Health Canada has approved three supervised consumption sites for Montreal – the first federal approvals for the harm-reduction facilities outside of Vancouver as Ottawa presses forward in its response to Canada's overdose crisis.
Montreal has waited two years for federal sign-off on the sites, during which fatal overdoses linked to illicit fentanyl have surged in parts of Canada, notably British Columbia and Alberta. The federal department announced the approvals on Monday, noting that such sites have shown positive results in Canada and other countries.
"International and Canadian evidence shows that, when run properly, supervised consumption sites can save lives without increasing drug use or crime in the surrounding area," Health Minister Jane Philpott said in a statement.
The sites are set to be established in addiction drop-in centres and needle exchanges already running in Montreal's Centre-Sud and Hochelaga-Maisonneuve neighbourhoods on the eastern side of downtown. Centre-Sud has several parks and soup kitchens that are hubs for the city's homeless while Hochelaga-Maisonneuve is one of the poorest neighbourhoods in Montreal.
Montreal has about 4,000 chronic injection drug users and about 1,000 of them are homeless, according to the city.
The sites still require renovations and site inspections from Health Canada before opening, which will likely take several months. A fourth site – a mobile unit – is still being considered by the federal government.
Jordan Westfall, president of the Canadian Association of People Who Use Drugs, said he was pleased to hear that Montreal's applications were approved, "but it's unthinkable our government waited this long in the first place."
Outside of Vancouver, Montreal had been furthest along in the process to open the sites, with the province and city each voicing their approval under the previous Conservative government. The city formally submitted its applications to Health Canada in May, 2015, but the process stalled waiting for federal approval.
The Conservative government stood in staunch opposition to the harm-reduction service, fighting Vancouver's Insite – to date the only public supervised injection site in North America – all the way to the Supreme Court of Canada, which sided with the Downtown Eastside facility.
The Conservative government then introduced the Respect for Communities Act, which required prospective injection site operators meet 26 costly and time-consuming conditions, which many viewed as a deliberate effort to block the opening of more sites.
Dr. Philpott, who has emphasized her government's pursuit of evidence-based solutions, repealed that legislation in December.
Montreal Mayor Denis Coderre first announced his intention to set up the sites more than two years ago and the former Liberal cabinet minister credited the current Liberal federal government for finally lifting roadblocks.
"The Supreme Court of Canada said clearly it's a matter of public safety and we now have a federal government that respects the view of the court," Mr. Coderre said.
Polls consistently show Montrealers support the establishment of supervised injection sites. A Mainstreet Research poll published in January showed 20 per cent of Montrealers disapproved of such sites, lower than any other major Canadian city. Two-thirds of Montrealers approved of them.
Quebec Public Health Minister Lucie Charlebois said Quebec and Montreal have a "broad social consensus" in favour of the sites.
"We're going to prevent deaths and illnesses associated with overdose," Ms. Charlebois said in an interview. "We're going to reduce sharing of needles and along the way we're going to reduce HIV infection. For the people in the neighbourhoods, there will be fewer needles on the ground. It will be safer for everyone."
The Quebec government has committed $12-million over three years to get the sites running.
"We pay more for their emergency room and ambulance services right now," Ms. Charlebois said, adding that establishing closer links with health and social services providers will improve health for addicts and boost the odds they get help.
The federal government is currently reviewing 10 other applications for supervised injection sites: one in Ottawa, three in Toronto, two more in Vancouver, two in Surrey, one in Victoria and Montreal's mobile site.
For injection drug users with chronic addictions, using under medical supervision, with sterile supplies, reduces the likelihood of overdose and blood-borne infections. Nurses are on hand with naloxone, a drug that reverses the symptoms of an opioid overdose.
Vancouver's Insite opened more than 13 years ago and currently logs more than 700 visits per day. It has never had a fatal overdose.