As Toronto prepares to respond to more overdoses caused by bootleg fentanyl, the city's plan to open three supervised-injection sites remains stuck in limbo.
Six months have elapsed since councillors in Canada's largest city voted in favour of adding the service to three health centres that already distribute clean drug paraphernalia and provide support to drug users.
But the city is still waiting for funding from the Ontario government and the go-ahead from Ottawa, which received Toronto's completed application last month.
"We're told it's coming soon," Toronto Councillor Joe Cressy said of formal approval from Health Canada. "But we need it now. We needed it yesterday."
Supervised-injection sites allow users who bring their own drugs to inject or consume them in a sterile environment under the watchful eye of health-care workers. If clients overdose, workers are there to revive them.
Toronto wants to offer the controversial service inside The Works, Toronto Public Health's needle exchange and harm-reduction facility, and inside the South Riverdale and Queen West-Central Toronto community health centres, both of which are operated by the province.
But such sites need exemptions from federal drug laws – exemptions the former government of Stephen Harper was loath to hand out. The Conservatives passed a law, the Respect for Communities Act, that required applicants for supervised-injection sites to satisfy a long list of criteria, including garnering the support of police and the local community.
The country has only two sanctioned supervised drug-consumption sites, both in Vancouver. Montreal has applied to Health Canada to open three locations and a mobile supervised-injection unit, while other major cities, including Ottawa, Edmonton, and London, Ont., are looking at following suit.
Health officials on Vancouver Island sent an application to Health Canada for a Victoria site just this week; they have two more applications in the works.
Although Health Minister Jane Philpott has vowed to scrap the Harper-era law, Toronto has already completed every step of the existing process, Mr. Cressy said, meaning Health Canada could grant the exemption right away.
Funding is another matter. Toronto has asked Queen's Park for about $400,000 to retrofit the three health centres and $1.8-million a year to run the trio of supervised-consumption operations, a request the Ministry of Health and Long-Term Care is still reviewing, according to a spokesman for Ontario Health Minister Eric Hoskins.
A Health Canada spokesman confirmed the department received applications for two of Toronto's proposed sites on Dec. 6 and the 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."
"Obviously, I would urge them to move as quickly as possible to give us the approval," Toronto Mayor John Tory said. "I think in this case it might be useful to have that approval and have these establishments in place before we get to any level [like Vancouver]. I hope we never do."
British Columbia and its largest city are in the grip of an overdose epidemic that caused 755 deaths in the first 11 months of last year, up 70 per cent from the same period in 2015. Illicit fentanyl, a powerful synthetic opioid smuggled in from China and often cut into heroin or pressed into fake OxyContin tablets, is driving the increase in overdoses and deaths.
Fentanyl has yet to take the same toll on Canada's largest city, but the drug is becoming more prevalent on Toronto's streets, according to police and public-health officials.
Mary Clare Zak, managing director of social policy for the City of Vancouver, said supervised-injection site operators in her city did not wait for federal approval, and applicants in other cities shouldn't either.
Vancouver's Dr. Peter Centre, a renowned HIV/AIDS clinic in the city's west end, began supervising illegal-drug injections in 2002, one year before the opening of Insite, the first dedicated safe-injection site in North America.
The Dr. Peter Centre did not receive a Section 56 exemption under the Controlled Drug and Substances Act until last January, one year after it submitted a formal application to Health Canada.
Last fall, former drug addicts and activists horrified by a string of fatal overdoses started an impromptu supervised-injection site in a tent in an alley in Vancouver's Downtown Eastside, an unsanctioned initiative that has saved lives, Ms. Zak said. It now has a warm home in a donated trailer.
"We cannot afford to wait for the federal government to grant us the exemptions," Ms. Zak added. "We can't. We're behind as it is. The response was not fast enough."
With a report from The Canadian Press