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An injection kit is shown at Insite, a safe injection facility in Vancouver, on May 6, 2008.JONATHAN HAYWARD/The Canadian Press

Health Canada has given Insite, North America's first government-sanctioned supervised injection site, the green light to continue operating for at least four more years, a marked departure from direction under the previous Conservative government, which actively sought to shut it down.

The move comes as cities across both Canada and the United States push for their own supervised injection sites in response to soaring drug overdose rates. Fentanyl, a powerful synthetic opioid that emerged as an illicit street drug in Canada several years ago, has been linked to a growing number of fatal overdoses here. Meanwhile, neighbours to the south are grappling with a full-blown heroin epidemic.

Until now, Health Canada granted Insite only one-year exemptions at a time and the criteria for each renewal is nearly as onerous as the initial application.

B.C. Health Minister Terry Lake said he is encouraged by Health Canada's voluntary move.

"It reflects an understanding of the tremendous value the facility has, and signals that Insite is an important part of health services within the Vancouver community in the eyes of the federal government," he said in a statement.

In Canada, a prospective supervised injection site operator must receive a Section 56 exemption from the Controlled Drugs and Substances Act. It's the same section of the law that researchers who use controlled substances for scientific purposes must use.

The previous Conservative government, which fought Insite to the Supreme Court of Canada and lost, made this exemption process more difficult by introducing the Respect for Communities Act last year, requiring a host of additional requirements, such as extensive community consultation and letters of approval from various bodies.

Supporters of the harm-reduction service viewed the new law as a deliberate effort to make it much more difficult, if not impossible, to open or maintain a site.

The four-year exemption, announced Thursday, means Insite can operate without reapplying until 2020. In January, Health Canada also granted a two-year exemption to Vancouver's Dr. Peter Centre, an HIV/AIDS clinic that has offered the service to registered clients in a small-scale setting since 2002.

Vancouver Coastal Health, which operates Insite in partnership with the PHS Community Services Society, also plans to submit an exemption application for three or four other integrated supervised injection sites, with an end goal of offering the service as part of standard nursing practice.

While supervised-injection service remains a lightning rod for controversy – critics say they condone dangerous and illegal drug use – the conversation does appear to have taken a more pragmatic tone lately.

Health Minister Jane Philpott, a doctor who founded a charity that raised more than $4-million to help those affected by HIV/AIDS in Africa, has expressed support for Insite, emphasizing the need to make evidence-based decisions. However, the Liberals have not said whether they will repeal or change the law enacted by the previous Conservative government.

Health officials from across Canada and the U.S. have contacted both Insite and the Dr. Peter Centre, looking to learn more. Svante Myrick, the young mayor of Ithaca, N.Y., made international headlines recently with his call for supervised-injection service in his city.

King County Sheriff John Urquhart, a long-time narcotics officer in Washington State, said he plans to attend a series of presentations there about Insite next week.

"The war on drugs hasn't worked," he told The Globe and Mail earlier this month. "We have to try something different, and therefore I am open to trying something different."

Supporters note that such facilities not only reduce immediate harms, such as fatal overdoses and the spread of blood-borne diseases, but serve as a way to connect drug users with the health-care system.

Earlier this week, Toronto's medical health officer called for three small-scale supervised injection sites in that city, proposing them for existing health clinics where harm-reduction supplies are already distributed.

In response, federal Conservative health critic Kellie Leitch said the opposition is "very concerned about what this … might mean for the law-abiding residents of Toronto. The drugs that are used at these sites, mostly heroin, are dangerous and addictive."

Since opening in 2003, nurses at Insite have supervised more than two million injections. There has not been a single fatal overdose.