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CLINICAL TOXICOLOGY
SEPTEMBER 2013
MOLLY- "NOT YOUR BEST FRIEND"
In recent months, a string of drug overdose-related
deaths and emergency room (EM) visits reported by
news media has turned the spotlight on a resurgence
of an obsolete drug, MDMA. In the latest
development, a three-day electronic music event in
New York City was forced to cut short after two
concertgoers died and at least four others were
placed under intensive care from suspected Molly
(MDMA) overdose. MDMA (3,4-methylenedioxymethylamphetamine), better known as Ecstasy, is
regarded as a congener of amphetamines.
Amphetamines work as a releasing agent in the
central nervous system and its actions lead to the
increased levels of dopamine, serotonin, and
norepinephrine in the synaptic cleft. MDMA may
work more selectively on the serotonin release. The
rapid flush of neurotransmitters can create a feeling
of euphoria, increased energy, and less social
awkwardness. MDMA is currently listed as a schedule
I controlled substance under federal laws, which
means there is no accepted medical use and a high
abuse potential. However, the potential medical
benefit of MDMA has been explored. Clinical trials are
being undertaken to use MDMA to treat posttraumatic distress syndrome and anxiety in terminally
ill cancer patients. MDMA is not a new synthetic drug.
It was first synthesized in 1914 and saw its heydays as
a party drug in 1990s. Into the 21st century, Molly
becomes the new name of MDMA and is promoted as
a highly purified form of MDMA. There are signs of
renewed interest in this drug among drug users,
especially first-time drug users and college students.
According to a national survey on drug-related
emergency room visits, the number of emergency
room visits involving MDMA overdose doubled in
2011 compared with that in 2004 [1]. The survey also
found that patients for MDMA-related EM visits were
predominantly young people (83 % of the patients
were < 30 years of age), and about 50% of those
patients were between the ages of 18-24 [1].
Cultural influence has a significant role in this new
wave of MDMA use. Molly has appeared in the lyrics
of two songs and become a necessity for fans
attending electronic musical events. American
Clinical Solutions provides testing services for
MDMA and its metabolite - MDA in urine and oral
fluid samples. In terms of pharmacokinetics, MDMA
undergoes hepatic metabolism mediated by COMT
and CYP2D6 to form MDA and several other
metabolites. MDMA is eliminated majorly through
the urinary route. Detection windows for MDMA in
urine and oral fluid are 1-3 days and 1 day,
respectively. Molly is promoted as a highly purified
version of MDMA, although that claim has never been
verified due to the illicit nature of MDMA. As with all
other illicit drugs, there were reports that Molly had
been cut with other substances such as methylone,
which can lead to increased risk of toxicity. It should
be pointed out that there is no safe or good batch of
MDMA. Overdose of MDMA can cause dehydration,
hyperthermia, symptoms of the serotonin syndrome,
seizure, multiple organ failure, and even death.
1. Drug Abuse Warning Network, 2011: National Estimates
of Drug-Related Emergency Department Visits. U.S.
Department Of Health And Human Services Substance
Abuse and Mental Health Services Administration.
Urine and Oral Fluid Confirmatory Drug Testing Laboratory - Support pain management - Monitor compliance - Identify undisclosed medications
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