The four deaths in 2013 exposed widespread use of illegal stimulants at concerts, raves and electronic dance music shows, along with the difficulties encountered by organizers to keep those substances out.
"Drugs have always been a big part of the scene and always will be," said Amy Raves, a Los Angeles-based rave advocate who has attended dozens of electronic music shows.
"The idea is how to promote safer raving, to educate kids that abstinence is the best policy, but to realize that's not always practical," she said.
Organizers are taking no chances this year at events from Tennessee's Bonnaroo, a four-day music and arts festival that wraps up on Sunday, to Mysteryland held each Memorial Day in Bethel Woods, New York, the site of Woodstock in 1969, to Electric Zoo, a popular New York City electronic festival.
Electric Zoo organizers said their three-day event has always had a zero-tolerance drug policy, but this year's screening will be especially robust and will include drug searches and amnesty bins so drugs can be discarded anonymously.
"We are redoubling our efforts at the gate," said Dr. Andrew Bazos, medical supervisor for show organizer SFX Entertainment.
Last year, the final day of Electric Zoo was canceled when two concertgoers died after taking the drug Molly, a mashup of MDMA, the component in the drug Ecstasy, and unregulated synthetic stimulants. Molly deaths were also recorded in Washington, D.C., and Boston.
Experts say Molly use has ticked up in recent years as celebrities such as Madonna and Kanye West referenced the drug at their own concerts and Miley Cyrus sang about "dancing with Molly."
The Electric Zoo tragedy was a wake-up call to many in the rave and electronic community about the dangers of Molly and other club drugs, Bazos said.
"How to be healthy has unfortunately been related to what happened at Zoo last year," he said.
The medical community continues to warn against the risks of so-called club drugs, saying the already dangerous substances become more potent when combined with warm temperatures, dehydration and exertion at all-day concerts.
"The message really should be 'Don't take drugs at all,'" said Dr. Harris Stratyner, an associate professor of psychiatry at Mount Sinai School of Medicine.
But it's unrealistic to urge total abstinence, some say. Amy Raves has started a Facebook community to offer advice on concert safety and health.
"I teach them the warning signs. What to look out for. To stay hydrated, to not overheat," she said.
"These kids love Molly, they love Ecstasy. So I tell them to go get a test kit and shave a little off and make sure that's really what it is," she said.
DanceSafe, a health organization within the electronic music community, places information booths and volunteers at raves and festivals across the country. The group also provides "drug checking services" for Ecstasy users, its website says.
Complicating the efforts of concert organizers and sponsors is the Illicit Drug Anti-Proliferation Act of 2003, a federal law that can hold accountable any company, manager or individual who knowingly allows drug use on their premises.
Anti-drug posters, leaflets and broadcasts at raves and concerts could be tacit acknowledgment that drugs might be used at the venue, Amy Raves said.
"It's a terrible policy. You can't hand out fliers to people and say 'Here, this Ecstasy, this is what you're taking, please be careful,'" she said.
A robust medical presence can also be expected this summer, with medical tents, doctors, nurses and EMTs on hand. Concertgoers are encouraged to report anyone who might be suffering from an overdose, exhaustion or other health issue.
(Reporting by Victoria Cavaliere; Editing by Barbara Goldberg and Gunna Dickson)
