Sometimes the traffickers inject liquid heroin into jeans so they can ship the drug where it needs to go. Sometimes it's a fake coconut or bananas.
In a few cases, according to US officials, heroin is injected into the bellies of dogs.
However it arrives, hundreds of thousands Americans have been turning to heroin more and more in recent years, and officials across the country are sounding the alarm as fatal overdoses have more than doubled in some states over the last decade.
Oscar-winning actor Philip Seymour Hoffman is suspected to have fallen victim to that grim trend, having been found dead in his New York apartment on Sunday with a needle sticking in his arm.
"It's reached epidemic proportions here in the United States," Drug Enforcement Administration (DEA) spokesman Rusty Payne said of heroin use.
Payne attributed the problem to a surge in heroin crossing the nation's southwestern border, where soaring seizures of the drug are a sign of soaring smuggling operations. In 2008, the DEA reported seizing 559 kilograms of heroin at the southwestern border; that more than tripled to 1,855 kilograms in 2012.
Other health experts and law enforcement agencies have said pain-medication addicts have turned to heroin to get a similar high after they lose access to popular prescription pills such as OxyContin.
In 2011, at least 178,000 Americans used heroin for the first time, according to the latest available estimate from the Substance Abuse and Mental Health Services Administration, almost doubling from five years earlier. And early indicators suggest that those numbers will continue to rise.
"This last year, we've seen a big uptick in heroin use. It's become rapidly very popular," Theodore Cicero, a professor of neuropharmacology at Washington University in St Louis, said.
For seven years, Cicero has been monitoring trends for patients in 150 drug treatment centers across the country.
In 2011-12, about 10 per cent of the people going into the drug abuse clinics were getting treatment for heroin abuse; that has risen to 20 per cent to 25 per cent of those clinics' patients over the last year, he said.
"We're seeing patterns of heroin abuse increasing across the population, but now it's becoming a rural and suburban issue rather than an urban issue," Cicero said.
Depending on the results of his autopsy, Hoffman may put the biggest face on a crisis that has hit the northeastern United States especially hard.
"What started as an Oxycontin and prescription drug addiction problem in Vermont has now grown into a full-blown heroin crisis," Vermont Governor Peter Shumlin said in his state-of- the-state address in January, which was primarily focused on the state's drug epidemic.
"We have seen an over 250 per cent increase in people receiving heroin treatment here in Vermont since 2000, with the greatest percentage increase, nearly 40 per cent, in just the past year," Shumlin said.