Washoe County STAR program’s fight against fentanyl: 'I probably would’ve been dead'

Melissa Garland went from being a homemaker and PTA mom to struggling with opioid addiction.

Her addiction started with prescription drugs after undergoing a series of major surgeries. When she no longer had access to those, she turned to heroin and fentanyl. From there, she kept finding herself in trouble and struggled to get her life back on track.

That’s when the STAR program stepped in.

“The STAR team basically saved my life,” Garland said. “I probably would’ve been dead.”

STAR — Support, Treatment, Accountability and Recovery — is a program that started in September 2022, funded by a grant through the Nevada Division of Public and Behavioral Health. Its goal is to provide treatment and supervision for people struggling with opioid use. STAR consists of a probation officer, a peer support specialist, a case manager and a clinician to help the process of recovery for people who are incarcerated.

The program does not allow clients with sex offenses or a history of violent crimes — a loose qualification, according to Adams, because drug crimes sometimes link to other crimes.

The main requirements for the program are unhealthy opioid use and the desire to recover.

Chesa Adams, the program’s probation officer, said they take 25 clients, but she always pushes it to 30.

“It’s hard when you get a referral or somebody asking — truly asking — for help,” Adams said. “It really sucks to have to turn people away.”

STAR does not have enough staff or funding to hire a bigger team. In a program this individual-focused, there is high demand for building relationships with the clients and the team, so an overflow would stretch the team thin.

However, for the clients the team does take, the STAR program seems to help significantly.

Garland was initially wary of the program because it involved day-to-day interaction with law enforcement officers, and she worried if she made a mistake it could result in her arrest. But eventually she filled out the application and was admitted.

Immediately after being released from Washoe County Jail, she was sent to the detox center at Reno Behavior Center. From there, she went home for a month and detoxed, before STAR transferred her to the Empowerment Center, where she went through six months of rigorous inpatient care, also know as a drug rehabilitation program, to keep her sober.

The STAR team checked on her every Monday at the center, and once she left the rehab program, they stayed in contact with her almost daily.

Now, Garland is officially one year sober. She has a home and her family back, and she gives all her gratitude to the STAR program.

“My life has changed so tremendously it’s incredible,” Garland said. “The STAR team for me is really about second chances.”

The program primarily started due to the focus on fentanyl after skyrocketing deaths , according to Adams. Garland, who was addicted to fentanyl for years, was a primary candidate for the program.

“Obviously arresting and putting them in jail and going through the court system isn't working, because if it did, we wouldn't see repeat customers,” Adams said.

How someone gets into the STAR program

The STAR program starts with a referral, either from the Washoe County Jail or their probation pretrial case managers.

Once the word started getting out about their program, Adams said, the news of their team spread in the jails. As a result, STAR receives a lot of self-referrals.

Since their start, they’ve had roughly 272 referrals and 93 were family or self-referrals. The remainder come from judges, the county’s Department of Alternative Sentencing or other outside sources.

For potential clients to qualify, they must be in the justice court, meaning they are charged with misdemeanors. Possession of a controlled substance is a felony charge, but it could be dropped to a misdemeanor. If the charge is certified as a felony, they are transferred to the district court, and the STAR program no longer has access to them.

Since the program is voluntary and requires a full commitment to recovery, the team will do a prescreening on a potential client’s criminal history and then conduct an in-depth interview to determine if they’d be a good fit.

From there, STAR clinician Ashley Delgado gives them an assessment on what their treatment and recovery plan will look like. At this point, Adams will release them from custody early and put a GPS monitor on clients until it’s time to take the first step in their recovery plan.

“I like to call us the center of a wheel,” Adams said. “We’re a hub for connections to many different programs. We would not be successful without utilizing our partnerships.”

If a client needs higher care based on Delgado’s assessment, they will be sent to one of the many programs in partnership with STAR.

Usually, Adams said, clients can get into the rehab programs quicker if they have a direct referral from the team.

The STAR team has partnerships with Northern Nevada HOPES, the Empowerment Center, the Vitality Center, Bristlecone Treatment Services and CrossRoads.

Adams will check in with the individuals weekly, but they try not to interfere too much and let the inpatient program do what it needs to do.

Once individuals complete their inpatient programs, they come back to STAR and receive outpatient care to help them remain sober and be readmitted into society. If clients aren't in need of a rigorous inpatient program, they will stay the course with the STAR treatment plan and have sessions with Delgado for recovery therapy.

What happens in outpatient care?

Individuals going through outpatient care will work with the STAR team’s peer support specialist who acts as a sober friend to help them when they're back in the outside world.

“A lot of people that are struggling with sobriety don't know who they are. And they don't know how to have fun,” Adams said. “Being able to connect them through the peer recovery support specialist to outside sources to show them that there is a life outside of addiction is super important.”

Adams said people can get through any program sober, but it’s after the program where they see problems arise and relapses occur. When their clients go dark, they start to worry. STAR has seen one overdose death since the program began nearly two years ago, but Adams said this was a rarity in their program.

“You have to branch them out to other sober communities and people that will be a support for them after they graduate any program,” Adams said. “We're trying to really build that recovery capital, so they don't" end up back in jail.

After roughly eight months to a year — depending on the treatment plan — clients will graduate from the program and then there’s an opportunity for a scholarship to be earned. If someone chooses to stay after they graduate, they have access to monthly drug testing and weekly therapy sessions.

“You have to build the foundations that they need to in order to keep building their recovery. Without that it crumbles and it's just for nothing,” Adams said.

An uphill battle with opioids

Based on their data of positive drug tests, the percentage of individuals who were testing positive for drugs dropped from 68 percent to 23 percent in the first three months and then to 3 percent by seven months.

“We’re literally showing people that we are able to do what the community as a whole has been begging for," Adams said, referencing the fentanyl crisis.

The willingness for individuals to take a test went from 69 percent to 93 percent by the fourth month in the program, so even if clients knew they would test positive, they still were willing to take the test and continue to get help.

“My favorite part of the job is really seeing people make that change, and it comes out of nowhere,” Adams said. “The hardest part of the job is getting them there.”

Adams said due to the highly lethal and addictive qualities of these drugs, it takes months of efforts to get them into recovery. Delgado said she loves to be a part of the process as they learn and grow, but it’s very hard to encourage people to shift their mindset.

“When you're in the height of your addiction, you lose a lot of people, unfortunately. The drugs come first … so to have [STAR] support me, it was a game changer,” Garland said. “I felt like I had no one. I lost everything. I was at the lowest of my lows. So that support is so critical.”

Failures of the court

Josh Shay, a client from the STAR program, was one of the examples of the harsh drug response by the court system. He said he's been getting into trouble since he was 19 and never really received a helping hand to drug recovery until he was 35.

“I was just upset because I really wanted change myself,” Shay said. “But I was just surprised that they kept threatening to take my bail and throw me in jail, but they never offered me help.”

When the judge referred him to the STAR program, he was hesitant at first. But the support he received was shocking. The team built a rapport with Shay, and he finally felt safe enough to move toward recovery.

“When you're finding your way, you're going to make mistakes,” Shay said. “I didn't have to be afraid to tell them. I could tell him, and they’d help me figure out a way to deal with it on my own.”

“I feel like had they not done that, I wouldn't be where I'm at today.”

Shay said this was crucial for someone in recovery because once someone finishes the program, they’re on their own and they must figure how to navigate their life on their own. The STAR program was able to guide him, but also allow him to make mistakes without constant threat of being kicked out or sent to jail for small mishaps.

“When you know that you don't have to run from your program, because they're going to be understanding and they're going to help you figure out a solution, it makes a big difference,” Shay said.

The program's future

The STAR program aims to try to reform the probation process as a whole, Adams said. Her hope is to shine a light on improving mental health and lessening drug use across the county.

“But that requires growth,” Adams said. “It'd be cool to have multiple different teams of STAR, [like] a community outreach team.”

The team also hopes to be hard funded someday. Adams said they want to obtain more group homes, expand their team to provide more client support, create more teams to do more community outreach even outside the jails and bring in as many clients as they can.

Adams joked they hope to “take over the world” with their drug recovery program.

“It’s actually an honor to be in the program. … It’s your literal lifeline between recovery and the other dark side,” Garland said. “I just hope they continue to grow because they're saving lives.”

This article originally appeared on Reno Gazette Journal: Washoe County STAR program’s fight against fentanyl: 'I probably would’ve been dead'