yvonne abraham

Getting real about heroin

 Boston, MA - 5/14/2016 - An ambulance drives along a stretch of Massachusetts Avenue nicknamed "Methadone Mile" in Boston, MA, May 14, 2016. (Keith Bedford/Globe Staff)
Keith Bedford/Globe Staff
An ambulance drove along the stretch of Massachusetts Avenue in Boston called "Methadone Mile."

It’s easier to talk about opiate addiction as a disease, and a public health emergency, when the user in question is someone like us, or someone we know.

But when that person is lying near the corner of Mass Ave. and Melnea Cass Boulevard, an active user unwilling or unable to commit to recovery, we bump up against the limits of our compassion and enlightened thinking.

And so we are inclined to debate and delay rather than demand the essential steps that could save lives. While we argue, users die, lethal fentanyl speeding the losses.


There’s a way to save some of these lives, but too many people don’t want to hear it. We must meet the most acutely ill addicts where they are, providing them with safe, medically supervised places where they can inject the drugs they’re going to take anyway.

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It’s not enough to push for prevention and for more treatment beds, though both are absolutely vital. It’s not even enough to issue users clean needles and training so that, if they must use, they do so more safely. Or to give them safe places to be high, though that will save lives, too.

“We have to go right to the point of injection to stop death for a lot of people,” said Dr Jessie Gaeta, chief medical officer at Boston Health Care for the Homeless, which treats acutely ill opiate users every day.

This approach works in other countries. A slew of medical studies on safe injection facilities like the one in Vancouver, Canada, show that they reduce overdose deaths and get people into treatment who might otherwise be beyond its reach.

“We have to get [opiate abusers] to a place where we can talk to them, and if there’s a glimmer of hope, we can try to move them in the right direction,” said state Senator Will Brownsberger, a Belmont Democrat who has filed legislation laying the legal groundwork for safe injection facilities in Massachusetts.


But people balk at this idea. Governor Charlie Baker is wary. Boston Mayor Marty Walsh is opposed but says he might be persuaded.

At a City Council hearing on the proposed facilities Monday, at-large Councilor Michael Flaherty had his mind made up. And it was still made up when I talked to him on Wednesday.

“We’re going to normalize heroin addiction,” he said. “I think it’s completely asinine that we’re talking about sitting around and allowing people to come in and sniff or inject heroin or who knows what.”

Flaherty, a former prosecutor, is a strong supporter of treatment and says he has helped many people find help. So why doesn’t he understand that heroin addiction has already been normalized plenty — normalized, as in frighteningly close to the norm — and that we have a massive crisis on our hands that requires drastic measures? His belief that an injection facility will somehow make opiates more attractive simply isn’t borne out by the studies.

Flaherty has no use for studies, period. “There’s no factual evidence” injection sites work, he kept saying, dismissing peer-reviewed papers in prestigious medical journals, and the endorsements of the American Medical Association and the Massachusetts Medical Society. He complained that there were no studies using data from the United States but was unmoved by the very simple explanation for that: There are no safe injection facilities in this country.


Look, in a perfect world, everybody would want treatment and everybody would be able to get it. But the world in which active users live is not perfect. It’s a daily dance with death, and the narcotic is leading.

The best we can do for some users is to keep them alive today and hope tomorrow will be different. It would be asinine to do otherwise.

Globe columnist Yvonne Abraham can be reached at Follow her on Twitter @GlobeAbraham