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Hey kids, want to learn about drugs in Toril?

(OK, so some of them actually have medicinal properties, if your character happens to have medical knowledge in their background.)

Local laws usually have restrictions regarding drugs. As ever, Waterdeep sets the standards for trading cities that want to market themselves as tolerant: the production and selling of drugs outside of medicine is fully illegal in the city, though it's not a crime to be found personally taking drugs. It is not technically a crime to be found in possession of drugs, however that only really applies to nobles, wealthy merchants and others of similar rank. Lower ranks will be assumed to be carrying the drugs with intent to sell, and be arrested unless they can provide evidence of their employment by a Guild of Apothecaries & Physicians, clergy or similar legitimate medical employment.

Drugs that can have fatal side effects may be treated as poisons, which can get you arrested and charged with "murder with justification" if law enforcement and/or the courts do desire. (You don't have to have actually killed anyone, tried to, or shown any inclination whatsoever for this).

The illegal drug trade works a lot as it does in reality, although unlike in reality they also have magic so portals, illusions and other "cheats" are pretty common. The grunt work of trafficking and selling is done by the lower ranking, more disposable members. Often the "runners" who deliver the contraband to the client are young children.

In Baldur's Gate I'd assume most of the drug trade and production occurs in the Undercellar and the Outer City.

-

Many substances are magical in nature and their effects can be unusual. Some came with more information than others.

Tekkil Painkiller. Ingested. Typically used by people dealing with severe chronic pain, taken by chewing leaves that release a milky substance. As well as its analgesic properties, tekkil causes lethargy which can render imbibers insensate in an overdose. Some people use it to completely numb their senses and escape reality, and the drug is moderately addictive.

Alindluth Painkiller, ingested. "Deadens all pain and prevents shock and nausea for a few minutes. No known side effects [but may cause comas in higher doses]"

Haunspeir Stimulant. Paste. Sometimes dried into pill form. Carrying a low risk of addiction it's usually used by wizards, students and such looking for a study boost, though it does cause physical harm to the body while it's in the system and seems to thin the skin, causing more damage when something breaks through (try not to get a papercut).

Tansabra Anaesthetic. Intravenous. A form of venom that places mammalian bodies into magical stasis, keeping their body temperature, oxygen levels and so forth stable as the subject's metabolic processes literally stop: blood flow and breathing ceases. (The text does not tell me what provides the venom.)

Kammarth Beige powder or jelly. An addictive and potent magical stimulant combining Underdark fungi and a rare forest root. Users start bouncing off the walls with endless energy and gain a boost to their speed and reaction times. Overdose will overload the nervous system and cause paralysis and physical damage.

Sezarad Root Ingestion. Chewing the root boosts health, healing and vitality, though it also causes minor confusion as a side effect. It carries a low risk of addiction.

"Battlewine" Or Rhul. A spicy red fluid with a bitter aftertaste. It's basically an anabolic steroid, misused it boosts muscle growth and physical performance but causes aggression. It's also addictive.

Vornduir Powder. Inhaled. Causes the user to feel warm and prevents them from registering cold. It prevents shivering and loss of mobility, however the drug does not actually raise body temperature and won't prevent hypothermia or frostbite. It also has a host of effects that occur totally randomly by individual. In some people it causes alertness and euphoria that lasts for days (during which they can't sleep). Some are totally unaffected, and some have allergic reactions. In some it causes the pain and pleasure response to temporarily switch (stabbing them with a knife would be ecstasy; a normally welcome caress is distressing). On some people it even acts as an antidote to some poisons.

Chaunsel Dermal absorption. Rubbing the drug into your skin causes it to become extremely sensitive to tactile stimuli. While I imagine it has some very predictable uses not mentioned in the text, in practical day-to-day adventuring thieves and other criminals apply it to their finger tips when working in darkness to heighten their awareness of what they're doing with their hands (if they don't have dark vision, anyway). Overdosing causes days of numbness.

"Thrallwine" Ingested. An herbal red wine, more fancifully known as Jhuild, often used by slavers: the imbiber becomes fearful and confused, and their thoughts are sluggish, making them easy to manipulate and control. It also has a steroidal effect, boosting physical strength for a time. It's not addictive.

Katakuda Brown paste. Dermal absorption. Imported from Kara-Tur (Kozakura, specifically, I think). It's traditionally used by a monastic order, and causes the skin to harden when applied, making it harder to damage and less sensitive to pain. If overused it will cause nerve damage, inflicting wracking pain and spasms.

"Dreammist" Inhaled. Properly called mordayn vapor, it's used by brewing a tea using ground leaves and inhaling the vapours. The drug is too potent to be ingested, and consuming the powder or drinking the tea will kill you. Induces visions of incredible beauty that enrapture the user and make reality unbearable in comparison. The drug is extremely addictive and slowly destroys both the mind and body (causing Wisdom and Constitution damage, respectively).

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Medical professionals were aware of at least one case of cancer thought to be linked to a hormonal medication taken to aid gender transitioning, leaked documents from a worldwide transgender nonprofit organization suggest.

In a report released on Monday, the think tank Environmental Progress published hundreds of messages it said were from an internal forum of members of the World Professional Association for Transgender Health (WPATH), in which they discussed gender-affirming treatment and the complications that had arisen from particular cases.

The report comes amid a national debate on gender-affirming health care, as states across the U.S. have introduced legislation to limit treatment for young people who identify as transgender.

Among the messages is one, dated February 24, 2022, in which a person—identified by the report as a doctor—said a colleague developed hepatocarcinomas, or liver tumors, after eight to 10 years of taking testosterone.

"To the best of my knowledge, it was linked to his hormonal treatment," the message said. "Unfortunately I don't have much more details since it was so advanced that he opted for palliative care and died a couple months after."

Newsweek could not independently verify the authenticity of the messages, which appear in the report as screenshots and printouts, and many have names redacted.

When approached for comment, a WPATH spokesperson did not confirm the veracity of the messages, but said it "stand[s] opposed to individuals who misrepresent and de-legitimize the diverse identities and complex needs of this population through scare tactics."

A potential link between testosterone—which regulates pubic development, and which biological males produce naturally more than females—and liver cancer has been noted before.

A 2020 paper published in The Lancet detailed one case in which a 17-year-old transgender man developed liver tumors after taking testosterone. The patient was advised to stop taking testosterone, and the study said the relationship between the hormone and the tumor growth was unknown.

Another study, published in October, found cases in which transgender individuals receiving hormone therapies developed liver tumors, but it said the results were "not sufficient to conclude that there is an association" between the two.

Gender-affirming hormone therapies have also been linked to other forms of cancer—though research has so far been inconclusive.

A 2019 study of transgender adults in Amsterdam found there was an "increased risk of breast cancer in trans women" who had received hormone therapy compared to biological men.

However, last year, another study in the U.S. found that while there were signs of cellular changes with some hormone treatments, testosterone "does not appear to increase risk for breast cancer" and "additional studies are needed to investigate the mechanism responsible for these changes at a cellular level and its role in cancer development."

The message referring to a case of liver cancer was seemingly in response to an earlier one, posted in December 2021, detailing an instance of a 16-year-old patient who had developed hepatic adenomas, benign liver lesions, after being on testosterone for a little over a year and a synthetic form of progesterone.

Hepatic adenomas are rare, but they are associated with oral contraceptive pills and are seen in patients treated with anabolic steroids, according to the National Library of Medicine.

In the messages, the WPATH members discussed academic papers, asked for advice on issues surrounding gender-affirming care and shared their professional experiences. Environmental Progress said the leaks showed members appeared to be improvising treatments and, in some cases, spoke out against safeguarding requirements.

Michael Shellenberger, the president and founder of Environmental Progress, said in a statement that the leaks show that WPATH members "know that the so-called 'gender-affirming care' they provide can result in life-long complications and sterility and that their patients do not understand the implications."

While proponents of gender-affirming care say that such treatments help overcome gender dysphoria—and that barriers to treatment can worsen the mental health of those who feel they are trapped in the wrong body—opponents say that a rise in young people exhibiting gender dysphoria may be in part a product of wider mental health issues that should be identified and addressed before changing a person's body.

Dr. Marci Bowers, president of WPATH, told Newsweek in a statement that it "is and has always been a science- and evidence-based organization whose recommendations are widely endorsed by major medical organizations around the world.

"We are the professionals who best know the medical needs of trans and gender diverse individuals—and stand opposed to individuals who misrepresent and de-legitimize the diverse identities and complex needs of this population through scare tactics."

Bowers added: "Gender, like genitalia, is represented by diversity. The small percentage of the population that is trans or gender diverse deserves healthcare and will never be a threat to the global gender binary."

Update 3/6/24, 4:10 a.m. ET: This article was updated to include comment from Marci Bowers of WPATH.

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A very popular doping product, Dianabol is an anabolic steroid widely used in the body-building world. Also known as D-bol, Danabol or Methandrostenolone, it is strictly forbidden for consumption and resale in most countries.

Despite its prohibition and health hazards, many bodybuilders use this product to gain muscle mass and strength faster. The results are certainly incredible, but not without consequences.

Dianabol pills (or methandrostenolone) is the grandfather of doping in modern bodybuilding. Many famous celebrities admit to having used this product during their bodybuilding career in the 60s and 70s, such as Arnold Schwarzenegger, who explained that his performance on the weight bench was closely linked to dianabol.

The creation of this steroid dates back to the late 50s. Moreover, it is still used in bodybuilding. John Ziegler, an American doctor, created and developed Dianabol in 1958 in Basel at the Ciba laboratory (now part of the huge Swiss pharmaceutical group Novartis).

Originally developed to treat certain diseases, the Americans did not hesitate to use methandienone at the Olympic Games to boost the performance of their team in order to compete against the Russians, who also used anabolic steroids. The Cold War even existed in bodybuilding!

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The scientific community has repeatedly pointed to the negative effects of Dianabol on the body. In addition to harmful effects on the liver, the "miracle" steroid is said to significantly increase blood pressure. 

To clarify all this, scientists have conducted a study on a population of athletes, with the aim of finding a dosage to limit the side effects.

Conducted in the 1980s, the study consisted of administering 100 mg of Dianabol daily to athletes. Of course, this dosage allowed the athletes to maximize their gains in muscle mass, knowing that they would have gained up to 7 kg of muscle, without increasing their fat mass. 

However, the study did not only show the positive effects of the steroid: there were also adverse effects on natural testosterone production and plasma GH levels.

Dianabol is a very common doping product in the world of body-building that is mostly taken orally. There is an Dianabol injection, but it is more difficult to obtain.

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An important weight loss: Dianabol also causes what is called "hydrosodic retention phenomenon". At the end of the treatment, the athlete loses weight.

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Dianabol is mainly presented in the form of pills to be taken orally and the cycles vary from one practitioner to another. It all depends on the level. Dosages vary from 20mg per day to 80mg maximum depending on the level. The Dianabol cycle fluctuate between 4 and 8 weeks maximum.

Some will spread the dosage over the day in two or three doses while others will take the daily amount in one dose 30 minutes before their workout.

If you consume the maximum amount of Dianabol (i.e. 80mg per day), your cycle should not exceed 6 weeks. It is also important to take a break between cycles. This break must be equal to the duration of the cycle (at least). 

Indeed, in addition to being dangerous for the health of the liver and the heart, Dianabol disrupts the hormonal system. It will then be more difficult to have a normal and natural secretion of testosterone.

For example, a beginner can take 10 mg per day: Either 10mg 30 minutes before the beginning of the workout or 5 mg in the morning to 5 mg at the end of the day.

For the intermediate profiles, generally the doses gravitate around 30 to 40 mg per day in one intake up to three intakes.

As for the confirmed bodybuilders, they will take doses up to 80 mg per day over a period of six weeks maximum.

Dianabol is often used as a "kick start" on a course of treatment before switching to other steroids. That is to say that it is used just at the beginning of a cycle to boost its power before switching to another product. In fact many bodybuilders combine DBOL with other products.

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Market Overview –

The Performance Enhancing Drugs Market is expected to reach USD 534.3 million by 2030, growing at a 6.6% CAGR during the forecast period 2022-2030.

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The Performance Enhancing Drugs Market is expanding rapidly, driven by the increasing demand from athletes and fitness enthusiasts seeking to enhance their physical capabilities. Performance drugs are in high demand for improving endurance, strength, and overall athletic performance. Market players are continuously innovating to develop safer and more effective formulations to meet the evolving needs of consumers in the sports and fitness industry.

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Segmentation –

The global performance enhancing drugs market is segmented on the basis of types, products, and end users.

On the basis of types, the market is segmented into ergogenic aids, nootropic, and others. The ergogenic aids segment by types is sub-segmented into anabolic steroids, dehydroepiandrosterone (DHEA), human growth hormone, and others. The nootropic segment by types is further segmented into racetams, ampakines, choline & acetylcholine intermediates, and others. On the basis of the products, the market is categorized into pills, injections, patches, and others. On the basis of the end users, the market is segmented into athletes, body builders, students, militaries, and others.

Regional Analysis –

Regional analysis of the Performance Enhancing Drugs (PEDs) Market offers valuable insights into the distribution and trends of PED usage across different geographic areas. Understanding regional dynamics is essential for stakeholders to grasp variations in regulations, cultural attitudes, and prevalence of PED use. For example, regions with highly competitive sports cultures may experience a higher demand for PEDs among athletes striving for an edge in performance. Developed regions with stringent anti-doping regulations may see a flourishing black market for PEDs, driven by athletes seeking to circumvent testing protocols.

Conversely, developing regions may face challenges such as limited access to education on the risks associated with PEDs or inadequate enforcement of anti-doping policies. Factors like socioeconomic status, access to healthcare, and prevalence of organized sports also influence regional dynamics in the PED market. By conducting a comprehensive regional analysis, stakeholders can identify emerging markets, assess regulatory landscapes, and tailor their strategies to address specific challenges and opportunities in each region. Moreover, understanding regional variations in PED usage patterns enables the development of targeted interventions and educational programs aimed at promoting clean and fair competition. Overall, regional analysis serves as a crucial tool for guiding policy-making, enforcement efforts, and public health initiatives in the PED market.

Key Players –

The performance-enhancing drugs competitive landscape includes Taj Pharmaceuticals Limited (India), Eli Lilly and Company (the U.S.), Balkan Pharmaceuticals (Europe), Onnit Labs, LLC (the U.S.), Douglas Laboratories (the U.S.), Bayer AG (Europe), BrainAlert, LLC (U.S.), AstraZeneca (Europe), and Novo Nordisk A/S (Europe).

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