A small line of dialogue between two Ghouls in Prime Video's Fallout TV show might have revealed a big secret about how the Ghoul drug works. The Ghouls' survival was believed to be connected to yellow vials they take regularly, but it seems there's more to that story than meets the eye.
One of the main characters in the Fallout TV show, Cooper "The Ghoul" Howard, is a rare human who remembers the world before the apocalypse. Despite being disfigured, he's managed to stay alive for 217 years, thanks to the yellow vials of mysterious medicine.
However, a simple line of dialogue between Coop and another ghoul, Roger, reveals that regular ghouls might not need any medicine at all. When we meet Roger in the show, Coop tells him he doesn't have any vials. Roger answers by saying the following:
I did okay. Twenty-eight years since I first started showing. Not as long as you, though. You’ve outlasted us all. How long since you first started wastelanding?
These couple of sentences imply that regular Ghouls don't need vials to survive and that vials were invented to prevent Ghouls who began turning into Ferals from completely losing their mind. That would also explain why there are so many non-feral Ghouls in the show, despite vials being extremely rare and hard to get.
At this moment, it's hard to tell what the yellow vials' original purpose was. Some say NCR developed them to prevent the Dayglow Ghoul population from becoming Ferals. Others say the vials contain RadAway, which helps Ghouls reduce the effects of radiation. Many organizations in the Fallout world meddle in scientific experiments, such as Enclave, Big MT, and Vault-Tec, and we're yet to see who's exactly behind those vials and why.
For more related info, check out Fallout Viewers spot Todd Howard Napoleon painting in TV show on Pro Game Guides.