What Is Molly?

Overview: “Molly” is a slang term for MDMA, a synthetic psychoactive substance that stimulates the release of neurotransmitters and has both stimulant and psychedelic-like effects. MDMA is classified as an “empathogen” or “entactogen” due to its ability to increase empathy and sociability. It has been used recreationally since the mid-1980s, but its therapeutic potential in treating PTSD has also been explored through MDMA-assisted psychotherapy. MDMA available outside clinical settings is often substandard and mixed with other substances, increasing the risk of adverse health outcomes.

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What is Molly?

“Molly” is a slang term used to refer to a crystalline or powdered form of MDMA (3,4-methylenedioxymethamphetamine), which is a synthetic psychoactive substance that falls under the phenethylamine class. Molly is structurally similar to amphetamine and possesses both stimulant and psychedelic-like effects. 

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Molly, also commonly referred to as “Ecstasy,” has been one of the most popular recreational drugs since the mid-1980s. The term “Ecstasy” typically refers to MDMA in pill form. However, both “Molly” and Ecstasy” are often used interchangeably. 

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MDMA is classified as an “entactogen,” which is a relatively newly established class of psychoactive drugs that differ in terms of their brain effects and the experience they induce from classic psychedelics and amphetamines. These substances are characterized by their ability to increase empathy and sociability and enhance mood and well-being, which sets them apart from other types of drugs.

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A Brief Look at MDMA’s History 

MDMA, initially known as ‘Methylsafrylamin,’ was first synthesized by Dr. Anton Köllisch, a chemist at Merck, in 1912. Dr. Köllisch was researching pathways that could lead to hemostatic substances (agents that promote hemostasis, which is the process of stopping bleeding), although it is often falsely claimed that Merck intended to market MDMA as an ‘anorectic drug’ or ‘appetite suppressor.’

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Decades after its initial synthesis under the name ‘Safryl-Methyl-Amin’, the first studies to investigate how MDMA interacts with the body and produces its effects were conducted by Merck chemist Max Oberlin to. Although Oberlin was forced to halt his research due to rising material costs, he encouraged other researchers to continue exploring this field.

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During the 1970s, Molly began to emerge on the recreational drug scene, gaining popularity for its euphoric and empathogenic effects. Alongside its rise in recreational use, MDMA found its way into clandestine laboratories, leading to increased availability. In the late 1970s, after its synthesis by chemist Alexander Shulgin, MDMA gained traction among therapists exploring its potential for therapeutic purposes.

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By the 1980s, MDMA was being distributed on a large scale, becoming a staple in the nightclub and rave scenes. This surge in popularity prompted regulatory action, and in 1985, MDMA was classified as a schedule I controlled substance in the United States due to concerns about its potential for abuse and lack of accepted medical use.

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The Brain Effects of MDMA

MDMA stimulates the release of the neurotransmitters or “chemical messengers”: norepinephrine, serotonin, and dopamine. MDMA also blocks the reuptake of these chemicals into neurons, resulting in increased concentration levels in the brain and prolonging their effects on the brain and body. 

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When MDMA is ingested, serotonin, which is associated with mood elevation, and norepinephrine, which has physical effects, are released in greater amounts than dopamine. 

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Studies have demonstrated that MDMA can decrease activity in the limbic system, a network of brain structures involved in emotions, motivation, learning, and memory. MDMA was also observed to reduce communication between the medial temporal lobe and medial prefrontal cortex, which are involved in emotional control.

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Interestingly, these connectivity patterns are opposite to what is typically observed in individuals who experience anxiety.

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MDMA may also increase communication between the amygdala, where we process fear, and the hippocampus, an area involved in the formation, organization, and storage of memories. These effects may be central to MDMA’s efficacy as a therapeutic aid in the treatment of post-traumatic stress disorder (PTSD), potentially enabling patients to access memories of traumatic life events with decreased fear.

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A group of neuroscientists at Johns Hopkins University recently demonstrated that MDMA releases oxytocin and stimulates oxytocin-mediated plasticity. This refers to the ability of oxytocin, a hormone and neurotransmitter known for its role in social bonding, trust, and attachment, to facilitate changes in the connections between neurons, which is known as neural plasticity.

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Oxytocin’s ability to promote empathy, trust, and the processing of bonding cues may play a role in the development of a solid therapeutic rapport between therapists and patients in MDMA-assisted psychotherapy.

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Considerable progress has been made in studying the effects of MDMA on the brain, but significant gaps in understanding persist. While some aspects of its impact are known, a comprehensive understanding of its long-term effects remains elusive. Further investigation is necessary to fully elucidate the complex interactions between MDMA and brain function.

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Subjective Effects of MDMA

The acute subjective effects of MDMA typically begin 30–60 minutes after consumption. After a 15-30 minute “come up” period, the drug’s peak effects set in, typically lasting for 90–150 minutes.

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According to research on the acute effects of MDMA, participants report feeling more sociable, empathic, and euphoric after taking MDMA. Additionally, common emotional effects include tenderness, affection, closeness to others, increased ability to interact with or be open with others, greater self-confidence and self-acceptance, and decreased defensiveness.

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People also report an overall sense of well-being, although some experience nervousness and anxiety.

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MDMA also has some sensory effects, including changes in visual perception, altered sound perception (such as enhanced music appreciation), altered time perception, heightened awareness, and tingling sensations.

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Somatic or physical effects may include increased energy, increased body temperature, accelerated heartbeat, bruxism (teeth grinding), muscle clenching, sweating, sweaty palms, and dry mouth. Some people also experience negative physical effects such as nausea and headaches, though these are quite rare.

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It is crucial to acknowledge that the MDMA available to individuals outside of clinical settings, primarily in pill form, is generally substandard and frequently mixed with substances that can raise the risks of adverse health outcomes. A recent analysis discovered that 40% of the 529 Molly samples tested did not contain any MDMA whatsoever. Therefore, reliable testing of MDMA samples is essential to ensure purity and promote safety. 

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Positive Outcomes of MDMA-Assisted Psychotherapy for PTSD

The US Food and Drug Administration (FDA) approved the Multidisciplinary Association for Psychedelic Studies (MAPS) to test MDMA for PTSD treatment in 2003. After successful clinical trials, the FDA granted Breakthrough Therapy Designation in 2017 and agreed on special protocol assessment for phase III trials.

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The positive outcomes from MAPS’ confirmatory phase III trial indicate that more than two-thirds of participants who underwent MDMA-assisted psychotherapy no longer met PTSD criteria two months post-treatment. With this promising data, the FDA is currently reviewing a New Drug Application for MDMA-assisted therapy, paving the way for it to become a legally recognized treatment some time in 2024.

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Factors Affecting the MDMA Experience: Set, Setting, and Dose

It is not possible to predict with certainty what the experience of taking MDMA will be like, as individual responses can vary widely. However, ensuring that the drug is used in the right circumstances is likely to facilitate a positive experience.

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Set and setting can play an important role in shaping the MDMA experience. “Set” refers to an individual's mindset or mental state going into the experience, while “setting” refers to the physical and social environment in which the experience takes place.

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Research has shown that a supportive and comfortable environment, such as one provided by trained therapists, can lead to more positive outcomes for MDMA-assisted psychotherapy. By setting intentions and creating a safe and comfortable environment, individuals can enhance the potential therapeutic benefits of MDMA.

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The effects of set and setting are rightly emphasized when discussing the use of MDMA and other mind-altering substances. However, what is often neglected but equally important is the dose. Participants in MDMA trials typically receive a split dose of 120-180 mg of MDMA. In the first experimental session, they may be administered an initial dose of 80-120 mg followed by a supplemental half-dose of 40-60 mg 1.5 to 2 hours later.

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MDMA is considered to be relatively safe in comparison to other commonly used recreational drugs such as tobacco and alcohol.

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Typically, MDMA doesn't cause any life-threatening effects on its own, but there are still potential health risks associated with its use. Fortunately, these risks can be minimized through the use of harm reduction practices.

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Hyperthermia and Hyponatremia 

MDMA can interfere with the body's ability to regulate temperature, especially when combined with physical activity like dancing and prolonged exposure to warm environments. This can lead to hyperthermia, the main cause of MDMA-related deaths (which are relatively very rare compared to other recreational drugs).

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To reduce the risk of overheating, it's important to take regular breaks from physical activity and stay well-hydrated. However, over-hydrating can be dangerous, as MDMA can cause water retention and lead to low blood sodium levels (hyponatremia), which can be fatal.

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To prevent hyponatremia, it’s important to pay close attention to how much water you’re drinking and avoid combining MDMA with diuretics like alcohol. By being mindful of hydration levels and avoiding excessive physical exertion, users can help ensure a safer MDMA experience.

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Neurotoxicity

There has been much discussion surrounding the neurotoxicity of MDMA in recent years. While it is generally agreed upon by scientists that MDMA is safe when used responsibly, continuous and high-dose usage can lead to some form of neurotoxicity. Therefore, it is highly discouraged to use MDMA at high doses for long periods of time.

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It is still unclear how much of this risk applies to the typical recreational user who only uses MDMA occasionally. However, users are advised to wait for several months between each use to allow serotonin levels to return to normal and to decrease the risk of neurotoxicity.

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Cardiotoxicity

Long-term, heavy use of MDMA can lead to valvulopathy, a condition that affects the proper functioning of one or more heart valves.

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A study published in 2007 found that 28% of regular or former MDMA users had pathologic echocardiographic results, compared to 0% of the control group. It's important to note that the individuals who developed valvular heart disease were consuming three doses of MDMA per week for at least six years.

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This suggests that the severity of MDMA-induced valvulopathy may be dependent on high-dose, cumulative use. More research is needed to fully understand the cardiovascular effects of MDMA. 

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Understanding MDMA: Key Takeaways 

In summary, MDMA, also known as “Molly” or “Ecstasy,” is a synthetic psychoactive substance that can have both stimulant and psychedelic-like effects. It belongs to a relatively new class of drugs called "empathogens" or "entactogens," which can enhance empathy, sociability, and mood.

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While MDMA has been popular for recreational use since the 1980s, recent studies have shown that it may have therapeutic potential in the treatment of mental health disorders, such as PTSD, when used in a controlled setting.

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However, it's crucial to note that the MDMA available outside of clinical settings is often of substandard quality and can pose serious health risks. Therefore, it's essential to use caution and seek professional help when considering MDMA use for any purpose.