The federal government has approved three supervised-injection sites for Toronto, further expanding a contentious harm-reduction service in its latest effort to counter a surging number of overdose deaths in Canada.

Illicit fentanyl and chemically similar drugs have caused fatal overdoses to skyrocket: Opioid overdoses in Ontario increased 11 per cent in the first half of 2016 compared with the same period the year before, B.C. is on pace to have 1,400 deaths this year and fentanyl-related fatalities in Alberta in the first quarter of 2017 are 60 per cent higher than in the same period last year. Advocates have pointed to these statistics to underscore the urgency of opening more supervised-injection sites.

Friday's approvals bring the national total to 12. Until early this year, the only public supervised-injection facility sanctioned by the federal government was in Vancouver, where it has operated since 2003.

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The three Toronto clinics that were approved to supervise injection-drug use already hand out clean needles and are spread across the centre of the city. They are The Works, Toronto Public Health's main harm-reduction clinic, which is next to the bright lights of the city's Yonge-Dundas Square; the Queen West Central Toronto Community Health Centre to the west; and the South Riverdale Community Health Centre in Leslieville to the east.

Toronto applied for permission from the federal government last year to open the sites. In January, the Ontario government pledged $3.5-million to get them up and running.

The green light follows years of work by local harm-reduction activists and an effort by advocates in the past year to allay concerns expressed by Toronto Police Chief Mark Saunders and win approval from Mayor John Tory.

City councillor Joe Cressy, the chair of the city's drug strategy implementation panel, said the three supervised-injection sites should open before the end of the year: "It's a deeply emotional day," he said on Friday. " ... We've lost a lot of lives over the last number of years. It hasn't been easy. Today's news means we are going to save many more."

Mr. Cressy cautioned that the city needs to do much more, citing the new drug strategy, which includes special training for transit workers and public-housing staff to deal with overdoses.

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"The sea change that has taken place over the last number of years where we have finally as a society begun to see drug use as a public health issue and not a criminal justice issue … is going to make life healthier for our city," Mr. Cressy said.

Overdose deaths have surged in North America due to illicit fentanyl, carfentanil and other drugs being cut into the street drug supply.

While data on overdose deaths in Ontario lag behind numbers available in B.C. and Alberta, the most recent figures show an increase: In the first half of 2016, 412 people died of opioid overdoses – an 11 per cent increase from the same period in 2015 (371).

Alberta confirmed 443 drug-overdose deaths last year, with 68 per cent (303) linked to fentanyl or another opioid. In British Columbia, a record 935 people died of illicit drug overdoses last year, compared to an average of about 250 in the years before the fentanyl crisis. Fentanyl was detected in about 60 per cent of those deaths.

Ottawa approved four supervised-injection sites last week: three in British Columbia and one in Montreal.

Federal Health Minister Jane Philpott said Canada's response to the crisis requires a "whole-of-society approach," and that opening such sites is but one part.

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"International and Canadian evidence demonstrates that, when properly established and maintained, supervised consumption sites save lives without increasing drug use or crime in the surrounding area," Dr. Philpott said in a statement.

"The evidence also shows that they decrease infections and the transmission of communicable disease, and can also decrease the use of emergency departments, as well as hospital admissions related to injection drug use."

Bill C-37, legislation that makes it easier to open such sites while also giving border agents more power to clamp down on incoming shipments of fentanyl, became law last month.

Insite, the supervised injection site in Vancouver's Downtown Eastside, averages about 500 injections a day. In 14 years of operation, it has never recorded a fatal overdose.