Ross is a customer of Spider Mike, a methamphetamine dealer. Spider Mike and his girlfriend Cookie are constantly arguing, and Ross strikes up a friendship with Nikki, a fellow addict. Nikki takes Ross to meet her boyfriend, "The Cook", who supplies Spider Mike with drugs from a meth lab he has set up in a motel room. The Cook gives a small amount of meth to Ross in exchange for bringing Nikki home, and says that he will get in touch with Ross if he needs a driver. Back at his apartment, Ross gets messages from his mother and his former girlfriend, Amy, wishing him a happy birthday. Ross, assuming that Amy still loves him, sporadically calls her and leaves messages on her answering machine. He then goes to the localstrip club while high, leading to an intense pornographichallucination. He takes April, one of the dancers he has a relationship with, home and has sex with her in a variety of positions, the last of which leaves her tied to the bed naked. As they finish, the Cook calls with an emergency regarding Nikki's dog, Taco, which needs to be taken to the veterinarian. April tells him to untie her but Ross, still high, duct-tapes April's eyes and mouth shut to keep her quiet and leaves her bound to the bed, playing music to cover her gagged screams. Elsewhere, two policemen working with a TV crew raid the trailer where Frisbee, another one of Spider Mike's customers, lives, falsely believing that a meth lab is located there. They take Frisbee and his overweight mother into custody and threaten him into helping them on a drug bust against Spider Mike. After driving the Cook around town to buy ephedrine pills, beer, and pornography, Ross returns to his apartment to apologize to April. In the Cook's motel room, he and Nikki have a fight after a prostitute arrives in response to the Cook's inviting her around. Nikki ends their relationship, and calls Ross and asks him to take her to a bus station so she can go back to Las Vegas, which Ross does, again leaving April still tied to the bed. While Ross and Nikki are out, Frisbee, now wearing a wire, visits Spider Mike to buy some meth so the cops can arrest him. When he enters, Cookie attempts to seduce him, as revenge for Spider Mike using a phone sex line, but finds the wire. As the cops burst in, a furious Spider Mike shoots Frisbee in the testicles; Spider Mike and Cookie are both arrested, and Frisbee is taken to the hospital. After Ross and Nikki go back to his apartment and find April gone, Ross finally drops Nikki off at the bus station, where they share a kiss, and hope to reunite if he ever goes to Vegas. Meanwhile, the Cook's meth lab catches fire and destroys the motel room; he flees to the adult film store, where he is arrested after the owner calls the police. Once the Cook makes bail, he calls Ross asking for a ride to another dealer's house in the city, which Ross agrees to do so that he can see Amy, who also lives in the city. The dealer provides the Cook with cash, some meth, and the equipment to start a new lab. The Cook promises Ross six months' worth of meth in exchange for being his chauffeur; he agrees on the condition that he can see Amy first. Amy, who has gotten her life together, wants no part of him after seeing that he still uses drugs and can only give her $100 of the $450 he owes her. As all the other characters go to sleep, the Cook drives a depressed Ross out to an old trailer in the countryside. Ross naps in his car as the Cook sets up a new lab in the trailer, only to blow it and himself up in the process.
The film received mixed reactions, with some analysts remarking that the film added nothing new to the genre of drug movies., the film holds a 37% approval rating on Rotten Tomatoes, based on 79 reviews with an average rating of 4.7/10. The website's critics consensus reads: "A chaotic drug movie that has little substance behind the stylistic flash." Time Out London was particularly harsh, accusing the film of "smug amoralism", and claiming that Åkerlund simply re-uses other people's ideas and techniques. Roger Ebert was more sympathetic in his review, where he described the film as having "effortless wickedness". His main appraisal is the fact that the film in no way attempts to romanticise any of the characters and further goes on to say, "it's interesting how this story and these people seem to have been living before the movie began and will continue after it is over; instead of a plot, we drop in on their lives". Ebert does, however, explicitly mention the similarities between this and the earlier Requiem for a Dream. This comparison may not have been lost on the filmmakers. The title on a pornographic tape purchased by a character reads "Rectum for a Dream", and the scenes which show consumption of the drug also show its dilating effect on the pupils in fast cutscenes.
