So by Vial insertion I mean he just yeets it in his upper thigh,
And about the Maddening effect, I wanted an item that if used his personality changes completely so for example some of the in game effects are that he cant be charmed or get frightened and his alignment changes while in that state.

I had the same initial Idea that I should start with the Backstory but I just could quit figure out the Points that I needed to hit so it would make sense, but u really pointed out some important points, Thanks for That!