The sweaty, overheated, agitated young people who come into the emergency department often say they've taken a synthetic drug they call "Molly," but physician Cathleen Clancy says she never knows for sure what these patients have actually taken.
Instead, Clancy, associate medical director at the National Capital Poison Center in Washington, D.C., and an associate professor of emergency medicine at George Washington University, treats the symptoms - including high fever, seizures, agitation and elevated heart rate - until whatever drug it is wears off.
"People are using themselves as guinea pigs," Clancy says.
Police report growing abuse of the club drug Molly, touted as a pure capsule of the hallucinogen Ecstasy, but health officials say the users may be paying top dollar for something else entirely - and it could be making them sick.
Molly's popularity, and the growing number of illnesses attributed to it, have caught the attention of Congress. Sen. Dianne Feinstein, D-Calif., and Sen. Charles Schumer, D-N.Y., have proposed a law that would tighten the regulation of synthetic drugs, including K2, Spice, Molly and "bath salts," which mimic the effects of drugs such as Ecstasy, PCP, LSD and marijuana.
"Synthetic drugs are diabolical," Feinstein said at a congressional hearing Wednesday. "This bill sends a strong message to drug traffickers who continually circumvent our nation's laws."
Underground chemists manipulate the molecules of the chemicals to create new substances they hope will fall outside the reach of the law, Joseph Rannazzisi, deputy assistant administrator of the Drug Enforcement Administration, said in testimony at the hearing. Government chemists have identified more than 250 compounds marketed as synthetic "designer drugs," he says.
"Unscrupulous chemists continue to synthesize new substances faster than we can control them," he says.
"Regardless of its precise chemical makeup, there appears little doubt that Molly is a clear and present threat to the health and safety of our young people," Sen. Chuck Grassley, R-Iowa, said Wednesday.
Molly, slang for molecular, is a crystalline powder form of the popular club drug MDMA, which in pill form is known as Ecstasy. Molly usually comes in capsules and is often sold and used at electronic music festivals and raves. Capsules sell for $8 to $40.
The drug can elevate a user's heart rate and body temperature and may lead to dehydration. At music venues where the drug is popular, vendors often sell high-priced and specially branded water, such as Mollywatr, which comes in a glow-in-the-dark container and uses slogans such as "Let's Get HIGH Drated" and "Just Say Yes."
Last month, New York's Electric Zoo Festival ended early after two people died of suspected Molly overdoses. A suspected Molly overdose at Boston's House of Blues prompted city officials to issue an alert about the drug.
Molly isn't new. In 2003, the DEA issued a safety advisory for it after police learned that dealers were selling it in high schools and at raves.
DEA seizures of pure MDMA or Ecstasy have dropped, indicating that dealers are creating the capsules from other drugs and marketing them as Molly, DEA spokesman Rusty Payne says. In 2008, the DEA seized 5,377 pounds of Ecstasy. Last year, the DEA seized 954 pounds.
When DEA labs test the seized drugs marketed as Molly, they instead find other synthetic drugs, particularly methylone, an ingredient often found in the drug called bath salts, Payne says.
"Just because it says Molly on the label, that means nothing," Payne says. "Molly can be whatever the drug dealer wants it to be. There are hundreds of different synthetic drugs out there. They look a lot alike and they are marketed alike."
The DEA analyzed 143 drug seizures suspected of being Molly submitted to one of its labs from October 2009 through September 2013. Chemical analyses revealed that just 13% of the drugs sold as Molly were MDMA.
An Alaska man pleaded guilty in August to importing more than 6 pounds of methylone from China and selling it as Molly to a person who then died of an overdose in April 2012.
In May, a federal jury convicted two Syracuse, N.Y., men of conspiring to import and distribute more than 220 pounds of Molly manufactured in China and sold in New York, Florida, California, Texas and Virginia. Most of the drugs were actually methcathinone, a stimulant, DEA records show.
Molly dealers market the drug to teenagers and young adults as a pure, safe high, says Joseph Lee, medical director of youth services at Hazelden, a drug rehabilitation center in Plymouth, Minn. Hipster teens who want to stand out seek out certain brands of drugs the way some teens seek out designer clothes, he says.
Problems can arise when the pill is tainted or mixed with another drug, when the user has an underlying mental health problem or when the user mixes it with other things, such as alcohol, Lee says.
"It's a nightmare of a mess that we're now into," says Bruce Ruck, director of drug information and professional education at New Jersey Poison Control. "People are buying things called Molly, and nobody knows what it is."
Molly surfaced in New Jersey in 2011, a decade after the Ecstasy craze faded. Last year, New Jersey Poison Control fielded 18 calls from hospital physicians about the drug, and one person died, says Steven Marcus, medical director of the New Jersey State Poison Center at Rutgers University. For the first nine months of this year, the center fielded 34 calls.
The young man who died in 2012 arrived at the hospital with a fever of 109, Marcus says.
In Clayton County, Ga., this month, sheriff's deputies seized nearly 50 pounds of MDMA worth $3 million on the street.
At the Georgia Poison Center, the number of cases involving "Molly" jumped from 57 in 2012 to 72 in the first nine months of 2013, director Gaylord Lopez says.
"It's not surprising," he says. "We're hearing rock stars and rap stars and people kids look up to talking about it."