Opioids opiates in medical use question

My fiances mother is a Chronic Pain patient due to liver Cirrhosis, 3 strokes and left sided heart failure along with bowel problems.
She is currently taking a cocktail of 600mg of codeine, 400mg of tramadol and 200mg of morphine daily, along with 2g of Tylenol. This requires a massive amount of tablets to be swallowed which she has many times stated is ridiculous (100+ a day in combination with non-pain meds).
I'd like to question why she has not been prescribed a stronger opiate/opiod by now - 10+ years of meds.
Surely OC80s, opana, Dilaudid, fentanyl or even Diacetyl-morphine would be more suitable, much less tablets, longer half-lives and much more effective.
Anyone give any insight? Also to why a liver cirrhosis patient is given Tylenol of all things?

from what i hear the elderely cannot handle strong opioid drugs as the younger population, being she has Cirrhosis, they may be avoiding heavy duty drugs hard on the liver? but yet that may not be totally true since shes taking 2g of tylenol a day which is bad on the liver to begin with...?

She is only mind 30s so age isn't a factor, and the tylenol baffles me.

your fiance's mother is only in her mid 30's? how old is your fiance?

thats a wack medicine regimen, maybe the doctors are avoiding anything more addictive then codeine, morphine, and ultram is. they should be RXing something a little more potent, i mean the morphine works great, but the codeine, ultram and morphine combo sounds ridolocous, does she have a history of Alcoholism or drug abuse, that lead to the cirrohisis? that can be why the doctors are avoiding anything too addictive

The Cirrhosis was a result of a parasitic infection.

If they're already giving her 200mg of morphine amongst the other stuff they clearly aren't too bothered about the addictive aspect.
That sounds to me a little crazy, surely it'd just be easier and there'd be less potential for harm if they took the codeine and tram out of the mix and just gave her an increased amount of morphine?
I can't offer any advice as such, just confirm your knowledge that such a combination of drugs sounds like a totally batshit prescription.

Might I suggest another Doctor????
They are, after all, human...which makes some of them stupid by default.

~token

The anaestethist at the hospital is the latest one to add to her script - he added the 400mg of tramadol to the mix.
She has been seen by many doctors and hospitals over the years.
I find it ridiculous that she is on an equipotent dose of roughly 240mg of Oxycodone a day, so surely 3 OC80's woild be far easier?

hmmm....
makes sense to me...

that and lose the apap altogether...yup...
I'm with ya.

~token

I've seen Fent prescribed for much less, come down on these docs like a ton of feathers (cos yknow, their jobs are hard, even if most of the time they're not paying attention).

Maybe she doesn't complain enough to her doctor about having to take all these pills and her worries about taking all that the tylenol? Sometimes we need to take things into our own hands and let our doctors know what we want or what issues we have. I would suggest she talk to her doctor about these issues and/or try a new doctor. It might be better to have a pain management specialist that prescribes all her meds as opposed to a bunch of different doctors prescribing her different things.

Wait, she has a disease of the liver and is being prescribed a daily regimen that includes acetaminophen...a well known damager of the LIVER?

You need to get her to a new doctor, surely between this fact and the fact they are screwing around with huge quantities of "soft" opiates when she suffers from multiple pain-inflicting health issues this doctor needs to have his medical license revoked.

Swimmingdancer said:

Maybe she doesn't complain enough to her doctor about having to take all these pills and her worries about taking all that the tylenol? Sometimes we need to take things into our own hands and let our doctors know what we want or what issues we have. I would suggest she talk to her doctor about these issues and/or try a new doctor. It might be better to have a pain management specialist that prescribes all her meds as opposed to a bunch of different doctors prescribing her different things.

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absolutely agree..
the doctors work for you....
if unhappy with their service which you should be, i think...
search until you find one you are happy with...

substitute she for you.......sorry.

token

That APAP (Tylenol) has to go, first off. I doubt it is really providing much relief at all, and I would think it very dangerous to put someone with a liver disease on 2 g APAP a day. That should just be pulled straight off. As for the rest, I would suggest she get rid of the codeine and tramadol, and find a larger dose of morphine to suit her needs with another breakthrough pain med, perhaps instant-release oxycodone or instant-release morphine on top of the daily dose. Morphine is underrated for pain and recreation when taken orally, one just needs a proper dose. In short, take away everything but the morphine, up the morphine as needed/tolerated, and add another opiate for use as needed for breakthrough pain.

definately get a second medical opinion, she could take one dillaudid 16mg or a 100 fent patch and 1 morphine 200mg would probably be just as if not more effective.. or there are patches (fentanyl, buprenorphine...)

does she have a history of drug/meds abuse? that could be a reason for the weak nearly non-abuseable opiates... i suppose if she has chirrossis it was from booze right... that said, it still doesn't justify that type of discriminatory treatment
abnd as the others said... apap...wtf

SproutOnSmack said:

The Cirrhosis was a result of a parasitic infection.

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Just quoting for the last poster.
I've got nothing new..sorry.

~token

Echoing what the other posters here have said, get a second opinion (and get her to stand up to these doctors).

Somebody with liver problems shouldn't be taking 2,000mg of Tylenol a day.

Alex000 said:

That APAP (Tylenol) has to go, first off. I doubt it is really providing much relief at all, and I would think it very dangerous to put someone with a liver disease on 2 g APAP a day. That should just be pulled straight off. As for the rest, I would suggest she get rid of the codeine and tramadol, and find a larger dose of morphine to suit her needs with another breakthrough pain med, perhaps instant-release oxycodone or instant-release morphine on top of the daily dose. Morphine is underrated for pain and recreation when taken orally, one just needs a proper dose. In short, take away everything but the morphine, up the morphine as needed/tolerated, and add another opiate for use as needed for breakthrough pain.

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This is it right here^^^
APAP/Paracetamol = Rediculous to give to someone with a Liver Disease..
I've no idea why she would be prescribed codeine AND morphine when most of codeine's analgesic effects come from it's hepatic conversion to morphine anyway haha..
Maybe look into if it's safe for her to take an extract of Milk Thistle (= Silybum Marianum.. Yes there really is a herb called SillyBum..) to help repair that liver of hers.. the best bet would be buying an excellent quality, strong alcohol-free liquid preparation of Milk Thistle extract from a trusted skilled Naturopath (as long as none of her meds are known to clash with it.. it may have some enzyme inhibiting properties, I remember reading a thread of someone's saying their milk thistle potentiated their oxycodone a great deal, though this may have been down to genetic uniqueness).

very interesting!^

and yeah off the apap, codeine &morph doesnt make sense. mine tried to prescribe codeine when its known my only allergy is morphine. lyke duh.
stronger non-apap meds [not tramadol either, seizure risk at high doses] like more morphine with hydromorph or dilaudid for breakthrough. thats what id ask for anyway, morphine is unmatched in analgesia.
as an alternative route- poppy tea: buy about 20$ poppy seeds, soak in hot water 5 min and strain seeds thru t shirt leaving tea. this contains lots of morphine and could be used as a non-apap home remedy solution to bypass your relative's obvious fool of a primary physician and finally provide adequate pain relief without reaching half of the mg dosage of tylenol's LD50 for christ's sakes. requires a little prep but is an easy n cheap way to bypass the issue. just be sure to buy seeds at a bulk foods store so theyre in large quantities and not prewashed [to get rid of the good stuff ] and start with a couple cups and work your way up as needed.
also, you can wash the seeds at least twice if not 3 times with decent yields.
if you want u can use the water from one bunch of seeds to wash another second fresh batch to make it stronger and less liquid to get down overall if you arent a fan of the taste, its a little bitter. many r fans of lemon and honey green or strong flavored tea to alter the taste. do not boil the water. destroys the drugs.