The Ontario government has agreed to help fund three supervised drug-injection sites in Toronto and one in Ottawa as part of an effort to better prepare Canada's most populous province for the eastward spread of illicit fentanyl.
Ontario said it is creating a framework to smooth the way for other communities to open supervised-consumption services of their own, while the federal Liberals have promised to knock down legislative barriers erected by Stephen Harper's government, which opposed letting users inject their drugs legally as health-care workers watched.
The upshot is that several more supervised-injection sites could open in Canada later this year. Health Canada is already reviewing a dozen applications for exemptions from federal drug laws, which the sites need to protect their clients from criminal charges for bringing their own illegal drugs to the facilities.
Aside from Toronto, Health Canada has received applications for four sites in Montreal, two in Vancouver, two in Surrey and one in Victoria. The applications from Surrey and Victoria arrived just last week, a Health Canada spokesman said.
Vancouver is already home to the only two sanctioned supervised-injection sites in the country.
Ontario Health Minister Eric Hoskins told Toronto Mayor John Tory on Monday that his government plans to support and pay for, at least partly, the three small-scale supervised-injection facilities that Toronto city council endorsed last summer.
Dr. Hoskins did the same for a supervised-injection proposal from the Sandy Hill Community Health Centre in Ottawa, which is preparing to submit an application to Health Canada but has not done so yet.
"I believe these initiatives around supervised-injection services are an opportunity to bring together all jurisdictions to tackle addictions and narcotics misuse," Dr. Hoskins wrote in his letters.
In Toronto, the service will be offered inside two community health centres and a harm-reduction facility, all of which already hand out clean drug paraphernalia.
The city asked the province for about $400,000 to renovate the three clinics and $1.8-million annually to run the supervised-injection sites, where health-care workers would be trained to revive drug users who overdose.
The province didn't specify how much it would cover.
The news from Queen's Park came as Mr. Tory and representatives from more than 20 organizations met to discuss how Canada's largest city can tackle an increase in overdoses caused in part by fentanyl, a powerful synthetic opioid that has already taken a significant toll in other Canadian cities, particularly Vancouver.
"Our [overdose numbers] are already unacceptable," Mr. Tory said. "The fact that our numbers are not anywhere near what they are in Vancouver is no reason for comfort in this city. This is a crisis."
Of the 253 overdose deaths Toronto had in 2015, 42 were linked to fentanyl. The year before, the overall overdose fatality figure was similar – 258 – but only 23 of those deaths were linked to fentanyl, according to Toronto Public Health. (The overall overdose figures also include poisonings caused by other drugs, by alcohol and by substances such as cleaning products.)
As of Nov. 30, there were 164 overdose deaths in the city of Vancouver, compared with 134 in all of 2015. Across the Vancouver region's two main health authorities, Vancouver Coastal Health and Fraser Health, there were 452 fatal overdoses as of Nov. 30, compared with 362 in 2015. About two-thirds of fatal overdoses across B.C. last year were linked to fentanyl, according to the province's coroner.
The Office of the Chief Coroner of Ontario has not yet published figures for 2016, but Toronto Public Health says that outreach workers are seeing more overdoses caused by illicit fentanyl, often mixed in with cocaine or heroin or pressed into fake OxyContin tablets.
"Fentanyl is … 50 to 100 times stronger than morphine," said Barbara Yaffe, Toronto's acting chief medical officer of health. "So it can easily kill you. Oftentimes drug users don't know what they're taking."
Dr. Yaffe set up Monday's meeting of police, paramedics, hospital emergency-room staff, harm-reduction advocates and other front-line workers in a bid to share information and guide the city's response to the overdose crisis.
Members of the newly established Toronto Overdose Early Warning and Alert Partnership plan to meet monthly, she said.
Dr. Yaffe said the group discussed the need for real-time information about overdoses so that workers can "target interventions" to the right corners of the city. Others at the closed-door meeting advocated for the overdose-reversing drug naloxone to be made more widely available in Toronto, especially at pharmacies and among drug users.
As for Toronto's supervised-injection sites, Dr. Yaffe said it would be at least a few months before they open.
The clinics have to be renovated before Health Canada can do the on-site inspection necessary to approve the sites under the existing Harper-era rules, Dr. Yaffe said.
Toronto Liberal MP Adam Vaughan said last week that foot-dragging by the province was partly to blame for the fact that Health Canada has not yet given Toronto's sites the green light.
"We have staff standing by in Ottawa, ready to attend any single request [from] the city to meet the requirements and the tests of the legislation … The staff is literally on standby," Mr. Vaughan said. "There is no higher priority in the Health Ministry. We want to get these open as quickly as possible. It's just up to the other levels of government to get their ducks in a row."
A Health Canada spokesman confirmed the department received applications for two of Toronto's proposed sites on Dec. 6 and an application for a third on Dec. 12. The department has asked for more information on the first two applications and is planning to respond to the third "very shortly."
With reports from Jeff Gray and James Keller