The Pastoral Clinic takes us on a penetrating journey into an iconic Western landscape—northern New Mexico’s Española Valley, home to the highest rate of heroin addiction and fatal overdoses in the United States. In a luminous narrative, Angela Garcia chronicles the lives of several Hispanic addicts, introducing us to the intimate, physical, and institutional dependencies in which they are entangled. We discover how history pervades this region that has endured centuries of social inequality, drug and alcohol abuse, and material and cultural dispossession, and we come to see its experience of the opioid epidemic as a contemporary expression of these conditions, as well as a manifestation of the human desire to be released from them. With lyrical prose, evoking the Española Valley and its residents through conversations, encounters, and recollections, The Pastoral Clinic is at once a devastating portrait of immigration and addiction, a rich ethnography of place, and an eloquent call to political activists, politicians, and medical professionals for a new ethics of substance abuse treatment and care.