Over the last few years, there has been an exponential increase in morbidity and mortality associated with heroin abuse. The current rise in heroin abuse and overdose is attributed to widespread use and abuse of prescription opioids, which can produce significant euphoric effects in humans. In fact, reports suggest that heroin abusers initially become addicted to prescription opioids but subsequently switch to heroin because it is cheaper and more easily available than prescription opioids. Over the years, the purity of heroin available for illicit use has been on the decline. Smugglers and heroin vendors have started mixing heroin with other clandestinely prepared, potent, analgesic opioids such as fentanyl. Fentanyl is 30 to 50 times more potent than heroin, and the combination can be quite lethal to abusers due to the increased potency and effects on the body's respiratory centers which may result in death. This review will mainly focus on some of the recent trends in heroin abuse and recent changes in laws with respect to dispensing and possession of naloxone, an effective antidote against heroin overdose. Finally, the role of the pharmacist in countering the current heroin epidemic by recognizing at-risk populations and providing the proper resources to addicts to prevent further heroin/opioid-related overdose fatalities will be discussed.