Heroin is smuggled into the United States and Europe from areas such as the Golden Triangle (Southeast Asia); with Afghanistan currently being "the world's largest exporter of heroin".

In the U.S.A the Harrison Narcotics Tax Act was passed in 1914 to control the sale and distribution of heroin and other opiates. The law did allow heroin to be prescribed and sold for medical purposes. In particular, recreational users could often still be legally supplied with heroin and use it. In 1924, the United States Congress passed additional legislation banning the sale, importation or manufacture of heroin in the United States. It is now a Schedule I substance, and is thus illegal in the United States.

In the US, opium was used to treat soldiers during the Civil War (1861-1865). During the late 1800s, doctors prescribed "tonics" containing opiates for many conditions. Rarely did these medicines list opiates as one of the ingredients. In fact, heroin was marketed as a cough medicine and a cure for morphine addiction. However, many physicians had concerns about possible addiction to these medicines.

In 2005, nearly 6.2% of high school seniors reported using methamphetamine at least once.