Joel says that this song is about the one and only time he tried heroin. The song is a musical recreation of his heroin trip, which he tried on a visit to Amsterdam. "It got me so high, I didn't know how to deal with it," he told Howard Stern in 2014. "I can see how people get addicted to this, because you just get way out and go to another place."
The line, "We could play the Blues all night," was written because when Joel did heroin, he felt a compelling urge to listen to Blues music.