Festival-goers dance to sun:monx at the Fractal Forest stage at Shambhala Music Festival. (Alexandra Posadzki/The Globe and Mail)

It's Friday evening at the Shambhala Music Festival, and a young woman in denim cut-offs is using an X-acto knife to separate a small quantity of a white powdered substance into three piles on a large white dinner plate.

She watches anxiously as a volunteer in gloves dispenses a drop of fluid onto one of the piles, turning it dark purple and confirming that the substance contains MDMA, the main ingredient in ecstasy.



Outside the tent near Nelson, B.C., where more than a dozen partiers are lined up, whiteboards bear descriptions of bad drugs circulating at the event: "Green playboy bunny baggie - sold as ketamine - actually methoxetamine."



"Bag with clubs on it - sold as E - unknown."



This is harm reduction at work. Health advocates are enthusiastic about the approach after a rash of deaths across the country thrust music festivals - and the drug habits of young people who attend them - into the spotlight. The heightened scrutiny has raised questions about how much effort festivals should make to keep participants out of harm's way.

The popularity of music festivals is on the rise, with new events every year. Electronic music alone is pegged as a $6.2billion global industry, according to the Association for Electronic Music, but that is only a slice of the pie. Canadian music festivals play a wide array of genres, including rock, hip hop and country. About 30,000 people flock to Kelowna every year for the Center of Gravity festival, while the Squamish Valley Music Festival drew more than 100,000 guests this year.

But as the number of festivals and attendees increases, so does the likelihood something will go wrong. About 80 people were admitted to hospital and a woman died of a suspected drug overdose at the Boonstock festival at the beginning of August in Penticton, B.C.



Last month, a man was found dead in his tent at the Pemberton Music Festival, which had an estimated 25,000 guests.



At Toronto's VELD Music Festival, which attracted about 70,000, two people died after taking drugs and another 13 were sent to hospital. Some people took upward of 10 pills or picked up drugs off the ground, Det. Sgt. Peter Trimble of the Toronto Police told the media. Some organizers deny the existence of drugs at their events. The harm reduction approach forces organizers and volunteers to walk a fine line between acknowledging drug use and condoning it.



Officials at Shambhala say giving people safety information - such as the importance of staying hydrated, or which drugs mix well and which do not - can keep prevent trouble.



Cameron Butler from Nelson, B.C., tests drugs at the Ankors tent at Shambhala Music Festival. (Alexandra Posadzki/The Globe and Mail)

“We’re not here to crash parties,” says Shaun Wilson, the festival’s security manager. “We’re here to help people party safe.”



It is virtually impossible to keep drugs out of a days-long event with campers and their gear, he acknowledges.



“We’re not able, in our searches, to go through everybody’s jar of peanut butter and their prescription bottles to see what’s a controlled substance and what’s not,” says Mr. Wilson.



At outdoor music festivals, heat, dehydration, marathon dance sessions and tainted drugs sold by unscrupulous dealers can create a "perfect storm" of risk factors, says Adam Lund, a researcher at the University of British Columbia. In some cases, people in the midst of a crisis may sequester themselves instead of asking for help for fear of being reported to the authorities.



In a worst-case scenario, that can lead to an unpleasant death.



Chloe Sage, who volunteers with the non-profit group Ankors, which operated the drug-testing tent at Shambhala, says she has been seeing a resurgence of PMMA, or paramethoxymethamphetamine, being sold as MDMA, and suspects it might be responsible for recent incidents. It is a dangerous drug that can cause users to overheat.



Harm reduction at Shambhala, by the numbers Ankors compiles statistics every year outlining the results of their drug testing efforts at Shambhala Music Festival. The following are the stats from the 2013 festival:

Total tests done: 2,254

Number of drugs disposed of after the test: 155 (6.8%)

MDMA capsules that tested positive for MDMA: 1,302

MDMA capsules that tested negative for MDMA: 339

Failure rate of MDMA capsules: 21%

Ketamine samples that tested positive for ketamine: 158

Ketamine samples that tested negative for ketamine: 63

Failure rate of ketamine samples: 29%

Mystery substances: 91

PMMA: 77 Alexandra Posadzki

“It’s like their thermostat breaks and they keep heating from the inside like a microwave,” says Ms. Sage. “People have dropped dead from it; that’s why it stopped being popular.”



One of the challenges of providing medical aid at large gatherings is a lack of research on the topic. "There are no provincial or national guidelines that say what the minimum standard of care should be," Dr. Lund says. "The evidence base for best practice at large gatherings is really thin."



“There are no provincial or national guidelines that say what the minimum standard of care should be,” says Dr. Lund. “The evidence base for best practice at large gatherings is really thin.”



Dr. Lund is hoping to change that. For the past five years, he has been leading a group at UBC's department of emergency medicine that is interested in medical care of people at large events. Its database contains information chronicling more than 20,000 patient encounters at everything from music festivals to sports.



The goal is to identify risk factors and determine how much of a burden certain types of events are likely to place on local hospitals. This summer, Dr. Lund's team is collecting data from Shambhala, Squamish and Pemberton.



Festivals-goers attend the Squamish Valley Music Festival in Squamish, B.C., on August 9, 2014. (Ben Nelms for The Globe and Mail)

It is late Saturday night at Shambhala, and the Sanctuary, the festival's chill-out space, is filled with people, most wrapped in blankets and curled up on mattresses or in hammocks. Psychedelic first aid, as it is colloquially called, provides a safe, non-judgmental place for people to go if they are having an intense drug trip and need to get away from the loud music and the bright lights. It is staffed by volunteers who have experience in the mental health field.



In addition to the Sanctuary and the drug testing booth, which festival organizers contract out to Ankors, the festival has a safe space for women, a harm reduction outreach team and a sexual health division. It even has a sober camp for people struggling with addiction that holds three AA-style meetings a day.



The festival's medical facilities are in a permanent wooden structure staffed around the clock with doctors, nurses and paramedics - even administrators to organize medical records. The first-aid team typically treats 200 to 300 patients a day, most for scrapes, blisters and mild dehydration.



There are only about a dozen serious, drug-related issues each year, says Dr. Brendan Munn, the head of medical, calling it a small fraction given that the festival’s population is over 10,000.



The festival also has more than 100 security guards, plus a plain-clothes investigation team to crack down on trafficking. Mr. Wilson says he strives to identify security workers who embody the Shambhala spirit.



“We try to avoid the door-bouncer type,” he explains. “We want the caregiver types.”



Security does not go after people for possession of drugs, but it does devote energy to finding drug dealers, Mr. Wilson says, especially those believed to be peddling dangerous drugs that are sending people to the first aid tent. "Hopefully, they end up in an RCMP vehicle leaving the site; that's our goal," he says.



He notes the festival has fewer fights and sexual assaults than any other music festival he has worked at, a fact he attributes to the no-booze policy.



But in spite of the festival's efforts to reduce risks, accidents happen. This year, seven people were taken to hospital, organizers said. It is unclear how many hospital admissions were drug related. In 2012, a man at Shambhala died of an overdose after ingesting a cocktail of illegal and prescription drugs.

Security staff pat down festival-goers entering the Squamish Valley Music Festival in Squamish, B.C., on August 9, 2014. (Ben Nelms for The Globe and Mail)

The term "overdose" typically conjures up images of a street youth in tattered clothes slumped in an alleyway with a needle sticking out of one arm. But those who have died at music festivals this summer have been described by friends, family and co-workers as bright, hard-working young people with promising futures who were simply looking to have a good time.



Annie Truong-Le, the 20-yearold who died after taking drugs at Toronto's VELD Music Festival this month, was a political science major at York University.



Ms. Truong-Le was too busy studying and working with community non-profits to be involved with drugs, says Chris Rugel, who had volunteered with her at Mentoring Arts Tutoring Athletics.



“She was a smart girl, she was going to school, she was doing all the right things,” says Mr. Rugel. “I don’t know what happened that day at VELD. It’s really sad. But I can only attribute it to her youth and having a little bit of fun and making a really bad decision that any one of us could have made in her position.”



Toronto Councillor Anthony Perruzza said Ms. Truong-Le interned in his office for six months during the summer of 2013 and had stayed in touch, helping organize community events.



“She was going places,” he says. “ I would never have looked at her and said, ‘There are problems here.’ Absolutely not.”



The pictures emerging of the other festivalgoers who have died this summer are similar. Willard Amurao, a 22-year-old from Ajax, Ont., who also died after ingesting party drugs at VELD, had a diploma in marketing from George Brown College.



Lynn Tolocka, a 24-year-old from Leduc, Alta., died after she collapsed from a suspected drug overdose at the Boonstock Music Festival in Penticton, B.C. According to a newspaper report, Ms. Tolocka was a martial arts enthusiast who grew up in a U.S. military family.



And Nick Phongsavath, 21, who was found dead in a tent at Pemberton Music Festival last month, was a software engineering student at the University of Regina and was among the winners of the Regina Engineering Competition last fall, according to a blog post.



“We’re not here to crash parties. We’re here to help people party safe.” Shaun Wilson, Shambhala’s security manager

People who spend hundreds of dollars going to music festivals are a different demographic from street youth with addictions, Dr. Lund says.



“People who are going out to these kinds of destination events are going there to have a really good time,” he says. “They’re using whatever drugs they’re using to enhance their experience, to have a euphoric feeling.”



Dr. Lund says it is unfair to blame electronic music, or music festivals in general. After all, drug overdoses at concerts are not new, he says.



"Every generation detests the music of its youth," Dr. Lund says.



Even Elvis was considered risky once. "This is just a different brand ... I don't think that electronic dance music should be particularly villainized for that."

