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An assortment of ecstasy pills in Vancouver, Sept 22, 2003.

A dangerous stimulant linked to five B.C. ecstasy-related deaths in the last six months could either be a fleeting issue or "the tip of the iceberg" ahead of other deaths, says B.C.'s chief coroner.

Lisa Lapointe said it isn't clear whether the PMMA or paramethoxy-methamphetamine linked to the five deaths in the past six months was in one batch or not.

"It could be just the tip of the iceberg. There could be thousands and thousands of pills out there with PMMA," Ms. Lapointe said Friday in an interview.

"That's the worry. We just don't know. It's an illicit substance."

The thinking, said Ms. Lapointe, is that the PMMA is being introduced, perhaps accidentally, in the process of manufacturing ecstasy.

The service only found the PMMA because they began testing for it after it was linked to ecstasy-related deaths in Alberta.

The overview covered all 16 of B.C's 2011 ecstasy-

involved deaths and two 2012 deaths. There is no known safe dose of PMMA.

The discovery, she said, is a B.C. first.

"It's potentially in the manufacturing process. It's potentially in the substances being used to make it. It's a news substance for us so we're on a learning curve," she said.

Ms. Lapointe said the situation confirms a longstanding service view about designer drugs like ecstasy.

"You don't know what you're taking so even if you have used ecstasy in the past and had no problems with it, the tablet you take tomorrow might be different, and it might kill you," she said.

"There's no guarantee of purity."

Three of the deceased were males between the ages of 14 and 37. Two were females between the ages of 17 and 22.

Although PMMA has been found in five cases, the service says there were 13 other ecstasy-related deaths in the same period that didn't involve PMMA.

The service's focus ahead is to work on public education targeting users in their late teens to early twenties to avoid taking the drug, said Ms. Lapointe.

Police have said there are an average 20 deaths from ecstasy each year in British Columbia.