When I describe Dungeons & Dragons to non-gamers, I'm often asked what drugs I use. This is rather ironic, since I don't touch the stuff myself, but one could argue that role-playing games do have something of a mind-expanding and even hallucinogenic effect if they're done right.

The medieval fantasy setting gives us a lot of room to play with the idea of drugs. Assuming your players are comfortable with such topics, mind-altering substances, both legal and otherwise, can be valuable story hooks, powerful plot devices, and of course, powerful items in the hands of either protagonists or antagonists. Thanks to the very magical nature of alchemy in most fantasy settings, drugs can be created to do almost anything. Our characters aren't limited to compounds that play with their serotonin and dopamine; whether you're looking at goblins turning themselves into the Incredible Hulk in the Pathfinder setting or a narcotic that transforms people into snakes in the Forgotten Realms, drugs are an endless source of story opportunities for a canny storyteller. Of course, magic aside, this column is really devoted to adding a touch of realism to your games, so let's ask a question: in a medieval fantasy setting, what drugs can be plausibly included in a game?

In one form or another, drugs go back to the dawn of human history. For the majority of that time, they weren't necessarily something to be restricted. Shamans and holy people have been using "entheogens" -- substances that help you to see god, or the spirit within you -- since before they were capable of writing down records of what they were doing. Marijuana products, including hashish, were certainly known in the middle ages, and opium and its derivates are found in some of the oldest known medical texts (and are also proscribed in some of the earliest codes of law). When you're wondering whether your characters should have access to a drug, a good first principle is to look up where it comes from, and if it's basically a natural product, even if we've learned how to refine and purify it in recent centuries, then it makes perfect sense for it to be known in your game world. If human history teaches us anything, it's that in every society, you can be certain that someone, somewhere, will have tried to eat or smoke every plant in the ecosystem, and the survivors will have some record of the effects of doing so.

What about more modern (and especially synthetic) drugs? Consider MDMA, better known as ecstasy. MDMA is a synthetic compound not found in nature, although it's derived from a fairly common tree oil. Although all the alchemical techniques necessary to synthesize MDMA have been known for centuries, the actual process wasn't discovered until the twentieth century. The drug was discovered by chemists working for a pharmaceutical company who were being paid to make some modifications to a specific molecule, trying to create a specific effect; an alchemist probably *could* have performed the same experiment in the 1600's, but it's hard to imagine that any of them would have, since they knew they were working with powders but didn't know much about benzene rings or enantiomers. A storyteller could certainly say that the alchemists in their world have sufficient skill to produce MDMA, but it seems... improbable. At best it's anachronistic, and at worst, if you've got somebody with a bachelor's degree in chemistry or something among your players, you risk damaging their suspension of disbelief.

Here's an even more interesting example: cathinones, and particularly methylenedioxypyrovalerone (MDPV), better known on the street as "bath salts." Bath salts really refers to a category of compounds as opposed to a single drug, but broadly speaking, it refers to a family of synthetic compounds which, when ingested, have an effect which has been liked to taking amphetamines, cocaine, and LSD at the same time. Bath salts were big words in the news around this time last year, when a series of violent murders took place in the US which were blamed on the drugs. Specifically, a number of users became paranoid and violent and killed people who they believed were attacking them, and in at least a few cases, the media reported that the bodies of the deceased were partially eaten afterwards (the stories became big news in gamer circles, of course, because for a few days people thought that the zombie apocalypse was finally upon us).

For my part, I've just recently developed a renewed interest in bath salts having finally seen my first patient in the emergency room who admitted to using them; assuming he was telling the truth, which is by no means certain, it's a bit of a scare, since most physicians are under the impression that the drug(s) haven't really reached my city yet. Obviously, bath salts have the potential to add some very interesting elements to a story, but if you're using "realistic" science, can they plausibly be introduced? MDPV was first synthesized in the 1960's, but it's use as a street drug was basically unheard of before the past ten years. My very brief research wasn't enough for me to learn whether this was actually the first of the bath salts drugs to hit the street, but it's safe to say that this is a drug of the 21st century and probably wasn't seeing a lot of use in, say, feudal England. It would be extremely unlikely for a medieval alchemist to stumble upon the recipe to synthesize any sort of bath salt-like molecule unless, for example, they'd used a Commune spell or something to contact the god of drug dealers and ask for some suggestions (which is by no means impossible; in my last campaign, there was a drug lord who did exactly that once per year to keep ahead of the competition). So, a drug like MDPV would be difficult to explain in a fantasy setting, but again, magic makes everything possible... that's why it's magic.

A little 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 March 30, 2013. 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.