This talk draws upon ethnographic fieldwork from two sites—extended in Dublin, Ireland and preliminary in Philadelphia—to explore the politics of public unconsciousness. Situated at the intersection of the anthropology of psychiatry and addiction medicine, and following dually diagnosed mental health patients through their treatment regimens for psychotic spectrum disorders and opioid use disorder, I propose that the specter of somnolence in the clinical and popular imagination reveals the precarious stakes of multiply medicated subjectivities in contemporary public health networks. Polypharmaceutical approaches to mental healthcare and addiction medicine are far from new, but the potential of both licit and illicit substances for use and misuse has proliferated in the aftermath of the (ongoing) epidemic of prescription painkiller and psychiatric drug abuse. In dialogue with dually diagnosed community mental health patients in Dublin, Ireland, and drawing upon preliminary research on the drug called tranq in Philadelphia, I ask: how are disparate scientific, legal, and popular standards of sobriety and intoxication invoked to determine a right to care and a right to occupy space, from the psychiatric clinic, to harm reduction organizations, and in the broader public beyond?