About the medical/pharmaceutical stuff

[Sonic Boomer]

Hey guys,

I don't know if the devs read these forums, but I wanted to tell you I've been watching some LPs of your game and was overwhelmingly impressed by the amount of details you've put in the game! I will definately buy it once it's released.

Also, I noticed you guys have some prescription medicines thrown in there, and since I'm a pharmacist, I wanted to offer my services as a free "consultant" if you ever wanted to add more drugs and such. Although, I have a feeling someone is already helping you, otherwise there's no way you would have heard of zolpidem, that's not something that's prescribed often for insomnia ;) Not in Canada at least.

N.B. Please pardon the grammar mistakes, english is my second language.

[Chiko]

The medical screen is one of the things I like the most in the game, even though I try my best so I don't have to use it often. The only thing the vanilla still lacks regarding this is a proper "overmedication" feature. It's already in mods but some ppl avoid using mods.

[Daniel@BlueBottleGames]

Thanks for the kind words, Sybreed! And it's good to hear that the level of detail is appreciated. I try to research most things before adding them to the game, because I enjoy games with realism and attention to detail (where appropriate).

I'm long had a note to self to some day add more drugs to NEO Scavenger, for variety. In particular, I think it'd be interesting to have a longer list of drugs in the game to make it harder for non-medic characters to use them.

With such an update, there would be several pills with unfamiliar names that all look the same, and taking them blindly might produce harmful effects, or none at all. E.g. one white pill is the antibiotic, while others might include birth control, anti-depressant, and anti-coagulants.

Basically, make it such that drugs are no joke :)

If you have a list of common drugs one might find in Michigan medicine cabinets that I could use, I'd be thankful for the suggestions! (off-brand/generic names preferred, for legal reasons)

@Chiko, overdosing is also something I think would add to the game's realism, not to mention strategy. Mixing certain drugs or plowing through antibiotics should not be considered a valid approach to getting well faster :)

[Sonic Boomer]

Well, I'll try to be careful and find a good balance between something that can enhance the gameplay without becoming too complex or tedious.

For starters, the easiest and most common drug would be acetaminophen (Tylenol), a common, not really efficient painkiller. At dosages over 4g/day (pills come in dosage of 500mg or 325mg), it can permanently damage your liver and this can result in your death. Yes, you can suicide by swallowing too many tylenol pills at once. In real life, the antidote, called acetylcystein, can neutralize the intoxication very efficiently, but it is very unstable (liquid form) and would likely be impossible to find in a post apocalyptic world.

Another prime example would be warfarin (Coumadin). It's a blood thinner commonly prescribed for atrial fibrillation or pulmonary embolism. The dosage of this medication is very tricky and if you take a too high dosage, your blood becomes too thin and a small cut can bleed for hours, or worse, internal bleeding can occur and won't clot until a few hours, which can lead to death. The antidote is vitamin K... also very unlikely to be found in a post apocalyptic world as it is only in liquid form, while Coumadin are pills. Btw, Coumadin is what pest controls use to kill rats! (Dosage is everything!)

Here are 2 examples of common drugs used worldwide, I'll make sure to try to find more and post examples here... I'll have a few days off next week so I'll try to come up with new stuff ;)

Also, you added amoxicillin and hydromorphon right? Amoxicillin cannot be taken if you're allergic to penicillin (a severe allergy case, not just a common rash) and hydromorphon cannot be taken if you had a severe allergic reaction to codeine or morphine (a non-severe reaction means you can take it). Although, demerol is a synthetic narcotic which usually doesn't cause allergic reactions to patients severly allergic to morphin and/or codeine... so there's always that option! BUT, It cannot be taken long term as it can cause weird neurological problems... by long term I mean for a month of more, and considering the average survival of scavengers, it shouldn't be an issue :P

[Lin]

There was a discussion a while back and I have been wondering (purely out of curiosity, not necessarily as a needed addition to the game): How many of these pills would be problematic if taken 50 years past the latest production date? How much would expiration dates affect them, storage aside (let's pretend they were stored in theoretically perfect conditions, closed pill boxes, appropriate, locked medicine cabinets, cold and dark places)

Btw, it's so neat to have a pharmacist around to ask these questions to, so thanks for your input and ideas!

[Sonic Boomer]

there aren't that many pills that are considered toxic when expired. The only one that comes to mind is tetracyclin, an antibiotic (fun fact: it is used in DayZ). That one can cause damage if ingested and is expired. Otherwise, most drugs are harmless, they simply don't produce any effect. Normally, expiration dates are estimated when a certain threshold is reached. That threshold corresponds to 90% of the active molecule still being intact.

In short, when a drug is considered expired (note: this corresponds to the factory expiration date, not the date on the pharmacy label), that means 10% of the active molecule degraded to the point where it won't produce any effect. Yes, that means most prescription drugs can last longer than the advertised expiration dates, but when studies are conducted with a certain dosage in mind, companies can't tell people to use expired drugs, it just wouldn't be safe (think heart disease prescriptions)

So, when does a drug usually expire? When we receive brand new pills from pharmaceutical companies, expiration dates usually go as far as 3 to 5 years later. Yes, that means no prescription drugs (or over the counter drugs) would be potent in a post apocalyptic world, 50 years in the future :S Most active molecules would have degraded completely. And we're talking about pills, liquids or IV stuff don't last as long.

I wanted to bring it up in my first post but didn't want to burst any bubbles. For gameplay purposes, I think it would still be interesting to add drugs, there's definately potential to deepen the gameplay without making it tedious.

edit: sorry for the potential grammar mistakes, just worked a 12 hours shift !

[Lin]

Interesting! Thank you for taking the time to answer. :)

To address the realism issue, within the game world we have hints of better types of preservative substances having been invented before the world fell apart, so we can all pretend something similar happened with pills as well. ;) Like you said, it deepens gameplay, and realism is good but not the end all be all of games like this. Still, I was curious, so I very much appreciate your input!

Thanks again and enjoy your well deserved rest! :D

[Sonic Boomer]

Publicado originalmente por Lin:

Interesting! Thank you for taking the time to answer. :)

To address the realism issue, within the game world we have hints of better types of preservative substances having been invented before the world fell apart, so we can all pretend something similar happened with pills as well. ;) Like you said, it deepens gameplay, and realism is good but not the end all be all of games like this. Still, I was curious, so I very much appreciate your input!

Thanks again and enjoy your well deserved rest! :D

Well, that would make a lot sense lore-wise and gameplay wise! I'm down with that.

[RalphRoberts]

Publicado originalmente por Sybreed:

Publicado originalmente por Lin:

Interesting! Thank you for taking the time to answer. :)

To address the realism issue, within the game world we have hints of better types of preservative substances having been invented before the world fell apart, so we can all pretend something similar happened with pills as well. ;) Like you said, it deepens gameplay, and realism is good but not the end all be all of games like this. Still, I was curious, so I very much appreciate your input!

Thanks again and enjoy your well deserved rest! :D

Well, that would make a lot sense lore-wise and gameplay wise! I'm down with that.

"Bacteria is afraid to eat it, so you don't have to be!"
;)

[Daniel@BlueBottleGames]

As Lin and Ralph point out, food expiration was something I had to take liberties with. Most foods as we know them would be cardboard and dust by the time Philip wakes up, and that had me stumped when I was first designing lore.

It was actually my brother-in-law who said, "so what? Pretend there are hyperpreservatives and just move on." That was a revelatory moment for me.

Maybe the next wave of survival simulators will have even fewer food and drugs :)

And thanks for the acetaminophen and warfarin suggestions! I actually have an OTC painkiller meant to replace Tylenol in the game (Cavillo). However, the Coumadin/Warfarin was a new one to me. I've added it in 4mg, blue pill form, using a similar style bottle to the amoxicillin. The effects aren't perfect simulations of real-world symptoms, but roughly amount to glacial wound healing and blood restoration rates.

Similarly, I've decided to remove names from all the pills themselves, so only the bottles list the names. Pills are now just "blue pill," "white pill," etc. unless the player has the medic skill. I think Kaaven did something similar a while back, and I like that idea, especially with more than one type of pill per color. Laymen won't know what a pill's WAR|4 or 54/733 marks mean, so this gives players one more reason not to pop pills without being careful.

Thanks again!

[Sonic Boomer]

Publicado originalmente por Daniel@BlueBottleGames:

As Lin and Ralph point out, food expiration was something I had to take liberties with. Most foods as we know them would be cardboard and dust by the time Philip wakes up, and that had me stumped when I was first designing lore.

It was actually my brother-in-law who said, "so what? Pretend there are hyperpreservatives and just move on." That was a revelatory moment for me.

Maybe the next wave of survival simulators will have even fewer food and drugs :)

And thanks for the acetaminophen and warfarin suggestions! I actually have an OTC painkiller meant to replace Tylenol in the game (Cavillo). However, the Coumadin/Warfarin was a new one to me. I've added it in 4mg, blue pill form, using a similar style bottle to the amoxicillin. The effects aren't perfect simulations of real-world symptoms, but roughly amount to glacial wound healing and blood restoration rates.

Similarly, I've decided to remove names from all the pills themselves, so only the bottles list the names. Pills are now just "blue pill," "white pill," etc. unless the player has the medic skill. I think Kaaven did something similar a while back, and I like that idea, especially with more than one type of pill per color. Laymen won't know what a pill's WAR|4 or 54/733 marks mean, so this gives players one more reason not to pop pills without being careful.

Thanks again!

About warfarin: It is the same drug that is used as rat poison. So, if you want to create traps with the drug, you could!

[Kaaven]

I think Kaaven did something similar a while back

Yup, that is what I did. And I've added second pill type of the same color:
- white can be standard Amoxicilin or Propranolol - beta-blocker heart pills (taking it causes a mild bradycardia)
- blue can be native Zolpidem or Esomeprazole - a heartburn pills (do nothing bad)
- orange can be Hydrocodone or Sertraline - antidepressant (makes player sedated and dizzy for several hours)

This way, player without a Medic skill can never know for sure, unless he is using pills from a marked bottle (and the opposing pill is always denying him the expected results).

[Daniel@BlueBottleGames]

Publicado originalmente por Sybreed:

About warfarin: It is the same drug that is used as rat poison. So, if you want to create traps with the drug, you could!

Would you eat an animal poisoned in such a way? Or do you mean for killing other humans/dogmen?

@Kaaven, I like that there's some uncertainty in the drugs. Right now, vanilla NEO Scavenger has pretty much no penalties for random drug use. They all have beneficial effects.

That may change, though :)

[Sonic Boomer]

Publicado originalmente por Kaaven:

I think Kaaven did something similar a while back

Yup, that is what I did. And I've added second pill type of the same color:
- white can be standard Amoxicilin or Propranolol - beta-blocker heart pills (taking it causes a mild bradycardia)
- blue can be native Zolpidem or Esomeprazole - a heartburn pills (do nothing bad)
- orange can be Hydrocodone or Sertraline - antidepressant (makes player sedated and dizzy for several hours)

This way, player without a Medic skill can never know for sure, unless he is using pills from a marked bottle (and the opposing pill is always denying him the expected results).

propranolol can also reduce stress or PTSD symptoms...

I won't go into details as to what the actual pills look like, cause the ones stated here are pretty different from one another IRL, for gameplay purposes this is irrevelant.

I do disagree with sertraline giving such side effects... if we assume someone is taking sertraline at full dose instead of starting slow like we do in a normal situation, the biggest side effects you can expect are headaches and nausea... which can still be debilitating, but anti-depressants don't make you sedated, that would be benzodiazepines. Hell, some anti-depressants actually give you a "boost" of energy.

I do agree that without the medic skill, you shouldn't be able to tell what your pills are supposed to do.

edit: Anti-psychotics could make you sedated, if you wanted to add some! A common one is Quetiapine... can also be used as a sleeping pill at low dosage.

[Sonic Boomer]

Publicado originalmente por Daniel@BlueBottleGames:

Publicado originalmente por Sybreed:

[About warfarin: It is the same drug that is used as rat poison. So, if you want to create traps with the drug, you could! [/quote]

Would you eat an animal poisoned in such a way? Or do you mean for killing other humans/dogmen?

@Kaaven, I like that there's some uncertainty in the drugs. Right now, vanilla NEO Scavenger has pretty much no penalties for random drug use. They all have beneficial effects.

That may change, though :)

Hmm eating an animal killed that way could be risky for yourself. Of course, I don't know how much warfarin you need to kill other animals... maybe the doses are very small compared to humans, but that's a risk I wouldn't take.

What I had in mind was a way to set traps for dogs and wolfmen. If you have some meat and warfarin, you could set a trap and kill an enemy animal this way... although I'm guessing it would some time to take effect, like 3 to 4 hours to kill perhaps? Besides, if an animal gets warfarin poisoned and is injured, it'll simply bleed to death. A single wound, not fatal to a normal person/animal, would not heal and bleed continuously.

[Chiko]

I know nothing about this so all this info is really interesting, specially for mod content. :3