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The book takes its title from the Velvet Underground song "Heroin", and concerns the exploits of several addicts living in rural America, as they engage in drug use, petty crime and murder. The stories are linked by shared locations (such as a dive bar in small-town Iowa) and repeated imagery. They are all narrated by a troubled young man identified only as "Johnathan White" ("Emergency").

The book is famous for its seemingly chaotic narrative style, which mirrors the mental states of its narrator. In "Car Crash While Hitchhiking" Fuckhead seems to have extra-sensory perception, which allows him to experience in the present a deadly car crash that won't happen until much later in the narrative. Despite his foreknowledge, he enters the car he claims to know will inevitably crash. "Emergency" picks up with Fuckhead while he's working a job as a hospital janitor and driving around under the influence of unmitigated batches of prescription medications that he's stolen from the hospital. The orderly, with whom he takes the drug-fueled, bunny-killing trip, helps to save a man who's been stabbed in the eye by his wife (this character, Georgie, is also the one who reveals the nickname of the narrator). The book ends on a more hopeful note as the final narrator enters a recovery program and begins to hold down a stable job writing a newsletter for the residents of a nursing home.

"Car Crash While Hitchhiking"

In this story, a drug-addicted narrator recounts hitchhiking in four different vehicles, first with a Cherokee, then a salesperson, then a college student, and finally a family composed of a husband, wife, young daughter and a baby. The salesperson is drunk and shares alcohol and pills with the narrator before leaving him off to find a student who drives him until he catches a ride with the family. Eventually, this vehicle is struck by another car resulting in the death of the driver of the other car. The story ends with the narrator looking back several years later, seemingly in detox, as he recounts his drug abuse, which the entire narration of the story reflects in a style of disconnect from reality.

"Two Men"

The narrator and his friends Tom and Richard are thrust into the role of reluctant chaperons of a mute man who unexpectedly climbs into their vehicle one evening after a dance. They drive him to several locations, the narrator berating the man constantly, for he believes he isn't actually mute. Upon arriving at the last location they discover that the mute man is an ex high school football star, and now is an addict in the company of wrongdoers. This realization strikes the narrator, proving that even the most successful or popular people can still fall from grace. After they deposit the mute man at the last location, he pursues the narrator and his friends as they attempt to leave him behind. He makes it as far as grabbing the side of the car before he crashes into a stop sign. Later, they run into a man named Thatcher, who the narrator recognizes at a gas station. Thatcher is a dealer who sold the narrator bad cocaine, and the narrator proceeds to follow Thatcher to his house, brandishing his gun and spitting threats. When they break into his residence, they encounter a woman who begs them to leave and informs them that Thatcher isn't present. The narrator presses, but the woman pleads and tells them that there are only two little children in the other rooms. Upon further investigation, Tom and Richard discover that there are in fact only two little children in the house. Thatcher had climbed out of the window.

"Out on Bail"

The narrator reflects on the young life of a well known man who he had connections with named Jack Hotel who was well kept, but kept his crimes a secret, while shifting to talk about his hard life in the present. He spends his time drinking at a bar known as the Vine (a reoccurring setting that the narrator finds himself at in later stories), where the other guests have also spent much of their lives consumed in drug addiction. Jack is no longer facing criminal charges but he and the narrator steal checks to fund their habit. The narrator is grateful for the apartment they find because he is still living but he is even more grateful for his life in the present, after Jack ultimately dies of an overdose. He ends the story by reflecting: "I am still alive" which shows that he can't believe that with the state of his addiction, he is continuing with his life.

"Dundun"

"Work"

The narrator and his girlfriend rent a hotel and shoot up heroin. Afterwards, they get in a fight and she runs away, but ends up coming back the next morning. Eventually, she leaves him for good and the narrator, in his loneliness, goes to a bar and finds his friend there, Wayne. Wayne comes up with an idea to rip the copper wiring out of his old abandoned house and sell it as scrap. As they are working, they see a beautiful woman flying under a kite who later turns out to be Wayne’s wife. The duo then end up going to the wife’s house and Wayne talks to her about unknown matters. They go to the bar after selling the scrap and actually feel good about themselves as they did the closest thing to honest work for the first time in their lives. Wayne then narrowly avoids a fight that he picks. Later, as the bartender fills their shots up all the way to the top, the men have a rare feeling of joy and satisfaction. The narrator later reflects on the day as one of his favorite memories.

"Emergency"

Reprinted online at Narrative

"Dirty Wedding"

"The Other Man"

This story begins with the narrator saying, “But I never finished telling you about the two men." Up to this point, the audience is unaware that this is a continuation of the story "Two Men," believing the two men to be the mute man and Thatcher. This set up of stories shows how fragmented the narrator is, and how unreliable he can be, getting sidetracked by other tales and forgetting to finish complete thoughts. The second man turns out to be Polish man who speaks in broken English. The narrator and the Polish man converse at a bar in Seattle before the Polish man reveals that he isn't actually Polish; he's from Cleveland. The narrator responds with nonchalance, before leaving and attempting to meet up with this friends Maury and Carol. A woman, presumably Maury and Carol's landlady, chases the narrator away and threatens to call the cops when he becomes belligerent. Later he winds up at another bar, and dances with a woman who he desperately wants to have sex with. It's revealed that the woman has been married for four days, but that doesn't stop them.

"Happy Hour"

"Steady Hands at Seattle General"

Two men converse with each other while in Detox at Seattle General Hospital. The two men are the narrator and his roommate, Bill. Both characters mention different types of drugs such as alcohol, cigarettes, and most importantly Haldol. Haloperidol is an antipsychotic drug, therefore we understand that the character is struggling with addiction. Knowing this gives the story a different tone because we understand that the characters are probably not thinking clearly. The narrator and Bill are in detox frequently, and they do not see it as a negative thing. They simply live one day at a time and being in detox is just part of their life. Bill reveals that this life of drugs and detox he lives cannot be sustained much longer. At the end of story, the narrator tells Bill he is going to be alright, but Bill disagrees with him by pointing to the bullet hole on his face.

"Beverly Home"

This story begins with the narrator discussing his job at a home for disabled people called "Beverly Home." He lists some of the more unusual clients of the home, then details how he starts watching a woman shower after work every day. The narrator shares his thoughts of raping her, but would be ashamed to be seen by her. Eventually, the woman's husband comes home and the narrator decides to leave. He also details his romantic relationship with a woman whose arms and legs are disproportionately small. Despite the fact that the narrator claims to not want to get to know this woman very well, they often eat out at Mexican restaurants, where the narrator learns that this woman works at an airline ticket counter. During this relationship, he continues watching the woman shower, eventually becoming obsessed with the idea of watching her and her husband have sex. He never sees them have sex, instead he sees them argue and make up. After this, he starts dating a woman who suffered from encephalitis as a child, and half of her body is paralyzed as a result. Her paralysis is significantly worse in the morning, which the narrator calls "unwholesome, and very erotic." The narrator then discusses the woman's ex-boyfriends, many of whom have died and the narrator pities. The story ends with the narrator, a recovering drug addict, noting that he is getting a little better every day in the midst of people who he calls "weirdos." Yet, he still identifies with them as he expresses his surprise that there is a place for "people like us."

In 1999, the book was adapted into a film of the same name starring Billy Crudup, Samantha Morton, Denis Leary, Jack Black, Dennis Hopper and Holly Hunter. It was directed by Alison Maclean and was received well by critics. It represents a rare attempt at turning a collection of short stories into a single, feature-length film. Johnson appears in the film briefly, playing the role of a man stabbed in the eye by his wife.