There is evidence that Detroit and St Louis imported the narcotics on behalf of and with the blessing of the Outfit during the 40's and 50's.

Tony Lopiparo, John Vitale, Frank "Three Fingers" Coppola, and Ralph "Shorty Ralph" Caleca of St Louis were reported to be working with Luciano and Coppola. Coppola had been involved in the drug trade in Detroit and New Orleans, as well as St. Louis when he was a member of the Green Ones gang, before being deported to Italy.

In 1950, Tony Giordano served as a drug courier for the St. Louis family. It is unknown how many trips he made to Italy, but law enforcement officials observed three of them. Each time Giordano met with Frank Coppola, who was working with Lucky Luciano in the drug trade there. Giordano was under the surveillance of Narcotics Bureau Agent Charles Siragusa. On the first two trips, Giordano and Detroit mobster Paul Cimino were unsuccessful in negotiating a heroin purchase. Cimino went back alone in the spring of 1951 and purchased 20 kilos of heroin, bringing it back in a steamer trunk with a false bottom according to Siragusa.

To the surprise of both Cimino and Coppola, the heroin had been diluted prior to the sale and Coppola needed to make good. Tony Giordano returned to Coppola's farm in Anzio to pick up the shipment. Upon arriving, an Italian newspapers broke the story of a major international drug smuggling ring bust in San Diego. The article spooked Giordano and he returned to the US empty handed. Years later, Siragusa wrote that Giordano was under surveillance and had he tried to return with the heroin he would have been arrested and almost certainly given a long prison term.

All of these guys had close relationships with Chicago. I have newspaper article or government report somewhere that indicates that Detroit and St Louis imported the drugs, which were then couriered to cities throughout the midwest, including Chicago. I have attached one article from the Post Dispatch that discusses Vitales's involvement.