Earlier this month, two teenage girls died at the HARD Summer music festival in Ponoma, California, reportedly from "suspected drug overdoses." Less than two weeks earlier, an autopsy confirmed suspicions that Nicholas Austin Tom, a 24-year-old Californian who died at the Electric Daisy Carnival in June, died due to MDMA intoxication. The deaths are only the latest in a string of drug-related fatalities linked to EDM concerts in recent years – part of a trend that's led to a major shift in the live music industry. Some festivals have responded to the mounting pressure by bending toward zero-tolerance drug policies: After two people died at Electric Zoo in 2013, the festival required the following year's attendees to watch a D.A.R.E.-like anti-Molly PSA and stepped up law enforcement efforts with drug-sniffing dogs and heightened gate security. Following the deaths at HARD Summer, one Los Angeles County official went so far as to suggest a temporary ban on raves. At the same time, some organizations have taken another approach: acknowledging the prevalence of drugs in the scene and working to integrate harm reduction services on-site at festivals. Two of the most prolific such groups are DanceSafe, a drug-education organization with a bent towards checking the chemical makeup of drugs, and the Zendo Project, an initiative that provides safe spaces for people undergoing unpleasant psychedelic experiences.
Since its inception more than 15 years ago, DanceSafe has provided harm reduction services like clean snorting straws and condoms to partiers across the country. The group has also dedicated itself to raising awareness about the environmental conditions that can lead to medical emergencies for MDMA users. These emergencies are rare compared to other drugs, and in most cases, they are preventable; while there is no comprehensive national data on MDMA-related fatalities, it is generally understood that a very small percentage of use results in death. The most common cause of MDMA-related death is hyperthermia, or over-heating. Dehydration and over-hydration can both be risk factors as well. Experts advise that users of the drug should be mindful of cooling down and staying hydrated, but focus on consuming electrolytes rather than large quantities of water, which can cause more harm than good.
While hyperthermia plays a key role in most MDMA-related medical emergencies, some deaths appear to be linked to the drug alone. Why does the drug kill some people and not others? It remains unclear whether dose is a significant predictor of fatality. A 2001 study noted that "The toxic or even fatal dose range overlaps the range of recreational dosage." Rick Doblin, the founder of the Multidisciplinary Association for Psychedelic Studies (MAPS), puts it in stark terms: "There is no safe dose," Doblin tells Rolling Stone, because medical emergencies depend on an "interaction between temperature, dose and the environment."
Despite these questions, information on the environmental factors that contribute to the majority of MDMA-related deaths is readily available. Mitchell Gomez, DanceSafe's national outreach director, cites risks of heat stroke and dehydration: "When there is not enough shade and not enough water and places to sit down, that is where we see the largest chunk of problems."
Highlighting the environmental component of MDMA deaths is the Phase-II FDA clinical trial on MDMA-assisted therapy for people suffering from treatment-resistant PTSD. Of the more than 1,000 patients who participated in studies for this and other trials, there were no deaths and no cases of hyperthermia. In fact, temperature increases were so insignificant that MAPS – the group running the current PTSD study – is seeking approval to stop monitoring body temperatures.
"The risk profiles of MDMA or any psychedelics taken in a therapeutic setting are fundamentally different than the risk profile when these drugs are taken in a recreational setting," Doblin tells Rolling Stone. Outside of the lab, users may be in dangerously hot environments, using other substances in addition to MDMA, engaging in rigorous physical activity or not consuming enough electrolytes. DanceSafe warns against mixing other drugs with MDMA, particularly stimulants that cause similar physical reactions, as well as alcohol, which can increase dehydration. (From a recreational point of view, alcohol can also interfere with the high of MDMA.)
Most controversial in psychedelic harm reduction is DanceSafe's establishment of drug checking kits on-site when allowed – a harm reduction strategy they compare to syringe exchange for intravenous drug users. While DanceSafe's reagent tests cannot check for potency or purity, they can detect the primary composition of a drug, and thus provide the user with the information to decide whether to take it, and to understand the health risks if they make that choice.
"MDMA is not what Molly means anymore," says Gomez – adding that DanceSafe often finds doses that don't merely cut MDMA with other substances, but replace it entirely with cathinones or other drugs. "They're selling a totally different substance as MDMA, and that's the nature of our market right now," Gomez says. "It's not cut substances, it's misrepresented substances."
User experiences on MDMA and cathinones can be similar, and so are the risk profiles. For people who have limited or no experience with MDMA, it can be hard to tell the difference. "Most drugs misrepresented as MDMA would probably trick you at least enough that you wouldn't immediately go back to the dealer and demand your money back," Gomez says.
According to Gomez, Molly samples have tested positive for a variety of known drugs, as well as new substances DanceSafe had not catalogued before. Misrepresented substances include "shotgunned combinations of stimulants" of varying proportions that "look like somebody took whatever stimulants they had lying around that day in whatever proportion they had them lying around and pressed them into a pill." Sometimes, DanceSafe sends samples back to a more elaborate lab to identify new substances. Gomez says DanceSafe is essentially playing the same catch-up game as police – it's next to impossible to stay ahead of rogue chemists who are constantly creating new substances.
The danger of Molly's mysterious contents was on display in February, when so-called Molly overdoses sent around 10 Wesleyan University students to the hospital. As it turned out, the "Molly" the students bought was not MDMA, or even one of the cathinones that produce similar effects. In a bizarre reveal, it turned out the toxic drug was actually primarily composed of a synthetic cannabinoid, AB Fubinaca, typically sprayed onto plant material and sold as spice. "That one in particular is very strange," Gomez says. "Somewhere along the line someone I suspect someone literally mixed up baggies."
While DanceSafe and Zendo are growing, Gomez says festivals still have work to do to ensure the safety of attendees. "I really do feel like it's more of an industry issue," he says, adding that it is rare to attend an event that appears to have sufficient water and shade. "I generally don't attribute it to any sort of maliciousness. I think most festival promoters are extremely interested in making sure nobody dies at their festival."
"I think most festival promoters are extremely interested in making sure nobody dies at their festival."
Some events, like California's Lightning in a Bottle and Portugal's Boom Festival, have become models for psychedelic harm reduction for their integration of services like drug-checking, trip-sitting and education on how to stay cool, hydrated and calm during a festival. In Europe and Canada, where harm reduction has become more mainstream, drug-checking and other risk minimization techniques are common.
One obstacle to enforcing this model across the U.S., advocates say, is the Illicit Drugs Anti-Proliferation Act, passed by Congress in 2003, which imposes harsh fines on event organizers who allow or encourage drug use on their premises. (The bill is frequently known as the Rave Act, or Reducing Americans' Vulnerability to Ecstasy Act, for the name under which it was originally proposed by then-Senator Joe Biden in 2002.) Dede Goldsmith, the mother of Mary "Shelley" Goldsmith, a University of Virginia sophomore who died after taking MDMA at Washington, D.C.'s Echostage in 2013, has launched a campaign to Amend the Rave Act in order to assure event organizers that harm reduction campaigns will not lead to prosecutions.
She believes Shelley, an honors student and health-conscious young woman, was unaware of the dangers of the commonly used drug, and could have benefitted from education and safer practices. "It's just a time bomb if MDMA is taken at concerts that are extraordinarily hot and humid," with lots of dancing and "no cool down spaces [or] adequate access to water," Goldsmith tells Rolling Stone. "Molly affects the body's ability to regulate temperature, and if you combine that with the bad setting like Echostage apparently was, it's a recipe for calamity."
This June, another young woman, 19-year-old Victoria Callahan, died from suspected MDMA-related causes at Echostage. DanceSafe has started a survey questioning Echostage attendees about the safety protocols they would like to see enacted there. "Conditions exist at festivals which can harm not only people that take drugs, but people that don't take drugs," Goldsmith says. "They're just public safety issues with so many people in such a confined area."
Andrew Bazos is chairman of CrowdRx, a medical services company for large events like Bonnaroo, Coachella, Electric Zoo and Electric Forest, along with venues like Madison Square Garden and Yankee Stadium. From his perspective, harm reduction groups can raise complicated questions. "It's a little bit trickier for a promoter to directly ally themselves with these entities," he tells RS, particularly when it comes to drug-checking. "I don't think we're ready to be offering that as a free service at our shows, because there's a tacit acceptance that drugs are okay if we do that. We don't get into the politics of that." Bonnaroo and Electric Forest recently seemed to distance themselves from groups like DanceSafe and the similar drug-checking organization Bunk Police, and have responded to tragedies at their events with a prohibitionist approach of increased gate security.
Bazos' company provides doctors, EMTs, ambulances and paramedics on site to treat conditions like hyperthermia as fast as possible. "When your body is put into a state where the heart and brain can't function well because of disturbances in electrolytes or disturbances in body temperature," Bazos says, "tissue starts to die quickly." To reduce the potential harms of hyperthermia, he says, on-site doctors administer cooling techniques found in hospital settings, which reduces the use of ambulances – a cost-saving and face-saving technique, given that, as he notes, local towns are unlikely to want their ERs overrun with festival-goers. "A lot of festivals are in rural locations and hospitals aren't equipped by high volume," he says. "Quicker care on site is much better for many conditions."
Even so, medical emergencies at CrowdRx events continue. This summer at Paradiso, for example, two deaths and 53 visits to the Quincy Valley Medical Center were reported. The temperatures were over 100 degrees, and the chief nursing officer at Quincy Valley Medical Center said, "The combination of high heat and multi-substance abuse resulted in a significant number of life-threatening conditions."
Harm reduction takes different forms with psychedelic drugs like LSD and psilocybin, focusing more on psychological effects than medical issues. "The medical concern that arises from LSD use is probably that the person becomes agitated and they become a danger to themselves or others," Stefanie Jones, the Drug Policy Alliance's nightlife community engagement manager, tells Rolling Stone. (Other medical issues can arise when dangerous drugs are misrepresented as LSD, a relatively new phenomenon. Drug-checking can identify substances like 25i-NBOMe, which has been linked to dozens of deaths, and can cause adverse reactions even in low doses.)
The Zendo Project works to provide a safe space – otherwise known as a chill-out tent – for psychedelic users who may be experiencing bad trips. The idea is to create an environment where people can calm down without interaction with law enforcement or medical staff, but with empathetic acceptance of their experience. Their mantra is that there is no such thing as a bad trip – just a "difficult trip" that can, with the right support, become an opportunity to confront unprocessed trauma or emotional disturbances that psychedelics bring to the surface. Volunteers include mental health professionals – but Linnae Ponté, project director of the Zendo Project, says, "sometimes someone who has no credentials but is just a really empathic, kind, compassionate person can be equally as instrumental in helping someone."
Rion Beauregard, 39, was a Zendo volunteer at the Envision festival in Costa Rica this February, and recalls treating a wide spectrum of cases, including many people who had deteriorated into a "non-verbal" state. One, however, was more lucid. Lydia Violet, a violinist who performed at the festival with her band Ayla Nereo on her 33rd birthday, sought out the Zendo Project for help dealing with an emotional trigger while on MDMA, a drug she had tried 6 or 7 times before. She says she had been aggressively hit on by a man at the festival, and was "jarred" and feeling vulnerable when she entered the Zendo space and met Beauregard, who she says provided support as she worked through her feelings about the encounter. "He basically let me know he was there to hold a safe space for me, and to allow me to go wherever I needed to go," Lydia says. "Rion was really empathic. He was just very affirming of where I was." Afterward, she says, "I felt safer as a woman, and I felt more whole in some way."
The Zendo Project has trained 500 people since 2012, and helped about 700 guests, Ponté says. At this year's Burning Man in late August and early September, they will have two locations for the first time, and a team of about 200 people – a number necessary for an operation that is open 24 hours a day. "The best-case scenario is when we can keep people from going to jail or going to the hospital," she says, adding that they work closely with security and medical staff. Beauregard says he dealt with his fair share of difficult cases, including a woman who repeated the same few words over and over while "flailing" around on her back, whom he helped by surrounding her with pillows instead of demanding that she calm down or stop flailing. One of the most challenging cases, he said, involved a violent male who hit his colleague and began choking his girlfriend. They separated the couple and were able to talk the man down before he turned himself over to security.
The Zendo Project has outlined four facets of psychedelic harm reduction: Create a safe space; sit, don't guide; talk through, don't talk down; and difficult is not the same as bad. Bazos' CrowdRx takes a different approach when addressing difficult situations, using techniques which can include the administration of sedatives and even restraints. "We want to make the person safe for themselves and for others," Bazos tells RS, adding that restraints may be employed when a doctor is not available to provide sedatives. Bazos notes that his company also employs plain-clothes individuals – medical or nursing students dressed in "non-threatening attire" – to give guests a "non-authoritarian" resource for assistance.
"I always say I dance a lot better on a half-dose than a full dose of LSD."
In addition to creating safe settings for psychedelic use, Doblin and Ponté also stress the importance of starting with low doses. "Less is more, I always tell people, especially whenever you're at an event like a festival or a concert where there's lot of stimulation," says Ponté "A lot of times, a half-dose is good for most people. And I always say I dance a lot better on a half-dose than a full dose of LSD."
Jones, from the Drug Policy Alliance, says the most important thing festivalgoers need to do is make sure event organizers know that they want harm reduction facilities on-site, and push promoters to make the policies promoted by groups like DanceSafe and Zendo Project into standard safety procedures. "For these harm reduction services to be more pervasive," Jones says, "attendees themselves have to ask for them."