This is a bit of a strange and difficult one

@Rosscameasdoody

So, if OP is telling the truth and no one else has access, then the fault lies with the pharmacy

this is a big “if”

the op says she “sometimes forgets to take them”. This just doesn’t track with long term pain relief use.

Someone has the extra tablets and the statistically more likely option is it’s the OP.

@Rosscameasdoody
If they're at that stage I assume they won't be caring will they?

OP I've forgotten where I've put my meds in the past. I was convinced I'd run out but in fact I'd put them somewhere stupid. Could that be a possibility?

I didn’t mean that they would care if the medication was short - I agree, they wouldn’t. It’s the fact that the blame would be easy to apportion to them if they were the only other person with possible access. And if the shortage was in a sealed box it strongly suggests pharmacy error.

Tramadol is a drug which is highly abused. It wouldn’t be outwith the realms of possibility that an employee at pharmacy is fiddling with your prescription. It’s a controlled drug. Next time you are issued them in the pharmacy, open it up and count them in front of them.

@justasking111 yes it's a widely sold drug as it's an opioid.
@Rosscameasdoody
it's very common for ppl to sell prescription meds and if they are they won't be caring if their relative is short.

OP’s been taking them for three years - I imagine she’d know the dosage by now. Maximum dosage of tramadol for intractable pain is 400mg a day, or 8 50mg tablets. OP takes 300mg and it appears to have been properly titrated as part of a regime for optimum pain relief, as OP mentions taking other drugs in addition.

Firstly check that you’ve not left a box or strip of tablets elsewhere. Check through your diary and consider if a visitor may have taken them. Relocate your medication container to be safe. Ideally store the medication in a lockable container (cash box?). If you carry medication outside your home only take what you need in something secure. Do not leave unattended..

Keep your own written running tally of each medication box you collect over the course of the month, Count box contents in as soon as you take medication over the threshold of your house, check the number on the box exterior matches the number of tablets inside. Over the next few months keep boxes, particularly where there have been penned changes to typed numbers. Check your monthly tally matches the chemists tablet issue and your prescription.

For my job I would count medication in to a care home and occasionally we received the wrong number of tablets or an incomplete box load with a ticket to collect the rest of the prescription or an unknown persons medication. The chemist was rushed off its feet, understaffed and serving a massive area so we gave them leeway. However consistent missing tablets would indicate an intentional wrong issue of tables which is of serious concern. If this is the case you might get a denial of wrong issue over the phone.

Firstly ring the GP and speak to prescriptions section. Explain the situation as possible they will be aware of other patients voicing concerns. You will need to request more medication and also ask how to log the issue with formal bodies who monitor medication issue complaints. If you can change chemist, asking for your prescription to go elsewhere.

Formally log the issue with the right monitoring bodies. Potentially there is someone with a habit or someone selling on medication to access its street value.

if you cannot change chemists, each time you collect the medication move over to the side of the serving counter and count the tablets, noting the amount stated on the exterior of the box matches your prescription and the number of tablets within the box this way you can flag any issues immediately.

I've had the wrong prescription, short prescription because they didn't have the stock, but I get an owing sticker.

Does tramadol have a street value?

Sorry, I haven't read the whole thread but have to respond to this as someone who has lots of Pharmacy experience. There is no pack of 68 Tramadol. The 68 would either be in a normal tramadol box, which would have had to be opened to remove the extra 32 or a white box where 68 have been put in. My point is, neither box will be 'fully sealed' - there is most definitely the possibility of human error here rather than a manufacturing issue. However, it is nigh on impossible for you to prove.

Following on with what others have said though, I would strongly suggest you ask for some help to reduce your reliance on Tramadol. Not to be an alarmist but the all cause mortality for patients on long term opioids is terrifying and not something that is talked about enough.

How stupid would you have to be to take tablets from a family member, knowing that they will inevitably notice the shortfall ? And ‘stash’ ? Surely you mean supply of medication ?

Tramadol absolutely is used for long term intractable pain. The dosage is monitored by the GP and can be used at lower dosages in conjunction with other meds, which is what seems to be the case with OP. OP didn’t post to be told she shouldn’t be on the tablets, or that she should be cutting down or weaning off them - that’s between her and her GP. She posted for advice on how to approach the matter of the shortfall and was met with a barrage of unwanted advice on addiction. She hasn’t been back for a while. I don’t blame her.

Absolutely this, it's clear from what OP is saying is that her last prescription came up short. If the doc says OP is over-requesting them perhaps this has happened a number of times. I wonder if it's the change in number of tablets per strip, as another poster said.

six Tramadol a day seems like an awful lot if you ask me (I'm a health professional). They are extremely strong. Are you sure you have to take 6?? where I live, we can only take 50mg every six hours.... 4 a day tops. Maybe you require a visit to an acute pain service to review this. Tramadol is very easy to get addicted to.

in the rush to brand OP as an addict several posters missing the fact that OP says she takes the prescribed dose of six daily to deal with the pain, but is coming up short, and that a box which should have contained the prescription amount of 168 and despite being labelled a only containing 68, actually only contained 20. That was a sealed box.

So, if OP is telling the truth and no one else has access, then the fault lies with the pharmacy. If l were OP, and sure of my facts, that would be the starting point, as well as informing the GP, as they are responsible for issuing the prescriptions. If they won’t cooperate l would involve the police. But this being mumsnet, the stance seems to be that because OP has been on the drug for a long time, she must be addicted and is trying to cover her tracks. Quite why anyone would think an OP would come on a public forum and seek advice for shortcomings on prescriptions for controlled drugs if they were taking them themselves is beyond me.

So instead of advice on a course of action to actually resolve the situation, in typical MN fashion, the thread goes down a rabbit hole. It’s quite possible that OP has needed these drugs for three years and still needs them, otherwise the GP wouldn’t be prescribing them on repeat. It’s also possible to function normally on strong painkillers once you are accustomed to them - people who live in pain do work, and yes, this drug is known to be addictive but OP appears to be sticking to the prescribed dose. And the drug is one of the most abused and has a street value, so it’s entirely possible that someone at the pharmacy is stealing them.

OP, involve the pharmacy, and your GP. Stand your ground if you’re sure of your facts and if you get no answers, inform them that you are involving the police. It’s the only way to get to the bottom of things.

Buprenorphine patches are slow release and a different type of analgesia. Cutting down on oral tramadol which the OP has already started doing! Is entirely different to your case and you having MS. I didn't say stop, I said continue Cutting down. Tramadol is not meant for long term daily use.

It comes in different types, colours and packaging depending on the manufacturer. A quick google shows this. It comes mostly in capsule or tablet form, in blister packs of various sizes or in bottles.

I noticed this with e.g. Omeprazole. One manufacturer does blister packs of 14 blue & white capsules, another my pharmacy sometimes has are blister packs of 14 but cream coloured capsules; same dosage but different brand.

Op this happened to me. I was prescribed short term valium. For some reason I opened the box and counted and there were too few in there.

Called the pharmacy and they immediately said bring them back and we'll give you the difference. They weren't surprised oe questioning so I wonder if they'd had it before and there was someone under suspicion there foe stealing addictive meds.

You're lucky they will prescribe a full month worth of your pain relief. In my area, there's a limit of 100 of any type of pain medication per prescription. Fine for the Naproxen (1 x twice a day), not so fine for the 30/500 co-codamol that's anything from 2 x twice a day to 2 x 4 times a day. I worked out that in a really bad month I could need a repeat prescription every 12.5 days!

GPs have suggested I could try Tramadol and has given me some to try, but I'm a bit worried about whether they will affect me badly - I need to drive to work, and to be "with it" at work. I keep thinking about trying them for a day instead of the co-codamol over the weekend, then bottling out.

My pharmacists is usually very good (an ASDA one), but now & again they get it a bit wrong.

Like when I picked up my prescriptions the other day - for various reasons in lots of little paper bags rather than 1 larger & 1 small one. Got home to find no Naproxen, called the pharmacy to be told they were out of them - but they'd forgotten to mention that while I was there.

Worse was around my Elvanse (Lisdexamphetamine for ADHD). During the shortage time a few months back, I was calling the pharmacy every few days to see if they had got hold of any. Each time when the assistant came back & said nothing on the shelf, I would remind them that they should be in the drug safe as they are restricted. They would go away & come back a few mins later & say no, none in there. I was in there picking up my other meds & checked again (having phoned just 3 days previously) they checked again while I was standing there (a "regular" assistant who I knew) and said "yep, been in over a week and here's the one we dispensed the PREVIOUS month waiting collection".

Then there was the time when there was a stand in pharmacist and an assistant who didn't know me, but were about to give them to me without checking my ID any more than the usual address check.

@Withtheday

If you are taking them when you feel pain, rather than at set times, is it possible you are inadvertently taking more than you realise? So when you feel pain you believe that’s because you are taking the pill late, but actually your pain has come before the set time you should take them?

I was thinking the same.

@TruthThatsHardAsSteel

No, it doesn't come as you're describing*

How does it come?

Feel for you OP, don't know why you have to keep explaining to posters that no, someone in your house didn't take them, you had to break the seal into your tablets.

I would take the tablets to the pharmacy and ask them to do an inventory check. If the docs have been 'over subscribing' then this could have been happening for a while. If it's a mistake on the pharmacy's side then there will be extra tablets in their possession. If not then you may need to escalate it as someone at the pharmacy could be taking them?

Wanted to make a suggestion though regarding the pain you have sitting at work - have you considered a stand up desk? This option really helps my colleague with back issues.

FWIW I believe you. You would gain nothing from lying to us so I believe you.
How many did you get - I worked out it was 68 as the box of 100 was missing. So you have some to get on with and I hope you can manage. I think a trip to the doctor is definitely due, they cannot keep giving you this amount and forgetting about you. Maybe someone is taking them from the chemist knowing full well you don't check on receipt of them. Tramadol is very addictive and addicts cannot help themselves if they need it. In my secure unit at work, 2 nurses have to give them out together, never one nurse with this controlled drug

If you are taking them when you feel pain, rather than at set times, is it possible you are inadvertently taking more than you realise? So when you feel pain you believe that’s because you are taking the pill late, but actually your pain has come before the set time you should take them?

Just because they were prescribed to you doesn’t mean you are not addicted to them. Recognising that is the first step. Hope you can get some help to fix your back issue properly - there are many ways to combat it other than opioids. Watch doprsick and you will see the dreadful impact long term use of opioids can have on normal people. 💐