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Nevertheless, listeners and the media personalities who are so inclined to judge these things have at times labeled the song a decadent endorsement of heroin use. Apocryphal tales of users overdosing while "Heroin" is playing on their record players are widespread. The song has become known as must-have for heroin users all over.
The irony, for those who would hear "Heroin" as a pro-heroin anthem, is that the lyrics are really, really bleak. Lou Reed's words in the song are those of a person who is nihilistic, unstable, and borderline incoherent… and worst of all, none of this seems to bother him much.
Reed bounces back and forth between four different themes in the course of the song. First, there are times when the focus is seemingly on celebrating heroin use, as in "'Cause it makes me feel like I'm a man when I put a spike into my vein."
Second, and more frequently, Reed seems depressingly and problematically nihilistic about his heroin use. The drug is equated with nullifying his very life, "be[ing] the death of me." And he seems to enjoy his own sense of meaninglessness. "Then thank God that I'm as good as dead / Then thank God that I'm not aware / And thank God that I just don't care," he sings.
The third theme is escape. Heroin is known to give users a sense of relaxation and euphoria. Euphoria is a rare, almost non-existent feeling in everyday life. Relaxation, too, is fleeting. Perhaps self-destruction, through drug use, is a means of escape. Reed sings, "I wish that I was born a thousand years ago ... that I'd sail the darkened seas ... Away from the big city," creating an elaborate fantasy that celebrates an isolated and peaceful life. Where these fantasy lands are longed for, Reed makes the real world into a sort of antagonist. The town he's living in, New York CIty, is filled with "evil"—perhaps the heroin itself—and is a place "where a man cannot be free." The "jim-jims," the "politicians makin' crazy sounds," "everybody puttin' everybody else down," and the Vietnam War are all negative forces that the lyrics invoke to justify the need to escape. Perhaps the strife of day-to-day life is the cause of heroin use… and perhaps the heroin use is, in turn, the cause of much of that day-to-day strife. So let's all just pretend to sail away…
But then, nothing is totally clear… and that's the song's fourth and final theme, stated clearly in the repeated refrain, "I guess that I just don't know," which ends all but one of the stanzas. It could be that Reed is conveying his lack of interest in anything through the refrain, but something darker might be at play. Each stanza sort of rises in action, just as the music does. The last stanza, for example, begins rather plainly, and then gets this vigorous sense of energy through Lou Reed's use of repetition. The word "blood" is repeated in two consecutive lines, and the following three lines are all variations of "thank God that I'm...." It is just like when someone excitedly tells you a story; it ends up being a bunch of "and thens" thrown together. But, at the end of this stanza, as with the others, whatever Reed had to say gets cut off by "I guess I just don't know." At times, he seems toe be just starting to form a thought when the refrain disrupts the grammar of the sentence.
These incomplete thoughts signal perhaps the most negative lyrical aspect of the song. The speaker seems incapable of conveying what he is attempting to say. Jim Morrison of The Doors said (before he died of heroin use) that drugs are a gamble with your mind. Jimi Hendrix (who choked to death on his own vomit after taking too many sleeping pills) said that the thing he missed most after using drugs was his mind. The broken sentences that end Reed's stanzas here hint at the danger of following Morrison and Hendrix down that tragic path.