ABSTRACT
The substance abused within the varying cultures of the world reflect the individual promotions inherent within each of these populations. A new epidemic has emerged, especially amongst the millennial generation, where party drugs and feel good music have laid a platform for risky, indulgent behaviors. Molly, otherwise known as MDMA, is a pure form of ecstasy. The notion behind molly is that the lack of other potentially harmful cutter drugs which typically lace ecstasy to give an enhanced effect, whether speed, methamphetamine, or other dangerous stimulants, makes molly safe for use. However, research has uncovered that MDMA, even in its purest form, is accompanied with a host of side effects, both long-term and short-term. Although potentially fatal upon the first dose, many believe they’ve gotten away with abusing molly when they’ve sobered up. The long-term effects of molly appear to be permanent, and thus are damaging to the individual beyond their own current comprehension. For this reason it is important to identify the underlying modifiable risk factors, and promote an intervention program of awareness in order to cease the use of molly, and it’s counterparts.
Molly – The Party Drug; Challenging A Natural Predisposition to Feel Good
Molly has been around for quite some time but has recently become more popular. Whether this is due to popular Hip-Hop/R&B artists singing about it or the EDM party scene becoming more popular, the reason is unknown; what we do know is that Molly is a dangerous drug that is often described as being “too fun to quit” (Haglage, 2013).
Molly, also known as MDMA, is the pure form of Ecstasy. Ecstasy itself is MDMA laced with other ingredients such as caffeine or methamphetamine (Partnership for drug-free kids, 2012, August 17). MDMA, short for 3,4-methylenedioxy-methamphetamine, is both an amphetamine and a hallucinogen (National Institute on Drug Abuse, 2016). Molly works mainly on the brain’s neurotransmitters. Molly targets three neurotransmitters in particular that produce feelings of happiness, warmth, and energy. Molly also increases the activity of serotonin and dopamine neurotransmitters. These neurotransmitters are known as the “feel good” molecules. The neurotransmitter that is affected the most is serotonin, which is the main reason why the drug has a euphoric effect. Once serotonin is activated, the neurotransmitter then activates the release of oxytocin and vasopressin. These two hormones are known to be involved in developing feelings of love, trust, and sexual arousal (Larry Sherman, 2013). This explains why some people call molly the “Love Drug.” The neurotransmitter dopamine is the one that produces energy that makes users stay up all night along. The third neurotransmitter molly affects are the neurotransmitters for norepinephrine, which are involved in the fight-or-flight response. Norepinephrine increases heart rate and raises blood pressure. Since the brain cannot recycle the dopamine, serotonin, and norepinephrine after it is released, the feeling only lasts between three to six hours (National Institute on Drug Abuse, 2016). This is because the brain releases the neurotransmitters so fast that it cannot keep up with production and it cannot recycle them. However, increased release of these three hormones leaves the user is endowed with energy and euphoria that makes the dancing season and night life especially attractive, and increases the risk for risky sexual behavior.
Molly has had a huge spike in usage since 2013, mainly with the young demographic. According to the U.S. Department of Justice Drug Enforcement Administration (DEA) in 2015b, the people that use MDMA the most are 18 – 22 year-olds that are not going to school full time. Molly is cheap, easy to access, and is said to be more fun than alcohol, weed, and cocaine. A comparison of the 2012 and 2013 Global Drug Surveys, conducted by an independent drug-use data agency, shows just how popular Molly has become. In 2012, 26.5 percent of U.S. respondents had tried MDMA in that year. In 2013, the number jumped to 60.9 percent (Haglage, 2013). Not only are the numbers of users increasing, the number of emergency related incidents are sky rocketing as well.
MDMA can produce confusion, depression, sleep problems, drug cravings, and severe anxiety. These problems can occur soon after taking the drug or, sometimes, even days or weeks after taking MDMA. In addition, chronic users of MDMA perform more poorly than non-users on certain types of cognitive or memory tasks, although some of these effects may be due to the use of other drugs in combination with MDMA (Ricaurte and McCann, 2001). Research in animals indicates that MDMA can be neurotoxic to the brain. One study in non-human primates showed that exposure to MDMA for only 4 days caused damage to serotonin nerve terminals, and that damage was still evident 6 to 7 years later (Ricaurte and McCann, 2001). Although similar neurotoxicity has not been shown definitively in humans, the wealth of animal research indicating MDMA’s damaging properties strongly suggests that MDMA is not a safe drug for human consumption.
For some people, MDMA can be addictive. A survey of young adult and adolescent MDMA users found that 43 percent of those who reported ecstasy use met the accepted diagnostic criteria for dependence, as evidenced by continued use despite knowledge of physical or psychological harm, withdrawal effects, and tolerance (or diminished response) (Leung and Cottler, 2008). These results are consistent with those from similar studies in other countries that suggest a high rate of MDMA dependence among users. MDMA abstinence-associated withdrawal symptoms include fatigue, loss of appetite, depressed feelings, and trouble concentrating (Leung and Cottler, 2008).
MDMA can also be dangerous to overall health and, on rare occasions, lethal. MDMA can have many of the same physical effects as other stimulants, such as cocaine and amphetamines. These include increases in heart rate and blood pressure, which present risks for people with circulatory problems or heart disease (Cottler et al., 2001). Other health concerns include muscle tension, involuntary teeth clenching, nausea, blurred vision, faintness, and chills or sweating.
In high doses, MDMA can interfere with the body’s ability to regulate temperature. On rare but unpredictable occasions, this can lead to a sharp increase in body temperature (hyperthermia), which can result in liver, kidney, cardiovascular system failure, or death. MDMA can interfere with its own metabolism (breakdown within the body), therefore, potentially harmful levels can be reached by repeated MDMA administration within short periods of time (Cottler et al., 2001).
Other drugs that are chemically similar to MDMA, such as MDA (methylenedioxyamphetamine, the parent drug of MDMA) and PMA (paramethoxyamphetamine, associated with fatalities in the United States and Australia) are sometimes sold as ecstasy or molly. These drugs can be neurotoxic or create additional health risks to the user. Furthermore, molly tablets may contain other substances, such as ephedrine (a stimulant), dextromethorphan (DXM, a cough suppressant); ketamine (an anesthetic used mostly by veterinarians), caffeine, cocaine, and methamphetamine (Cottler et al., 2001). Although the combination of MDMA with one or more of these drugs may be inherently dangerous, users who also combine these with additional substances such as marijuana and alcohol may be putting themselves at even higher risk for adverse health effects (Cottler et al., 2001).
The short term effects of molly are increased energy, distortion of time and perception, and an increase in enjoyment from touching. However, it also causes an inability to regulate temperature causing sharp increases in body temperature and even hyperthermia. Heatstroke, liver, kidney, and cardiovascular system failure, perceptual changes, anxiety, jaw-clenching, dry mouth, and appetite changes are also prevalent. Other responses include heightened blood pressure, increased headaches, chills, eye-twitching, blurred vision, nausea, dehydration, muscle tension, severe sweating, faintness, seizures, and day-after depression. Heatstroke (hyperthermia) is the primary cause of death. Taking molly in combination with other drugs, such as alcohol, can increase the risk (Cottler et al., 2001).
Long term effects of taking molly are dramatic increase in heart rate; leading to serious complications for people with cardiovascular disease. Dehydration can lead to liver and kidney failure. Since molly depletes the amount of serotonin in the brain and blocks uptake of serotonin, it causes disturbing emotional reactions, confusion, depression, sleep problems, and severe anxiety. Symptoms can last a long time after taking the drug and because it is so toxic to the brain it can also impair memory. Brain damage can also result and is directly related to quantity and frequency of usage (Cottler et al., 2001).
The three concrete modifiable risk factors most associated with MDMA use are risk perception, current ecstasy dependence, and perceived behavioral control of obtainment (Leung et al., 2010). Several non-modifiable risk factors also exist, including gender, ethnicity, measures of lifetime consumption at a single point, and the age of onset (Parrott, 2001). These are important to understanding the development of addiction although they are not subject to change and cannot be part of the intervention process. Therefore, it’s important to remain focused on the modifiable risk factors that can be understood and implemented into intervention programs going forward.
Initiation of ecstasy use can be predicted by an adolescent’s early initiation of smoking, drinking, and marijuana use (Wu, Liu, & Fan, 2010). The early initiation can be attributed to include either premature marijuana use, or drinking and smoking. Parental drug history is also a strong indicator of whether adolescents will engage in MDMA use. However, living within close quarters with parents and close parental monitoring deters MDMA use. A positive attitude towards substance abuse, a disregard for the consequences of substance abuse, sensation seeking tendencies, and a close association with deviant peers are all predictive of adolescent initiation of ecstasy use (Wu et al., 2010). As a predictive tool, those with high-sensation seeking tendencies and close friend’s drug use were more likely to be susceptible to MDMA use than users of tobacco/alcohol and marijuana alone (Martins, Storr, Alexandre, & Chilcoat, 2008). High sensation seekers are more likely to abuse marijuana, tobacco, drinking, and ecstasy as well. Those with low parental monitoring were also more likely to abuse these same drugs. The strongest indicator of ecstasy use appears to be whether friends are also users (Martins, et al., 2008).
Risk perception is defined as an attitude that summarizes an evaluation of an object along a favorable-unfavorable attribute dimension. It’s been shown that risk perception has a direct relationship to lifetime ecstasy use and consumption (Yacoubian, Boyle, Harding, & Loftus, 2003). According to the National Institute of Drug Abuse in 2014, “while many social and cultural factors affect drug use trends, when young people perceive drug use as harmful, they reduce their level of use.” “Education is one of the most important tools for use in preventing MDMA abuse” (National Institute on Drug Abuse, 2006). The subjects that were reported regular users of MDMA perceived that MDMA use was not as dangerous as their drug-free counterparts (Leung, Ben Abdallah, Copeland, & Cottler, 2010). MDMA users rated that the risk regarding ecstasy use once per week for a month existed, but did not rank the risk as high as non-MDMA users rated the risk level. Based on the diagnostic tools within the DSM-IV, which are able to identify predictors for ecstasy dependence, the users of MDMA showed higher levels of predictors for dependence than non-users. This aids in the validity of the DSM-IV as a predictive tool for diagnosing those vulnerable to MDMA use and abuse. Further, it appears that identifiable risk factors are present in those most likely to participate in MDMA use.
MDMA use, as well as general drug use, is a goal-directed behavior that aims to cope with the user’s expected lifetime utility maximization (Ben Abdallah, Scheier, Inciardi, Copeland, & Cottler, 2007). This decision making appears to be closely related to the effort that is used through cognitive, rational choices to obtain MDMA. This suggests that the time spent finding and consuming ecstasy has a direct influence on the decision to pursue, purchase, and use ecstasy. The convenience of purchasing and consuming ecstasy is therefore in a direct relationship with the likelihood of engaging in this behavior (Ben Abdallah, et al., 2007).
Although mood has not been directly tied to ecstasy use, it appears that there is a relationship between the two. Recent depression was not a stimulus for ecstasy use, while using ecstasy to alleviate chronic depression (Boys, Marsden, & Strang, 2001) and depression preceding ecstasy use (Lieb, Schuetz, Pfister, Von Sydow, & Wittchen, 2002) were reliable predictors of future use. Further, regular ecstasy users are reported to have elevated levels of psychological distress in comparison to the general population (George, Kinner, Bruno, Degenhardt, & Dunn, 2010). Sociodemographic characteristics and other drug user patterns are important contributors to this distress. Stress level has been associated with risky behavior and drug use (Wu, Grady, Rosales, & Berenson, 2011), and should be considered in the intervention programs going forward.
MDMA, or its street name counterpart “molly”, should be regarded as a potentially lethal, addictive, and highly damaging substance. The neurotoxic effects of MDMA on the brain present a growing problem within the United States, and around the world. Within growing populations that have already shown to be suffering from mental health problems, it appears that users are using molly in an attempt to heighten their experience of life, lift depression, and gain social approval (Haglage, 2013). The lasting neurological effects of molly abuse create a self-fulfilling prophecy as serotonin terminals are damaged, creating a more difficult ability to reuptake serotonin and continue to feel positive emotions (Ricaurte & McCann, 2001). This situation can lead to further drug abuse, as the majority of users are sensation seekers that will not cope well with diminished serotonin levels. Interventions should focus on identifying those who are predicted to be at risk of molly use. These modifiable risk factors include socially-deviant peers, depressive symptoms, stress, access to MDMA, low parental monitoring, and low risk perception. Fostering rehabilitative interventions after MDMA use can help prevent future use, although it appears that the damage brought on by MDMA could remain irreversible after initial use.
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