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Researchers examine cluster of PMMA-related deaths

March 4, 2015

Multi-pronged approach to public awareness credited for managing outbreak

CALGARY — Newly published research into deaths caused by PMMA underscores the universal dangers associated with use of street drugs, and the importance of a multi-pronged approach in managing emerging clusters.

Deaths from exposure to paramethoxymethamphetamine in Alberta and British Columbia, Canada – a research paper that details the largest case study of its kind – reviewed deaths from PMMA that occurred in Alberta and B.C. from July 2011 to April 2012, and considered the role of public health responses in managing outbreaks of PMMA-related deaths.

A total of 27 PMMA deaths occurred in Alberta (20) and B.C. (seven) between July 2011 and April 2012. Since then, only one PMMA death has occurred in Alberta.

“The value of communication and collaboration among multiple stakeholders when managing an epidemic, including when it comes to increasing public awareness, should not be underestimated,” says Dr. Jennifer Nicol, Alberta Health Services (AHS) emergency room physician and lead author of the study. “Many factors undoubtedly contributed to the marked decrease in PMMA-related deaths after April 2012, and we do feel that the multi-pronged approach to public awareness was one of those factors.”

Unprecedented collaboration between law enforcement, health services, Emergency Medical Services (EMS), poison control centres, public health agencies, Alberta’s Office of the Chief Medical Examiner and the B.C. Coroner Services enabled significant public awareness efforts initiated in response to the first cluster of deaths in late 2011.

These efforts were sustained beyond April 2012. They included co-ordinated public service announcements and media engagement; the dissemination of information packages to parents, educators, student populations, community agencies and drug-user forums; and alerts for health care professionals distributed to all Poison Control Centres in North America.

PMMA has been responsible for numerous deaths worldwide, earning it the street name ‘Death’ or ‘Dr. Death.’ Though it’s in the same class of drugs as MDMA, a.k.a. Ecstasy, and often sold on the street interchangeably, PMMA is considerably more toxic and is known to cause overheating of the body, seizures, organ malfunction, cardiovascular problems and death.

Much like MDMA, PMMA is often taken for its euphoric and stimulant effects. However, because the initial effects of PMMA are often delayed and milder than MDMA, users may take more of the drug in an attempt to get the desired effect.

Regardless of the amount of PMMA taken – or the age, gender or race of the deceased – the study findings support the fact that no street drug, in any dose, is safe.

“When you take street drugs, you can’t be sure what drugs you’re actually taking, and no one is immune to the effects,” says Dr. Mark Yarema, Medical Director of the Poison and Drug Information Service (PADIS) of AHS and co-author of the study.

The deceased patients ranged in age from 14 to 52, typically died 17 hours after exposure to PMMA and, in the majority of cases studied, other drugs were found in their bodies, including MDMA, cocaine and methamphetamine.

“The takeaway is the importance of knowledge,” says Dr. Yarema. “Whether it’s AHS speaking to media, Albertans calling our toll-free poison and drug information line, concerned parents visiting, or drug users speaking with their health provider: take the opportunity to increase awareness. It could save lives.”

Deaths from exposure to paramethoxymethamphetamine in Alberta and British Columbia, Canada will be published in CMAJ Open (Canadian Medical Association Journal - Open, available at Numerous institutions and agencies in Alberta and B.C. contributed to this paper.

Alberta Health Services is the provincial health authority responsible for planning and delivering health supports and services for more than four million adults and children living in Alberta. Its mission is to provide a patient-focused, quality health system that is accessible and sustainable for all Albertans.

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