We have built up a great deal of insight into the early developmental trajectories that lead to heroin use. These cluster under five domains: social disadvantage, parental drug use/psychopathology, childhood abuse and neglect, early onset psychopathology and antisocial behaviors, and a developmental sequence of drug onsets. While not all heroin users have these risk factors, the broad clinical picture shows these early correlates to be the predominant presentation. We discuss each of the early psychosocial correlates of heroin dependence, as well as possible early interventions. Given the chronicity of heroin dependence, interventions to prevent heroin use emerging would reduce the considerable burden of disease associated with the disorder.