I've made a DoMT-like artifact in one of my games that worked to great effect, and really enhanced the gameplay. The first thing I did was make it so that you can draw as often as you like. The fear of getting something bad is good enough to keep players from unfettered drawing. The second thing I did is scrap the effects listed in the DMG, and make up my own. I used a full 52 card deck... red cards do something good, black cards do something bad. The higher the card, the more powerful the effect, and I'd base the effect sortof on the suit of the card... hearts would do something intangible or spiritual (like raise a stat, or change someone's mind), diamonds would do something physical (like create an object or summon help), and likewise with spades and clubs.
The effect would ALWAYS be -relevant- to the situation at hand, or do something that alters the current situation somehow, either for better (red cards) or worse (black cards). The entire thing was up to DM adjucation, but since I was the DM, I had a blast with it, and my players loved it as well. It was like being given 52 "fate" or "action" points, half of which are BAD fate points, half of which are good, and the intensity of each point varied. And it never broke the campaign, because anything campaign breaking wouldn't happen (since I decide the effect) and it was never overused, because my players were terrified of the bad things happening.
To make things even more interesting, the deck changed hands a few times during the campaign, it would be stolen by the enemy, who would use it, and then the players would steal it back, and it went back and forth about 4 times. Every time the deck was used, the game changed somehow, but always in a way that was fun and enjoyable for everyone (even when bad things happened, because the bad things happening represented new challenges to overcome).
It's a tricky way to handle a magical item since it relies on DM adjucation so heavily, but it can work, and it can work well. Consider giving it a try if you ever feel the urge to put one of the bloody things in your game.