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A steep and steady climb in the number of drug overdoses in British Columbia has put increased pressure on health authorities to open additional spaces for users to consume illicit substances under medical supervision.

Fatal drug overdoses have increased almost every year since 2009, spiking with the emergence of illicit fentanyl in 2012. Advocates have long called for more supervised-consumption sites – particularly in the Fraser Valley and on Vancouver Island.

Now, after being accused of dragging their heels, Fraser Health and Vancouver Island Health Authority (VIHA) appear poised to submit applications to Health Canada to open multiple consumption sites, which would include supervised injection service, but could also allow people to inhale drugs such as crack-cocaine. Vancouver is expected to pursue additional sites as well.

Just four months ago, the Fraser Health Authority said it had no plans to open such a site. That same month, the Vancouver Island Health Authority said it was working with stakeholders to look at what an appropriate supervised-injection model would look like.

But after 43 non-fatal overdoses in Surrey this past weekend, Fraser Health announced on Monday that it is "rapidly implementing an aggressive strategy to combat drug overdoses and deaths" in the region that includes "identifying priority sites for supervised-consumption services."

Meanwhile, VIHA said it is preparing to submit an application to offer supervised-consumption services at multiple sites in Victoria, likely integrated into existing facilities. Once service models and sites are identified, a community consultation process will take place, spokeswoman Kellie Hudson said.

Provincial Health Officer Perry Kendall declared a public-health emergency in April, warning that British Columbia could reach 800 overdoses deaths this year. The latest figures from the B.C. Coroners Service show the province is on pace. In the first half of 2016, at least 371 people died of illicit drug overdoses – a 74.2-per-cent increase over the same period last year.

The top three cities where such overdoses have occurred, from 2007 to 2016, are Vancouver, Surrey and Victoria.

In Surrey's most recent spate of overdoses, some users reported that they had taken crack cocaine and some reported using heroin, said Victoria Lee, chief medical health officer for Fraser Health. However, none knew they had ingested furanylfentanyl, a fentanyl analogue detected in some of the crack, and fentanyl, detected in some of the heroin.

Fentanyl and its analogues are many times more toxic than heroin and are particularly dangerous for people who do not use opioids daily.

Dr. Lee noted that supervised consumption is but one part of Fraser Health's overall plan. The health authority developed an overdose prevention and reversal strategy in the fall of 2015 – increasing the distribution of naloxone and other harm-reduction supplies, for example – and, this spring, enhanced it to include exploring supervised consumption and other services.

The sites, number and locations are still to be determined, but will also likely cater to more than just injection-drug users.

"Substance-use patterns have changed. We do know that more people are using different types of substances that do not include just injection drugs, so we want to make sure … we are meeting the needs of our population," Dr. Lee said. "While injection drugs are one component of harm we want to mitigate and reduce, there's also crack and other substances that are smoked and consumed in different ways."

In late February, Victoria Mayor Lisa Helps wrote to federal Health Minister Jane Philpott seeking her advice, inquiring about her expectations regarding supervised-consumption services in Victoria. The Health Minister responded last month with information on how to apply, and a personal note of support for the service.

"As Minister of Health, I continually look for ways to keep Canadians healthy and reduce risks and harms to them," Dr. Philpott wrote. "For this reason, the government's approach to supervised consumption sites will be guided by evidence, which in this case is clear: When properly established and managed, supervised consumption sites can save lives and improve health without increasing drug use and crime in the area."

Toronto City Council recently approved three supervised-injection sites.

Shane Calder, a spokesman for Yes2SCS, a group advocating for supervised-consumption sites on Vancouver Island, called the slow process "shameful."

"The inaction, and seeming incompetence, of the provincial government and Island Health is bordering on the disastrous," Mr. Calder said. "People are dying and they meet to debate mandate and terms of reference. It's disgusting. The time the act is well past."