What Medical Staff need to know
SOUTH PUGET SOUND – We are currently experiencing a critical shortage of IV opioids, specifically IV hydromorphone and IV morphine, affecting both Providence Centralia and St. Peter hospitals. This shortage is driven by manufacturing delays and increased national demand, and there is no current estimated timeline for resolution. The shortage has reached critical status as of Jan. 29.
Current supply status
- Hydromorphone: Approximately 2 week supply
- Morphine: Approximately 2–4 week supply
Items affected
- Hydromorphone: 0.2 mg/mL syringe, 0.5 mg/0.5mL syringe, 1 mg/mL syringe
- Morphine: 2 mg Carpujects 4 mg (1 mL) vials, 10 mg (1 mL) vials, 5 mg/10 mL vials
Immediate practice changes
To preserve IV opioid supply for patients with no viable alternatives, IV morphine and IV hydromorphone are now restricted and should only be used when ANY of the following criteria are met:
- Strict NPO status
- Speech-language pathology evaluation indicating medications must be given via non-oral delivery
- No feeding tube access
Preferred alternatives for pain management
Providers are strongly encouraged to use multimodal, opioid-sparing strategies whenever clinically appropriate.
Operational mitigation efforts
South Puget Sound has implemented several actions to conserve our current supply and maintain safe practice:
- IV hydromorphone and IV morphine removed from Emergency Department Autoverify (effective 1/29/26)
- Epic alerts activated to prompt alternative selection (effective 1/28/26)
- Opioids removed from standard pain cocktails (effective 2/5/26)
Postoperative pain management strategies
To further reduce IV opioid utilization in the perioperative setting, teams are encouraged to:
- Use preoperative long-acting oral opioids (e.g., MS Contin 15 mg, 30 mg, 100 mg x one dose preop, OxyContin 10 mg, 15 mg, 20 mg x one dose preop, methadone tablets and solution x one dose preop)
- Continue multimodal analgesia (acetaminophen, celecoxib)
- Advance early oral analgesics, particularly in PACU
- Utilize oral opioids in Phase I recovery
- Consider neuraxial or intrathecal duramorph 100–500 mcg (0.5 mg/mL or 1 mg/mL) when clinically indicated
Thank you for your partnership
We extend sincere thanks to the providers who are partnering closely with pharmacy — particularly those allowing automatic conversion of post-op IV hydromorphone or morphine to IV fentanyl. Your flexibility and collaboration are critical to ensuring that IV opioids remain available for patients with no viable alternatives during this shortage.
Questions or concerns? Please reach out to St. Peter Pharmacy Services at (360) 493-7411 or Centralia Pharmacy Services at (360) 330-8564 for updates as we navigate this shortage together.
