Based on fieldwork conducted in rural Puerto Rico among people who inject drugs (PWID) between 2015 and 2019, this ethnography examines how a particular socio-cultural environment promotes and sustains addiction, and illustrates the effects of continuous drug use on the lives of those afflicted. It shows that as drug users develop drug dependence, most of their efforts are oriented not towards seeking pleasure but preventing painful withdrawal symptoms, understood as “being sick,” by finding the next dose that will, even momentarily, relieve them. Findings illustrate what it means to live with a drug addiction, while also taking into account Puerto Rico’s history of colonialism, recent neoliberal policies, and the recurrent economic and environmental crises that have severely impacted the provision of services on which PWID depend, while also fueling their despair and vulnerability.