At the time of writing this article, the author was the Chief Executive Officer at the Bureau of Applied studies in New York State Office of Alcoholism and Substance Abuse Services (OASAS). Published in ‘The Mount Sinai Journal of Medicine’, the article aims at describing the state of heroin use and abuse in New York. It examines the past, current and future events of abuse of this drug in the state. First, the article analyzes the historical trends of heroin use in New York. It traces the first cases of abuse back to the late 1800s. The author shows that among the first users of the drug were women. However, an increased rate of use was recorded when Chinese laborers immigrated into the city. In addition, the author asserts that early heroin use was primarily through smoking. However, intravenous injections increasingly replaced smoking between 1910 and 1920s. The author also asserts that the drug became a commodity of trade that was controlled by criminal organizations during the mid 20 th century. Secondly, the author traces the historical trend of demographics of heroin users in the city. According to the author, females were the major users and addicts of heroin in 1970s. In addition, Hispanics and other South American groups make the largest ethnic groups that abuse the drug. Moreover, the majority users are aged between 30 and 37 years. The author also compares the trends of heroin use with cocaine. He asserts that the rates of abuse of the two drugs have been increasing between 1920s and 1970s. However, due to emphasis on health education and preventive measures, the number of users has been reducing since 1970s. For instance, the article shows that the number of users reduced from 200,000 in 1974 to less than 160,000 in 1998. Using these statistics and analysis, the author predicts the future of heroin use and abuse in New York. In particular, the trends of heroin abuse between 1970 and 2000 are used to predict the future of the drug in the city. For instance, the purity of heroin sold in the city changed significantly. Secondly, the majority of the users were aging, which means that the prevalence is reducing rather than increasing. The author indicates that the rate of use has decreased in the last four decades, but the purity of the drug, its availability and channels of sale have increased. Therefore, the author uses these aspects to predict the trend of heroin abuse in the 21 st century. He argues that the purity of heroin retail will continue to improve significantly. Secondly, due to avoidance of the drug by young generations, the user group will get older every year. Thirdly, he argues that some areas that had many users will see a reduction in the prevalence of heroin abuse. However, city suburbs and less urban areas will experience an increase in the rate of heroin use. In these areas, the author argues that younger generations are likely to adopt this behavior, which means that criminal organizations are likely to shift to these new areas. The author concludes that new and effective measures should be developed and established in the new areas. He argues that efforts should be made to focus on new areas because they will be the major hubs for drug criminal