Six months after Toronto city council approved three supervised injection sites, officials are still waiting on legal approval from Health Canada and funding from the Ontario government necessary to open their doors.

The city’s situation is not unusual. While there’s wide consensus among all levels of government in Canada that safe injection sites are needed to curb the fatal opioid crisis, roadblocks persist in the form of funding or bureaucracy.

Under federal law, jurisdictions must submit lengthy applications to Health Canada for exemptions to open supervised injection sites, an arduous process that has no strict timeline. It took two years for Health Canada to approve the country’s second and last safe injection site, located in Vancouver, and Montreal has been waiting on its application for more than a year — although it submitted incomplete applications.

British Columbia, which is the only Canadian province to declare a public health emergency in response to opioid overdoses, took the radical step this week of opening a number of new supervised injection sites without Health Canada’s approval. But the province is getting around the regulations by referring to them as “overdose prevention sites,” not “supervised injection sites.”

“We can’t wait for federal changes in order to save people’s lives,” BC provincial health minister told the Georgia Straight at the time of the announcement. “And so in the face of this crisis, we really just wanted to do more.”

Health Canada is currently reviewing eight applications for supervised injection sites in three cities, according to data provided to VICE News from the department. Montreal is waiting for an answer from its four applications submitted in May of 2015. The department said that a number of criteria were incomplete, and that it is reviewing the completed information for one application.

Toronto submitted applications for two sites a couple weeks ago. But even if Health Canada does approve its safe injection sites, the city still hasn’t heard whether Ontario will provide the funding. A spokesperson for the Ontario health minister confirmed to VICE News that the department has no timeline to approve the request for funding, and has no desire to follow BC’s lead.

“I don’t believe that there has been a slowdown in deaths, and so there’s urgency to get these services up and running as soon as possible.”

“Considering the rapidly escalating overdose crisis and the fact that these sites will save lives, that is an unacceptable response,” Councillor Joe Cressy, who spearheads the city’s drug strategy efforts, told VICE News on Thursday.

He added that if the funding were to come through before the federal exemption, the city might consider moving ahead without federal approval, like British Columbia. “We would cross the bridge when we got to it,” he said. “We can start saving lives today, but we need the money.”

The city needs $400,000 from the province to build the safe injection cubicles, as well as $1.8 million for ongoing operations, Cressy explained.

“That’s not a lot of money in the context of the provincial budget or saving lives.”

The situation looks slightly different in Alberta, the province that’s seen a spike in fentanyl-related deaths over the last year — more than 338 so far this year — but refuses to declare a public health emergency. Just this week, the province announced that 15 people there died from carfentanil, the elephant tranquilizer that’s said to be 100 times more potent than fentanyl.

Alberta’s health ministry recently announced $730,000 in funding for supervised injection sites, however no city has made an application for one.

Elaine Hyshka, a professor at the University of Alberta’s who is helping lead Edmonton’s efforts to open supervised injection services, said the city’s application for the services won’t be ready to submit to Health Canada until next summer. And she admits it could be more than a year after that before it’s approved.

In the meantime, she would welcome any effort by the Alberta government to move forward with supervised injection services, even if that happened without federal approval.

“I don’t believe that there has been a slowdown in deaths, and so there’s urgency to get these services up and running as soon as possible.” She added that British Columbia is likely better equipped to get creative and move quicker because it’s under a public health emergency.

“We don’t have that same context here,” she said.

Andrew MacKendrick, spokesperson for federal health minister Jane Philpott, said the department “remains committed to the process” that exists to open safe injection sites, but recognizes that British Columbia is “at the edge of the crisis … and is facing an extraordinary situation” compared to other provinces that have not seen as many overdose deaths.

He added that the health department is looking closely at BC’s unprecedented approach, and “that it would be too early to evaluate it right now.”

He said the minister is going to implement legislative changes to make it easier for cities to get exemptions to open supervised injection sites.