1. In my opinion drug usage is 100% your choice as long as you are an adult and it isn't hurting anyone else. If you feel like you have a problem, seek professional help.
2. I do not wish to offend anyone with this guide; if you find something in this tutorial offensive, please contact me and I will edit it accordingly.
3. Information in this guide is not accurate medical information, and you shouldn't apply any of it in real medical emergencies. Information in this tutorial has been picked mainly from the internet without much source control so take it with a grain of salt.
To start with,
I've always been intrigued by mind-altering substances so it wasn't a big surprise that I've had quite a few characters that have had problems with substance abuse. I thought it was a good idea to write this tutorial since morphine is still the only drug available in the game, which increases the risk of people roleplaying addiction to it or other opioids inaccurately. Initially, I was about to write a guide on drug addiction in general but the subject is definitely overbroad for one guide.
This is the second version, so there are some differences to the old one that got swept under the rug when the forums were cleansed. I tried to make it a bit more readable and easier to understand and added a few things.
I. What is it, how it happens & basics
II. Different kinds of opioids and their effects
I. What is it, how it happens & basics
Most of us are familiar with addiction and dependency but sometimes we mix them up with each other. Opioid dependence (Substance dependence) is a state that develops due to a repeated use of an opioid. Upon ceasing to use opioids after dependence has developed often leads to opioid withdrawal (Chapter IV). Addiction is a much more complicated matter psychologically and you can read a lot about it here. If we look at addiction in the context of opioids, it is a condition in which a person keeps using them despite the negative consequences.
I will briefly touch on opioid use disorder which is "a problematic pattern of opioid use that causes significant impairment or distress" according to CDC. This is the condition that we usually refer to as opioid abuse/addiction/dependency in our everyday language. If you search for "Opioid dependency" or "Opioid addiction" on Wikipedia, you will get redirected to "Opioid use disorder". In short terms, opioid use disorder is very much the combination of opioid addiction and dependency and the medical condition that an opiate addict will most likely be diagnosed with.
Opioid use disorder can develop over time when using a prescribed opiate based medication or it could simply start from an individual "trying" a drug. Some are more prone to becoming addicted than others. Addicts don't often recognize the addiction themselves and often start to think about it only after someone tells them about it, but this may vary among individuals. Addicts might seek for other addicts to fit in better but many addicts try to hide their addiction as well as they can.
Something you also have to note is that using multiple kinds of drugs at once can cause a lot of different symptoms. For example, there is a total of 834 drugs (5047 brand and generic names) that are known to interact with morphine. You can check the huge list of them over at https://www.drugs.com/drug-interactions/morphine.html. Most of these are not relevant to you, but you should at least remember that if your character has used morphine or other opioids for a longer time, he or she probably knows to mix carefully.
There is a reason why I didn't dedicate much space for why people become addicted to opioids and that is that there is a) very little research concerning this, b) it doesn't really matter in the apocalypse, does it and c) the little research there is on it is very much not understandable by anyone who isn't a professional.
Now I thought I should add this small segment for it since I saw something that really affected the way I think about this, which was this TED Talk by Johann Hari titled "Everything you think you know about addiction is wrong" and this video by Kurzgesagt (This essentially is a summarization of Hari's new book "Chasing The Scream: The First and Last Days of the War on Drugs", so they pretty much talk about the same thing, but this Kurzgesagt video is just 5 minutes). It's about a 20-minute watch if you watch them both and they are both very interesting if you are actually interested in the subject matter.
Hari summarizes it well in the end with "The opposite of addiction is not sobriety. The opposite of addiction is connection." The idea is that people have become more disconnected than ever in modern society and it drives people to things like drugs. The more people actually care about each other, the less likely would people need to run away from their life to something that makes them feel good; if you can't make connections in life with people, it's easy to make those connections with drugs.
That statement of addiction not being just "chemical hooks" that take over a person's body might seem crazy at first because that's what we have always been taught. In school they tell us, if you go and use heroin for a week or two regularly, you'll get withdrawal effects that force you to continue seeking the substance (Substance dependency). This is based on experiments, in which the researchers put a rat in a cage alone and gave it a choice between heroin laced water and normal water, and the rat almost always drank the heroin laced water until it died. These experiments were re-done in the 70s when Professor of psychology Bruce Alexander noticed that the rats were put in a situation where they are in a place they don't know, alone and the only thing there was to do was to drink heroin water. Professor Alexander's experiments put multiple rats in "rat park", which has loads of things for the rats to do and loads of other rats. As a large surprise, in Alexanders experiments, the rats hardly ever went to the heroin water and never overdosed on it.
In the Kurzgesagt video and Hari's book, they tell you that there was this great example of this on humans, which was the Vietnam war where loads and loads of soldiers used heroin to escape from the horrors of the war. Back in the United States they feared that after the war they would have an army of heroin addicts walking the streets, but what happened was that when the soldiers came back to home where they had their family and friends, almost all of them simply never used heroin again and didn't even get any withdrawal effects.
An apocalypse like the one that our characters are living in, is a lot like a war, in which horrible things happen almost every day and there are rarely any real human bonds. This is why many characters would actually be very prone to creating a bond with opioids.
What to do:
If your character tries a drug once, it is very much up to you if he or she becomes addicted but it isn't very likely. Constant usage does often lead to dependency which then leads to addictive behavior.
Emotes & text chat are your friends when it comes to your character using drugs. Emote a lot and emote well. It's all about if you can make the scene believable.
If the drug is intravenous, like morphine or heroin, emote pulling your sleeve up and finding a vein before using it.
Keep in mind the general knowledge about opioids
What not to do:
Use an opioid and instantly take more of it within five minutes and tell everyone that you are addicted now.
Inject intravenous drug through your clothes.
Mix drugs randomly unless you have a deathwish (Wouldn't blame you)
II. Different kinds of opioids
Some terms you should be aware of:
Immediate-release (IR): The substance will affect immediately
Controlled or slow-release (XR) / Extended-release (ER): The drug will be released slowly or controllably in your body to ensure longer lasting effects
Since modding hasn't been introduced to DayZ yet, we only have one opioid item in the game at this point. In the future, modding can obviously change this a lot. Right now, your best bet is to emote a lot of things. For example, we already have syringes in the game, and you could emote having heroin in them and injecting it. We also have vitamin bottles which can be easily emoted to be things like Vicodin or Oxycontin in them.
Something worth noting is that morphine isn't as common as heroin (shouldn't be a big surprise) regardless of the fact that you can only find morphine syringes laying around. Of course, finding diamorphine (hospital grade heroin) or morphine from a hospital in larger quantities than an auto-injector is possible, but you could probably find heroin or some opioid painkillers from residential houses and apartments where people would have left them.
Opioids and other drugs for that matter are going to be hard to come by in the apocalypse, but if there is demand, there is supply. Most common opioids to find would probably be any kind of Chernarussian painkillers that would be something along the lines of Oxycontin or Vicodin.
A good way to roleplay taking any opioids in DayZ right now is, of course, emoting as I've mentioned before. A decent emote for taking some Vicodin could be:
*Takes out a white pill bottle that has a "Vicodin" label on it, opens it and takes one pill from it*
Some prefer using a vitamin bottle at the same as they emote taking pills which could make people notice your emotes a bit easier.
Using heroin or other intravenous drugs is very much just emoting as well. For example, for heroin you should emote at least:
Dissolving the powder into an injectable form
Rolling up your sleeve
Tying something around your arm to make your veins easier to hit
Filling a syringe with the liquid substance
Finding a vein and then injecting
The effect lists below do not obviously include all effects as they vary among different people. Since all opioids act more or less the same way in the brain they all have very similar effects that often only vary in intensity. You can check out this chart for some comparison between opioids and other painkillers. Opioids are what you often hear referenced as "downers" and there is a lot of clashing information about if opioids are central nervous system (CNS) depressants (like alcohol), but for the sake of simplicity we'll say that even though they do excite some areas of the brain, they do produce CNS depression and hence they are to be called depressants. Some of the most common effects of all opioids are:
What are some of the most common opioids that your character could be using?
Orally relative strength is 1, which is the base relative strength used in the Opioid equivalency table. Intravenously administered has a relative strength of 3.
Morphine is the most common opioid in-game but not in the real world, hence your character is more likely to use other opioids unless he or she has access to a hospital with morphine.
Morphine auto-injectors that are in DayZ contain a 10mg dose of morphine that gets injected upon pressing the needle down.
Auto-injectors are probably the easiest way of administering morphine, but they only have a relatively small amount of morphine in them since highly tolerant addicts can use up to 2000-3000mg per day. Note that the minimal lethal dose of morphine is around 200mg for nontolerant users, but in the case of hypersensitivity, even 60mg can cause sudden death.
Most commonly morphine is used intravenously (IV), but it can be used orally as well. Morphine is usually found at hospitals and not so much on the streets.
The best way to roleplay a tolerant morphine addict is to emote out larger amounts of morphine in syringes, saline-like IV administered bags full of liquid morphine or otherwise. Because it is a miracle to find morphine in large quantities, it is fairly common to use heroin, which you can find more easily.
Intravenously or intramuscularly administered heroin has a relative strength of 4-5.
Heroin is a derivative of morphine and a lot stronger which is one of the reasons why it is more common.
Heroin is one of the most commonly abused opioids and it is highly available in the street markets.
It should be easier to find than morphine from residential housing or apartments. You can also find hospital grade heroin (diamorphine) from hospitals since it is used as a pain medication in severe cases of pain.
Heroin can be used intravenously (IV), intramuscularly (IM) or orally, though IV use is the most common.
Oxycodone (The most common brand name is Oxycontin)
Has orally around a relative strength of around 1.5.
is often taken in pill form as an immediate release or delayed/slow release. Oxycodone can be administered intravenously as well, but among addicts, pills are the most common way of taking it. A good way to of roleplaying oxycodone is emoting a pill bottle with a label saying Oxycontin or another oxycodone brand name on it. Using these pills can be done via consuming the pills from a vitamin bottle or just by emoting them. These tablets can also be crushed and administered intranasally.
Hydrocodone (Some common brand names are Zohydro ER and Hysingla ER)
Has orally around a relative strength of 1.
Hydrocodone is usually used in the form of pills.
These pills can also be crushed and administered intranasally.
Has orally around a relative strength of 1. Paracetamol has roughly a relative strength of 0.0028 (1/360).
It is just a mix of Hydrocodone and paracetamol which has mostly same effects as Hydrocodone.
The most common brand name is Vicodin, and people often know it from the TV-series House M.D.
The thing that most people don't know about opioids that have paracetamol in them is that they are fairly hard to abuse as is due to their high paracetamol content and paracetamol overdose causing serious liver damage.
See paracetamol poisoning on Wikipedia or Acetaminophen on Drugs-Forum.
Has a relative strength of 0.1-0.15.
Codeine like many other opioids is used for treating pain and cough. It's widely known for its syrup form's recreational use. It's commonly referred to as 'syrup', 'lean', or 'purple drank.'
Also appears in a pill form, but the syrup form has been the most commonly misused form of codeine lately.
It is one of the most easily available opioids since in most countries you can get some cough syrup containing Codeine from pharmacies.
What to do:
Look at the effects listed here and on the internet and try to roleplay them as well as possible. Emoting and text chat is your friend when emoting the effects.
If you pick one drug, do some additional research about it.
Add variety to the effects and emoting them, don't keep on scratching your leg the same way again and again.
Commit to the addiction. Drug addicts that are heavily addicted will value drugs over anything. (Except your life because of the server rules of course)
Use brand names or nicknames for the substances for the most part (Oxycontin or oxy instead of Oxycodone). You can find common names for different opioids quite easily.
What not to do:
Don't go around hallucinating after injecting a morphine auto-injector you just found from the nearby hospital.
Don't take the easy route and choose morphine. It is not the most common opioid out there.
For many addicts, it's not about the effects that they get from the drug anymore, but they have just formed a habit or try to keep away the physical withdrawal symptoms.
Since opioids have a lot in common, there are some general withdrawal effects. Opioid withdrawal effects can vary a lot among individuals, and the following progression of them might not apply to everyone.
The withdrawal process from opioids is horrible and painful. This is one of the most common reasons for people not quitting and relapsing. There can be periods during the withdrawal that the recovering addict is suicidal or otherwise irrational due to the intense pain and feelings.
The early symptoms can be noticed after 16 to 24 hours after the last dose. They include:
Lacrimation (eyes tearing up)
Inability to sleep
Yawning very often
After the first day passes without using any opioids, the effects usually get worse, and they include:
Nausea and vomiting
Dilated pupils and possibly blurry vision
High blood pressure
Involuntary leg movements (restless leg syndrome)
After about 72 hours from the last dose, the effects should start to go away and at that point, the addict has gone through the physical withdrawal effects. Even though the physical withdrawal effects disappear, addicts usually have a psychological need for the drug for a long time after. This psychological need can be noticed as thinking and talking about the drug or just craving for it.
Knowing at least some of these withdrawal effects should help you to roleplay withdrawal correctly.
Note that unless there is a constant supply of opioids available, your character is bound to have at least some withdrawal symptoms here and there if he or she has developed an opioid dependency.
Addiction to opiates is usually very strong, and the withdrawal isn't pretty. The addict often needs a close friend to get him or her through it. It isn't an easy process, and it is bound to fail without proper supervision. Speaking to other addicts or anyone about it might help the recovering addict.
Opioid overdose is the primary cause of death by opioids. An overdose happens by using too much of a substance. It can be because a person has taken a slow release pill of some opioid and then drank alcohol which speeds up the release. Overdose can also happen because addicts usually develop tolerance to the drug and have to take too much of the drug to get the same effects as before.
Opioid overdose effects vary a lot, and the information you get may be contradictory. I chose to trust the information from WHO (World Health Organization), and I picked some effects for you to roleplay. I'm going to quote their information sheet directly because it offers you the best information
So the most lethal symptom is respiratory depression and finally a respiratory arrest. Opioids don't necessarily cause the airways to close, but the breathing and gas exchange may just slow down and stop due to the effect on the person's brain.
Some sources also indicate that there are a lot of other symptoms, but WHO doesn't recognize them in their information sheet. This contradiction could be because of varying symptoms among different kinds of overdoses and different mixtures of drugs that caused the overdose. These are some of the other possible symptoms:
Awake, but unable to talk
Body is very limp
Face is very pale or clammy
Fingernails and lips turn blue or purplish black
For lighter skinned people, the skin tone turns bluish purple, for darker skinned people, it turns grayish or ashen.
Breathing is very slow and shallow, erratic, or has stopped
Pulse (heartbeat) is slow, inconsistent, or not there at all
Choking sounds, or a snore-like gurgling noise (sometimes called the “death rattle”)
Loss of consciousness
Unresponsive to outside stimulus
In case a respiratory arrest doesn't happen, and the person is still breathing, they could go unconscious and choke on their vomit.
Roleplaying an overdose can cause your character to die without proper and immediate treatment. Minor overdose might not be fatal but requires as much immediate medical attention as a major overdose. A major overdose is fatal if you don't receive immediate care from a medical professional that knows how to treat an opioid overdose.
Treating an opioid overdose is important to avoid death. Just providing basic life support and naloxone to the patient can prevent the death of the patient. An opiate addict or their caretaker should always carry naloxone in the case of an overdose. Providing oxygen to the patient will help him or her to be able to breathe, but the administration of naloxone is necessary to counteract the effects of an opioid overdose.
Naloxone is the most effective treatment for an opioid overdose. It can be applied intravenously, intranasally or intramuscularly. It blocks the opioid from affecting a person and undoes the symptoms of an overdose.
Since overdose is a touchy subject, it's important that you try to roleplay it as well as you can.
You can do additional reading about the subject on many sites. Wikipedia is usually not preferred in your college essays, but it saves you time regarding this kind of research as you don't have to skim through hundreds of books and websites about the subject.
I hope this has helped at least someone to shape their next character and roleplaying experiences.
If someone doesn't beat me to it, I might try to write a few other tutorials about other substances as well.
Sources and additional reading: