Heroin abuse and addiction is steadily increasing worldwide, particularly among young people and pregnant women. In the current report, we present the challenges encountered in the management of a pregnant patient with heroin dependence in the pre- and intraoperative stages and discuss the choice of anesthetic technique under emergency circumstances. We performed an emergency cesarean section (C/S) under spinal anesthesia in a 23-year-old pregnant woman who presented with fetal distress and who had a history of heroin abuse during pregnancy. After delivery, 1 mg midazolam and 50 μg fentanyl were administered to relieve maternal anxiety. We recommend the use of regional anesthesia, if not contraindicated, in pregnant women with opioid dependence requiring emergency C/S.Keywords: Anesthetic managament, caesarean, heroin addiction.