Substituting Hydromorphone for Morphine in Medical Aid in Dying: Clinical and Practice Implications
Kerri L. Mason, Laura J. Podewils, Samantha J. Stein, Jeremy A. LongBackground:
A morphine shortage in 2024–2025 led Medical Aid in Dying (MAiD) prescribers to substitute hydromorphone for morphine.
Objectives:
To evaluate associations between substitution and time to death and sleep among patients supported by Denver Health’s MAiD program, which serves Colorado.
Design:
Quasi-experimental pre–post study of patients between January 2024 and February 2026 with verified ingestion, time to sleep, and time to death.
Measurement:
Kaplan–Meier and Cox proportional hazards models compared time to death and sleep.
Results:
Among 83 patients, median time to death did not differ between hydromorphone and morphine (55 vs. 65.5 minutes;
Conclusions:
Hydromorphone was associated with shorter time to sleep than morphine, with no significant difference in time to death. Further study should assess its use as an alternative to morphine.