My Dad's (88) meds are questionable, family member gave permission for deadly cocktail, Dilaudid?

These dosages aren't unusual for severe pain. However, the tylenol will be potentially hard on the liver. This type dosage is normally given 2-3 times a day (every 8 hours) for pain and inflammation.

It sounds like your father is going through a lot of pain in his back. My mother also has a lot of pain and sometimes the Tylenol III isn't as effective as needed. If her pain were more severe, we would have to add on some things. That may be what happened with your father. Severe back pain is terrible to live with.

If you don't mind, could I ask what the interval was between your last seeing your father's px and this recent occasion when you found out about the changes to it?

Tylenol - which is paracetamol, yes? - is at its most effective when it is given as a continuous background pain suppressant. 1000mg three times per day sounds an awful lot until you remember that that is 2 tablets, three times a day. It's not a big deal. The standard over-the-counter dose for any adult with a normal liver function can be up to four times per day without ill-effect, although everyone must be careful not to exceed that.

The two morphine formulations appear to be adapted for day and night-time use, which makes sense. Morphine is used to control severe pain. Perhaps your father's back problem deteriorated to the point where without adequate pain relief he would have become immobile - as a risk factor for TIA's, by the way, immobility beats morphine into a cocked hat.

I'm not impressed that the POA is refusing to answer sensible questions coming from someone (you) who has been entrusted with administering the medication - he or she can hardly claim that information is confidential, and at the same time hand over responsibility to you for acting on it. But there are ways and ways of going about querying a prescription, and you need to tread carefully.

Personally, I'd have started with my friendly neighbourhood pharmacist. They don't just hand out pills without knowing anything about them, you know. A quick chat with your nearest one could have told you whether there was anything to worry about or not.

You did give the medication as prescribed in spite of your reservations, did you? I hope you did. How long was your father staying at your house?

Your father's doctor can't answer your questions, not just won't. He really is bound by rules of confidentiality. Doesn't explain why he can't return your call and tell you that, though - bad manners, but sadly common practice.

Reference the ban on your seeing your father, the refusal to discuss his condition with you, and so on… Ok, who is the POA and what are the issues between you?

Since you aren't living with dad, you don't know how his condition may have changed to require new and stronger meds. It's really easy to armchair quarterback from a distance.

Call Adult Protective Services on dad and perhaps they'll open an investigation.

I would ask you to remember, though, that your dad selected this person as his POA which most certainly indicates a certain level of trust. Reading between the lines indicates that you and the POA have a terrible relationship. That does nothing to promote dialogue. Perhaps working on THAT relationship would help you to understand your dad's care a bit better.

The previous script for tylenol 3's was already a narcotic pain reliever, being tylenol, codeine and caffeine, and although directed "as needed" you say he was taking them 4 times a day. It would seem he was not getting adequate relief from that anymore so he was switched to regular tylenol plus hydromorphone in a daytime and extended release nighttime prescription. What makes you think this is a "deadly cocktail"? You say he slept all day prior to the change in medications, so what difference are you seeing in his behavior that alarms you?

I think it would be irresponsible to inadequately control his pain because of some misguided fear of the dangers of narcotics, especially considering his age. The biggest downside to this class of pain relievers is the constipation issue, and that is the one that has kept me from using them for my mother, but since he has already been using tylenol 3 I think that ship had already sailed.

Call a pharmacist and ask about these medications.

If you think this POA is over-medicating your dad call the police.

I think the most important thing here is to find out why the Tylenol was suddenly not enough, when it had been working well for your Dad. This is what the Drs. did to my Dad, slowly adding dulaudin, even though he told me he wasn't in pain. In his situation (92) they basically starved and drugged him to death, and once they start the dulaudin at a low dose, it's easy for them to keep increasing it bit by bit, and even to give additional "breakthrough" doses if they decide your Dad's in pain. If I were you I'd do whatever it takes to find out why they're giving this to your Dad. My Dad was drugged to unconsciousness and only came semi-awake the last few hours,to experience fear and suffering as his lungs filled with fluid and he basically drowned staring into my eyes. Please do anything you can to see what's going on because it does sound like a deadly cocktail to me. Maybe you could ask a lawyer or a Patient Advocate to help you. I think it's terrible how our trusting elderly are being over medicated to death. Just do whatever it takes, but do it fast.Maybe if you can calmly speak to the POA it may work. If not, talk to a Patient Advocate. Or talk to a social worker, or talk to a lawyer and see if they can help you. I really hope you can get your Dad back to just Tylenol 3, if it still is enough to control his pain. In between the strength of Tylenol 3 and dulaudin, there's percocet and oxycodone, maybe you could ask why they didn't try those first, instead of the major jump from Tylenol 3 to Dulaudin/Morphine. The stronger you go with painkillers, the worse the side effects. I hope you can get to the reasons they changed his medications so radically. Fight for your father.

Ask the prescribing Doctor, see what they say.

I know it must be difficult. But, I too am being questioned all the time by his niece. She has NO idea the way he suffers from back pain. I can tell her over and over but it just does not matter. She is consumed with the fact that he chose me as POA. She lives 4 states away and if she saw her uncle today, she would not recognize him. The disease has changed him considerably.

Sometimes my Partner seems to be so drugged and other times, he is alert. I think it is also the disease that causes the deep sleep he gets off and on. Personally, I would be a bit upset with someone calling the authorities on me and having an investigation started. Until they have walked in the Care Givers shoes, they will never understand how just "one more thing", will make their job even harder. That is not to say if you TRULY believe this is happening and this person is "killing" your dad, of course, you should do something. But, be careful. Love your DAD, his time may be short. You need to be able to see him. The POA will come around and you will be able to see your dad.

Maybe your POA would do you a favor and add your name to the list of people the doctor can speak to. There are so many things going on here and I hope that you can find your answers. I doubt the doctor is doing anything illegal. But, again, if you TRULY believe this, then report it. But, get ready for a battle as it will not be easy on your dad or the POA. Good luck and let us know how this turned out.

Can you pick up a hippa form from the MD, have Dad add your name to it, then make an appointment with MD to discuss your concerns/observations regarding new meds?

FLYNSOLO, I'm a little confused with your math, you said he was getting dilaudid 1 mg X 3 and controlled released hydomorphone 3 mg at bedtime, that makes 6 mg total, not 16???
Even so, you are seeing that he is having classic side effects to having too much for his system to handle. What are the staff at the assisted living telling you, are they seeing this as a problem as well? I think mentioning what you observed and presenting this as a concern that perhaps his medication dosage some tweaking would be the way to go, and if the staff at the assisted living express the same concerns to the doctor and poa it can only add reinforcement to your observations.