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Artistic License - Pharmacology
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Ah, the wonderful world of medications, drugs, and poisons. Staples of Murder Mysteries and Medical Dramas, and not too infrequently plot devices in Science Fiction (hard or otherwise). Sadly though, there are some writers who never seem to do their homework on the substances in question. Books, screenplays, etc. from such writers often cause those knowledgable of such things to want to ask, "Dude, what have you been smoking?" The absolute worst examples may lead to being Killed Off for Real.
May be related to Artistic License - Biology. See also This Is Your Index On Drugs and Toxic Tropes. That Old Time Prescription is a subversion. A visit to Erowid is often recommended as an antidote to this in regard to many drugs.
Tropes:
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Examples:
Anime And Manga .
- Death Note features a criminal who his bio says is extremely violent and deranged because he is a marijuana addict. Marijuana's effects do not include violent criminal behavior. This could be due to Marijuana Is LSD, or because marijuana use is highly stigmatized in Japan, to the point where Paul McCartney wasn't allowed into the country for ten years following a pot bust.
Film
- Amazingly mostly averted in Crank. Although medical professionals do not agree on how long someone could live without adrenaline, all agree that the symptoms are spot-on and the time frame is not that unrealistic. The description of what the Beijing Cocktail did and what he can do to circumvent its effects is also 100% accurate pharmacology.
- In one scene of Meet the Parents, Greg's anxiety becomes so severe he has to treat it by stuffing multiple pieces nicotine gum in his mouth like a chipmunk and chewing it. Nicotine gum is not supposed to be chewed, but instead placed between the gums and the cheek so that the nicotine can be absorbed through the mucosal membranes over a longer period of time. Chewing the gum causes all of the nicotine to be released at once, possibly leading to an overdose which, though not necessarily fatal, can manifest as a number of different symptoms that will make the user very uncomfortable to say the least.
Comic Books
- Every comic-book use of drugs fails miserably at pharmacology, especially the Batman villain Scarecrow, since his gimmick is a hallucinatory "fear gas." Hallucinogens take 30-90 minutes to circulate to the brain and actually cause hallucinations (and almost all are administered orally). Hallucinations are also extremely unpredictable and are usually caused by setting and expectations before ingesting the drug and most people can easily tell a hallucination from reality. In short, the drug onset is unlikely, the route of administration is atypical, and most importantly, the effects are wrong. Some drugs might fit:
- Salvia Divinorum
 , which can be smoked. Inhalable, rapid onset, etc etc. Not nearly nasty enough to use as a weapon... but such chemicals do exist and can have most unpleasant effects.
- If you think the effects of salvia are not capable of inducing fear to the degree that it could be used as a weapon, you've obviously never smoked it. "Rapid onset" means just a few seconds, a minute at most. The reason it hasn't caught on as a party drug is that large doses (which are actually still very small) can cause the person to experience horrifying hallucinations.
- It also causes a very short period of sharp decrease in muscle tonus which is usually reported as disconcerting. It may be also pretty surprising for anyone truing to smoke salvia while standing. And hallucinations usually occurs in massive dosages in already phobic or anxious subjects. Hallucinations are endogenous, so it is technically impossible to create a drug that will predictably cause a repeatable horrifying hallucination in every recipient.
- DMT, without an MAO inhibitor, can be smoked - nearly instant onset, incredibly strong effects. Without an MAO inhibitor, it only lasts ten minutes, with one it lasts much longer. See also 'datura' also called devil's weed or jimsonweed, which is notorious for it's 'true' hallucinations, often indistinguishable for reality.
- Couldn't the expectations bit be accounted for by the fact that everyone hit with it knows it's supposed to be a fear gas?
- An important thing to remember about onset time is that it's vastly dependent on route of administration, orally ingested drugs take a longer time to work because they have to be absorbed through the stomach lining and it takes awhile for them to filter into the bloodstream, inhalation is much faster as the drug goes directly from the lungs into the blood stream, most smoked or inhaled drugs will start to show effects within a few minutes possibly even a few seconds, with peak effects kicking in within 5-20 minutes.
- The Marvel Comics one-shot title "Carnage: Mind Bomb" shows the side effects to a vitamin c overdose as being a severe shock to the nervous system. Dr. Kurtz, after blasting Carnage with a sonic pistol to keep him at bay, injects Cletus Kasady with an overdose of vitamin c which causes the symbiote to disconnect from Kasady's brain and body. At best, Cletus would suffer indigestion if it had been taken orally but by injection any excess would be filtered out with no such side effects. This sort of happens as the vitamin c is metabolized out quickly(in minutes, but the writers had the good sense to tell us that his metabolism was much higher than normal so it didn't seem too much like magic or convenience) and the symbiote reconnects. This use of vitamin c is just odd, considering that Dr. Kurtz also injects him with "classified" drugs as well to make Carnage more talkative and open, so why not do the same with the first injection?
Literature
- More than one classic mystery fiction writer assumed that aspirin was not just a pain reliever but a sedative as well. Ngaio Marsh was especially prone to having characters take aspirin as an insomnia remedy. In one novel, it was even used as a knockout drug.
- To a certain degree, Truth in Television. Many people treat aspirin as if it's a sedative, and if you have a headache or a backache, relieving the pain will help you get to sleep.
- The placebo effect works particularly well on problems like insomnia.
- Poisoned weapons in media are sometimes used to instantly kill an enemy of superior skill if the user even gets a scratch in.
- Used in Hamlet, where it was intended to kill no matter who 'won' (and be slow enough that the poisoner would not be suspected in this case).
- Averted in A Song of Ice and Fire. The poison that Oberyn Martell uses to kill Gregor Clegane takes weeks or months to kill him. This aversion is itself subverted in that the poison he used should have been instantly fatal, but it was "thickened" somehow to prolong the suffering.
Live Action TV
- Chuck: Likes poisons. One particular example had an enemy spy inject herself with a large quantity of ricin to avoid capture, because "everyone talks". She dies instantly, despite the fact that ricin can take days to work, slowly shutting down its victim's organs and rendering them in a position of considerable pain. Just tell yourself that the large syringe had hit a major blood vessel and she died of internal bleeding.
- Criminal Minds: You might be intrigued to see a murderer in one episode killing his victims by instructing them to kill themselves, which they do obediently after he blows a certain muscle relaxant at their faces. As this Criminal Minds Wiki entry points out, this was exaggerated from urban legends about scopolamine.
- CSI: Crime Scene Investigation: The season 12 episode "Brain Doe" features an MMA fighter who uses dimethyltryptamine, DMT, as a performance-enhancing drug. In real life, it's an extremely powerful hallucinogen. Presumably, the writers read about athletes using the other DMT, the designer steroid desoxymethyltestosterone, and mistook it for the drug...
- Dexter: The sedative he uses on his victims (which also incidentally takes effect immediately) is a real-life tranquilizer, used to sedate elephants. Apparently, getting it on a human's skin can kill them. Maybe he dilutes it?
- Carfentanil (tradename Wildnil), a chemical relative of fentanyl, is the most potent opiate. 10,000 times stronger than morphine, it is used for large animals. Yes, a small amount on your skin can kill you.
- General Hospital: An 80s story arc had a character get Easy Amnesia from exposure to a chemical that occasionally produces short term memory loss, but far more often results in crippling brain damage from even mild exposure.
- LOST: In one episode urley is desperately searching plane wreckage for clonazepam, an anti-anxiety drug, to control his hallucinations. It is unlikely this drug would help. Later, Jack, a medical doctor who should know better, describes clonazepam as an antipsychotic, which it definitely is not.
- Merlin: Gaius must be a truly magnificent magician, because he is an absolutely terrible herbalist. Valerian would have very little use for an injury. Fenugreek is an herb used to increase a mother's milk supply, not "heal" someone on the brink of death. The list goes on. The writers must have a big piece of paper hung on a wall with a list of herbs they thought sounded cool and a large supply of darts.
- Midsomer Murders: In one episode an old lady took a large amount of pills, wrote a suicide letter, had tea and then confessed to everything to the detectives before oh-so-conveniently dying before she could be arrested.
- Revolution: It's highly unlikely that the asthma inhaler Grace uses to treat Danny has a shelf life anywhere near 15 years, especially without temperature controls. Grace does appear to have access to some high technology and a larger conspiracy, so it's possible new medications are being manufactured somewhere.
Meta
- Addiction has three aspects: habituation, tolerance and withdrawal. Marijuana, for example, doesn't fit the classic model for any of these categories. (Some have referred to a "reverse tolerance" effect, probably due to novice users not knowing they need to inhale and (for a little while holding their breath. Some tolerance occurs, but even daily users find the effects readily obtainable.) Ceasing use of cannabis causes no withdrawal symptoms whatsoever: unless you include minor insomnia among those who use it as a sleep aid (people prone to insomnia before ever using marijuana). Strong habituation—in which people will endure tedious, difficult or risky situations to obtain the drug (similar to with heroin or cocaine)—does happen, but only for a tiny percentage of users: most of whom have problems with impulsive behavior in many areas of their lives. Needless to say, many other "addictive" substances don't meet those three aspects. This is why, even more egregiously, writing someone as being physically and biologically addicted to Frothy Mugs of Water or the G-Rated Drug is, therefore, failing pharmacology forever. Emotional addiction, on the other hand, would be somewhat more believable.
- A number of substances now known not to cause physical dependence can indeed cause horrifying psychological dependence, and in fact, "classic" habituation/tolerance/withdrawal addiction may only be a real thing for depressants and opiates. Most medical publications (including the DSM, which handles drug dependencies, and does list cannabis among them) and addiction counseling agencies do not distinguish between psychological and physical addiction.
- The above is further illustrated that while emotional and psychological addiction is real, not even all emotional/psychological addiction necessarily needs to involve drugs at all. In some cases (binge eating disorder, hoarding/shopping addiction, gambling addiction, romance/sex addiction) the "drug" is, in a case of Your Mind Makes It Real, none other than the endogenous neurotransmitters of one's own brain, when a positive emotional experience (anything from gobbling chocolate cake to a big gambling win to an orgasm) produces an excess of those neurotransmitters, and therefore the addict seeks out the experience.
- Lack of said neurotransmitters (especially endorphins and/or a proper response to them, or dopamine and a proper response to it), on the other hand, actually can predispose people to addiction to physically addictive substances such as opiates (that physically mimic endorphins as well as well as have an effect on dopamine) or MDMA/amphetamines/methamphetamine (that physically force the release of more active dopamine into the brain). So in effect, if a person's brain is imbalanced in a way that it has higher levels and enjoyable/pleasurable activities can produce the craving for more of them as if they were drugs, the person is more likely vulnerable to emotional addictions (from anything from cannabis to chocolate to having sex irregardless of risk or personal cost of doing so). If, on the other hand, the person's brain is imbalanced to where it does not produce enough dopamine or endorphins to stave off feeling low, they are at more vulnerability to seek out the physically addicting substance that, at least for the short term, provides a high that relieves that low.
Newspaper Comics
- In For Better or for Worse, Deanna gets pregnant with her and Michael's first child, Meredith, by accident. She claimed she was switching birth control prescriptions and didn't know that there would be a period of increased fertility between cycling off the old meds and starting the new. Although not everyone knows this side effect, Deanna is a pharmacist and admits she should have realized the risk.
Real Life
- Some statements made in news articles and in anti-recreational drug information. You do not go into a blind killer rage from smoking marijuana (unless it was heavily contaminated with PCP and that's unlikely). LSD does not break your chromosomes and render you infertile (though some of the things now sold as it might cause some nasty side effects.) Scare 'Em Straight becomes laughable at a point.
- There's usually a tiny kernel of truth in there someplace. A patient who took one dose of MDMA (Ecstasy) was in a coma by morning, and dead that afternoon. Not from the drug itself but from water intoxication. (The drug messes with sodium levels and body heat regulation, and Ecstasy is usually used in raves, where there is plenty of physical exertion, sweating and drinking.) If the ads would explain the real dangers instead of using stupid scare tactics, maybe people would at least be more careful, and survive.
- It's a simple Law of Great Numbers. Medicines are thoroughly tested and producers are obliged to indicate any side effects, even there was only one case observed in millions of uses. This is why some seemingly harmless medicines have very severe possible side effects listed. Now scale it up to drugs that lack quality control and are taken in uncontrolled manner with pretty vague dosage.
- In Real Life, drugs and poisons take time to take effect. Drugs taken orally, for example, can take anything up to 30 minutes to 2 hours to cross into the blood and take effect. In some works of fiction, they're sometimes shown taking effect instantly or at least more quickly than what they logically should. One such trope is Instant Sedation.
- Belief that drugs work instantly is a major cause of real-life overdoses. This is especially common in situations where one wants relief quickly, like constipation or sleeplessness or pain, or where one wants to get high fast. While with some drugs the overdose will only be unpleasant or embarrassing, many of them can kill you. Yes, even over the counter pain. ALWAYS check the time to onset before concluding that the first dose didn't work.
- An unfortunately common example is paracetamol, also called acetaminophen or Tylenol. If the regular dose doesn't get rid of your headache, do not stack up another dose, lest you suffer irreversible liver damage leading to a very slow and painful death.
- Another common mistake is with laxative enemas. If the first one doesn't work and, er, stays where you put it, then the right response is to call a doctor. Use more than one and you will absorb too much phosphate, again leading to a slow and painful death. Water and saline have a bit more of a safety margin but even too much of those can cause electrolyte imbalance or intestinal rupture.
- Possibly the worst fictional offender in the Instant Sedation department is depiction of veterinary tranquilizer darts. Even the strongest take time to work, which can leave you with an angry, panicked, and now drug-addled animal running around for several minutes. This is one reason police or keepers will sometimes have to fatally shoot an escaped animal, to keep bystanders safe. (The other reason is that it's actually safer when you miss. If a human gets hit with a gorilla-strength Cap Chur dart, and is not actually standing in a hospital at that moment, he's more surely dead than if he was hit by a shotgun.)
- In fictional depictions (as well as in most pharmaceutical advertising), drugs and chemicals always appear to act as if the human body is a vacuum. In Real Life, there is no such thing as a drug without side effects, some of which can be unpleasant or unwanted, and some of which can be more valued than the drug's main effect (e.g. Viagra was originally developed as a heart medication, but turned out to have more usefulness for increasing blood flow to another part of the anatomy). Drugs and chemicals also have interactions with other drugs and chemicals. Even placebos can have side effects or interactions due to their inert ingredients.
- This is why when you are about to start a new drug, it's always a good idea to tell the doctor everything else you're taking. Also ask about food restrictions, vinegar or wine can cause a fatal heart attack if you're taking an MAO inhibitor, and grapefruit juice can render some antivirals and antirejection drugs ineffective.
- The concept of "set and setting" is related to the above and also something that many people in Real Life ignore, to their regret, as well as almost never being mentioned in fictional portrayals. "Set" means the mindset in which you consume the substance (e.g. your motivation for taking it and present emotions, e.g. someone Drowning My Sorrows and someone having a celebratory drink may have very different reactions to the alcohol, even if they are the same person), while "setting" is the surroundings in which the substance is consumed (e.g. are you drinking that can of beer in your car behind the wheel, in a loud sports bar, or quietly at home? All may have very different effects on yourself and those around you.) Ignoring set and setting in the use of a substance causes substance use-related deaths and injuries, bad experiences with side effects or original effects, and other problems. "Set and setting" is important in how ANY substance taken will affect you and its effect on others around you as well, although it is probably most important for drugs that more perceptibly alter your perceptions of reality (i.e. "hallucinogens": psychedelics, dissociatives, and deliriants).
- Another Real Life problem is the belief that ease of access equals safety.
- Acetaminophen/ASA/Paracetemol/Tylenol is one of the easiest pain killers to buy over the counter. An overdose will kill you even more surely, and far more painfully, than an overdose of any opiate. A fatal dose of morphine is easy to spot, and a hospital can counteract it with breathing support and an antidote. An acetaminophen overdose is harder to spot, and unless it's caught very early, the only treatment is a liver transplant.
- A common discussion point in drug regulatory affairs classes is the fact that Acetaminophen would have never been granted FDA approval—much less OTC approval—if introduced today. ASA overdose is still the most common reason for drug-related hospitalizations in the US.
- DXM/Dextromethorphan, an over the counter cough remedy that even kids can buy in most states, is one of the most risky legal highs around. Mix the effect with anything from antidepressants to MDMA to certain foods, and you can quite easily die from serotonin syndrome.
- Diphenhydramine (Benedryl) is an anticholinergic drug which, at normal doses, alleviates allergy symptoms and insomnia. In large doses, it's a potent deliriant which can cause total short-term memory loss as well as extremely vivid hallucinations. The most common hallucinations? Spiders and shadow-people.
- The earlier-mentioned datura/Angel's Trumpet/jimsonweed may be the king of this trope. It naturally grows in many locations, and a small dose causes hallucinations and delusions that would otherwise be seen only in paranoid schizophrenia or heavy PCP use. Or that same small dose might just kill you instead, because it's also incredibly poisonous. No matter that it's easy to get, it is at least as dangerous as crystal meth, or any other drug you can think of. In many places it's argued that anyone who tries to get high on jimsonweed might as well be the poster child for Utter Failure At Pharmacology.
- This extends to nearly all plants containing tropane alkaloids. It is usually legal to possess or grow them. And they are extremely dangerous (active dose close to lethal dose, poisoning often involves cardiac arrest and other CV failures). Many psychedelic fungi (especially of Amanita family) also qualify.
- Tobacco. In most countries, it can be bought over the counter (or even from a vending machine) by anyone deemed old enough by law, and if you're not old enough, accessed easily enough through friends/family/co-workers/whatever that are. It's also almost as/more addictive than heroin and one of the most physically destructive drugs over long-term use.
- Ditto for alcohol. Not only quite addictive and dangerous when used on a regular basis or overdosed but also heavily interacting with many prescription drugs sometimes heavily decreasing their toxicity threshold (especially the acetaminophen mentioned above).
- This article on prescription opiate abuse. "The government's risk management plan is specific to extended release versions of opioid drugs, which come in both pill and patch forms and are designed to give long-lasting effects. That potency carries serious risks when patients abuse them as stimulants." Critical Research Failure meets this trope meets Insane Troll Logic meets Marijuana Is LSD and they all had G-Rated Sex to produce this. Anyone taking an opiate as a stimulant will be sorely and sadly disappointed.
- Confusing pulmonary, blister and nerve agents with each other. Only blister agents cause, well, blisters. (We're looking at you The Rock. And you Eden Its An Endless World)
- The belief, propagated by a few old mystery stories, that finely powdered glass was an undetectable poison to slowly shred the victim's insides. If it were finely powdered enough not to be painful in the mouth, it would do no damage further down the line.
- During a TV debate on legalizing illegal drugs the "keep drugs illegal" person stated that alcohol was not a drug. No point in continuing to watch.
- Homeopathy:
- Reason no.1: The law of similarity. "Let like be cured by like" or "water with 'memory' of arsenic will cure anything with symptoms similar to arsenic poisoning."
- Reason no.2: Succussion. Apparently, banging weakly adulterated water against a wall will turn it into a weak elixir, banging water weakly adulterated with that will make a stronger elixir, and so on until, if you weren't pouring out most of the water, you'd have used, by 25C, the mass of the observable universe per hundred micrograms of toxin. And then you keep going.
- The explanation is that "String theory says that all mass is strings, and all mass can be the size of a bowling ball, so all mass has the same mass as a bowling ball". Yes, it's based on assumptions that String Theory is true, as well as a complete and utter unknowing of the difference between mass and volume. A better explanation (minus the sardonic Potholing) here.
- To be precise, that's not so much "the" explanation as an explanation from someone who comes across as… what's a nice way to put it? The more common explanation homeopaths give for their remedy is that, in one way or another, "water has a memory". At the time homeopathy was first being developed, atomic theory wasn't as well-established, so some people figured that no matter how much you diluted something, there'd still be something there. In this view, water isn't made of separate non-liquid molecules but out of… water, at all levels of abstraction, and therefore you can never remove all the solute from a solvent. Since we know better now, a new account about "water memory" (often coupled with "quantum" something) had to be developed.
- It's worth noting that at the time homeopathy was first proposed, many "medicines" included things like arsenic or mercury - so dilluting them down to nothing actually did improve patient outcomes by virtue of "not poisoning people". Nowadays, not so much.
- Some people think that the iron and other metals found in cereal, vegetables, meat and other foods is somehow different than the iron used to build cars and skyscrapers. Iron is iron- the same stuff they pour into blast furnaces is the same stuff in your bowl of Wheaties, in your steak, and in your blood... just in very, very, very small amounts.
- The iron in your Wheaties is probably not in the form of elemental iron, but is in some oxidized form, possibly an acid salt, like ferric citrate, or some iron oxide.*
Which, by the way, is rust.
- Contrary to what one might see in many espionage movies, potassium cyanide does not kill in matter of seconds. It takes at least few minutes before cyanide begins to act, and few following minutes to cause death by massive apnea and cardiac failure. Additionally, victims are also portrayed as frothing at mouth and quickly passing out. In reality, an acute cyanide poisoning is pretty messy affair involving strong seizures.
- For this exact reason, the preferred suicide method for Those Wacky Nazis was biting a glass vial of cyanide and immediately shooting oneself in the head. Eva Braun did not shoot herself (apparently because she wanted to leave a good-looking corpse), but seems not to have suffered strong seizures (from the testimony of those outside the room where she did it) - some speculate that Hitler may have held her through the process, then bitten his capsule and shot himself after. When Heinrich Himmler had to bite his capsule without a pistol, he suffered a long and painful death, though this may have had something to do with his desperate British captors scraping whitewash from the walls and forcing him to eat it in a futile effort to make him puke the poison back up.
Tabletop Games
- Averted apparently in the d20 games style. It's not a perfect simulation, but the fact that there's an onset time you have to sit out has made me turn away from poisoned dartguns as a way to convince distant enemies to go to sleep in the modern-set Spy Craft game. Granted, there aren't many other means, but such is the difficulty of life.
Video Games
- Tsukihime, Kohaku uses the dried crushed seeds of Korean morning glories (aka datura) to give several characters hallucinations and make them think they're going insane. So far so good, but it also depicts the effects of the hallucination as giving the victim a sort of hypnotized pseudo-mind control state, where Kohaku can whisper to them something while unconscious and have them believe her.
- In Left 4 Dead, painkillers are a useful healing item, and you down the entire bottle in a second without water. Louis is famous because of this.◊
Web Original
- The weblog Polite Dissent often reports on such misuses in comic books and TV shows, primarily pointing out when the wrong drugs are being used, super heroes blandly hand out DEA Controlled Substances, and where the dosages are ridiculously off. The author of the blog is a comic book fan and a licensed doctor, so the articles can be quite informative. He also does surprisingly comprehensive write-ups of House from the same perspective.
Western Animation
- An episode of The Simpsons had Lisa being put on antidepressants and immediately falling into a blissful and oblivious state complete with hallucinations. In real life antidepressants simply get you back to normal; they don't give you instant happiness. And they certainly don't cause visual hallucinations.
- While it is not the normal reaction, there is a bit of truth to this one. Anti-Depressants when given to a bipolar individual can make them go into a manic episode. They also can cause mood imbalances when they're first started while the body acclimates, but nothing so extreme.
- They also take a while to take effect; it wouldn't be the instant mood lift that Lisa got.
Side effects may include, but are not limited to, Headache, Watery Eyes, Spontaneous Human Combustion and Dry-Mouth. Ask your doctor if this Trope is right for you...
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