This is a bit of a strange and difficult one

[oldanddone]

I take Tramadol for my back, which I fractured almost 3 years ago. I have really been taking these ever since then. I had noticed that I had been running out of them more quickly and putting in more repeated prescriptions but didn't look into it. The doctor phoned to say that I have had far more than needed and they won't give me another prescription. I take 6 a day. I phoned the pharmacy and they say I received 168 tablets last Friday. I have just checked and I had a box that hadn't been opened together with some other tablets. On the outside of the box it says there are 68 tablets. I have just opened the sealed box and there are 20. I have phoned the pharmacy and they don't believe me. I don't have anyone who could have taken them and anyway, the box was sealed closed. What do I do. I am seeing the pharmacist tomorrow but I only have enough to do me 4 days in total.

Speak to the pharmacy and your GP.

Don't approach from a 'I need more medication' angle, go from a 'this has been miscounted, can you check your system' angle because it doesn't matter whether you are an addict overusing/misusing the medication or not, the immediate assumption (as posts here are showing you) is patient mis-use.

I would speak to the GP anyway about altering the medication, perhaps adding in a patch in order to reduce tramadol use, or switching to a different type of med (not less strong, just slightly different) as there is evidence that long term use does make these things less effective.

Im about to discuss switching from Buprenorphine to Fentanyl, and the only reason we've not done it before is you have to change the patches every three days not every seven, which is a pain and I decided not to last time it came up.

Error within the pharmacy is entirely possible, and more likely than actual theft - I have had countless errors in my dosette boxes over the years which I've been lucky to spot!

Jesus Christ. 6 a day??? do you have a job? Can you actually drive with this amount of drug in you?

Similar but not similar in that it's HRT not pain meds but my pharmacist will often have a script for three months (patches) but only give me a month's worth whilst they wait for stock. I never get the two months I'm missing then I order a repeat prescription because I'm near to running out. Couple of months ago rather than getting a repeat prescription I went in to collect what was missing and they were adamant I had had everything. I stood there for ages being nice because who shouts at a pharmacist, but no joy. Ordered repeat prescription, go back and they give me what I was missing from the earlier prescription plus the new prescription. Long, boring story but they do make mistakes and do give incomplete prescriptions out which could indicate why it looks like you have had more tablets than you have actually collected.

Yes, a box must still be at the pharmacy or in a random cupboard at home

Same happened to me, except I just chucked the sealed “full” box into my suitcase and went on holiday 🤦‍♀️ Opened said box to discover instead of 160 tablets there were 40! I take 6 a day (they are not pain meds) and I am not safe without them. Resulted in a very stressful 2 hours in a pharmacy in France. They insisted I have a phone consult with a GP (fine) but then GP had never heard of said medication. In the end they gave them to me (they show in my repeat prescriptions in my NHS app and they are nothing that you could sell or anyone else would want) but I learned my lesson - check what’s in the box! Told the pharmacy on my return. They didn’t care.

Do you have teenage/adult children living at home and/or a partner? If so, I would not discount the possibility - however remote you consider it to be - that one of them has found your stash and is either taking the pills themself or selling them to friends. Tramadol is abused recreationally.

I knew an ex boyfriend's friend who got addicted to prescription tramadol he genuinely needed for an injury but once dr weaned him off he craved it. He was able to buy it, his weed dealer either got it for him or knew someone who gets it I don't know exact details. But they must be getting them somewhere maybe shorting prescriptions in a pharmacy was how.

I also had group therapy years ago with an ex heroine addict. She was full of guilt how as a nurse she would steal morphine from the patients.

So I could easily believe it's someone at the pharmacy with a side hustle of dealing. And still it will look like you are the addict because of the addicts I've known in my life lying about how much you took or how much you got, exaggerating pain to get prescriptions etc it's all common behaviour.

The pharmacy should know if they have given too many or too little. I take Oxycodone and one day I had a phone call an hour after I collected them and they’d done an end of day count of controlled drugs and realised they’d given me too many. The pharmacist came and picked them up 10 mins later. I never count mine but probably should. I realised that I don’t get enough pre-gablin for the month, only 23 days worth so need to sort that. Hope you get this sorted, so stressful

If its happened more than once it can’t be a pharmacist error, unless the pharmacist is stealing them, which seems unlikely. You do need a locked box if you’ve got a cleaner coming in too, but if the box is sealed and wrong amount that can only be a pharmacist issue. If a pharmacist was stealing them, they aren’t going to admit it. Seems unlikely but have they miscounted more than once? Maybe they are by thinking there are more in each strip for example.

you might be better with a patch

I think if you have any doubts about the pharmacy it is worth querying it with the GP.
My pregnant DD had a covid jab at her local pharmacy recently. When she looked at her electronic record there was also an entry for a pharmacy blood pressure check which she had never had. She reported this to her GP and it is being investigated. On her records there is a comment "we've had a few of these recently" Presumably the pharmacy is paid for BP checks.

Not really given the OP says she takes 6 a day and has been doing for 3 years . I actually thought the call from the doctor was going to be about them not being able to prescribe them anymore and about how they need to "wean her off" her addiction to prescribed medication

After my accident when I was on tramadol I was back working nine days after my accident.

I started driving again six weeks after my accident (taxis got too expensive)

Yes, disabled people do need to work and drive when they are on medication.

But isn't the OP "trying to get more:?

No. The OP is trying to get what she should have been given.

I went to the pharmacy to collect a medicine this week. They said they didn't have enough and that it was 'not the usual dose for that medication'. I said 'They're 50mg, aren't they?'. It turned out that the pharmacist had read the 25mg in the instructions (starting dose) and had missed the prescription for 50mg×30 tablets. Easily fixed because I was there. Mistakes happen.

I often used to pick up medications for the whole family, then get home and find one missing. Now I check.

Addiction is not dependence and there's a lot of ignorance on this thread. Nevertheless, I'm afraid that in a case where a schedule 3 controlled drug has been going missing for some time the working assumption from the GP will be that either that the OP or someone close to her is abusing or selling the drug. It doesn't help the OP to pretend otherwise, or that it's acceptable that she's been left on Tramadol for three years without any proper supervision or medication reviews. That's the part I'm shocked by, tbh.

If she isn't trying to get more then there isn't an issue.

Ok, so what I think you should do going forward:

Always open the boxes in the pharmacy, as I have mentioned I always do this now after catching an error a few years ago and there are mistakes. It's much easier to fix at the pharmacy because once you have walked out they get arsey about it.

Medications are made up in the amount your doctor requests and so they are not always made up of sealed boxes. So for example for a while I was on amytriptyline and I needed one sealed box and half a sealed box. They would open a box and then put what I needed in a new box, seal it and label it. So if you are getting an amount that is not made up of whole sealed boxes it is possible a mistake has been made in terms of how many are in the box. I have had this error.

I also do a medication audit every Saturday. I literally go through and count all my meds and work out how many days (weeks) I have left of each. I'm quite severely disabled following an accident and I take a lot of meds so this helps me keep on top of what I have. I then order (app or on paper) whatever I'm running low on.

In terms of checking the pain meds you are on - I saw a pain specialist. I was on tramadol for about 18 months/ 2 years. He added in an SSRI (I started on amytriptyline) which basically dials down the nerves which transmit pain. So it's not a painkiller in the standard sense of the word. It also makes you drowsy, so I took it at night and it really helped my sleep - previously I was waking up in pain a lot of the time.

I then started to step down on the pain ladder. The amytriptyline reduced the volume of the pain if you like, and I switched to using paracetamol plus codeine alternated with naproxen sodium for the pain.

Tramadol made me feel quite nauseous. I found the amytriptyline/para+codeine/naproxen an improvement in terms of pain control to be honest even though theoretically tramadol is a more powerful painkiller.

I'm ten years down the line now. On good days and in the summer I can manage on just over the counter painkillers - paracetamol and ibuprofen. On bad days or in the winter I use para + 30mg codeine and naproxen sodium.

I take duloxetine instead of amytriptyline now - and yes to whoever asked (sorry) I sweat like a pig. Better than pain though!

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. 💐

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?

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

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.

@TruthThatsHardAsSteel

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

How does it come?

@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.

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.