Mayor Martin J. Walsh knows more than most about addiction. He got sober more than 20 years ago — alcohol, not drugs — and has stayed that way thanks to what some simply call the program: Going to meetings, working the 12 steps, taking sobriety one day at a time.
“It changed my life. It helped make me the person I am today,” Walsh said of the role Alcoholics Anonymous has played in his decades-long recovery. “So when I got elected as a state rep, I was a big advocate for [putting] more money into recovery, and most of my thinking was abstinence-based treatments, 12-step programs, and counseling and therapy.”
And so the notion of the city providing places for people to inject illegal drugs acquired outside the facility under the watchful eye of medical professionals, places known as supervised injection facilities, made the mayor recoil. This wasn’t abstinence; if anything, it sounded like the opposite of the ethos that transformed his life.
But if AA meetings could change his life, maybe it’s not so surprising that one could change his mind, too.
At a meeting one night last spring, someone at the podium said something that set in motion a remarkable evolution in the mayor’s thinking.
“He said, ‘Whatever the pathway into recovery is, we should be accepting of it,’ ” Walsh recalled. “He was talking about recovery, but I started thinking immediately, ‘Am I in the right place on safe injections?’ ”
If Walsh remembers who said it, or where, he’s not telling. In AA, that second “A” is for anonymous. But the comment began turning Walsh from a self-described “hard no” on supervised injection facilities, into someone who, if not quite a supporter yet, sounds quite convinced of their lifesaving potential and eager to see how they might fit into the fight against the opioid epidemic here.
After that AA meeting, Walsh asked staff from the city’s office of addiction services for some research. He read through some of the studies, including a large body of research that supports the creation of supervised injection sites because, at their most fundamental level, they save lives. An overdose can quickly turn deadly — it did for nearly 2,000 people in Massachusetts last year.
But under the watchful eye of a trained medical professional with the overdose-reversing drug Narcan on hand, fatal overdoses at supervised injection sites have been nonexistent.
The sites also have broad support within the medical community, part of a philosophy called “harm reduction” — the idea that public health policies should seek to lessen the pain, suffering, and stigma that afflicts people living with addiction.
So whether supervised injection facilities lead people directly into recovery is almost beside the point: 100 percent of the people who die in bedrooms and bathrooms and alleys with needles in their arms will assuredly never make it to another Narcotics Anonymous meeting. But if Boston can keep people struggling with addiction alive, then maybe eventually they will find their way to recovery. This idea, simple but revelatory, took root in Walsh’s head.
At a conference in Boston not long after, Walsh sidled up to the mayor of Edmonton to ask about Canada’s supervised injection sites. The answers weren’t what Walsh expected.
“He was not responding the way I think a mayor would respond if there was this chaotic scene,” Walsh said. “I kinda got hooked a little bit.”
Now a member of the state’s Harm Reduction Commission, charged with recommending new ways to tackle addiction and the opioid crisis, Walsh traveled to Montreal and Toronto in January with Cambridge Mayor Marc McGovern and toured injection sites in both cities. He came back largely convinced that operating the sites responsibly and without neighborhood chaos is at least possible, and worth a very close look for Boston.
In a recent interview, Walsh pored over notes and documentation from the trip, recalling the details of each stop, the fact that neither the rooms inside nor the streets outside were overrun with people hanging around, buying, selling. He watched a woman shoot up, something he said he’s seen before.
“I think that if it keeps people alive, it’s worth exploring,” Walsh said. “Am I afraid to take this issue on? No, absolutely not.”
That represents a major evolution for a mayor who, less than a year ago, wanted nothing to do with the idea.
“Having sat with him on the committee, I’ve experienced an opening, a willingness, to engage in the conversation. And a real effort to understand something that is foreign to a lot of people,” said Cindy Friedman, a state senator from Arlington who serves with Walsh on the Harm Reduction Commission.
“He opened himself up. . . . That’s what it means to take this epidemic seriously.”
To walk that path could not have been easy for Walsh. Despite evidence that supervised injection sites save lives — a 2017 survey of scientific literature found decreases in overdose deaths, ambulance calls, and HIV infections — they do not seem to have drawn widespread support from the public.
“Some people think this is wrong, what I’m doing,” said Walsh, who still gets calls and texts from friends and acquaintances who are trying to coax people they care about into recovery — and know they can count on Walsh for help and guidance.
But he also catches flak from the other side. At a recent harm reduction meeting, commissioner Aubri Esters, an intravenous drug user, took Walsh to task for dragging his feet while people are dying.
“It’s personal for me,” Esters said at the meeting late last month. “My people are dying, under those trucks on Methadone Mile.”
“It’s personal for me, too,” Walsh said.
But opening a supervised injection site is no simple matter, as it’s not at all clear that they are legal. Though several are functioning in Canada, none are open in the United States. US Attorney Andrew Lelling has repeatedly vowed to meet any attempt with enforcement action.
Last week, the US attorney in Pennsylvania sued a Philadelphia nonprofit called Safehouse over its plans to launch a site there. The lawsuit hinges on a section of the federal controlled substances act known as the crack house statute, that makes it illegal to “manage or control any place . . . for the purpose of unlawfully manufacturing, storing, distributing, or using a controlled substance.”
But supervised injection sites aren’t crack houses, and the law was written long before anyone contemplated the idea of creating a medical facility for injection drug users.
In the federal case against Safehouse, prosecutors wrote, “It does not matter that Safehouse claims good intentions in fighting the opioid epidemic.” Whether the courts agree remains to be seen.
If Boston decides to move forward with its own sites — Walsh said a city facility, rather than a nonprofit, would be his preference when the time comes — the legal path may be clearer, because a municipality may be able to build a public health case that a nonprofit could not.
“When he said ‘a nonprofit shouldn’t do this — we should do it,’ that’s incredible,” Friedman said. That, she said, would open the door to legal questions about what a city or state can do during a declared emergency.
This opioid crisis has claimed so many lives that we’ve had to get a lot better at talking about addiction. But truly believing that addiction is a disease, and an epidemic, has been slower.
“Addiction is here. Any pathway into recovery . . . we should be looking at it,” Walsh said. Supervised injection facilities aren’t the only solution — far from it. And Walsh still believes strongly in the path he walked to sobriety.
“There’s no magic solution. It takes a community. And part of what I witnessed in the injection sites was a community . . . people who cared about people, and had the patience, and wanted to try to help these folks live.”
That’s not just saying the right thing — it’s believing it, feeling it, understanding it.
Sometimes, that means opening your mind. Or even changing it.
Nestor Ramos can be reached at email@example.com. Follow him on Twitter @NestorARamos.