Developmental Drugs

June 11, 2020 Eric Lis

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It’s hard to imagine a campaign setting that doesn’t have drugs.

Drugs are ubiquitous in human history. There’s probably never been a time period when humans existed without making use of one substance or another to get high, get low, dull pain, reduce inhibitions, or warp perception. In the days before alcoholic drinks were deliberately brewed, primitive humans sought out over-ripe and fermented fruits, and hallucinogens have probably been used to have spiritual experiences and visions since before there was a capacity to keep a record of it. Unless a campaign takes place in some sort of ultra-puritanical heaven, there’s almost certainly some substance that creatures use to induce euphoria or mess with their minds… and even in that hypothetical heaven, there’s probably some form of music, or even prayer, which is used in much the same way. Important as they are, it’s a shame if a campaign setting’s drugs don’t grab players’ interests, since drugs are always a potential storytelling tool, source of conflict, source of income, or source of stat boosts and penalties at critical moments. While drugs certainly don’t have to be realistic, it’s nice if they make some sense, so to that end, here are a couple of simple guidelines that might help a storyteller invent plausible intoxicants, or at least, add some plausibility to the absolutely ridiculous drug that’ll make the game really interesting.

Meanwhile, elsewhere in the body…

Very few molecules affect the body in only one place. Generally speaking, any drug which has an effect on a body does so by either binding to a certain receptor or interfering in the action of an enzyme, and for the most part, the same enzymes and receptors are found throughout the body. For example, morphine dulls pain by binding to the μ-opioid receptors, thereby dulling pain. The μ-opioid receptor is also richly found in the intestines, and especially the large intestine; when morphine binds to those receptors, they slow intestinal movement, which is why morphine (and most of our really effective pain killers, as well as drugs like heroin) cause constipation. Similar, cocaine gives people a rush because it binds to receptors in the brain, but it also hits receptors in the heart and that’s what gives people heart attacks.

A drug’s side effects can be surprising and seemingly unrelated to their primary intended effect, like how the tetrahydrocannabinol in cannabis makes blood vessels dilate and thereby makes eyes appear red. That said, there are some relatively predictable rules. Drugs that wake people up also tend to speed up the bowels, and vice versa; something which is “activating” in one part of the body tends to also be activating in others. Similarly, drugs that wake people up are more likely to result in some form of increased aggression than drugs that make people sleepy, although marijuana’s tendency to cause paranoia can certainly result in aggressive behaviour as well. A drug that helps focus concentration probably impairs sleep, while a drug that promotes sleep probably increases the risk of odd or frightening dreams.

And speaking of unwanted effects,

What goes up …

Pretty much any drug you would care to name has the potential for a come-down right after its main effects wear off, or a prolonged withdrawal after extended use. Generally speaking, a drug’s come-down is simply the opposite of its main effects. Cocaine use gets followed by periods of melancholic mood and fatigue. Heroin use is followed by diarrhea, pain, and agitation. A person who gets used to smoking marijuana every day is likely to have a few days of generalized anxiety when they stop. An alcoholic, whose body is used to having its nervous system depressed, can develop seizures and dangerously high blood pressure when neural activation suddenly returns to a non-drinker’s normal. A drug with a powerful or very unpleasant come-down is more likely to be addictive, because the user will have a lot more motivation to seek out another hit and stop the bad feeling, and a drug whose come-down involves the heart or lungs is more likely to have life-threatening risks than a drug that doesn’t.

At the end of the day, of course, drugs don’t have to make sense. Ten years ago, very few people would have predicted that methylenedioxypyrovalerone (better known as “bath salts”) would turn a handful of its users into flesh-eating zombies, but it kind of did. What seems impossible today might always turn out to be possible tomorrow… even if it usually won’t.

More than four years ago, Dr. Eris Lis, M.D., began writing a series of brilliant and informative posts on RPGs through the eyes of a medical professional, and this is the one that appeared here on June 11, 2016. Lis is a physician, gamer, and author of the Skirmisher Publishing LLC OGL sourcebook Insults & Injuries, which is also available for the Pathfinder RPG system.