MDMA (3,4-methylenedioxy-methamphetamine), otherwise known as ecstasy or “Molly”, is a derivative of a synthetic psychostimulant amphetamine that is used as a recreational drug.1,2,3 “Club” or “designer” drugs are the names used to describe the class of synthetic compounds of which MDMA falls under, along with other drugs, such as ketamine and methamphetamine.1,4 The appeal of MDMA is its ability to produce a sensation of mild euphoria and well-being, and feelings of love and connectedness with others.1,4 The drug comes in the form of a white, crystalline powder: the powder can be crushed and pressed into a pill casing. The drug may be ingested orally, placed on the tongue, dissolved in a beverage, or snorted intranasally, and has a dosage of 1 to 2 mg per pound of bodyweight, typically totaling to 125 to 180 mg per dose.4
The National Survey on Drug Use and Health found that in 2014, 6.6% of individuals over the age of 12 years old had used MDMA in their lifetime and 12% of individuals between the ages of 18 and 25 had used MDMA in their lifetime.3 Around the world, the prevalence of MDMA use has risen, especially among adolescents and young adults.5 MDMA originally gained popularity among Caucasian adolescents and young adults who engaged in the nightclub or “rave” cultures; however, the use of MDMA is beginning to affect a larger range of users and ethnicities.3 More recently, there has been an increased public awareness and popularity of MDMA and its purified compound “Molly,” 6 partly attributed to its pop culture presence through song lyrics of popular artists such as Miley Cyrus, Kayne West, Rihanna and others. Due to the expectancy that it contains no toxic adulterants, Molly is often perceived as safer than other illicit drugs.6 However, the “purity” of the drug is very ambiguous when purchased on the street, as dealers often cut the powder with other cheaper substances, such as methamphetamine and caffeine.6 A study on confiscated MDMA showed that there were a variety of ingredients and a 70-fold variability of MDMA concentration among the tablets; 36% of the tablets confiscated contained absolutely no MDMA at all.1 Recent publicized deaths have increased the public’s awareness of the dangers associated with Molly. MDMA-related cases in emergency departments has doubled from 10,200 visits in 2004 to 22,000 visits in 2011.6
The reputation of MDMA consists mainly of its positive effects such as feelings of empathy toward others, decreased anxiety, enhanced sensory perception, and a general sense of happiness.6 However, alongside the pleasurable effects of MDMA are adverse physiological and psychological effects, even from low doses of the drug.1 These side effects can include blurred vision, sweating, nausea, anxiety, panic attacks, hallucinations, brief psychosis, depression, and insomnia. In severe cases, individuals have experienced kidney failure, hyperthermia, cardiac arrhythmias, seizures, and even death.1,6 Environmental characteristics, such as high heat or poor ventilation, in combination with potential hyperthermia and excessive physical exertion (such as dancing) can result in extremely high fever, a breakdown of muscle cells, heat stroke, and seizures.1
Although there has been increased awareness of the potential dangers of MDMA use and ambiguity of what the MDMA being dealt is really made of, there has also been a development of the common belief that improved management and quality control is the solution to the drug’s adverse consequences.2 Many individuals believe that the dangers of using MDMA are mainly due to poor control of the environmental temperature and consuming contaminated forms of the drug.2 Although both of these aspects add to the dangers of MDMA, ensuring environmental factors and purity of the MDMA does not infer overall safety.2 In fact, a study performed by Kahn, Ferraro, and Benevensite, found that “purified MDMA” is no safer than traditional MDMA and has the potential to cause intracranial hemorrhaging.6 Professionals and the general public should be made aware of the potential cognitive disorders, mood disturbances, and increased risk of cerebrovascular accidents.2 The long-term effects of MDMA use has not yet been extensively studied,4 but consequences of its exposure could create for a major healthcare issue in the future.2 Conversely, research involving MDMA use in the therapeutic process is initiating policy reconsideration even though its recreational use has gained many adversaries and has been at the forefront of many debates.