Often classified as a “club” or “designer” drug, MDMA, also known as “Molly” has been around for decades. It wasn’t until the late 1990s, when it became the drug of choice in nightclubs and electronic dance music scenes, that it’s popularity began to skyrocket. It’s no coincidence that emergency rooms and healthcare professionals began, around this same time, to confront more and more people who had overdosed on the psychoactive substance. Originally created in 1912 by a chemist at the pharmaceutical company Merck, methylenedioxy-methamphetamine (MDMA) saw it’s first applications by a small set of psychotherapists in the late 70’s and early 80’s. Because MDMA makes users feel uninhibited, researchers believed the compound might have some therapeutic benefits. However, by 1985 the drug received a Schedule I classification from the federal government, meaning that authorities believe the drug has no accepted medical use. The name Molly comes from a derivative of “molecule”.
MDMA goes by several different street names, including: Generally coming in pill or powder form, users either ingest or inhale the drug. The chemical makeup of MDMA causes neurotransmitters to flood the brain with serotonin, norepinephrine and dopamine. These chemicals bring about feelings of euphoria, increased sociability, a sense of inner peace, mild hallucinations and enhanced sensation, perception or sexuality. MDMA has become a popular drug, in part because of the positive effects that a person may experience within an hour or so after taking a single dose. Those effects include feelings of mental stimulation, emotional warmth, empathy toward others, a general sense of well-being, and decreased anxiety. In addition, users report enhanced sensory perception as a hallmark of the MDMA experience. The adverse effects of MDMA can be significant and even fatal, especially in crowded, overheated places, such as all night dance parties known as raves. Even with authorities on high alert at these events, two teenage girls fatally overdosed in August of 2015, at a music festival in Pomona, California.
While overdose rates on MDMA aren’t as high as other narcotics, there are still reports of deaths due to abuse of the drug every year. The immediate dangers of taking MDMA include: Hyperthermia, overheating the body which can lead to liver failure Intense sweating and perspiration Increased heart rate and blood pressure Because MDMA depletes the brain from so many endorphins and creates a lack of serotonin, individuals who have consumed the substance over the weekend can experience anxiety and depression days after using it. The nickname for this is “suicide Tuesdays.” Other uncomfortable symptoms than can last from a few days to a week are: The pop culture acceptance and promotion of MDMA in music and film, it’s reputation as a party drug, has created a dangerous demand, which generally results in users consuming less than pure MDMA. Even test centers, which are more and more common at music festivals, cannot identify bulking agents, such as lactose, or other drugs that MDMA might be cut with.
They can only inform users as to whether the MDMA is pure or not. It’s then up to the individual whether to take the drug or not. The National Institute on Drug Abuse reports that while studies have shown varying levels of physical addiction to MDMA, symptoms of psychological dependence can be nearly as damaging. One reason for the dependence is tolerance. Individuals have to take more of the drug to experience the same high, and many continue to consume it even after acknowledging the physical and psychological harm they’re causing themselves. Treatment for MDMA dependency can be effective using cognitive behavioral therapies, which helps those recovering to modify their actions and thought processes. One on one counseling and group therapy are also useful tools for getting to the underlying causes such as depression or trauma that might be causing self-destructive behavior. As with any treatment and recovery from drugs or alcohol, patience, understanding and support can help individuals move to a happier, healthier and sober lifestyle.
Give us your feedback about this page, hereWhile most patients with MDMA overdose improve with supportive care, life-threatening complications may result from severe toxicity. Fatalities have been reported because of severe hyperthermia (ie, heat stroke) accompanied by disseminated intravascular coagulation, rhabdomyolysis, and acute renal failure. Death from cerebral edema and seizures secondary to hyponatremia and the syndrome of inappropriate antidiuretic hormone secretion (SIADH) has also been reported. As in any amphetamine toxicity, the danger of cardiac arrhythmias and cardiovascular instability always must be entertained. Careful attention to the airway, breathing, and circulation (ABCs) and vital signs is standard in overdoses, and serial neurologic checks are required. Provide oxygen, obtain intravenous access, and perform cardiac monitoring. A bedside glucose determination is indicated in any patient presenting with altered mental status. If a patient is hypoglycemic, administer thiamine and enough glucose to maintain adequate serum glucose concentrations with frequent monitoring.
If verbal communication is possible, providing reassurance is important. Avoid physical or pharmacologic restraints if possible. Place the patient in a calm, quiet room. If severe agitation or disruptive behavior persists, sedation using benzodiazepines and/or physical restraints may be necessary. If acute toxicity caused by ingestion is known, perform gastrointestinal decontamination by administering activated charcoal. Orogastric lavage usually is not necessary unless a life-threatening co-ingestant is involved and the patient presents within 1 hour of ingestion. Whole-bowel irrigation may be indicated if body packing of drugs is suspected. Although respiratory distress is uncommon, endotracheal intubation and mechanical ventilation may be required in patients who cannot protect their airway or have respiratory compromise because of conditions such as seizures, cardiovascular instability, or trauma. Patients presenting with severe hyperthermia require aggressive cooling measures and adequate fluid resuscitation.
Obtain a rectal temperature. Aggressively cool hyperthermic patients to 102°F. Morbidity is directly related to the severity and duration of hyperthermia. Management considerations are as follows: Dantrolene (1 mg/kg or 80 mg intravenously [IV]) has been used for the treatment of hyperpyrexia after conventional therapy. Dantrolene is typically used to treat malignant hyperthermia, a genetic disorder of the skeletal muscle due to a defect in the ryanodine receptor that allows for massive release of calcium from the sarcoplasmic reticulum during exposures to general anesthetics. MDMA-induced hyperthermia is thought to be centrally medicated from via serotonin toxicity. Although the mechanism of dantrolene does not seem to correlate with what is known about MDMA-induced hyperthermia, dantrolene was first used to treat hyperthermia in the setting of MDMA-related hyperpyrexia in 1992 due to the similarity of presentation. A systematic compilation of MDMA case reports suggests that there may be some evidence of benefit in using dantrolene to treat hyperthermia.
[25] The study showed decreased morbidity and mortality with rare side effects from the dantrolene itself, especially in patients who present with temperatures above 40°C, especially above 42°C. The biggest caveat with using case series and case reports is recognizing the limitations of reporting and publication biases. A study in an animal model found that clozapine resulted in a marked and immediate reversal of MDMA-induced hyperthermia, via inhibition of brain metabolic activation and blockade of skin vasoconstriction. Carvedilol was modestly effective in attenuating MDMA-induced hyperthermia, and labetalol was ineffective. Treat seizures with benzodiazepines. Most seizures are self-limited and respond well to benzodiazepines. Protect the airway and consider phenobarbital or propofol in patients with refractory symptoms. Treat the underlying cause and check electrolytes, especially hyponatremia. Start with fluid restriction, but consider adding hypertonic saline in refractory or severe cases;
in these cases, adding 3% saline and furosemide may be indicated but at a rate no greater than 0.5-1 mEq/L/h. Foley catheter placement is indicated to monitor urine output in patients with rhabdomyolysis. Check urinalysis for myoglobin and creatine kinase for rhabdomyolysis. Recognition and treatment of rhabdomyolysis with fluids, alkalinization of the urine, and furosemide may be indicated to prevent acute renal failure. Alkalinization of the urine with sodium bicarbonate is helpful. Administration of furosemide and mannitol may also be considered. Obtain cardiac monitoring and an electrocardiogram in patients complaining of chest pain or palpitations. Order appropriate cardiac enzyme measurements if cardiac injury is suggested. Significant cardiac dysrhythmias may require pharmacotherapy or cardioversion and/or defibrillation. Initially, manage hypertension with benzodiazepine sedation. In patients with refractory symptoms or signs of end-organ damage, nitroprusside or nitroglycerin can be used to lower the blood pressure.