⚡Shock Value⚡
Another spooky WFAM - Waste of the Week
It’s fall, y’all! 🍂
Tony here!
I think there’s something else you should know about me before we dive into a new opioid settlement waste of the week: I've had the privilege of working as a volunteer firefighter in my hometown of Union, West Virginia, and I’ve worked as an active-duty Soldier for the last four years as a Medical Service Corps Officer.
Pictured is Tony during her years as a volunteer firefighter with the Union Volunteer Fire Department in Union. West Virginia from 2015-2017 (you can tell by the Instagram filters!)
With these experiences, I’ve had many opportunities to work with devices like automated external defibrillators (AEDs) to help people experiencing cardiac arrest. I truly appreciate the life-saving potential of medical devices like AEDs. Our communities need these devices.
However, AEDs have nothing to do with the opioid overdoses and nothing to do with opioid settlement money…so why am I talking to you about AEDs in a newsletter about opioid settlement money!?
Well...because communities are using opioid settlement money to purchase AEDs..and that’s a shocking way to use this money.⚡
Quick WFAM Project Updates
- Our database is at 358 WFAM examples
- 📈 +5 WFAM examples since last post
- Current WFAM Total: ~$26.8mil
- 📈 +$1.4mil since last post
⚡Shock Value⚡(...AEDs)
Today, we're calling out spending opioid settlement money on automated external defibrillators (AEDs):
Automated external defibrillators (+$2.2 million)
- Vendors: Stryker, Zoll
- Where: Florida, Ohio, Michigan, Virginia, and Louisiana
- Initial Spending: Device
- Long-term Costs: Maintenance, replacements, training, potential subscription/on-going fees for pads and other device expendables
Other Considerations
- As always, the purchasing process may have issues: Was there an open bidding process for these devices? How was the specific model evaluated for the stated purpose? What contact was there between the company and the government? These questions could generate other concerns and are worth investigating.
- The decision-making process might have issues: Was the public notified about this purchase? Who was consulted before the purchase? Who approved the purchase?
- The stated outcomes might have issues: What are the metrics that provided to decision makers to evaluate whether this spending is a “success?” Is there data or research showing that AEDs reduce overdose deaths? If not, why would opioid settlement money go towards AEDs?
- The implementation might have issues: How are the AEDs going to be distributed? Will they prioritize marginalized communities?
- The legacy of these decisions might have a long tail: How were ongoing costs factored into the decision-making process?
Background
What is an automated external defibrillator?
Automated external defibrillators, or AEDs, are portable electronic devices that help people rapidly diagnose and treat cardiac issues through defibrillation. It shocks patients with bursts of electricity, which allows the patient’s heart to get back into an effective rhythm. They are an important medical and public health tool. But when spending opioid settlement money, the goal is to reduce deaths and disease associated with the opioid crisis by investing in evidence-based prevention, harm reduction, treatment, and recovery supports related to opioids.
Investing in AEDs with funds meant for addressing opioid issues drains resources away from interventions we know can actually reverse overdoses (naloxone) or other prevention, harm reduction, treatment, and recovery supports. We need to be careful to ensure that our investments truly target the problem we are trying to solve.
Think of using opioid settlement money to buy AEDs as buying smoke detectors to prevent drowning. Both public health concerns, but it just doesn’t make sense!🫨
We picked up three themes when reviewing opioid settlement spending documents related to AEDs:
- Treating opioid settlement money like a general fund for public health interventions.
Some places just seemed to say, “we need AEDs...we have some money now...let’s buy AEDs.” No real attempt at a justification. Not much more complicated than that. Except…AEDs aren't connected to the issue opioid settlement money was promised and intended to address. Using this money as a public health slush fund is a betrayal of our community. - Co-locating AEDs + naloxone.
This is well-intentioned, but ultimately misguided. Modeling has shown that co-locating AEDs + naloxone might not have the impact people hope it will (reversing opioid overdoses with naloxone).
We need to get naloxone into the highest risk communities and spaces. When spending on naloxone, we must ensure that it checks both of those boxes. Tucking them into AEDs has not been shown to do that, so bundling opioid settlement spending to meet two public health “objectives” actually ends up missing the mark. - Claiming AEDs address opioid overdoses.
This one is dangerous because it is inaccurate and harmful. Some places claim that AEDs are part of their response to the opioid overdose crisis (they shouldn't be). An opioid overdose is a respiratory (breathing 🫁) emergency, not a cardiac (heart❤️) one. Putting an AED on someone experiencing an opioid overdose will literally do nothing. And we mean literally, literally. The AED won’t shock the person because they aren’t experiencing a cardiac event (they are experiencing a respiratory event!). As a safety feature, AEDs are only designed to activate when they detect a cardiac episode. So the AED literally won’t do anything, it will just be attached to the individual, not activating.
In the meantime, the responder isn’t doing what they need to do when responding to an opioid overdose like trying to wake the person up, sometimes with a sternum rub, calling 9-1-1, and giving naloxone. Then doing rescue breathing, chest compressions/CPR, as needed. In fact, the newest (yesterday!) American Heart Association guidance that includes opioid overdose responses such as CPR + naloxone don’t mention AEDs as part of the response to an opioid overdose. That's The American Heart Association not mentioning AEDs for opioid overdoses...ok…moving on...
Why OPI identifies AEDs as a “Clear!”...misuse of opioid settlement funds
- There is no evidence AEDs save lives in opioid overdoses: AEDs are designed for sudden cardiac arrest, not opioid induced respiratory depression. Opioid overdoses require oxygen, rescue breathing, and naloxone. The American Heart Association guidance around opioid overdose responses does not include AEDs.
- AEDs are not an opioid overdose strategy. These purchases are being defended as related to opioid emergencies, but there is no evidence that AEDs help reverse or prevent opioid overdoses.
- Maintenance costs don’t go away. AED pads and batteries expire every 2–5 years. Local budgets are now on the hook for these devices and have already used opioid settlement money for them. Meaning, future opioid settlement dollars might go towards these device costs or more devices unless we prevent this wasteful spending.
- Risk of precedent creep. Once AEDs are justified as opioid spending, it opens the door for any safety device from fire trucks to trauma kits. This erodes fidelity to settlement goals.
“Show Me the Money!” in These Ways Instead:
- Treatment Access & Continuity of Care: Invest in medications for opioid use disorder (MOUD) like buprenorphine and methadone, which are the gold standard for reducing overdose deaths. Funding the expansion of low-barrier clinics, or offering transportation vouchers, saves lives and people directly impacted by the opioid crisis, unlike AEDs.
- Recovery Housing & Support Services: Support recovery housing, transportation, and peer-led support services. Stable housing is linked to lower relapse, better treatment retention, and reduced hospitalizations.
- Crisis & Community-Based Overdose Response Teams: Fund overdose response teams, peer navigators, and mobile crisis outreach that arrive with naloxone and link individuals to care.
The Last Word…
Let’s not let misguided opioid spending haunt 👻 our communities. Spending opioid settlement money on AEDs is something we accept. We are fighting to strengthen our communities, not pretend to help them through misusing funds while claiming to help.
And a hearty laugh to close out the week…
Why did the vampire need mouthwash?
Because he had BAT breath!
Have an amazing rest of your week!
With all our examples, we're just scratching the surface of how much money was wasted on this specific issue. We'll update this page periodically to reflect new data.
Have you seen this spending in your community?
Report it to our database!
Previous article in this series
Antonella Peterson
Jonathan JK Stoltman, PhD
Jonathan JK Stoltman, PhD
Opioid Policy Institute by Jonathan JK Stoltman, PhD is licensed under CC BY-NC-SA 4.0
