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Afflictions, Poisons & Diseases

Wherever there is life, there are insidious perils that threaten the health and well-being of living creatures. Some of these afflictions, including many diseases, are inherent to the natural world. Others, such as drugs, are crafted by people the world over for recreational, unscrupulous, or other uses. and some—curses being the most notorious—exist solely to cause harm to others.

Afflictions strike creatures with potent and often escalating results. This section presents a variety of curses, diseases, and drugs for use in your game.

Depending on the tone of the campaign, the GM might want to roll secret saving throws for PCs affected by an affliction. This is particularly effective when the affliction is an element within a survival or horror game, or when it’s part of a mystery.


A curse is a manifestation of potent ill will. Curses typically have a single effect that takes place upon a failed saving throw and lasts a specified amount of time, or can be removed only by certain actions a character must perform or conditions they must meet. Rarely, curses will have stages; these follow the rules for afflictions.

Curses may come from a malicious action, such as a lich’s Paralyzing Touch or a spell from an evil spellcaster.

Guardians of a tomb or treasure might ward their charge with a curse as protection against thieves. In some rare cases, a curse might manifest as a response to a terrible act, such as a massacre. When using a curse in your game, assign the curse to an item, location, situation, or similar element.

Then, decide on a trigger for the curse—such as a creature attempting to steal a warded book, destroy a work of art, or slay a specific creature. A curse can even be tied to a specific location, in which case it functions as a simple hazard. Once that trigger occurs, the curse affects the triggering creature or creatures. Each affected creature must attempt a saving throw against the curse; if they fail, they are subject to the effects specified in the curse’s Effect entry.


Exposure to disease can be a hazard, such as when PCs come into contact with a plague-ridden corpse; such hazards grant XP as a simple hazard of the disease’s level. When a disease gives a sickened condition that can’t be reduced until it runs its course, that typically means the disease has symptoms such as a difficulty swallowing, loss of appetite, or nausea that make eating and drinking difficult but not impossible. Despite the condition’s prohibition on eating or drinking, a creature can slowly and carefully eat and drink as long as they aren’t in an encounter.


Drugs offer short-term benefits with harmful side effects and long-term consequences. These short-term benefits, such as euphoria, draw many to drugs, but addiction keeps users hooked long after their first dose. A character can voluntarily fail their initial save against a drug, but for each dose they consume, they must attempt a saving throw against addiction, a disease that represents cravings and withdrawal. Addiction is unique to each drug, so a character can be affected by multiple instances of addiction at once.

Certain drugs alter how addiction works for that drug, adding the virulent trait to the addiction, limiting the maximum stage a character can reach, or adding additional stages beyond those listed in the base affliction.


For some of the poisons available, please refer to the Equipment Items category.

Alchemical poisons are potent toxins distilled or extracted from natural sources and made either stronger or easier to administer. Each poison’s stat block includes the Price and features for a single dose. Poison doses are typically kept in a vial or some other type of safe and secure container.

Applying alchemical poisons uses Interact actions. A poison typically requires one hand to pour into food or scatter in the air. Applying a poison to a weapon or another item requires two hands, with one hand holding the weapon or item.

A creature attempts the poison’s saving throw as soon as it’s exposed to the poison; on a failed save, the creature advances to stage 1 of the poison after any listed onset time elapses.

Some poisons have the virulent trait. This means the poison is harder to remove once it has taken effect.

Method of Exposure

Each alchemical poison has one of the following traits, which define how a creature can be exposed to that poison.

Contact: A contact poison is activated by applying it to an item or directly onto a living creature’s skin. The first creature to touch the affected item must attempt a saving throw against the poison; if the poison is applied directly, the creature must attempt a saving throw immediately when the poison touches its skin. Contact poisons are infeasible to apply to a creature via a weapon attack due to the logistics of delivering them without poisoning yourself. Typically, the onset time of a contact poison is 1 minute.

Ingested: An ingested poison is activated by applying it to food or drink to be consumed by a living creature, or by placing it directly into a living creature’s mouth. A creature attempts a saving throw against such a poison when it consumes the poison or the food or drink treated with the poison. The onset time of ingested poisons typically ranges anywhere from 1 minute to 1 day.

Inhaled: An inhaled poison is activated by unleashing it from its container. Once unleashed, the poison creates a cloud filling a 10-foot cube lasting for 1 minute or until a strong wind dissipates the cloud. Every creature entering this cloud is exposed to the poison and must attempt a saving throw against it; a creature aware of the poison before entering the cloud can use a single action to hold its breath and gain a +2 circumstance bonus to the saving throw for 1 round.

Injury: An injury poison is activated by applying it to a weapon or ammunition, and it affects the target of the first Strike made using the poisoned item. If that Strike is a success and deals piercing or slashing damage, the target must attempt a saving throw against the poison. On a failed Strike, the target is unaffected, but the poison remains on the weapon and you can try again. On a critical failure, or if the Strike fails to deal slashing or piercing damage for some other reason, the poison is spent but the target is unaffected.

Section 15: Copyright Notice

Pathfinder Core Rulebook (Second Edition) © 2019, Paizo Inc.; Designers: Logan Bonner, Jason Bulmahn, Stephen Radney-MacFarland, and Mark Seifter.

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