Substituting Hydromorphone for Morphine in Medical Aid in Dying: Clinical and Practice Implications

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.