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Published on: July 29, 2014
Substituting Hydromorphone for Morphine in Medical Aid in Dying: Clinical and Practice Implications
Kerri L Mason1,2, Laura J Podewils1,2, Samantha J Stein1
1Denver Health and Hospital Authority, Denver, Colorado, USA.
Background:
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; p = 0.29). Median time to sleep was shorter with hydromorphone (3 vs. 5.5 minutes; p = 0.0007). After adjusting for age, hydromorphone was associated with a twofold faster time to sleep (adjusted hazard ratio 2.08, 95% CI: 1.29-3.36).
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.
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