June 29th, 2020

Over My Dead Body: Writing Killer Drug Scenes

By Miffie Seideman

Ever ended a rough week by killing off one of your characters? Yeah, me too. No matter what people say, it can be cathartic. Even therapeutic. But, for authors with little to no drug knowledge, plot twists involving an overdose (accidental or otherwise) can seem complicated. To maintain credibility with readers, authors should make sure to get at least a few crucial drug-related facts right.

Written well, an overdose scene is a page-turner. But if your character instantly drops dead from an insulin overdose, the thud you hear won’t be from the body dropping to the ground.

It will be from readers closing your book in utter disappointed.

It’s fiction. Why not just make up facts?

I hear this argument quite often. As authors, we spend an inordinate amount of time researching historical data, geographic facts, magical lore, and so much more, to craft well-developed stories. Drug scenes should be no different.

Our readers may be one of the millions of healthcare workers, from paramedics to doctors. Some may be diabetics or cancer survivors. Some may be struggling with alcohol or opioid addiction. Today’s readers are savvier than ever before about drugs.

Writing blatantly inaccurate drug scenes can ruin a story for these readers, risking negative reviews. For example, the recent movie Knives Out relies on a flawed drug-related plot twist that ruins an otherwise fun, well-plotted (and mostly well-acted) story. Numerous online reviews were quick with grievances.

How to write drug-related scenes well (without medical knowledge)

Before writing these scenes, whether they involve smoking pot at a frat party or spies using lethal injections, I recommend researching the following key points:

Historic validity

Verify that the drug, and the way you depict it being given, existed in the historical time period of the story. For example, an early 1800’s historical fiction with an insulin-using diabetic character would be grossly inaccurate. Neither insulin nor injections were discovered until the 1900’s.

Societal trends

The socioeconomic circumstances of your characters will impact the drugs used and abused. A character living on the street might smoke crack cocaine, while a high-society hostess may serve an Ecstasy-laced cheese platter.

In addition, many drug use trends, and their prescribing habits, change over time. It was no accident that Agatha Christie’s pivotal scene in Murder on the Orient Express revolved around barbital, a popular sedative during the story’s time period.

Accurate Side effects

Consider these two important questions:

  • What are typical side effects for the drug? A character should have a few realistic side effects. Hallucinations of paint dripping down walls are obviously more likely with an LSD trip, while a heart attack might end an energy drink chugging contest.
  • How long do the effects take to develop? While instant effects are tempting, almost no drug works instantly. But this is actually wonderful for dramatic writing! For murder and overdose scenes, this fact gives authors a built-in real timeline to evolve the danger, creating a page-turner.

Putting it all together

Once you’ve gathered some basic clear facts, you can create a believable three-dimensional scene the reader won’t soon forget.

That insulin scene? It’s now set in the 1990’s. A woman measures insulin from a vial into a syringe, and gives herself a dose. The anticipation grows, as the reader watches helplessly, knowing the woman’s husband secretly switched the insulin concentration. As the woman sits back to watch an evening movie, the danger slowly evolves. She starts to feel dizzy, examines the insulin bottle, confused. The dose seemed right. Slowly, she realizes what has happened, knows she needs to find help. But she can’t think clearly. She tries to get up, stumbles, falls, her breathing strained. Does help arrive in time? The reader has no choice but to turn the page to find out.

Happy Plotting!

Note: Miffie has agreed to share her pharmaceutical know-how with us as an ongoing feature! If you have questions and scenarios you'd like her to explore for future posts, please share them in the comments.

Feel like you're killing your readers with unrealistic drug scenes? I’d love to hear your comments and questions!

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About Miffie

Miffie Seideman has been a pharmacist for over 30 years, with a passion for helping others. She’s a published non-fiction author, with another peer-reviewed journal article coming out this month. An avid triathlete, she spends countless hours training in the deserts of Arizona, devising drug-related plot twists. She can be found hanging around onwemerrilystumble.com and on Twitter @MiffieSeideman.

28 responses to “Over My Dead Body: Writing Killer Drug Scenes”

  1. lrtrovi says:

    Great post, thanks! You bring up a very important point about accuracy in plot twists. There's always a reader or two out there who can spot one! My daughter just graduated Med School so I turn to her often for injury, forensic, and other dead-body related plot needs 🙂

    • Congratulations on your daughter graduating from medical school! What an accomplishment (and what a fantastic resource for you!). What area is she going into? Thanks for your comments!

  2. Jenny Hansen says:

    I don't write a lot of dead bodies, but I do have a plot that could benefit from some slow poison. What are your thoughts on eye drops, or something else easily found at home?

    • Ah, Jenny...so many to choose from! Eyedrops are readily available and have been in the news recently for use in murders. Visine is great to 'get the red out' when drops go into the eye. Swallowed, however, it can be lethal. Over several days in drinks, it would subtly start to work, slowing down the heart rate, dropping the blood pressure, making the person drowsy, and, eventually, send them into a coma and death. Any drug in the home can be toxic in the right dose, so lots of options when writing!

      • Jenny Hansen says:

        This is good food for thought, Miffie! If they went to a doctor, would the doctor know to check for poison, or would it present like a thyroid issue or something else? In other words, would it show on a blood test or urine sample?

        • Good question, Jenny!

          If there were enough symptoms to go to a doctor, then the symptoms would look a bit like an opiate overdose (oxycodone, for example). The emergency rooms don't typically test for the chemical in Visine (tetrahydrozoline) in blood and urine tests. They would test for the usual suspected drugs, and, of course, tests would be negative. Without knowing the cause, doctors would treat the symptoms, and over time the chemical in the visine would be gone from the body and symptoms would disappear. The alternative plot is that the character's blood pressure and heart rate are so low by the time he gets to the ER that it is too late to save him.

  3. Yvonne says:

    I've always been very mindful of keeping things accurate because as you said, it bothers me when I read a book and something I have knowledge about is totally wrong. I would love to learn more about possible drug abuse with psychotropic drugs like for example SSRI or anti-psychotics. What are possible consequences when a depressed or psychotic person willingly or accidentally overdoses and how does it feel? It's something that could become an aspect in my WIP.

    • Hi, Yvonne! Overdoses from antipsychotics are far too common. SSRIs by themselves are safer than the older antidpressants, such as tricyclic antidepressants, but still can be lethal. A fun twist to your plot might be a character using 2 interacting drugs ( like an SSRI plus he abuses dextromethorphan, or takes St John's Wort), causing much higher serotonin levels. The character would be drowsy, and would not think clearly ( confused conversations, dropping off in the middle of sentences), he'd be agitated, his heart rate would go up, his muscles would seem very stiff and rigid. His body temperature can go dangerously high, and he may end up with tremors or seizures. Check our some online information on "Serotonin syndrome". I'd love to hear what you end up doing or help with any further questions. Hope this helps!

  4. Bryan Denson says:

    Great post! I bet EMTs are a font of knowledge on the subject.

    • Kris Maze says:

      Hi Bryan, As I have several Emergency Responders in my family, I agree that they're also a great source of stories with twists and turns. Many things they share are great fodder for authentic story telling. The true stories of courage and overcoming obstacles can be inspiring. Good point!

    • Agreed, Bryan! EMT's and ER docs are such a wealth of knowledge when it comes to these matters. They see far more than we would probably care to know!

  5. Eldred Bird says:

    My next novel (a stand alone not related to my series) will involve putting someone into a medically induced coma. I'm probably going to be picking your brain a lot when I get to that part of the book!

  6. Kris Maze says:

    Hi Miffie,
    Your point about not making up medical point just because it is fiction, is important to consider. The ways we add details should be relevant to the world of the book and make sense to the reader. Writers add credibility to their writing by doing the extra research and fact checking.

    I'm glad you are going to be a regular here and look forward to your posts!

  7. ecellenb says:

    Wonderful post! My next manuscript is still brewing in my brain, but as there will be elements of spying involved I know drug questions will come up.
    I look forward to your next post!

  8. jrfinley says:

    Thank you for this post! It's always jarring to get yanked out of one's suspension of disbelief by something unrealistic. In fields where there are a lot of sources, it's easy for authors to avoid, and deciding to just make it up in an unfamiliar area carries the risk of losing a reader not only for that story but from then on.

    Most of us have areas of knowledge in which we've had this experience, and this is one of mine - one of my careers was as a psychotherapist and I did a lot of that work in addiction treatment programs, so there are common mistakes that are real nails-on-chalkboard territory for me (not only the effects and dynamics of drug use, but things like calling stimulants narcotics and the phrase "drugs and alcohol" (unless something's changed, alcohol is a drug - that phrase is the equivalent of "cars and convertibles." Another from the mental health field is the careless use of "schizophrenia" to mean dissociative identity disorder, i.e. multiple personalities. That's not drug-related, though it's as off as - to continue the previous metaphor - using the word "airplane" when one means "convertible.")

    By the way, the other area that has caused me a lot of tooth-grinding and led me to completely give up on at least one author is information related to the miltary and weapons. I served in the Marine Corps for twenty years and have been shooting for fifty, and nothing makes me groan and toss a book into the recycling faster than lazy mistakes in those areas (the aforementioned author, otherwise a good writer, had a character slide a fresh magazine of ammunition into his revolver. That's just not caring.)

    We all have blank spots and need to know our limitations. I'm not a musician and have never played in an orchestra, so if I was writing about that kind of character and situation, I'd get in touch with my local symphony orchestra and ask them to look over whatever I was writing and tell me if I was making mistakes or missing anything I should include.

    Thanks again!

    • Thanks for your comments! All so very true! I totally agree about the 'drug and alcohol' statements. , too. I can well imagine extrapolating those same issues to a variety of specialty areas, such as you mentioned. Always good for authors to know their knowledge limitations (and the limitations of searching Google), and reach out for help!

  9. Ann G. says:

    In my first novel published in 2018, I had a character who has developed a morphine addiction from time in the hospital in WWII. I looked up a lot of info on what that is like and also what withdrawal is like and included much of the description in my book. The only thing I fudged on was how long it took him to get clean, and that was to keep the pace of the book moving along. As a former psychologist, I agree with that commenter's statements about inaccurate use of "schizophrenia" and other psychological terms. A favorite of mine that gets misused all the time is "attitude." A little off topic, but I'm also from Canada, and nothing is more aggravating to Canadian readers to read a scene that takes place in Canada but it's identified incorrectly. The one I've seen most often is placing Victoria, BC, on Victoria Island. No, folks. Victoria Island is in the Arctic. Victoria, BC is on Vancouver Island. Yet the city of Vancouver is on the mainland. Use your atlas and get it right! (Rant over.) Thanks for this timely post!

    • Hi Ann! I am alway so surprised when reading scenes that completely get geographical areas incorrect. It is so hard to duplicate an area that you haven't lived in, but certainly not hard to get at least the basics right and reach out to locals to fill in the rest. I was laughing pretty hard at your example of though. I live in the desert of Arizona, and I can't tell you ow often folks get what it is like to live here completely wrong. Thanks for enjoying the post!

      • Fellow Arizonan here, and I totally agree. Worst one I read was a few months ago. The author wrote that the main character flew into Tucson and drove 8 hours to reach the AZ community she actually wanted to go to. If she hadn't been clear the MC was driving a car, I would've asked if she was taking a wagon, as that's the only way I know someone could travel from Tucson to anywhere else in AZ for 8 hours and remain in the state. Then she named a community (which really does exist) that's only about an hour from Tucson as being an immediate neighbor to the MC's destination point. Doh! And we won't even go into the fact she had both federal and state gun laws so wrong as to be laughable.

  10. dholcomb1 says:

    I"m reading a book right now which has the character going through some cancer treatments, but the diagnostic equipment being used wasn't SOP until ~ 5 years later than the story is taking place. How do I know? It sounded off, so I looked it up. I remember the grandma next door when I was growing up having the same medical issue, and it wasn't available then. I'm surprised the editor didn't question it.

    Research, research, research.

    The book has dual time periods, and the author is using the term "selfie" in 2012--it was only starting to gain use around that more modern time. The character's age is not young enough for it to be a common usage term.

    I know that's not related to drugs, but it's another example of the author not doing the homework.

    As for drugs, I have enough medical-related and counselor friends in my circle, I can use them for my research.

    denise

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