Curses, diseases, drugs, and poisons can all have effects on a character that continue long past the character’s first exposure. This deterioration in physical or mental health is often represented by what is called a “progression track.” Diseases and poisons each have default progression tracks whose steps have specific rules consequences; drugs use the relevant poison track (for example, drugs that affect Wisdom use the Wisdom poison track). Some specific afflictions have their own unique progression tracks defined in their stat blocks. Curses generally do not use progression tracks—their effects continue until they’re cured without progressing through stages.
Before an individual is subjected to an affliction, she is considered healthy in terms of the affliction’s progression track, if any. When initially is targeted by an affliction, she must succeed at a saving throw to avoid its effects; if she fails, she is subject to the affliction. If the affliction has a progression track, she is no longer considered healthy with respect to that affliction and immediately gains the effects of the first step on its progression track. For diseases, this is the typically the latent state; at this step, the victim can pass the disease along to others if it’s contagious, but generally suffers no ill effects from it herself. For poisons, the first step on the progression track is usually the weakened step. A truly deadly affliction might cause the victim to start further along a progression track than normal.
Diseases and poisons each have a listed frequency specifying how often a victim must attempt subsequent saving throws to prevent the affliction from progressing. Success could help the victim recover (see Curing an Affliction below); failure means that the victim moves one step further along its progression track, gaining the effects of the next step and keeping all previous effects. A character using a drug must attempt a saving throw each time she uses that drug. Victims typically fail voluntarily, progressing along the drug’s progression track in exchange for benefits, and withdrawal from the drug acts as a disease (see the stat block for Addiction).
Each progression track has an end state—a point at which the affliction has progressed as far as it can. Once an affliction has reached its end state, the victim keeps all current effects (but doesn’t suffer further effects) and can no longer attempt saving throws to recover from the affliction (see below). By default, diseases, poisons, and drugs have an end state of dead, but some afflictions have less severe end states, while others might have no end state, allowing victims to continue attempting saves.
Some afflictions cause the same effects as a condition (such as sickened). Effects that modify, prevent, or remove those conditions do not apply; only effects and immunities against the appropriate affliction apply.
Curing an Affliction: Diseases, drugs, and poisons can be cured if they are treated before the victim reaches the end state. In the case of a disease, the victim must fulfill the conditions in the disease’s Cure entry (usually succeeding at one or more consecutive saving throws). Each time she does so, she moves one step back toward healthy; once she reaches healthy, she is cured. Poisons and drugs work differently—fulfilling the cure condition (or reaching the end of a poison’s duration) removes a poison from the victim’s system, but she remains at the same step on the track and recovers gradually. For every day of bed rest (or two nights of normal rest), a victim moves one step toward healthy. This rate of recovery is doubled by successful Medicine checks (see Long-Term Care), though tenacious poisons might require a longer recovery period.
Curses can be cured only by fulfilling the unique cure conditions listed in their individual stat blocks or through magic.
Usually, the spell remove affliction immediately cures a victim of an affliction (moving the victim of a disease, drug, or poison to a healthy state on its progression track). However, once a disease or poison has reached its end state, only the most powerful magic or technology (such as miracle or wish, or in the most extreme cases, reincarnate or a regeneration chamber) can remove its effects.
Reading Affilction Stat Blocks
Listed effects stack with the standard effects for the listed track, unless the effect specifies a different track, in which case it supersedes the regular track. If a disease or poison doesn’t specify an effect, it imposes the standard effects for the listed track.
The individual lines of information in affliction stat blocks are described below. Those marked “Optional” appear only if relevant.
Name: This lists the name of the affliction.
Type: This shows the type of the affliction, such as a curse, disease, drug, or poison. Where applicable, this line also states in parentheses the means by which it is contracted, such as contact, ingestion, inhalation, or injury. Afflictions that have multiple methods of contraction indicate this here.
A contact affliction is delivered by any contact with bare skin, which generally requires an attack against EAC if the intended target is unwilling. A contact affliction can also be injected like an injury affliction. Contact afflictions often take 1 minute or longer to take effect.
An ingested affliction is delivered by tricking the intended target into eating or drinking it. Ingested afflictions often take 10 minutes or longer to take effect.
An inhaled affliction is delivered the moment a creature that breathes (and isn’t wearing a space suit or suit of armor that filters out such toxins) enters an area containing such an affliction. Most inhaled afflictions fill a volume equal to a 10- foot cube per dose. A creature at risk can attempt to hold its breath while inside such an area to avoid inhaling the affliction. There is a 50% chance each round a creature holding its breath doesn’t need to attempt a saving throw against the affliction (see Suffocation and Drowning).
An injury affliction is delivered through damage to the target, usually via a slashing or piercing kinetic attack dosed with the affliction. These afflictions often take effect immediately.
Save: This indicates the type of saving throw necessary to avoid contracting the affliction, as well as its DC. Unless otherwise noted, this is also the saving throw to avoid the affliction’s effects once it is contracted.
Addiction (Optional): Typically only applicable to drugs, this line lists the saving throw type and DC to avoid addiction. See Diseases for more about how addiction works.
Track: This line indicates the progression track used once a character is affected by the affliction.
Onset (Optional): Some afflictions have a variable amount of time before they set in. Creatures that come into contact with an affliction with an onset time must attempt a saving throw immediately, and if they fail, they suffer the appropriate effect after the onset time has passed. The creature then must continue to attempt saving throws against the affliction’s effects as normal.
Frequency: This is how often the periodic saving throw must be attempted after the affliction has been contracted. If the affliction lists an amount of time after its frequency—such as 1/minute for 6 minutes—that means its effects last for only that amount of time, regardless of whether the affected creature ever succeeds at a saving throw. Such an affliction cannot be cured via successful saving throws; after its duration ends, the victim remains at her current step on its progression track until she receives the benefit of remove affliction or a similar effect.
Effect (Optional): This line lists the affliction’s special effects, if any, beyond the effects of its appropriate progression track.
Cure (Optional): This indicates how the affliction is cured. Usually, this is number of consecutive, successful saving throws. Even if an affliction has a limited frequency, it might be cured earlier if the affected creatures succeeds at enough saving throws. Afflictions without a cure entry can be cured only through spells such as remove affliction.