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An employee prepares injection equipment at Insite, the legal supervised drug injection site, in Vancouver.Rafal Gerszak/The Globe and Mail

The federal government has approved four more supervised-injection sites – three in the Vancouver region and one in Montreal – in its latest effort to combat an escalating overdose crisis across the country.

The new round of approvals brings the number of federally sanctioned sites to nine, significantly expanding what was once a radical intervention limited to a single location in Vancouver's Downtown Eastside. Such facilities, run by local health agencies, allow users to consume illicit drugs in the presence of health workers who can intervene in the event of an overdose.

The three new facilities in B.C. will replace existing "overdose-prevention sites," which provincial health officials opened without federal approval to provide a similar service. One is in the Downtown Eastside and two others are in Surrey.

The fourth approval announced Friday is for a mobile site in Montreal – the first of its kind in Canada.

Mark Lysyshyn, medical health officer for Vancouver Coastal Health, said he was pleased with the approval, adding that the health authority has seen a need to expand the service for some time.

An order issued by B.C.'s Health Minister in December allowed the province to open about 20 overdose-prevention sites, which helped alleviate the pressure. From Dec. 8 to April 2, they logged more than 66,000 visits and reversed more than 480 overdoses, according to the B.C. government. No one has ever died at a supervised site.

"But it is still great to have the approval because if the [province] ever rescinded the order, the sites would be allowed to continue, and continue saving lives," Dr. Lysyshyn said. "The fact that it becomes permanent also allows us to invest more in the facility and grow it over time, and have it be a health service that is really high quality."

Victoria Lee, chief medical health officer for Fraser Health, said the health authority also wants to allow users to consume drugs intranasally or orally under supervision, but that Health Canada said it needs more time to review that request.

"We wanted to be able to provide supervision for people that are at risk, that are taking substances in different ways," she said. "We do require [additional] approval for those other means of consumption still from Health Canada; it's just the supervised-injection portion that was approved."

The two Surrey sites are expected to open in June, Dr. Lee said.

There are already two approved supervised-injection sites in Vancouver, including Insite, which became the first sanctioned supervised-injection site in North America when it opened in 2003. The other is in a specialized HIV/AIDS centre that was approved last year, quietly operating since 2002.

Aside from the mobile site, Montreal received conditional approvals for three locations in February, while sites in other cities, including Toronto, Ottawa and Victoria, are also awaiting approval.

In a statement, federal Health Minister Jane Philpott said evidence shows the harm-reduction sites decrease infections and transmission of communicable disease. As well, they can decrease hospital admissions and the use of emergency departments in relation to injection drug use.

"Our government's approach to the crisis is, and must be, comprehensive, collaborative, compassionate, grounded in sound evidence and firmly dedicated to saving lives and protecting the health and safety of Canadians," the statement said.

On Thursday, Canada's big-city mayors issued a set of recommendations to the federal government on how to respond to the overdose crisis. Among them, the mayors called for expedited implementation now that Bill C-37 – legislation that makes it easier to open supervised-injection sites has been passed – and approval of existing applications.

The expansion of supervised drug-consumption facilities is in contrast to the previous federal Conservative government, which spent years attempting to shut down Vancouver's Insite before finally losing at the Supreme Court of Canada. The Conservatives responded by introducing legislation that imposed strict requirements on new facilities.

Across B.C., more than 1,300 people have died of drug overdoses since Jan. 1, 2016.

Insite, B.C.'s supervised injection site program, has begun piloting a program to curb the number of overdoses from drugs unsuspectingly mixed with fentanyl. Registered nurse Marjory Ditmars shows The Globe and Mail how the quick and simple test works

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