How to Write Realistically About Drug Use in Your Novel

Today’s post is excerpted from The Grim Reader: A Pharmacist’s Guide to Putting Your Characters in Peril (Red Lightning Books, 2024, used with permission) by Miffie Seideman.

Writers have asked how they can realistically describe a drug they’ve never personally used. How can they accurately portray a character’s actions or symptoms?

Know your history

Building a credible scene requires researching some historical facts, including:

• Was the drug discovered yet? A scene using insulin set in 1820 is problematic since this treatment wasn’t discovered until the 1900s. Fentanyl shouldn’t be used in a 1930s scene since it wasn’t available for use until the 1960s—opium or morphine would be more accurate choices.
• Was the method to take the drug invented yet? Since insulin must be given as a shot, that scene is even less authentic as the hypodermic needle wasn’t invented until the mid-1800s. Older historical fiction could involve the use of poultices and mustard packs, while skin drug patches (transdermal patches) are only appropriate in more modern scenes.

You also need to consider what drug trends existed in the time period of your story. Medical knowledge changes over time and with it the drugs prescribed. This, in turn, impacts the type of prescription drugs diverted into street supplies or available in home medicine cabinets.

Here’s a sample scene:

He picked up the empty glass vial next to her lifeless body. Chloral hydrate! He’d been a fool to leave it where she could find it.

Is this author’s sedative choice realistic? It depends on what year the scene takes place. Popular sedatives have changed significantly over the decades. In the late 1800s, chloral hydrate was popularly used to treat anxiety and insomnia. It was replaced by bromides, which were also unfortunately used to create the “bromide sleep” to sedate patients in asylums. By the 1920s, awareness that bromides caused prolonged hallucinations led doctors to prescribe barbiturates like phenobarbital (barbital) instead. So, it was no accident that Agatha Christie chose to weave barbital into the plot of Murder on the Orient Express. Once the medical profession realized the growing trend of barbiturate addiction, benzodiazepines (“benzos”) became the new alternative. Surprisingly, despite safety concerns, it wasn’t until the early 2000s that chloral hydrate was finally removed from the US market.

Based on these prescribing changes over time, how would you revise the sample scene to take place in the 1940s? In 2000?

Sample scene, setting 2020:

He quietly opened her medicine cabinet, fumbling through bottles, until his fingers landed on the one labeled “Vicodin.”

Over the last decade, the growing opioid crisis has caused concerns about overprescribing and addiction. But in the early 2000s, poorly treated pain created a national push for better pain control, resulting in increased prescribing of opioid drugs such as oxycodone, hydrocodone (Vicodin), and Percocet. Eventually, this led to an oversupply of opioids, excess stores in medicine cabinets, and increased street supplies.

Then, with addiction and overdoses escalating rapidly, additional prescribing restrictions enacted in the US reduced drug availability. The unintended consequence of this was an increase in the black market demand for opioids, which escalated illicit drug smuggling into the US. This influx of opioids has included illicit fentanyl, both in bulk and laced into street drugs such as heroin and counterfeit pain pills. The culmination of these events has resulted in the current fentanyl overdose epidemic.

Due to these rapid social changes in a span of only twenty years, an opioid scene set in 2020 will look very different than one set in 2000.

So, is the scene above appropriate? If the character’s grandmother held onto leftover hydrocodone (Vicodin) after her last surgery a couple of years ago, then yes. Many people, especially the elderly, squirrel away leftover tablets instead of tossing them into the garbage. Some patients hoard pills, afraid they won’t be prescribed enough the next time they’re in pain. But if the character’s grandmother is depicted as having been given the pills after a recent surgery, then no. Opiate prescribing in the US has been extremely restricted during the last several years. Few opioids are prescribed after surgery and when they are, the number of tablets is usually enough for only a few days of treatment. In this case, it would be more realistic to have the character not find the pills he wants and resort to buying some from his friend at school. And where would his friend have gotten the pills? He probably bought them from a stranger at a party.

Study drug abuse trends

Different countries, and different locations within countries, have varying trends of drug use and abuse over time. Factors affecting these differences are complex, but include laws, local cultures, drug availability, drug costs, and proximity to country borders. A drug-related scene in a town along the US-Mexico border will look quite different than one set in a Midwest farming town. The resources page at the Drug Enforcement Administration (DEA) website contains a wealth of information regarding location-based trends in drug abuse and even maps of the locations where clandestine labs have been found. The National Drug Threat Assessment, published regularly on the site, details national data related to illicit drugs. For international information, a great resource is the United Nations Office on Drugs and Crime website.

Research slang and look for “trip reports”

How your character talks about drugs and the related paraphernalia is just as important to sounding authentic as what the character does with them. A well-written scene using drug jargon can immerse readers in the setting, even if they don’t know what the exact terms mean. A great example of this can be found in Good Girls (Season 1, Episode 6) when Boomer pressures Darren into selling him drugs. Darren’s response—the litany of drugs he has available to sell, including everything from “Addys” to “fat bags of herb”—is both authentic and funny.

Drug jargon not only changes over time but also with geographic location, age, socioeconomic status, and a host of other factors. Hundreds of street names and a wide variety of related slang exist for various drugs. But applying slang to your scene will require additional research to identify the terms that will sound the most authentic in your story. For example, while doobie and vape are slang terms used for marijuana, having your 2020s high schooler talk about “takin’ a hit off a doobie” would be as out of place as having a 1960s hippie invite someone to “vape some dank weed.” And jargon like dubsack and trippin’ balls should be used in the right context.

Online videos posted by recovered addicts or current users offer a well-rounded sense of how to use such jargon realistically. Using the search words trip report with the name of a drug can be a starting place. For example, a search for DXM, third plateau, and trip report will result in numerous videos of users that were filmed during their DXM trips, offering profound insight for writing a scene. In addition, a few social influencers have posted videos documenting their journey through drug addiction, recovery, and sometimes even relapse.

Consider socioeconomic status

What’s your character’s income? What are the economics of the setting? Crack is a credible choice in a plot involving a low-income character because it’s a relatively cheap drug, while a cheese platter spiked with ecstasy is more appropriate in a high-society women’s brunch scene. Is your character a penniless alcoholic? Instead of passing out after chugging a fifth of Tanqueray gin, the medical responders should find him near death from drinking cheap isopropyl (rubbing) alcohol.

The market cost of drugs has an impact on drug trends. For example, in about 2013 Arizona high school students switched from abusing expensive oxycodone pills to cheaper and more available heroin. But an influx of illicit pills from Mexico has driven oxycodone prices down, making it the preferred choice again. Many of these pills, however, are counterfeit and tainted with potentially lethal doses of fentanyl. Now, an upsurge of fentanyl overdoses and deaths are being reported in those same high schools.

How is the drug usually used?

Avoid the temptation to improvise ways to get the drug into your character just to fit a scene. Most drugs given the wrong way won’t work as planned. If your villain spikes a drink with insulin to kill an adversary, he’ll be sorely disappointed when his victim lives. Insulin must be injected or, in some cases, inhaled, to avoid destruction during digestion.

Learn how fast a character should show symptoms

Avoid writing instant drug effects. They are almost always unrealistic. Instead, build page-turning tension using the actual time it takes for drugs to cause harrowing symptoms. Despite what movies would have you believe, a chloroform-soaked rag won’t make a character instantly pass out, and the effects will wear off quickly after the rag is removed. Even injecting drugs rarely works instantly. For example, a villain attempting to kill with an overdose of insulin shouldn’t see the victim immediately fall to the ground. Insulin takes time to work, initially dropping the person’s blood sugar, leaving his brain foggy, his vision blurry and making him shaky. As his blood sugar drops dangerously low, he can suffer a seizure and lose consciousness. Now your character is on the way to dying.

Use the reader’s own knowledge and need for suspense to your advantage. Did your character swallow a handful of pills? Since many people know it takes several minutes for pills to have an effect, you can let your readers build their own anticipation, waiting for the inevitable, while you slowly develop the scene tension.

Need to hasten a character’s demise? Write the scene using a drug that can be injected into a vein (IV) or inhaled, which generally works faster than a shot into muscle (IM) or swallowed pills. Reserve plots using a skin patch for slow-moving scenes since it takes time for drugs to absorb and cause symptoms. High or lethal doses can rapidly create dangers for your character. But, for any of these methods, symptoms should still appear in a cascade, not all at once. For example, a rapid injection of a high fentanyl dose can suddenly cause chest muscles to become rigid, making it hard or impossible to breathe. Then, with no oxygen, several other symptoms can evolve—such as blue lips, seizures, a slowing heartbeat, and death—over several minutes (or pages). The character shouldn’t die instantly, even with this potent drug.

And keep in mind that not all overdoses are lethal. Depending on the drug, your character may suffer serious symptoms but realistically survive. This fact offers a world of harrowing conflicts that can make your character strong enough to ultimately tackle his inner demons.

A note of caution when using brand names

An abundance of caution should be used when deciding to use the brand name of a drug in your story. Brand names can be acceptable, but using language that tarnishes, defames, or falsely depicts a product as dangerous can bring litigation. Authors can circumvent these concerns by avoiding the use of brand names entirely. It’s often not even necessary to specifically mention a drug name to develop a scene. Instead of mentioning the brand OxyContin, build tension as the character opens the leftover bottle of pain pills. Instead of Adderall, a stressed college student studying for finals can reach for his “study buddies” bought in a previous scene. Simply describing what the medicine does can be effective, evoking the reader’s memory of similar experiences. If you want to be completely fictional, invent your own brand name, but try to stay within the symptoms expected from that kind of drug. Suzanne Collins blended several of these concepts well in The Hunger Games series. The sweet syrup that calmed Gale’s pain and was extremely addictive was reminiscent of morphine. If you do choose to use a real brand name, consider getting a legal consult to verify that you haven’t crossed the boundaries of acceptable use.

Additional resources

There’s a wealth of drug information available. A few resources to consider include:

• FDA (Food and Drug Administration) and DEA online databases and drug resources, which provide information on changing trends in various geographic locations as well as updates on the legal status of various drugs.
• Social networking groups focusing on related specialty writing topics, such as trauma or emergency medicine, can be a wealth of information.
• Newspaper articles and medical journals are great places to find real cases.
• Local medical professionals, police, and medical examiners can provide insight and realistic ideas.
• The US national poison center is an often-forgotten resource that collects data from fifty-five poison centers throughout the US. It provides free information to the public on poisonings, drug exposure, chemicals, poisonous plants, and venoms. It’s a wealth of information on trends in drug abuse, overdoses, and poisonings based on age groups and geographic locations. The poison center is also available to guide the general public during poisoning emergencies, such as the frantic parents of a toddler found chewing on iron tablets next to an empty vial.

If you found this post helpful, be sure to pick up a copy of The Grim Reader.

Miffie Seideman

Dr. Miffie Seideman, Pharm.D. worked as a newborn ICU pharmacist for over 25 years, lectured on medication errors and drug safety, and led medication safety teams. As an avid triathlete, she also spends long training rides developing her new gritty YA fantasy, mixing demons, dragons, and betrayal. She lives in Phoenix, Arizona.