The number of people who die of drug overdoses in Toronto every year is climbing dramatically, health officials said Monday, as the city's board of health voted unanimously to proceed with public consultations on supervised drug-injection sites proposed for three central health clinics.

Just before the meeting began, City Councillor Joe Cressy, who is the chairman of the city's drug strategy implementation panel and a champion of the proposal, ‎told reporters that 252 people had died of drug overdoses in Toronto in 2014.

The number, which Mr. Cressy said was the latest available from the coroner's office, is up from the 206 deaths in 2013, and much higher than the 146 total ‎in 2004. Most of the increase, health officials say, can be blamed on opioids, including heroin and its newer and deadlier relative, fentanyl.

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"It's a painful number," Mr. Cressy said, pointing out that in Toronto's notorious 2005 spike in gang violence known as the "summer of the gun," the death toll was 52, and the city acted to stem the tide.

"It is time to act."

Advocates and health experts say supervised injection sites, which allow addicts to use pre-obtained drugs under the watchful eye of a nurse as well as receive clean needles and get access to other treatment, make fatal overdoses much less likely. Mr. Cressy agreed, however, that supervised injection sites were only one tool that must go along with other measures, such as more distribution of "overdose kits" that include the anti-overdose drug naloxone.

The provincial and federal governments must still approve the injection sites, and legislation passed by the previous federal Conservative government mandates consultations with health experts, the public and police.

After Monday's vote, the board of health and the three clinics planning to add proposed supervised injection sites will proceed with public consultations, including local meetings and open houses at the clinics starting as early as April and expected to conclude in June. A report on the results of those consultations is supposed to come back to the board of health by July.

The three sites already provide a range of "harm-reduction" services to drug addicts, including needle exchange services that account for the bulk of the nearly two million needles Toronto public health officials hand out each year.

The three sites include the Works, Toronto Public Health's harm-reduction clinic near Yonge-Dundas Square, Queen West Central Toronto Community Health Centre near Queen Street West and Bathurst Streets and South Riverdale Community Health Centre on Queen Street East near Carlaw Avenue in Leslieville.

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More than 20 health experts, drug users, advocates and people who live near the proposed sites addressed the board of health on Monday, but not a single opponent of the injection sites, unveiled last week, showed up to voice disapproval.

A chorus of health and community leaders, as well as four former Toronto mayors – David Crombie, John Sewell, Art Eggleton and Barbara Hall – has come out in favour of the idea in recent days.

Toronto Mayor John Tory said last week that he agreed something needed to be done to counter the rising overdose deaths, but he had not made up his mind. He told reporters he hoped the public consultations would produce a "rational" discussion of whether the sites are the right move.

City Councillor Paula Fletcher, who represents the east-end ward that's home to the South Riverdale Community Health Centre, says she supports the clinic and harm reduction but that health officials need to show the surrounding community there will be no significant ill effects. City Councillor Mike Layton, whose ward is home to the Queen West clinic, says he supports the idea.