Meet “Dr. Death”: PMMA and PMA

April 18, 2012, 10:50 pm

PMMA pills


Severe paramethoxymethamphetamine (PMMA) and paramethoxyamphetamine (PMA) outbreak in Israel. Lurie Y et al. Clin Toxicol 2012;50:39-43.


PMMA and PMA are hallucinogenic stimulants with effects similar to those of mescaline and ecstasy (MDMA). Once absorbed into the system, PMMA is metabolized to PMA, a drug so dangerous its street names include “death” and “Dr. Death”. Animal data suggest that PMA both increases release and decreases re-uptake of serotonin, and may also inhibit monoamine oxidase.

Manifestations of PMA toxicity – similar to those of MDMA – include tachycardia, hyptertension, hyperthermia, nystagmus, and hallucinations, as well as severe hyperthermia (up to 109oF), renal failure, and death. PMMA and PMA are more potent and longer-lasting than MDMA. Because onset of drugs effect is delayed, it is easy for a user to ingest large amounts and develop severe toxicity.

This paper reports on 24 fatalities that occurred in Israel between February 2007 and January 2008 that tested positive for both PMMA and PMA. Although the authors provide much information about these cases, there were so many co-ingestants that it is impossible to determine what clinical effects could be attributed to PMMA and PMA alone. Only two of the cases were alive on arrival at hospital. However, this paper is worth reading since it reminds us of an important and still-current problem.  Last month, the Calgary Herald reported that there had been nine PMMA-associated deaths in the city since last July, most related to tainted ecstasy.

Related post:

Potent stimulant PMMA associated with ecstasy deaths

[Photo of PMMA pills from]


  1. Adam Glass Says:

    MDMA is a more potent serotonergic than PMA/PMMA. The recent lethality of the Canadian pills was especially due to the fact that they contained a mixture of PMMA and MDMA, so that users were unwittingly ingesting an MAOI with their ecstasy.

  2. Leon Says:


    Thank you for your comment.

    Almost all the deaths associated with PMA/PMMA that I’ve seen reported have involved co-ingestion of MDMA and/or other sympathomimetic stimulants. The statement in my post would have been better phrased: “It has been reported that PMMA and PMA are more potent and longer-lasting than MDMA.” Are you aware of any literature that actually compares the potency of the two drugs?

  3. Adam Glass Says:

    Differential behavioural and neurochemical effects of para-methoxyamphetamine and 3,4-methylenedioxymethamphetamine in the rat.

  4. Leon Says:


    To the extent that rat studies can be extrapolated to humans, that paper did show that PMA produced a greater degree of hyperthermia than MDMA. I think that existing literature suggestions PMA is more lethal than MDMA, but it is of course impossible to be sure. (Actually, the question itself is not clear. What does “more lethal” mean. What are equivalent doses of the two drugs?)

  5. Adam Glass Says:

    Yes I meant that the combination of PMA with a strong monoamine releaser is especially lethal.

    Some of the anecdotal accounts I’ve read of the Canadian deaths suggest that at least one of the victims (and probably more) took just one or two powder-filled capsules. I assume a supplier was short on MDMA and stupidly tried to potentiate his formula with PMA.

    Shulgin reports an active PMA dose is 60 mg.