By Alexandra Keeler

An Ottawa mother, who lost her daughter to addiction, is frustrated by Recovery Care’s failure to help her opioid-addicted son

Masha Krupp has already lost one child to an overdose and fears she could lose another.

In 2020, her 47-year-old daughter Larisa died from methadone toxicity just 12 days into an opioid addiction treatment program. The program is run by Recovery Care, an Ottawa-based harm reduction clinic with five locations across the city, which aims to stabilize drug users and eventually wean them off more potent drugs.

Krupp says she is skeptical about the effectiveness of the support and counseling services that Recovery Care claims to provide and believes the clinic was negligent in her daughter’s case.

On Oct. 22, the Ottawa mother testified before the House of Commons Standing Committee on Health, which is studying Canada’s opioid epidemic.

In her testimony, Krupp said her daughter was prescribed 30mg of methadone — 50 per cent more than the recommended induction dose — and was not given an opiate tolerance test before starting the program. Larisa received treatment at the Bells Corners Recovery Care location.

Krupp’s 30-year-old son, whom Canadian Affairs agreed not to name, has been a patient at Recovery Care’s ByWard Market location since 2021, where he receives a combination of methadone and hydromorphone, another prescription drug administered through the treatment program.

“Three years later, my son is still using fentanyl, crack cocaine and methadone, despite being with Dr. [Charles] Breau and with Recovery Care for over three years,” Krupp testified.

“About four weeks ago, I had to call 9-1-1 because he was overdosing,” Krupp told Canadian Affairs in an interview. “This is on the safer supply program … three years in, I should not be calling 9-1-1.”

Open diversion

Founded in 2018, Recovery Care is a partner in the Safer Supply Ottawa initiative. The initiative, which is led by Ottawa Public Health and managed by the nonprofit Pathways to Recovery, provides prescription pharmaceutical opioids to individuals who are at high risk of overdose.

Pathways to Recovery works with a network of service providers throughout the city — including Recovery Care — to administer safer supply.

Krupp says she supports the concept of safer supply, but believes it needs to be administered differently.

“You can’t give addicts 28 pills and say ‘Oh here you go,’” she said in her testimony. “They sell for three dollars a pop on the street,” she said, referring to the practice of some individuals selling their prescribed medications to fund purchases of more intense street drugs like heroin and fentanyl.

Krupp says she sees her son — and other patients of the program — openly divert their prescribed medications outside of the Recovery Care clinic in ByWard Market, where she parks to wait for him.

“[B]ecause there’s no treatment attached to [my son’s safer supply], it’s just the doctor gives him all these pills, he diverts them, gets the drugs he needs, and he’s still an addict,” Krupp said in her testimony.

Donna Sarrazin, chief executive of Recovery Care, told Canadian Affairs that Recovery Care has measures to address diversion, including security cameras and onsite security staff.

“Patients are educated at intake and ongoing that diversion is not permitted and that they could be removed from the program,” she said in an emailed statement.

“Recovery Care works to understand diversion and has continued to progress programs and actions to address the issues. Concerns expressed by the community and our teams are taken seriously,” she said.

Krupp says she has communicated her concerns about her son reselling his prescribed medications to his doctor, Dr. Charles Breau, both in-person and through faxed letters. “I never hear back from the doctor. Never,” she said.

Krupp also said in her testimony that police have spoken to her son about his diversion.

Breau did not respond to inquiries made to his clinical teams at Recovery Care or Montfort Hospital, a teaching hospital affiliated with the University of Ottawa.

Sarrazin said Breau is not able to comment on patient or family care.

In Krupp’s view, the safer supply program would be more successful if drug users were required to take prescribed medications under supervision.

“If he was receiving his hydromorphone under witnessed dosage and there was a treatment plan attached to it, I believe it would be successful,” she said.

Dr. Eileen de Villa, the City of Toronto’s medical officer of health, reinforced this point at the Oct. 22 Health Committee meeting. She said Toronto Public Health’s injectable opioid agonist therapy program — which combines observed administration with a treatment plan — has seen “incredible results.”

De Villa shared a case of a pregnant client who entered the program. “She went on to have a successful pregnancy, a healthy baby, has actually successfully completed the treatment, and is now housed and has even gained custody of her other children,” she said.

‘An affront to me’

Krupp also says Recovery Care fails to deliver on its promise of supporting patients’ mental health needs. Recovery Care’s website says its clinics offer “mental health programs which are essential to every treatment plan.”

Krupp and her son’s father have both requested a clear treatment plan and consistent counselling for their son. But he was started on safer supply after participating in only one virtual counselling session, she says.

She says Recovery Care has only one mental health counselor who services four of Recovery Care’s clinics. “If you’re getting $2-million-plus a year in funding, you should be able to staff each clinic with one on-site counselor five days a week,” she said.

Instead of personalized assistance, her son received “a sheaf of photocopies” offering generic services like Narcotics Anonymous and crisis helplines. “It’s almost an affront to me, as a taxpayer and a mother of an addict,” Krupp said.

Krupp says that, following her testimony to the parliamentary committee, Breau reached out to offer her son a mental health counseling session for the first time.

Sarrazin told Canadian Affairs that patients are encouraged to request counseling at any time. “Currently there is no wait list and appointments can be booked within 1 week,” she said in her emailed statement.

Class actions

Today, Krupp is considering launching a class-action lawsuit against Health Canada and the Government of Canada, challenging both the enactment of safer supply and the loosening of methadone dispensing requirements in 2017. She believes these changes contributed to her daughter’s death in 2020.

She is also considering joining an existing class-action lawsuit in B.C., which alleges Health Canada failed to monitor the distribution of drugs provided through safer supply programs.

The Pathways to Recovery initiative received $9.69-million in funding from Health Canada from July 2020 to March 2025. In June 2023, Health Canada allocated an additional $1.9 million to expand Ottawa’s safer supply program across five sites and improve access to practitioners, mental health support, housing and other services.

“I want to see that money being put to a recovery based treatment, not simply people going in and out and getting their medications and just creating this new sub-layer of addicts,” Krupp said.

This article was produced through the Breaking Needles Fellowship Program, which provided a grant to Canadian Affairs, a digital media outlet, to fund journalism exploring addiction and crime in Canada. Articles produced through the Fellowship are co-published by Break The Needle and Canadian Affairs.

Header photo caption: Canadian Forces veteran Gordon Hurley in Hawija, Iraq, 2017. [Photo provided by Gordon Hurley]

When he was stationed in Bosnia in 1994, Steve Lamrock would drive a truck loaded with food through villages full of hungry people.

As a Canadian Armed Forces platoon quartermaster, one of Lamrock’s duties was transporting food to other soldiers involved in the United Nations Protection Force’s peacekeeping mission in the war-torn country.

“I had people starving to death, children starving to death,” he recalled, his wife seated beside him for support. “I could see, weekly, the deterioration in certain people in the community and the elderly from a lack of nutrition.”

Often, there was a surplus of rations.

“The UN policy was, if you can’t give exactly equal to both sides, you don’t give anything away,” he said, adding that it could trigger violent raids if you provided food to just one faction.

“So we would throw out food when there’s people starving to death.”

Moral dilemmas like these haunted Lamrock long after he retired from the military in 2009. Tormented by nightmares, he turned to alcohol to cope. “When I drank so much I passed out, I wouldn’t dream or remember the dreams as vividly or as often,” he said.

Canadian Forces veteran Steve Lamrock. [Photo provided by Steve Lamrock]

Lamrock — whose 24-year military career included tours in Afghanistan, Bosnia, Croatia, Kosovo and Iraq — was identified as suffering from psychological distress caused by the perception of having violated one’s moral or ethical beliefs. Experts are now calling this moral injury.

Moral injury is not formally recognized in the Diagnostic and Statistical Manual of Mental Disorders, an authoritative manual on mental disorders. But experts and veterans say moral injury affects many individuals who serve in the military, and requires better institutional support and treatment than are currently available.

Moral injury and addiction

“[Moral injury presents as] shame, guilt and anger that occurs when someone is exposed to an event that goes against their moral values, standards or ethics,” said Dr. Don Richardson, a psychiatrist and scientific director of the MacDonald Franklin Operational Stress Injury Research Centre in London, Ont. The centre studies the impact of stress injuries on military personnel, veterans and first responders.

Moral injury can result not only from witnessing or causing harm, but also from being affected by an organization’s actions or inactions, Richardson says.

The term moral injury was first introduced in the 1990s by American psychiatrist Dr. Jonathan Shay, who worked with veterans of the Vietnam War. It gained wider recognition following the Iraq and Afghanistan wars, when traditional treatments for post-traumatic stress disorder (PTSD) — such as Cognitive Behavioural Therapy — were proving to be only partially effective.

While fear is often at the core of traditional PTSD cases, feelings of guilt, shame, anger and betrayal are more strongly linked to cases of moral injury, says Dr. Anthony Nazarov, associate director of the MacDonald Franklin Operational Stress Injury Research Centre and an expert on moral injury.

Nearly 60 per cent of Canadian Armed Forces personnel deployed in NATO operations in Afghanistan reported exposure to morally injurious events, according to a 2018 study co-authored by Nazarov. Those exposed to such events demonstrated a greater likelihood of developing PTSD and major depressive disorders.

Dr. Ronald Shore, a research scientist and assistant professor in psychiatry at Queen’s University, says individuals suffering from moral injury often develop coping strategies due to a lack of support to help them process traumatic experiences.

One common coping mechanism is substance use, he says.

“You’re constantly feeling like something is wrong with you, that you’ve done something wrong … that leads to that self-regulation with addiction,” Shore said.

Lamrock says his experiences in Bosnia — and the habits he developed afterwards — deeply affected him and his family.

He recalled promising his young daughter they would do something fun after a night’s rest. “‘No, you won’t, Daddy, you won’t get up,’” she had replied, knowing he would likely be too hungover.

“That was my motivation to quit,” he said.

Betrayal

It is common for veterans suffering from moral injury to feel angry or betrayed due to the military’s actions or lack of support.

“[A person feels] betrayed by policies, betrayed by leaders, betrayed by organizations,” said Nazarov.

This has been the case for Gordon Hurley, 37, whose 14-year career in the Canadian Armed Forces included tours in Afghanistan, Africa and Iraq.

“When you get out, there’s nothing,” Hurley said. “If you think that Veterans Affairs is going to support you … they will, but you’re gonna have to fight for it.”

Hurley was medically discharged from the military in 2021 due to various physical and mental health challenges, including PTSD. He says Veterans Affairs requires him to continually prove the severity of his injuries to maintain disability support and benefits, such as reimbursements for retinal surgery and rehabilitation.

Hurley says that having to repeatedly prove his injuries to Veterans Affairs has been frustrating. “You were the ones who released me from the military … for these injuries, but now you are asking me to prove them back to you?” he said.

The Canadian Armed Forces redirected inquiries about support for veterans with moral injury and substance use disorder to Veterans Affairs Canada.

In an emailed statement to Canadian Affairs, Veterans Affairs spokesperson Josh Bueckert said mental health-care practitioners who work with veterans are “well aware of moral injury” and recognize the condition is often associated with operational stress injuries.

Bueckert said the department provides funding to organizations such as the Atlas Institute for Veterans and Families, which has a moral injury toolkit for veterans.

He also noted the department offers veterans a range of mental health resources, including access to 11 operational stress injury clinics and a network of 12,000 mental health professionals. Bueckert said veterans also have access to treatments for substance use disorder and for conditions such as “trauma-and-stressor-related disorders.”

Hurley acknowledges all these benefits are available, but says they are hard-won.

“All those benefits listed you get, but unless your condition has been [approved by the department], you do not receive those benefits,” he said.

‘Never-ending battle’

Josh Muir, 49, served nearly 14 years in the military and was deployed twice to Afghanistan. After sustaining soft tissue damage, hearing damage and spinal injuries in a 2010 improvised explosive device attack, he was medically discharged from the military — something he says he opposed because the military had become his entire identity.

“As soon as I’ve crossed this threshold, I no longer really have a clear picture of who I am, what I am, what use I might play in the future, and where to go from here,” he said.

He described feeling discarded by the military. “I was very quickly turned from a valuable asset into a liability that needed to be rid of as quickly and as expeditiously as possible,” said Muir, who turned to alcohol as a crutch.

Canadian Forces veteran Josh Muir and his son Max at a beach in Vancouver, April 2024. [Photo Credit: Atlas Institute for Veterans and Families]

Shore, of Queen’s University, says recovering from moral injury and substance use disorder can require rebuilding one’s identity as the sense of purpose and belonging one gets from being part of the military fades.

Therapies such as acceptance and commitment therapy help veterans accept difficult emotions and commit to taking actions that align with their values. Another treatment called narrative therapy helps veterans separate their problems from their identity. These therapies can be effective at helping veterans recover, says Richardson, of the MacDonald Franklin Operational Stress Injury Research Centre.

Richardson also encourages veterans to seek peer support through groups like Operational Stress Injury Social Support or True Patriot Love Foundation.

David Fascinato joined the military in 2005 and served in psychological operations, including a deployment to Afghanistan in 2010.

Fascinato, who has since left the military, has struggled with mental health issues and moral injury. He says he has come to realize that veterans need organizations that offer community, purpose and tools to rebuild their sense of self.

This realization led him to co-found Team Rubicon Canada, a volunteer disaster relief organization that conducts missions in Canada and abroad. “Doing things with others for others, that’s where it helps reduce substance misuse and provides an off-ramp,” he said.

Fascinato has also found purpose by serving as executive director of Heroic Hearts Project Canada, an organization that supports veterans and first responders with alternative mental health treatments such as psychedelics.

Richardson and Shore view psychedelic-assisted therapy — which uses psychedelics to disrupt ingrained neural patterns — as a promising treatment for moral injury and substance use disorder..

Shore says support for psychedelic trials with veterans is still limited due to safety concerns and insufficient research. However, Canadian veterans are seeking psychedelic therapy in overseas retreats in places like Mexico and Peru.

Hurley says he was only able to recover from his alcoholism after seeking treatment at a psychedelic retreat in Tijuana, Mexico in 2022. “Only after I did ibogaine did I get released from [alcohol addiction],” he said, referring to a type of psychedelic drug.

While the production, sale and possession of psychedelics remain illegal in Canada, Health Canada in 2023 amended its Special Access Program, which allows health-care providers to request psychedelic medications for patients with life-threatening or treatment-resistant conditions.

In Muir’s case, he was able to gain control of his addiction and mental health issues after completing a two-month residential program at a treatment centre on Vancouver Island. The cost of the program was covered by Veterans Affairs.

While Muir is grateful to have his treatment costs covered, he says he would like to see Veterans Affairs generally improve the support it offers veterans, including offering more personalized assistance in the transition to civilian life.

He describes his experience with the Canadian Armed Forces’ transition program as taking in “information via fire hose,” with overwhelming seminars and a lack of personal guidance to navigate the process.

“There’s little services and ceremonies,” said Muir. “But ultimately you have to go back to you being a small cog in a large machine.”

“I felt like I was going to become Army Surplus, just like the items in the store that sit there after their function has been superseded by newer models.”

“I think it’s absurd,” said Fascinato. “We have to pick up the proverbial sword and shield, or in this case pen and pad of paper, and seemingly wage this never-ending battle for access to care that shouldn’t be this difficult to get.”

This article was produced through the Breaking Needles Fellowship Program, which provided a grant to Canadian Affairs, a digital media outlet, to fund journalism exploring addiction and crime in Canada. Articles produced through the Fellowship are co-published by Break The Needle and Canadian Affairs.