One young man may have taken up to nine high-purity MDMA pills in the hours before he died at a NSW music festival, a Sydney court has been told.
The coroner is examining the deaths of five young people - Diana Nguyen, Joseph Nguyen Binh Pham, Callum Brosnan, Joshua Gerard Tam and Alexandra Ross-King - at NSW festivals since mid-September.
It's thought MDMA was a factor in each case, but counsel assisting Peggy Dwyer on Tuesday said while they all took pills, the circumstances of their deaths varied.
One young person appeared to have taken a single MDMA tablet while evidence suggests one of the men who died took six to nine pills which were 77 per cent pure MDMA.
"(That's) a very high rate of purity," Dr Dwyer told the Glebe Coroners Court during a directions hearing.
One of the five combined the psychoactive drug with alcohol while other cases included no booze.
Medical attention was only sought by some, Dr Dwyer said, adding not all the toxicology reports have been finalised.
Ms Nguyen and Mr Pham died on September 15 after the Defqon.1 festival near Penrith while Mr Brosnan collapsed after attending Knockout Games of Destiny dance party at Sydney Olympic Park on December 8.
Mr Tam died after the Lost Paradise festival near Gosford on December 29 and Ms Ross-King attended FOMO festival in western Sydney on January 12. All five were aged 23 or younger.
An inquest into the deaths will likely investigate the availability of water and refreshments at music festivals along with shade and medical services. Pill testing was not mentioned on Tuesday.
"If there are (recommendations) they will be based on the objective evidence, heard in open court, and subject to scrutiny," Dr Dwyer said.
"It is clear that members of the public are extremely interested to learn why these young people have lost their lives."
Acting state coroner Teresa O'Sullivan said the five deaths were a "terrible loss" for the families concerned and the wider community.
"The grief their loved ones are experiencing and will continue to experience is difficult to comprehend," she said.
Ms O'Sullivan also reiterated a NSW Health message issued 10 days ago about the risk of taking MDMA at festivals and the ways to reduce harm.
"There are more music and dance festivals planned," she said.
"We don't want to see any more deaths."
A further directions hearing is scheduled at Lidcombe Coroners Court on February 28.
Health Minister Brad Hazzard on Monday said he'd been advised four of the festival goers "died because of a direct link with MDMA" and early evidence suggested the remaining death was also linked to the drug.
It's yet to be determined if the coronial inquiry will examine two drug overdose deaths at festivals before 2018.
Australian Associated Press