Although it’s still unclear what’s in the black pills in AHS, the effect they have on the naturally talented is virtually limitless. As long as someone is talented already, their potential skyrockets once they start taking the black pills.
If they don’t have talent already, though, they’re destined to become the pale creatures that hang around Provincetown.
So when Mickey takes a pill despite TB Karen’s concern that he might turn into one of the creatures, he does so with the risk in mind. However, he reasons, he would rather be one of the bloodsucking pale creatures than live as sex worker with unrecognized talent.
Luckily for him, he doesn’t turn into one of the creatures. And neither does Harry’s daughter, Alma. But now that Harry wants Alma to stop taking the pills, anything can happen.