This paper offers an exploration of problem drug use in the urban environment, connecting with broader concerns about the progress and contradictions of city redevelopment and change. The discussion is situated within some recent theoretical debates about the political economy of uneven development, urban restructuring and neoliberal governance. The empirical discussion is based on studies of economic and social change, conflict and grassroots praxis in the inner city of Dublin, Ireland, wherein a heroin crisis has impacted for the last few decades, affecting in particular working‐class communities disadvantaged by broader patterns of economic restructuring and urban renewal. This provides some important analytical and political insights from a city that has undergone rapid and intense transformation and deepening patterns of inequality over recent decades, alongside the emergence of new forms of urban governance and community organization and contestation. The paper concludes with some considerations about the place and meaning of problem drug use in the city based on the foregoing theoretical and empirical discussion.