mental Health Services 
Administration found that annual estimated visits to hospital 
emergency departments by people 21 and younger involving the drug 
increased 128 percent - from 4,460 to 10,176 - between 2005 and 2011, 
though 2010 may have been the peak.

A mainstream drug

"We like to party dancing with Molly/ Doing whatever we want," sings 
Miley Cyrus.

"Something about Mary, she gone off that Molly/ Now the whole party 
is melted like Dali," raps Kanye West. From Rihanna: "Palms rise to 
the universe/ As we moonshine and Molly/ Feel the warmth, we'll never 
die/ We're like diamonds in the sky."

Patil Armenian, an emergency medicine and medical toxicology 
physician at the University of California at San Francisco/Fresno, 
says Molly "is now a mainstream drug, not just a club drug. It is all 
over college campuses, high schools . . . used by those in their 30s 
and 40s. It was once thought of as a middle-class Caucasian drug, but 
we are seeing it in the African American population as well."

Armenian, whose main area of research is MDMA and designer drugs, 
said that a huge problem is that the various pills and powders being 
sold on the street as Molly have unknown strength and chemical 
composition so that anytime people use it, they are taking a huge risk.

"We have seen terrible outcomes even with pure MDMA," Armenian said. 
"The poison is in the dose. Everything is poisonous if you take 
enough of it." Goldsmith's mother, Dede Goldsmith, said a toxicology 
report found that her daughter's death was the result of ingesting pure MDMA.

Armenian and Neavyn said Molly is easily obtained, often under the 
label of research chemicals on what is called the dark Web - sites 
that conceal their addresses and are reachable only through special 
browsers. Working with a DEA agent to avoid legal problems, Armenian 
said, she was able to buy as part of her research a chemical compound 
very similar to pure MDMA, paying for it via PayPal. "It was 
impressive how easy it was," she said.

When people have died after taking Molly, Armenian said, it has 
usually been due to serotonin syndrome, which causes agitation, rapid 
heart rate, high fever, high blood pressure, loss of muscle 
coordination, seizures and unconsciousness. Anyone taking 
antidepressants is at greater risk because the drugs increase the 
effects of serotonin, which become magnified by MDMA.

Andrew Bazos, founder of CrowdRx, which provides emergency medical 
services at many summer concerts, says the combination of music, 
drugs, heat and nonstop dancing is a perfect storm for trouble.

"With dropping sodium levels, electrolyte imbalance and increased 
body temperature, it creates an inhospitable environment for the 
heart and brain to live happily and normally," said Bazos, who is 
also a physician at the New York University School of Medicine. Molly 
fools the body's temperature-regulating system to stop functioning 
properly, he said, allowing a concertgoer to overheat to a dangerous extent.

CrowdRx EMTs are constantly on the lookout for people having trouble 
walking, thinking and answering questions. In addition, they screen 
those in trouble for increased temperature. CrowdRx purchased a 
device (I-stat) that measures electrolyte levels onsite so that if 
necessary someone can get IV fluids right away to correct electrolyte 
levels. They also have cooling baths to treat those with rising temperature.

Bazos and Neavyn say anyone tempted to enhance the concert experience 
by using Molly should think twice. These are chemicals developed in 
laboratories for research, Neavyn said. "When you start experimenting 
with research chemicals, even the most skilled chemists can get it 
wrong, You just don't know what you are getting when you take that 
capsule or snort that line," he said. "That one bad choice can be 
your last choice."

[sidebar]

What to know about Molly

 From a National Institute on Drug Abuse summary about MDMA:

Reported undesirable effects:

Anxiety, restlessness, irritability, sadness, impulsiveness, 
aggression, sleep disturbances, lack of appetite, thirst, reduced 
interest in and pleasure from sex, significant reductions in mental abilities

Potential adverse health effects:

Nausea, chills, sweating, involuntary jaw clenching and teeth 
grinding, muscle cramping, blurred vision, marked rise in body 
temperature (hyperthermia), dehydration, high blood pressure, heart 
failure, kidney failure, arrhythmia

Symptoms of MDMA overdose:

High blood pressure, faintness, panic attacks, loss of consciousness, seizures 
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MAP posted-by: Jay Bergstrom