Molly (MDMA)

[rwik123]

I wanted to create a thread to talk about the more and more frequent use of the club drug called "Molly" (MDMA). In the last few weeks there have been a handful of deaths linked to supposed Molly usage, Boston at the House of Blues and Electric Zoo in NYC leading to the closing of the festival.

If people have had patients under the influence of this, share how they presented and any intricacies of this drug and how you treated them.

I've personally seen people under the influence of it, but have never witnessed the overdose presentation of it...seizure activity ect. Its been known to present with tachycardia, bruxism (why rave goers sometimes chew on a pacifier), and intense sweating leading to hyponatremia in the late stages.

I'd be curious to know if there are a mass of uneducated users flocking to the drug, or if it now being cut/mixed with other, more potent substances.

 

[DesertMedic66]

We had a lot of Molly use at our Coachella music festival. We had patients present with "voices are telling me things". To people claiming to not be able to breath who were breathing fine. We had a fair amount of seizures caused by it. The worst ones we had were 3 patients in respiratory arrest.

Most patients were tachy (around 120) and profusely sweating.

I know the drug is starting to be cut with other drugs which can make the effects stronger but it also leads to more complications.

 

[brian328]

I'd be curious to know if there are a mass of uneducated users flocking to the drug, or if it now being cut/mixed with other, more potent substances.

a lot of people blindly use it/try it because it is the "party drug." they take more than one without knowing the effects. most of the time it is cut with ketamine, GHB, meth, caffeine, and/or ephedrine along with some other psychedelic drugs.

you perspire a lot and people easily get dehydrated on it along with the rapid heart rate.

i believe there have been multiple cardiac related deaths from this drug at recent festivals.

 

[TheLocalMedic]

There is a difference between ecstasy (MDMA) and "Molly" (MDA). They have many similar effects, but user often report that MDA tends to give a more intense high as well as occasionally having hallucinogenic properties.

That being said, the biggest issue is hyperthermia with both drugs. If people are being responsible users by staying hydrated and taking breaks from physical activity, then generally there aren't too many problems. However first time users or uneducated users may get themselves into trouble if they overdo it. It's the hyperthermia (not electrolyte imbalances or "other stuff" in the drug) that can cause seizures.

Look for very dilated pupils, bruxism, euphoria, tachycardia and hyperthermia. Best treatment is cooling and hydration, treat seizures with cooling measures and a benzo.

If you're working in a club or party setting, hand out waters and see if you can get the overly-active ones to peel off and take a break for a minute.

 

[Tigger]

Molly is MDMA, MDA is/was known as the "love drug" and if one needs a personified name for it I believe it would be Mandy.

Though close cousins, they are not the same substance and MDA isn't so widely used as of late.

Ecstasy can be MDMA, it can be MDMA cut with something else (ketamine, GHB, am/methamphetamine, caffeine, etc as an other poster listed), or it can be something entirely without MDMA that's just a "party drug" that the user likely has no idea what it actually contains.

Just some terminology reference from my neck of the woods/hippy college.

 

[VFlutter]

Molly is usually a powder or capsule instead of a tablet.

 

[BeachMedic]

It's been cut and mixed with more potent substances since forever. This isn't an epidemic that's been gaining momentum over the last few weeks. This is just the party scene and the way it's been for decades. It's just that ecstasy has a trendy new form and name.

Where most kids mess up isn't from a bad batch of drugs mixed with unknown substances. It is that they mix their mdma usage with their alcohol usage; potentiating the aforementioned hyperthermia and dehydration. If it were a bad batch of drugs you'd see these kids dropping by the handful like what happened in San Francisco a few years back.

Drugs kill people everyday and have been for a long time. It's only big news when a popular New York rave gets cancelled I guess.

As far as patient presentation...retardedly euphoric and sweaty is probably a good way to describe it.

 

[Amberlamps916]

So far, I've only had one patient who took Molly. He preceded to masturbate while en route to the hospital whilst telling us how much he, ahem, wanted to sleep with us, and then subsequently masturbated/attempted to masturbate once restrained on the gurney during the 2 hours it took for us to get a bed. Good times.

 

[the_negro_puppy]

The biggest dangers from ecstasy / MDMA / Molly are hyperthermia and hyponatraemia.

Caused ironically by people either drinking not enough water / rest / heat versus many recorded deaths of people drinking excessive amounts of water with no electrolyte replacement. Don't forget serotonin syndrome as a rarer complication.

As EDM continues to explode in America you guys will see more of this. Drug use and EDM goes hand in hand. The best outcome is too have lots of harm reduction measures in place to educate people on MDMA use and risk mitigation (read: how to use safely). Zero tolerance has failed and drug use is more prevalent than ever despite 30 years of the war on drugs.

It is a reasonably safe drug when used carefully which is why its so popular. Only a small % of users have serious medical complications from use.

 

[EpiEMS]

As EDM continues to explode in America you guys will see more of this.

Do you see a lot of MDMA users as patients down under? One would think that Europe, Australia, etc. would have more as EDM has been a larger "subculture," if you'll pardon the word, for longer. Any tips for management of the acute MDMA patient?

 

[the_negro_puppy]

Do you see a lot of MDMA users as patients down under? One would think that Europe, Australia, etc. would have more as EDM has been a larger "subculture," if you'll pardon the word, for longer. Any tips for management of the acute MDMA patient?

Yes ecstasy / MDMA use at nightclubs and music festivals has been widespread in Aus since around 2005, with a few high profile deaths at festivals not unlike those seen in NYC.

One huge problem is that the quality or purity of the drug. Many pressed 'ecstasy' tablets here don't even contain MDMA, due to difficulty in obtaining the products require to synthesise it (Safrole).

Instead many stimulant analogues such as BZP, 2CB, and PMA with PMA producing toxic effects when co-ingested with MDMA. Many of the other chemicals have psychedelic and other properties which MDMA does not.

So at festivals you have a bunch of young adults, running around mixing alcohol, with a broad array of different stimulants producing a wide variety of results. Presentations you can expect to find:

- Anxiety, panic attacks, mild hallucinations and disorientation.
- Chest pain, palpitations, chest tightness and DIB, dizziness.
- Collapse, unconsciousness, vomiting, seizures etc are generally caused by co-ingestion of alcohol & drugs + environmental factors such as heat exhaustion.

The typical MDMA affected user will have dilated pupils, tachycardia at rest will be restless / slightly agitated and constantly moving limbs etc. They are usually pretty euphoric, firendly and easily distracted by stimulus such as flashing lights and music (Lol)

It is actually pretty hard to 'overdose' on MDMA. The therapeutic dose is around 120mg with typical uses topping up and partying over 4-8 hours.

As others have mentioned the biggest problems found are mixing MDMA with other drugs or alcohol, ingesting adulterated substances and environmental exposure (heat stroke or drinking too much water to compensate with no electrolyte)

The best thing you can do is remove the patient from stimulus, have a responsible friend on hand to help reassure them. Manage dehydration / heat stroke as per guidelines, manage emesis / airway and be prepared for possible seizure activity. Get a good history from friend if possible as to what was taken, how many, the times, if the patient has eaten and how much water they have been drinking.

High profile cases here:

http://au.news.yahoo.com/thewest/a/-/breaking/15891569/teen-sought-treatment-before-ecstasy-death/

http://www.couriermail.com.au/news/...more-australians/story-e6freoof-1225825004959

Summary- Pure MDMA in itself generally doesn't directly cause death or serious complications. It is usually co-ingesting other substances, unknowingly taking other stimulants that are not MDMA or not managing its effects (rest, hydration, electrolyte replacement)

 

[EpiEMS]

Presentations you can expect to find:

- Anxiety, panic attacks, mild hallucinations and disorientation.
- Chest pain, palpitations, chest tightness and DIB, dizziness.
- Collapse, unconsciousness, vomiting, seizures etc are generally caused by co-ingestion of alcohol & drugs + environmental factors such as heat exhaustion.

Thanks for the comprehensive response! I was very curious as to what the adverse effects presented as, since I've yet to have a patient present with an MDMA-related problem.