Music scene's Molly is not a friend to drug users

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During the 2012 Ultra Music Festival in Miami, pop star Madonna asked how many in attendance "had seen Molly."

Rapper Tyga, with Wiz Khalifa and Mally Mall, released the song "Molly" in April that repeats the name about 100 times in describing their obsessive search for the so-named.

In her song "We Can't Stop," Miley Cyrus is busy "dancing with Molly." Kanye West sings of Molly, too, in his "Blood on the Leaves."

So who is this Molly that pop stars have in mind?

You might know or have guessed that Molly is a fairly common street drug that causes hallucinations and euphoria but also promises an eventual crash. In addition to the drug's advertised purity and potency, celebrity endorsements are boosting its popularity.

What's not as widely advertised is the fact it's dangerous, addictive and even deadly.

Molly and Molly look-alike drugs already are widely used throughout southwestern Pennsylvania, and there are concerns that they will become more popular. Drug experts note, however, that what's happening with Molly is nothing new. Drugs have been glamorized ever since the rock-star infatuation with marijuana, cocaine, heroin and other illegal drugs in the 1960s and 1970s.

But parents and the general public, especially those older than 40, might be unaware of Molly, its role in popular culture and its local presence. Molly also represents another chapter in the growing use of illegal synthetic and chemical drugs rather than plant-based ones -- including another spate of overdoses statewide of the highly potent synthetic opiate, fentanyl (fentanil).

Based on drug lingo, red flags should rise whenever a teenager tells a parent he or she plans to hang out with Molly. "Make sure they have a friend named Molly," said Neil Capretto, medical director and addiction psychiatrist at Gateway Rehabilitation Center.

Whenever he polls a roomful of drug abusers at Gateway Rehab about what drugs they are using, Dr. Capretto said about 60 percent of those 18 to 38 acknowledge using Molly. "Some are very heavily involved with it and using it on a regular basis," he said. "Some are involved in high levels of Molly on college campuses."

Molly is short for molecule, referring to a pure or purer form of 4-methylenedioxymethamphetamine (MDMA). The white powder -- the same as what's in the drug Ecstasy -- raises serotonin levels in the brain to induce feelings of euphoria, pleasure, empathy and closeness, often leading to unprotected sexual activity. The high can last three to six hours.

"It causes a rise in chemical serotonin and feels good on the rise going up, but what goes up must come down," Dr. Capretto said. "A weekend of Ecstasy can lead to suicidal thoughts on Monday and Tuesday with depression. Then the person goes back on it. We have seen an increase in people addicted to it. Most people have periods of use or abuse with more people using it as their main drug.

"It's like a dog chasing his tail," he said. "You are on it, then off it for a few days, then on it again."

'Not taking the real thing'

Allegheny County Medical Examiner Karl Williams said the county crime laboratory on average gets one positive for MDMA a week in seized drugs, but gets several weekly positives for Molly look-alike drugs that are variations of MDMA.

"There are a lot of that whole class of drugs around, but Molly is rare in terms of drugs seized," he said. "My lab tests every seized drug. People might think they are getting Molly, but it's not showing up in the lab.

"They are not taking the real thing," he said. "There is not that much pure stuff around, but there are other similar compounds with the base molecule that are amphetamine look-alikes."

Mike Manko, spokesman for Allegheny County District Attorney Stephen A. Zappala Jr., said heroin and cocaine continue to rule the local drug scene and command most of the attention of drug enforcement.

Despite perceptions that it's safer than Ecstasy, Molly is claiming lives nationwide, in particular in connection with electronic dance music events.

In late August, during a Zedd concert in Boston, one person died from an MDMA overdose and two others were hospitalized. There also was a reported MDMA overdose death in August during the HARD Summer festival in Los Angeles. Two people died from overdoses of MDMA and four others were hospitalized in critical condition on Aug. 31 during the Electric Zoo festival on Randall's Island in New York City.

"Molly already has had an impact," Dr. Capretto said, noting that celebrity promotion of the drug further popularized its use. "It's an advertisement for it. Madonna and the rappers can do this for any drug."

Ecstasy, in use for decades, became popular a decade ago, but Dr. Capretto said diluted or cut versions of it reduced its potency while the impurities caused unexpected side effects. Decreased potency and higher risk typically leads to a drug's decline. Molly's higher potency, with what drug users perceive to be lower risks from impurities, have made it "the Cadillac of MDMA drugs," he said.

Allegheny County has experienced a steady increase in drug overdose deaths, but the rise is not associated with Molly. Dr. Williams reports no Molly overdose deaths in Allegheny County to date. An average of about 55 annual overdose deaths occurred in the 1980s, with that total rising to 288 in 2012, Dr. Capretto said.

"Drug overdose deaths are the leading cause of accidental deaths in Allegheny County, and I would think other counties are finding the same thing," Dr. Capretto said, noting that Westmoreland County has scheduled an Oct. 1 conference in Greensburg to deal with an overdose problem there that's "getting worse."

Synthetic and chemical drugs are more popular among millennials, including the synthetic opiate, fentanyl, that can be 70 to 100 times more potent than morphine. They can be so potent, Dr. Capretto said, that a person can die before removing the needle from his or her arm.

"These all are concerns," Dr. Capretto said. "The opiate problem still is huge, but there is always something on the horizon."

And then there's fentanyl

A bigger problem in Pennsylvania and other states this year is illegal use of the prescription pain killer, fentanyl.

In June, the state Department of Drug and Alcohol Programs issued a warning that fentanyl and its derivative, acetyl fentanyl, a deadly drug that resembles heroin, had caused 50 confirmed overdose deaths and five nonfatal overdoses statewide. Overdoses occurred in Allegheny, Beaver, Blair, Butler, Cambria, Washington and Westmoreland counties, among others.

The prescribed narcotic is used to relieve severe or chronic pain and commonly is used for cancer patients, "or as a last-resort pain medication," the state program reported.

"As a recreational drug, acetyl fentanyl can often resemble heroin, as it has the same consistency, color and packaging," it stated in a news release. "If a heroin user unknowingly mistakes fentanyl for heroin and takes too much of the drug, the user is at high risk of a fatal overdose."

The last major fentanyl overdose outbreak occurred in 2006 with 269 deaths in Philadelphia alone.

In response to this year's fentanyl overdoses, the state drug and alcohol department has activated a Rapid Overdose Task Force to monitor county drug-center calls and keep track of overdose cases in hospital emergency rooms to determine when statewide action might be necessary to reduce the number of overdoses.

Another program goal is to ensure that people who experience overdoses leave the hospital and enter drug rehabilitation.

"Over this weekend, if there would be an uptick in young people in emergency rooms or calls to county drug centers, our department will get a call and start monitoring the situation," said department Deputy Secretary Cheryl Dondero. "We feel we have a fabulous response force in place, whether the problem is fentanyl, Molly or types of heroin."

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