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.

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.

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.

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.

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.

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.

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.

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.

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 ?

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.

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?

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.

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.

@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.

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.

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.

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?

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

@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.

If you received 120 tablets (presumably a box of 100, then 20 from the box that said 68) and taking six per day you should have a 20 day supply. If you collected last Friday (presuming 25th) you wouldn't have only a 4 day supply left.

If it was a manufacturer original sealed box then that would be a manufacturer error. If it was a pharmacy split box (probably for 68) then human error and miscounting or someone stealing is possible. However, there would be far easier ways to steal tramadol than from a checked prescription bag as you are bound to raise as a concern. It is a controlled drug but not one with a running quantity in a register like morphine would be so much lower risk to steal from the shelf or patient returned (which are totally unaccounted for).

An error is entirely possible, everyone makes them on occasion but the fact you have only four days left and running out sooner and sooner every month would obviously led to questions about how many you are taking.

Your body builds a tolerance to opioids and they actually lower pain thresholds/cause more pain if taking long term, if you are only taking them when you feel pain it's entirely plausible that you are taking more than six a day, even if unintentionally.

Do some research into opioids, they are no longer recommended from chronic pain for a good reason. It may be a blessing to try reduce/ look at other holistic pain management.... The live well with pain is a great toolkit to get started.

@Rosscameasdoody meaning of "stash" = to store something safely in a secret or hidden place". The OP has explained that her "store of medication" was stored somewhere that no one else would find it, hence my use of the commonly-understood (though apparently not by you) term "stash".

As regards family members pilfering the pills, it happens all the time with opiates. I'm not sure what your objection to that proposition as a possibility could be.

Are you always so dismissive of other people's views?

Also echoing a previous poster that no tramadol manufacturer makes a sealed pack size of 68 so whilst it might be in a closed box it would not be sealed as such

No, l’m not dismissive of other peoples’ views at all. Nor do l quote dictionary definitions of words in the knowledge that they are not being used according to that definition. ‘Stash’ is a well known term for a store of illegal or illicit drugs. And on a thread where an OP has posted for advice which has led to unfounded and unwarranted suggestions that she is an addict, l think the term is inappropriate. But then you knew that.

In your shoes I would speak to the Police first. Just tell them what happened, for their record keeping. If tablets are going missing they need to know about it, yours may not be the first report made.

Then speak to your GP and explain you were missing 1/4 of your prescription from the Pharmacy and have already sought advice from the Police about it (your willingness to involve them will hopefully show them you are genuine).
Ask the GP for help and advice managing your pain without the remainder of this month’s prescription (again showing that you are not just after more tramadol) and ask for your next prescription to be sent to a different pharmacy.

Good luck!

I’ve received odd amounts of prescription drugs in pharmacy white boxes with the label detailing how many tablets are in the box, as part of the full prescription - or where the pharmacy doesn’t have the full amount to make up the prescription and there is a note that l am owed more. These are often made up of strips off odd numbers of tablets and l assume the pharmacist is ensuring that these are used up and not wasted. The boxes are always sealed with a clear adhesive dot at each end.

I know I will be physically addicted if that makes sense. You can't just stop these tablets

Very true. I've been on 240mg of codeine daily for 7 years. Would certainly be an interesting time coming off that lot.