Table 1: Summary of 27 deaths associated with the use of paramethoxymethamphetamine (PMMA) in Alberta and British Columbia, June 2011 to April 2012.

Case	Location and circumstances around presentation and death	Drug(s) believed to have been consumed	Postmortem findings
1	Took drugs at home; became unwell, friend called 911; died in ER	Ecstasy	Pulmonary edema, CAD
2	Took ecstasy alone; found 9 hours later; died in ER after unsuccessful resuscitation	Ecstasy	Rapid rigor mortis
3	Took pills alone, felt unwell and self-presented to ER; died in ICU	Ecstasy	Cerebral edema, pulmonary edema
4	Took ecstasy with friends; became unresponsive; transported to ER in private vehicle; died in ICU	Ecstasy	Cerebral edema, ascites, pleural effusion
5	At house party after taking drugs; became unresponsive; transported to hospital via EMS; died in ICU	Ecstasy	Rhabdomyolysis
6	Found unresponsive at house party; transported to hospital via EMS; had cardiac arrest, died in ICU	Ecstasy, alcohol	No autopsy
7	At house party; found unresponsive after last seen 1.5 hours earlier; transported to hospital via EMS, had cardiac arrest; died in ICU	Ecstasy	No autopsy
8	Found dead in bed at home	Unknown	Trivial soft-tissue abrasions
9	At house party with friends; became unwell; cardiac arrest after intubation with EMS; died in ICU	8 tabs of ecstasy	Lung congestion, patchy pneumonia
10	Watching live performance; became unwell; cardiac arrest with EMS; died in ER after unsuccessful resuscitation	1–2 g of MDMA, cocaine	Cardiomegaly, spleen congestion
11	At nightclub; became unwell; transported to ER in private vehicle; died in ICU	6 tablets of MDMA, hallucinogenic mushrooms, LSD	No autopsy
12	Found dead at home	Unknown	Pulmonary congestion, cerebral edema, mottled myocardium, cardiomegaly
13	Friend noticed patient acting abnormally; transported to hospital in private vehicle after seizure; died in ER	2 snorts of MDMA/ecstasy powder	Congestion of heart, lungs and liver
14	Took drugs at house party; found unconscious outside at nearby property; died in ER after unsuccessful resuscitation	Unknown amount of white powder believed to be ecstasy	Congestion of heart, lungs, liver and spleen, cerebral edema
15	At a bar with friends; that night at home had a witnessed seizure, followed by cardiac arrest; pronounced dead upon EMS arrival	Unknown	Pulmonary edema, congestion of heart, liver and spleen, cerebral edema
16	Took 2 doses of ecstasy at bar; began acting strange upon return home with friends; had seizure en route to hospital with EMS, and cardiac arrest in ER; died in ER after unsuccessful resuscitation	2 pills of ecstasy	Pulmonary edema, kidney and spleen congestion, interstitial hemorrhage in heart
17	At home with friends drinking and taking drugs; found dead the next morning	Cocaine, MDMA, alcohol	Fatty liver, unremarkable post mortem
18	At a house party; felt unwell, called 911; cardiac arrest soon after EMS arrival; died in ER after unsuccessful resuscitation	Unknown white powder snorted	Rib and sternal fractures, pulmonary edema, advanced cirrhosis, enlarged spleen
19	Took MDMA powder the night before; felt unwell; found unresponsive the next afternoon; pronounced dead with EMS	1.5 g of MDMA rolled in paper and ingested	Cerebral and pulmonary edema
20	Took drugs throughout the night at home; had cardiac arrest; died in ER after unsuccessful resuscitation	MDMA, cocaine	Pulmonary congestion, cardiomegaly, nephrosclerosis
21	At party the night before with friends; found dead at home the next day	Ecstasy, cocaine	Edema and congestion of lungs, liver, spleen and kidneys
22	Last seen 3 days earlier; police/EMS attended; pronounced dead at the scene	Unknown	Pulmonary congestion
23	Partying with friends the night before; no history of drug use; found dead the next day	Unknown	Pulmonary edema
24	Last seen 3 days prior. Police/EMS attended, dead on scene.	Cocaine, alcohol	Congestion of lung, liver, spleen and kidneys
25	At house party; took multiple doses of MDMA through the night by snorting and ingestion; became confused and unresponsive; friends called 911; died in ER after unsuccessful resuscitation	0.5 g of MDMA	Pulmonary congestion
26	At party with friends; EMS called; cardiac arrest after intubation; resuscitated in ER, died in ICU	7 tabs of MDMA	No autopsy
27	At concert; took drugs and alcohol; pronounced dead at home with EMS	MDMA, cocaine, alcohol	No autopsy

Note: CAD = coronary artery disease, EMS = emergency medical services, ER = emergency department, ICU = intensive care unit, LSD = lysergic acid diethylamide, MDMA = methylenedioxymethamphetamine.