West Malaysia has had a long history of drug use, beginning as early as the 1800s. While early use was primarily restricted to Chinese coolies and Indian immigrant laborers, the 1970s saw drug use become the domain of the youth of Malaysia and achieve the proportions of a national crisis. This paper traces the early origins of drug use and misuse in Malaysia, its development and expansion during the 1970s and the current efforts at eradication and rehabilitation. This examination of Malaysian efforts in response to the spread of drug use or misuse may provide researchers and practitioners in other countries some historical and cross cultural perspectives on current international efforts at eradicating similar problems.