Around the world, potentially effective responses to serious social problems are left untried because those responses are politically, culturally or morally problematic in affected communities. I describe the process through which communities import such practices as "high-stakes institutional translation". Drawing on a study of North America's first supervised injection site for users of illegal drugs, I propose a process model of high-stakes institutional translation that involves a triggering period of public expressions of intense emotion, followed by waves of translations in which the controversial practice is constructed in discursive and material terms many times over.